News analysis: Ebola outbreak exposes fault lines in insurance, assistance, and healthcare, experts warn

Warnings have emerged that the Ebola outbreak in the Democratic Republic of the Congo (DRC) could move towards the scale of the 2014–16 West Africa epidemic, following new modelling from the US Centers for Disease Control and Prevention (CDC) that points to a potentially escalating trajectory.

The World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC) back in May after cases of the Bundibugyo strain were confirmed across multiple regions, including areas affected by conflict and population movement.

This outbreak differs from many previous Ebola events because it involves a strain for which no approved vaccine or targeted treatment is available, alongside ongoing challenges in early surveillance and detection.

Where outbreak anxiety shows up first

Superintendent Pharmacist Ana Carolina Goncalves from online platform Pharmica told ITIJ that pharmacies often served as an early point of contact for travellers seeking guidance during outbreaks, particularly regarding regional risk and disruption rather than direct infection.

“While pharmacies are not at the centre of outbreak response, they often act as an early point of contact for travellers seeking information,” she said. “Following recent Ebola activity in the DRC and reported cases in Uganda, the questions tend to revolve around regional risk assessment for adjacent countries, antimalarial cover, what to do on returning from affected regions, and how to manage ongoing prescription medication if travel plans are disrupted.”

She pointed out that the wider issue for insurers and assistance providers was often indirect disruption rather than infection risk, including shifting travel advisories, border restrictions, quarantine measures, flight disruption, and constrained access to routine healthcare.

Epidemic exclusions vary significantly across the market, and that inconsistency creates genuine claims exposure and customer relations risk when an outbreak escalates

Goncalves added that medication continuity was a recurring pressure point during travel disruption. Travellers on long-term treatment – including for hypertension, diabetes, asthma, mental health conditions, and hormone therapies – could face disruption to medication continuity if their stay was unexpectedly extended and equivalent treatments were not readily available abroad.

“This can place additional demand on assistance providers, who may need to provide additional emergency medication or, in some cases, repatriation arrangements that earlier preparation could have helped to reduce,” she warned. “It can also create avoidable claims friction, particularly where travellers need extended accommodation, replacement medication, urgent clinical review, or evidence that a medicine could not be sourced locally.”

Differences in formulation, naming systems, and regulatory frameworks between countries, she added, could also complicate substitution and increase reliance on assistance services for emergency supply or repatriation.

Coverage lines blur as outbreak escalates

Simon McCulloch, a spokesperson at travel insurance provider Staysure, said the outbreak underscored how quickly operational risk escalates once a PHEIC is declared. He said confirmed cross-border transmission increases exposure for insurers and assistance providers, particularly where epidemic exclusions and policy wording differ across markets.

McCulloch told ITIJ that once government advice moves to ‘do not travel’, new policies typically exclude related claims, while policies issued beforehand required more complex claims assessment and clearer interpretation of coverage boundaries.

He added: “There’s also a wider policy wording issue the industry hasn’t fully resolved: epidemic exclusions vary significantly across the market, and that inconsistency creates genuine claims exposure and customer relations risk when an outbreak escalates.”

McCulloch also highlighted evacuation as a key operational constraint, noting that Ebola requires isolation-capable transport, specialist medical crews, and suitable receiving facilities.

The policy challenge is that most contracts define evacuation to the ‘nearest adequate facility’, a definition that becomes very difficult to apply when few facilities will accept an Ebola patient

“The first medical evacuation of the current Ebola outbreak (to Berlin’s Charité in May) confirms this is a live operational reality rather than a contingency scenario,” he said. “The policy challenge is that most contracts define evacuation to the ‘nearest adequate facility’, a definition that becomes very difficult to apply when few facilities will accept an Ebola patient. That ambiguity needs to be resolved in pre-planning, not during case management.”

He added that border controls and screening requirements could further restrict routing options, making pre-planning essential rather than reactive coordination.

McCulloch said lessons learned from the 2014–16 West Africa outbreak had improved surveillance and response capabilities, but gaps remained in consistency of policy wording and operational alignment during claims events.

Exposure risk is hard to pin down

Medical uncertainty adds another layer of complexity for insurers and assistance providers. While much of the focus has centred on containment efforts and travel restrictions, the characteristics of the virus itself continue to present significant challenges for risk assessment, clinical decision-making, and traveller support.

