Importation risk and preparedness priorities across Africa in the 2026 Bundibugyo Ebola outbreak

The ongoing 2026 Bundibugyo Ebola outbreak in the Democratic Republic of the Congo and Uganda raises concerns about regional dissemination across Africa. Anticipating where imported infections are most likely to occur, and whether recipient countries are prepared to detect and contain them, is essential for prioritizing surveillance and response. We developed an integrated spatial framework combining high-resolution epidemic and population data, air and land mobility, geographical accessibility, conflict-adjusted travel times to estimate the risk of Ebola importation across African countries. We contextualized importation risk using different national readiness indicators. We quantified overall, air-mediated, and land-mediated importation risk under the current epidemic situation and evaluated outbreak amplification scenarios in major regional hubs. Importation risk was highly concentrated geographically, with neighbouring countries accounting for 85% of the estimated continental risk. However, high-risk destinations extended beyond the immediate neighbours, whereas some neighbouring countries remained at low risk, reflecting the complementary roles of land and air mobility in shaping regional dissemination. South Sudan, Rwanda, Kenya, Tanzania, Zambia, Ethiopia, Burundi, Angola, South Africa, the Central African Republic, and Nigeria were estimated at high risk, but differed markedly in healthcare system capacity and emergency preparedness and response. Readiness gaps were largest in South Sudan, Burundi, and the Central African Republic. Botswana, Burkina Faso, Cameroon, Chad, and Ghana emerged as a second tier of preparedness priorities, combining intermediate-high importation risk with low readiness. Under outbreak amplification scenarios, the highest-risk countries remained largely stable, but additional countries entered the high-risk group and continental importation pressure increased substantially, highlighting the need for dynamic preparedness planning. Integrating high-resolution epidemiological data with complementary land and air mobility provides a refined geography of regional risk and preparedness across Africa, supporting better targeted surveillance, preparedness investments, and international support while allowing priorities to be rapidly updated as outbreaks evolve.