Democratic Republic of Congo: Children must be included in Ebola treatment and prevention research
Children with Ebola disease are at a disproportionately higher risk of dying.
Children must be included in Bundibugyo virus treatment and prevention research, says Doctors Without Borders/Médecins Sans Frontières (MSF). The commentary, published in The Lancet Child & Adolescent Health in August, states specifically that children should have timely access to pediatric formulations for ongoing trials of oral post-exposure prophylaxis (PEP)
The current Ebola disease outbreak caused by the Bundibugyo virus in the Democratic Republic of Congo (DRC) has disproportionately affected children. As of Aug. 4, 2026, and among confirmed cases for whom age is reported, the proportion of children under five years old who were diagnosed and who subsequently died from Bundibugyo virus disease was significantly higher than that of adults.
Delayed inclusion in trials, lack of pediatric dosing guidance and safety concerns are familiar barriers to access to medical countermeasures for children and pregnant and breastfeeding women and girls. Currently, the EBO-PEP study, which began on July 14, 2026, is evaluating the oral antiviral drug obeldesivir for preventing infection following high-risk exposure to Ebola disease caused by the Bundibugyo virus. If this proves to be effective, it could offer a practical and scalable method to protect people who have had recent contact with someone with Ebola disease. While children weighing less than 30 kilograms (approximately 12 years old or younger) are excluded from the trial in its original design, it is expected that a planned protocol amendment to include children over 20 kilograms will soon be accepted.
“We need to generate the evidence now so that children can access effective preventive treatments alongside everyone else, not after the outbreak is over.”
Neal Russell, MSF pediatric advisor
However, owing to the lack of an available pediatric formulation of obeldesivir and the absence of published data supporting tablet crushing or dissolution, children under 20 kilograms (six years old or under) are still excluded from this study. While the trial is conducting a sub-protocol for those excluded consisting of intravenous (IV) drug remdesivir, a daily IV treatment course over 10 days is operationally very difficult in outbreak settings, especially for young children. Pharmaceutical manufacturer Gilead has recently expressed willingness to make pediatric formulations of obeldesivir available soon. It is yet to be seen when the trial with oral formulations will start.
“Too often, the inclusion of children in the development of medical countermeasures to address public health emergencies is left to the ‘small print’,” says Neal Russell, MSF pediatric advisor. “But today, with children at a disproportionately high risk of dying if infected with Ebola in the current outbreak in DRC, their inclusion is paramount.”
“Researchers, donors and other stakeholders must urgently support a pediatric obeldesivir sub-study, build on existing dosing guidance and accelerate the evaluation of other oral antivirals and monoclonal antibodies as post-exposure prophylaxis. We need to generate the evidence now so that children can access effective preventive treatments alongside everyone else, not after the outbreak is over,” he says.
“Gilead – the pharmaceutical corporation manufacturing obeldesivir – has committed to reproduce the antiviral in its pediatric formulation. We hope Gilead will provide a clear and accelerated timeline for doing so and stakeholders can organize pediatric studies with this formulation or with modified adult tablets as soon as possible, so that all children at risk can be included in studies evaluating which post-exposure prophylaxis options are most practical, timely and effective.”
