Rwanda's lessons for strengthening Africa's response to current Marburg virus disease outbreaks.

Abstract

Marburg virus disease remains a major threat to global health security in Africa, where recurrent filovirus outbreaks intersect with fragile health systems. In 2024, Rwanda faced its first Marburg virus disease outbreak, yet achieved an unusually low case-fatality rate of 23%, in contrast to the high mortality reported in the Democratic Republic of the Congo (83%), Angola (90%), Uganda (60%), and Tanzania (100%). In this Health Policy paper, we summarise the key lessons from Rwanda that can inform the responses to current and future Marburg virus disease outbreaks in Africa. Using a narrative synthesis of published literature, reports, and field investigations, we identified crucial pillars underpinning Rwanda's performance: a preventive One Health system that traced the outbreak to a single zoonotic spillover; innovative infection prevention and control measures; rapid nationwide expansion of molecular testing; early triage, active case finding, comprehensive supportive care, and access to investigational therapeutics; biomarkers for patient monitoring; and rapid workforce mobilisation and community engagement. Rwanda's experience shows that high survival rates are achievable in low-resource settings, when early detection, laboratory systems, and integrated clinical and infection prevention and control strategies operate within coordinated multisectoral structures. Other countries facing Marburg virus disease outbreaks can adapt Rwanda's model by institutionalising One Health surveillance, strengthening laboratory and biosafety systems, scaling emergency care readiness, integrating biomarker-guided protocols, and establishing pretrained rapid-deployment workforces.