In July 2024, Rwanda faced a Marburg virus outbreak among health workers in the capital Kigali, challenging the nation’s health system and testing its pandemic response capabilities.
For Rwanda, it was the first ever outbreak of the highly infectious disease, which on average kills around half of those infected, according to the World Health Organization (WHO).
When the first cases emerged, health minister Sabin Nsanzimana was at the UN General Assembly in New York.
“I saw a message from our team telling me Marburg had broken out in Kigali,” Nsanzimana recalls in an internal communication on how Rwanda managed the Marburg virus.
“I couldn’t believe it was true. But a few hours later, they confirmed – it’s Marburg.”
The outbreak challenged traditional assumptions about epidemic spread and control. Speaking to SciDev.Net, Nsanzimana outlined some of the lessons learned from it.
“We used to follow the convention that combating epidemics required lockdowns to prevent the spread of disease from rural areas to cities,” he said.
But things were different in the recent outbreak, which started in one of the country’s leading referral hospitals, he explained.
He said this prompted health authorities to work with the WHO to revise conventional outbreak response measures.
“We need to build the capacity to detect and contain an outbreak wherever it emerges, rather than working under the assumption that outbreaks will originate in rural areas,” the minister said.
Rapid response
The measures taken meant Rwanda was able to limit the death rate from the outbreak to 23 per cent – the lowest rate ever recorded for Marburg.
Nsanzimana attributes the success to the rapid scientific response and streamlined bureaucratic processes.
“Employing science, especially vaccines and medical equipment, needs to be done swiftly,” he said.
“It is entirely possible for a country to achieve in six days what would normally take six months – provided all institutions work together as a team. That is exactly what we did in securing vaccines, treatment, and equipment.”
The outbreak nevertheless had severe consequences. Fifteen people died from the virus, according to the Rwanda Biomedical Centre – most of them doctors and nurses with decades of experience between them.
“It was challenging to treat people who knew exactly what Marburg meant,” stated Menelas Nkeshimana, head of department of health workforce development at Rwanda’s health ministry, in the health ministry’s internal communique about the outbreak.
“Everyone knows Marburg was a death sentence. But we had to keep going. Someone had to be there, someone had to help.”
In November, Rwanda’s WHO representative, Brian Chirombo, announced the end of the outbreak in the country.
“The robust response by Rwanda shows how committed leadership, concerted efforts by partners, and a strong health system are crucial in addressing public health emergencies, saving and protecting lives as well as safeguarding the health of individuals and communities,” Chirombo said.
Of the 66 confirmed cases, 51 patients had recovered and no new cases had emerged for 42 consecutive days, according to the RBC.
“We had a patient, one of our colleagues, who survived,” said Nkeshimana,
“When he woke up after being on a ventilator, the first thing he asked for was juice. It meant his brain was intact, he remembered who he was. These are the victories that kept us going.”
The Marburg virus, which is transmitted to humans by fruit bats, spreads through contact with bodily fluids of an infected person. Symptoms begin with a high fever and can lead to haemorrhaging, which may be fatal.
While Rwanda has contained its first Marburg outbreak, Tanzania is facing its second outbreak of the disease, confirming a single case in the northwestern region of Kagera last month.
Understanding Marburg
According to Rwandan health officials, their approach for tackling the Kigali outbreak included conducting a detailed scientific investigation to understand the virus’s origins and behavior.
“When we characterized our virus, we found that it had a common ancestor with an outbreak from 2014,” said Yvan Butera, Rwanda’s minister of state for health.
“Through our genomic sequencing, we discovered that the virus originated from bats in mining areas,” the minister explained.
He said scientists determined that this was a single viral introduction, which helped focus their response precisely.
There are currently no approved vaccines or antiviral treatments for Marburg, but a number of drugs are under development.
During the outbreak, the Sabin Vaccine Institute delivered about 2,700 investigational doses of the Marburg vaccines to Kigali for two targeted clinical trials.
These trials were crucial in understanding potential treatment approaches during the outbreak, according to Butera.
“We were able to deploy two specific treatments based on understanding the virus’s genetic makeup,” he said.
“This scientific approach helped us achieve the lowest case fatality rate ever recorded for Marburg in the world.”
Joining forces
At the start of the outbreak, health authorities established a command post, as set out in its pandemic response plan, bringing together different sectors, such as health, local government and security, to coordinate the response.
“Out command post had ten pillars … all aligned with one vision,” said Annick Ishimwe, division manager of medical technology.
“What made it work was how quickly people could act. We cut bureaucracy, made decisions fast, and had everyone’s support.”
Rwandan health authorities said global solidarity helped contain the disease, with international partners ready to help within 24 hours of the first case.
Ishimwe believes institutional trust also played a huge role.
“Due to our track record, Rwanda benefits from a lot of trust internally and externally,” he explained.
“People trust us because we’ve proven time and time again that we do things in their best interest.”
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