After a full week of no new Marburg cases, Rwanda appears to have contained one of the biggest recorded of the deadly virus outbreaks – and with a low case fatality rate of 24%.

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, who visited the country over the weekend, praised the level of Rwanda’s critical care for patients as well as how the country deployed high-level leadership  to address the viral haemorrhagic fever, which often kills over 80% of those infected.

“Two of the patients we met had experienced all of the symptoms of Marburg, including multiple organ failure, but they were put on life support, they were successfully intubated and extubated, and are now recovering,” Tedros told a media briefing in Rwanda on Sunday.

“We believe this is the first time patients with Marburg virus have been extubated in Africa. These patients would have died in previous outbreaks.”

Intubation involves inserting a tube through a patient’s nose or mouth into their windpipe (trachea) to help them breathe. This tube can be connected to a ventilator. Extubation is when the tube is removed.

Tedros added that Rwanda had worked for many years to “strengthen its health system, to develop capacities for critical care and life support that can be deployed both in regular hospital care and in emergencies”.

However, he warned that Marburg is “one of the world’s most dangerous viruses, and continued vigilance is essential”.

The outbreak will only be declared over once no new cases have been recorded for 21 days, potentially on 5 November.

Sabin’s vaccine candidate used

Although there are no approved vaccines or therapeutics for Marburg, Rwanda fast-tracked the trials of a vaccine candidate from the Sabin Vaccine Institute, and an antiviral drug, remdesivir.

On 5 October, Sabin delivered 700 doses of its single-dose candidate vaccine, followed by a further 1,000 on 12 October.

These have been used to vaccinate health workers “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. Patients’ close contacts have also been vaccinated.

Rwanda developed its own trial protocol after rejecting the WHO’s protocol which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science. Rwanda opted to vaccinate all trial participants at once.

However, the remdesivir trial does involve a control group.

“The swift initiation of the open-label trial was set in motion on 26 September, when the Rwandan President’s office contacted Sabin CEO Amy Finan to request assistance with the outbreak response,” Sabin said in a statement.

Rwanda officially declared the outbreak the next day.

“In an outbreak, every moment counts, and our seamless collaboration with the Rwandan government was key to accelerating the process,” said Finan.

Sabin’s manufacturing partner, Italy-based ReiThera, produced the drug substance and filled and finished doses for shipment to Rwanda.

“On our side, we moved quickly by leveraging our experience with other outbreaks and having vaccine doses and supporting documents ready, thanks to a strong partnership with ReiThera,” Finan added.

Sabin’s team only consists of 15 staff members, but Finan said that “their dedication, along with that of our Rwandan colleagues, BARDA [the US Center for the Biomedical Advanced Research and Development Authority] and other partners, enabled us to mobilise so rapidly. 

“This remarkable effort highlights the power of partnerships and preparedness in addressing urgent public health needs,” said Finan, who also visited Rwanda over the weekend.

Meanwhile, Tedros congratulated Rwanda for the speed with which it initiated trials of both vaccines and therapeutics, adding that the WHO hopes that these trials “will help to generate the data to support approval of these products for future outbreaks”.

Belen Calvo Uyarra, the European Union’s Ambassador to Rwanda, also praised the country’s rapid response to containing the virus.

“Respect to the government of Rwanda and the Rwanda Ministry of Health for proactive leadership, rapid and robust continued response, and professionalism of health workers,” Uyarra posted on X.

She and Tedros also visited the site of the BioNTech vaccine manufacturing facility, announced two years ago to facilitate local production of vaccines. 

Two years ago I visited #Rwanda for the groundbreaking ceremony of the BioNTech facility in Kigali, which raised great hope for local production of vaccines in Africa. Today, I returned to the site and was proud to witness the fast progress of construction of the facility.… pic.twitter.com/8YGwcTVaYe

— Tedros Adhanom Ghebreyesus (@DrTedros) October 20, 2024

“I was very pleased to see the significant progress in construction,” said Tedros.

“One of the key lessons of the COVID-19 pandemic was the need to expand local production of vaccines to avoid the inequitable access to vaccines that we saw, and we’re pleased to see the way Rwanda and BioNTech are investing in local production.

“You know how Africa was treated when the vaccines arrived, with vaccine inequity and vaccine nationalism, and we hope these strategic investments will fix the inequity problems we faced during COVID.”