National Ebola preparedness policy architecture and health system readiness in the Democratic Republic of the Congo and Uganda: a scoping review anchored in the 2026 Bundibugyo outbreak

Background The 2026 Bundibugyo virus disease outbreak was declared in the Democratic Republic of the Congo (DRC) on 15 May 2026, and Uganda confirmed its first case the same day. Neither country had a licensed vaccine or treatment for the virus, yet the outbreak took very different courses in the two. This scoping review maps the evidence on their national preparedness instruments and health system readiness. Methods We followed the Arksey and O'Malley framework, Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. National instruments in force at the onset, International Health Regulations evaluations and outbreak documents were sought from the issuing bodies, verified and charted against 52 component requirements in ten dimensions, with operational specificity as an eleventh. A fixed rule assigned each country a four-level descriptor per dimension, and documented outbreak risks were mapped against the gaps. Results We included 57 sources, 15 of them national instruments. Uganda's instruments addressed 47 of 52 components (90.4%) and the DRC's 38 (73.1%), and 31.7% of Ugandan and 15.2% of Congolese provisions were highly specific. Uganda was rated higher in six dimensions, including surveillance, isolation capacity, displaced populations and accountability, and equal in five. Both were inadequate on cross-border governance, and neither had a Bundibugyo-specific countermeasure provision. In the 2023 Joint External Evaluations the mean indicator score was 2.75 in Uganda and 1.63 in the DRC (paired difference 1.13, 95% confidence interval 0.83 to 1.42). Uganda's outbreak ended with 20 confirmed cases, whereas the DRC had reported 7890 confirmed cases by 23 September. The DRC's response plan of May 2026 was highly specific in 21 of 37 provisions. Conclusions The two countries differed in standing capacity and in the specificity of their standing instruments. The DRC's highly specific response plan suggests that its gap lay in standing arrangements rather than in response planning. A documentary review cannot establish that these differences caused the different courses of the outbreak. Priorities are surveillance and isolation capacity in the DRC, cross-border governance in both countries and national pathways for investigational Bundibugyo products.