Dr John Akinjolire, a medical expert working with travel insurance price comparison site PayingTooMuch, said the outbreak was clinically complex due to the virus strain and transmission environment.

He said movement along mining and commercial routes, combined with conflict-related disruption, had increased the risk of wider regional spread, while early detection delays had contributed to continued transmission.

The 2026 outbreak is a serious development. It is particularly complex from a medical point of view due to the virus strain involved

He explained: “The 2026 outbreak is a serious development. It is particularly complex from a medical point of view due to the virus strain involved. Known as the Bundibugyo ebolavirus, it currently has no approved vaccine or treatment available. This is different from the Zaire strain seen in the 2014–16 West Africa outbreak, where vaccine development was more advanced.”

He added that the combination of limited medical countermeasures and multi-zone transmission made clinical risk assessment more complex than in previous outbreaks.

On assistance challenges, determining exposure is not always straightforward, particularly in early illness, where symptoms could be non-specific.

“One of the main challenges for medical assistance providers will be in determining which travellers may have been exposed to the virus and which have simply travelled through areas that are not affected by the outbreak,” he added. “That assessment is not always straightforward, particularly in the early stages of illness.”

Early symptoms such as fever, fatigue, and muscle aches overlap with many other conditions, complicating remote assessment and triage.

Dr Akinjolire also said outbreaks placed additional pressure on local healthcare systems, potentially affecting access to care and the standard of treatment available to travellers.

He noted that travellers with underlying conditions or weakened immune systems could face heightened risks if medical care was required in affected regions.

When borders move, insurance reacts

Government travel advice remains one of the most significant triggers for insurance coverage decisions during an outbreak, according to Jo Wynyard, Commercial Director at PayingTooMuch.

She said changes to official Foreign, Commonwealth & Development Office (FCDO) travel advice were among the most direct operational triggers for UK insurers, with destinations classified as ‘advise against all travel’ typically falling outside standard policy cover for new bookings. Travellers already in affected areas, she said, were then left to decide whether to remain, return home, or pursue a claim.

Wynyard added that multiple governments had already issued differing levels of advisory guidance across the region, creating uneven risk exposure for both travellers and employers.

Border controls and screening measures further complicated matters, she said, particularly where travellers are transiting through affected areas rather than staying within them. She noted that entry restrictions, quarantine requirements, and refusal of admission could apply regardless of a traveller’s final destination.

These overlapping measures often create claims scenarios that do not sit neatly within standard policy frameworks.

Wynyard also said the industry had improved its operational readiness since previous outbreaks, but that insurers were taking a more cautious approach to epidemic-related risk. She stressed that travellers needed to understand policy exclusions and coverage limitations before purchasing cover to help avoid disputes at the claims stage.

Turning outbreak risk into operational readiness

Insurers and assistance providers may need to take a more proactive approach to outbreak preparedness, particularly as Ebola cases and travel advisories evolve rapidly across multiple jurisdictions.

McCulloch said insurers should focus on three core operational priorities to reduce both claims exposure and customer harm during outbreaks.

“Prioritise three things. First, review your policy book against current advisory levels and make sure your epidemic exclusion position is clearly understood internally: ambiguity in claims handling at this stage is avoidable.

“Second, pressure-test your assistance arrangements: medical evacuation capacity for infectious disease cases is finite, and providers who haven’t confirmed their network capabilities may find them unavailable when needed.

“And third, get ahead of customer communication for anyone with live bookings in the region. The reputational and claims cost of a customer travelling under a false assumption about their coverage is significantly higher than the cost of proactive clarity now.”

While operational preparedness has improved since previous Ebola outbreaks, policy clarity continues to lag behind evolving risk environments

One of the most persistent challenges in outbreak scenarios remains the lack of consistency in how epidemic-related exclusions are written and applied across the market. While operational preparedness has improved since previous Ebola outbreaks, policy clarity continues to lag behind evolving risk environments.

McCulloch said: “The outstanding gap remains epidemic exclusion inconsistency across policy wordings, and it is an area where greater standardisation would serve both customers and the industry’s reputation.”