Rwanda's experience responding to the 2024 Marburg virus outbreak has shown the importance of investing in disease surveillance, community health systems and emergency response capacity, Minister of State for Health Yvan Butera has said. Butera was speaking on Thursday, September 24, on the margins of the 81st United Nations General Assembly in New York, where Rwanda, Armenia and the Pandemic Fund convened global health leaders to discuss how countries can strengthen pandemic preparedness and build more resilient health systems. ALSO READ: WHO chief commends Rwanda’s swift response to Marburg outbreak The event, titled “Prepared for What’s Next: How Country Investments are Powering Global Health Resilience,” brought together health and finance leaders to discuss how domestic investment, the Pandemic Fund and other partners can help countries close gaps in preparedness and strengthen health systems. He said Rwanda's response to Marburg virus was built around quickly identifying cases, tracing contacts and monitoring communities to prevent the virus from spreading beyond the initial cases. “When Marburg hit Rwanda, our target was not to permit transmission. Marburg is a cousin of Ebola, being among the top two or three deadliest diseases in the world. So, we are talking about a disease where 80 per cent of people who contracted it could die, and that was a scary thing,” he said. Rwanda confirmed its first Marburg outbreak on September 27, 2024. By the time the outbreak was declared over in December, the country had recorded 66 confirmed cases and 15 deaths. Almost 80 per cent of the cases were among healthcare workers. ALSO READ: How Rwanda detected the first Marburg virus cases Butera said one of the first priorities was to establish where the virus had come from and how it was spreading. Rwanda used genomic sequencing to compare the virus with earlier Marburg stains, helping epidemiologists identify its relationship with a previous outbreak in Uganda. They combined the laboratory information with epidemiological investigations and contact tracing to identify people who might have been exposed. “You need to have the capacity of an epidemiologist. Controlling an outbreak becomes more difficult when health authorities cannot establish who has been in contact with whom. The response was extended into communities through door-to-door surveillance, to reduce the possibility of undetected infections,” he said. ALSO READ: End for Marburg outbreak may be in sight, but vigilance remains critical Butera said about 9.6 million people were screened in communities for signs of the disease during the response. That work relied heavily on Rwanda's community health workers. The country has about 54,000 community health workers. “The community health workers were able to support us with surveillance and contact tracing. During an outbreak, that capacity has to be available 24/7,” he said. The Marburg outbreak also exposed the need to protect healthcare workers and ensure hospitals can handle patients requiring intensive care. Butera said Rwanda moved to strengthen intensive care capacity after recognising that healthcare workers were particularly exposed to the virus. Another lesson, he said, was the importance quick deployment of new medical interventions during an outbreak. “Rwanda moved from diagnosis to the administration of an investigational vaccine in about 10 days, while an investigational monoclonal antibody was also deployed through collaboration with the United States. All that capacity has to be built ahead of time,” he said. The country's response helped bring the outbreak under control. WHO said the outbreak was the third-largest Marburg outbreak recorded at the time, while the final case-fatality ratio was 22 per cent, the lowest to ever be recorded anywhere in the world. Butera said the lessons also extend to financing, which he said must be available for immediate deployment when an outbreak begins. “The financing that goes with that also has to be prepared. You need to have resources that you can quickly deploy. When you're in an outbreak, we talk about seconds. Within seconds, things can change, so finance has to also go in seconds,” he said.
