How Rwanda's health system stopped Marburg in its tracks

So what is behind this turnaround?

In Rwanda there was probably a three-to-four-week interval between when the first case happened and when it was detected. Within days, you had training programs at all hospitals. You had triage protocols to make sure that people coming in with symptoms consistent with Marburg got tested and isolated. You had personal protective equipment and all the things that are really needed to keep health care workers safe as well, and you had international assistance coming in from the United States and other countries. 

What about the possibility of a Marburg vaccine?

Let me just give a little bit of context: For a very, very long time for a lot of these viral hemorrhagic fevers, there were no vaccines. There was no treatment. Now, in 2014 that changed, and out of that, we now have FDA-approved Ebola treatments. We have multiple vaccines that do a really good job of helping us control outbreaks. 

Similarly, for Marburg, the Sabin Institute has been working towards developing vaccines for diseases like this that may not have a big enough market for pharmaceutical companies, but are really, really important in terms of managing how we respond to scary disease outbreaks. 

So the Rwandan Ministry of Health, almost the day after the outbreak was identified, contacted the Sabin Institute and said, 'we would love to have access to some of these vaccines: can we make it happen? And in a pretty unprecedented display of speed, between the time the Rwandan Ministry of Health asked the Sabin Institute for vaccines and the time that those vaccines were in the country, being injected into frontline healthcare workers, it was eight days. Eight days. 

Now, we don't have great data on whether they work. We don't know, do they reduce mortality from 90% to 20%? Do the vaccines provide sterilizing immunity, meaning that it's impossible to get infected? Or do they maybe make the severity of illness much less for people that got vaccinated? We don't know that. But what we do know is that for people in Rwanda, for Africans to have access to one of these tools so quickly, just meant a lot for their morale.

How is their response compared to other responses in the past?

I think the response in Rwanda to Marburg is really emblematic of why we invest in global health security and why we need partners, especially partners that can do this work all over the world. If you recall, 30 years ago, Rwanda was mired in a genocide. The country was completely turned over. Over 800,000 people died, and in the aftermath, there has been a very dedicated process of rebuilding. There's been a lot of international investment. Much of that investment has gone into building up a strong health system. There was a lot of international support, but also internal capacity building to make sure that they could have their own strong health sector. 

That’s important because once Marburg was first recognized, this work was done by Rwandans, in Rwanda. The response was led by an incredibly strong Rwandan Ministry of Health, and they were able to use a lot of the tools and training that they picked up over the past few decades to lead a really strong internal response, thus keeping us all safe by containing this outbreak at its source and catching it quickly.

Is it important for us to pay attention to places like Rwanda that are getting responses like this right?

Absolutely. Look, it's been nearly five years since SARS-COVID-2 started circulating, and I don't know anyone who will look back on the last five years and say the U.S. got it right. There are lessons for us to learn from everywhere. Are there lessons to take away from Rwanda? Absolutely.

The lesson here is that having coordinated messaging and response, alongside rapid action, can truly save lives. Even during COVID, there were places that did things really, really well: that were able to build up a sense of community or societal trust, which is really, really helpful in terms of responding to outbreaks. 

So what is your message to folks in the U.S.? Should they be worried about Marburg?

I don't think anyone has any reason to be worried about Marburg, but I do think it's important to be tuned in, to be healthy, to be concerned and to express your concern for what happens in other places to your elected officials.

Our takeaway should be that we are incredibly lucky that none of us is realistically concerned about a case of Marburg showing up in our hospitals, or in our schools. And the reality is that we are lucky only because of what the international community has done over the past couple decades, and what the Rwandan government has done —in the same time—but also over the past couple weeks. 

This is a massive success for global health security, and should be a reason for us all to remember and value the support that we give as a country to other places to not only keep themselves safe, but to also keep us safe.