MSF calls on researchers, donors and manufacturers to take urgent actions  

London, September 1, 2026 

In a commentary published in The Lancet today, MSF calls for urgent action from all stakeholders involved in research on Bundibugyo virus treatment and prevention to ensure that children are meaningfully included in planned, evidence-generating research on medical countermeasures, and, in particular, have timely access to paediatric 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 the Congo (DRC) has disproportionately affected children. As of 4 August 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 paediatric dosing guidance, and safety concerns are familiar barriers to access to medical countermeasures for children and pregnant and breastfeeding women and girls (PBWG.) Currently, the EBO-PEP study, which began on 14 July 2026, is evaluating the oral antiviral 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 a case of Ebola. While children weighing less than 30 kg (approximately 12 years old or younger) are excluded from the trial in its original design, we can expect that a planned protocol amendment to include children over 20kg will soon be accepted.  However, owing to the lack of an available paediatric formulation of obeldesivir and the absence of published data supporting tablet crushing or dissolution, children under 20 kg (6 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) remdesivir, a daily IV treatment course over 10 days is operationally very difficult in outbreak settings, especially for young children. Gilead has recently expressed willingness to make paediatric 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’ 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 paediatric 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. Gilead – the pharmaceutical corporation manufacturing obeldesivir – has committed to reproduce the antiviral in its paediatric formulation. We hope that Gilead will provide a clear and accelerated timeline for doing so, and that stakeholders can organise paediatric 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. ”
Dr Neal Russell
Paediatric Advisor, MSF