Peer Review Report For: Cross-Border Ebola Virus Disease Preparedness in Uganda and the Democratic Republic of the Congo: A Systematic Review of Health Security Capacities, Gaps, and Priorities [version 1; peer review: 1 approved]

Abstract

Background Recurrent Ebola virus disease (EVD) outbreaks in the Democratic Republic of the Congo (DRC) continue to pose substantial cross-border health security risks to neighbouring countries, particularly Uganda. Although numerous preparedness initiatives have been implemented to prevent, detect, and respond to cross-border Ebola transmission, evidence on their effectiveness, strengths, and persistent gaps remains fragmented across peer-reviewed and grey-literature sources. This review synthesized available evidence on cross-border Ebola preparedness in Uganda and the DRC and identified key capacities, challenges, and priorities for strengthening regional health security. Methods A systematic review was conducted in accordance with PRISMA 2020 and reported using the Synthesis Without Meta-analysis (SWiM) framework. PubMed, Scopus, Web of Science, African Journals Online (AJOL), and major grey-literature sources were searched from January 2000 to 18 May 2026. Findings were synthesized across nine predefined preparedness domains. Results Seventy-one evidence sources were included, comprising 32 primary studies and 39 grey-literature documents. Evidence was most concentrated in border surveillance and point-of-entry preparedness (24 sources), contact tracing and rapid response (22 sources), cross-border mobility and importation risk (18 sources), infection prevention and control (17 sources), and regional governance and coordination (17 sources). Preparedness activities included mobility mapping, traveller screening, healthcare-worker training, laboratory strengthening, risk communication, and cross-border coordination mechanisms. The synthesis identified substantial preparedness capacity across surveillance systems, laboratory readiness, healthcare-facility preparedness, and regional collaboration. However, important gaps persisted in some major preparedness domains. Conclusions Cross-border Ebola preparedness in Uganda and the DRC has expanded considerably over the past two decades through investments in surveillance systems, laboratory networks, healthcare-worker preparedness, and regional coordination. Nonetheless, persistent vulnerabilities remain in humanitarian settings, preparedness sustainability, and emerging preparedness domains. Strengthening integrated, sustainable, and cross-border health-security systems will be critical for mitigating future Ebola threats and enhancing epidemic preparedness across East Africa.