A diagnostic void in the Congo Basin: proposing a zoonotic orthopoxvirus as the cause of a hemorrhagic fever outbreak and a call for equitable health security

The definitive etiology of the Basankusu outbreak remains unresolved, but the clinical and ecological evidence points toward a potential zoonotic origin consistent with known patterns of pathogen emergence in the Congo Basin. In a setting constrained by limited diagnostic capacity, such evidence-informed approach provides a pragmatic framework for immediate public health action-guiding the deployment of targeted diagnostics (pan-poxvirus PCR), therapeutics (tecovirimat), and vaccines (MVA-BN). Ultimately, preventing future outbreaks of diseases of poverty requires a global commitment to investing in local diagnostic capacity, sustainable development, and equitable health security within high-risk endemic regions like the Congo Basin.