Rwanda’s swift and effective response to its Marburg virus outbreak has showcased the importance of a One Health approach, a key topic of debate in ongoing pandemic treaty negotiations. The outbreak, traced to a tin miner working in Gamico Mining Company’s Tunnel 12, underscores the risks of zoonotic spillover and the necessity of coordinated public health interventions.
The index case, a 27-year-old miner, is believed to have contracted the Marburg virus after exposure to bat droppings in Tunnel 12. Initially misdiagnosed with malaria due to overlapping early symptoms, his condition raised alarms when further testing confirmed Marburg virus disease.
Upon confirmation, the Rwandan Health Ministry, in collaboration with the Rwanda Biomedical Centre (RBC), implemented decisive measures to prevent further bat-to-human transmission. The introduction of physical barriers within Tunnel 12, including a locked door that allows bats to exit while restricting human access, was a key intervention.
Dr. Edson Rwagasore, a senior official at RBC, emphasized the importance of controlling human-bat interactions. “We worked to ensure no future bat-to-human spillovers,” he stated. “Our key interventions were to create a buffer between the bats and humans, conduct regular testing of bats, and work on understanding transmission better.”
Beyond sealing off high risk areas, Rwanda’s response involved tracking the movement of bats using GPS tags and conducting regular testing of bat blood, saliva, and feces. Authorities identified six other high risk mining sites and introduced similar measures, including closures where necessary.
The health ministry also took steps to educate miners. Gamico Mining Company issued its 1,600 workers with personal protective equipment (PPE) and trained them to avoid bat interactions while allowing mining operations to continue safely. Additionally, Gamico Clinic was upgraded to monitor miners and their families, ensuring early detection and rapid intervention in suspected cases.
Despite these efforts, the virus still spread within the community. Sixty-six people were infected, and 15 succumbed, resulting in a 22.7% case fatality rate the lowest ever recorded for Marburg virus. The index case survived, but tragically, his wife, newborn child, and some healthcare workers did not.
Rwanda’s ability to contain the outbreak so effectively was bolstered by international support. The World Health Organization (WHO) and other global health experts provided technical assistance in identifying and managing cases. The Sabin Vaccine Institute, based in the U.S., contributed investigational vaccines for an open-label study, which likely played a role in reducing fatalities. The antiviral drug remdesivir was also used in treatment.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus visited Rwanda at the end of the outbreak and commended the country’s strong healthcare response. He highlighted that two critically ill patients, who experienced multiple organ failure, survived after being placed on life support and later extubated marking a significant medical achievement for Africa.
Rwanda’s response is a textbook example of the One Health approach, which integrates human, animal, and environmental health to prevent disease outbreaks. Dr. Sabin Nsanzimana, Rwanda’s Health Minister, described the crisis as “an opportunity for us to expand our preparedness capabilities.”
Community health workers played a crucial role, going door-to-door in at-risk communities to identify individuals with fever or diarrhea key Marburg symptoms. Contact tracing and quarantine measures were promptly enacted, helping to break transmission chains.
However, despite Rwanda’s success, the One Health approach remains a contentious issue in global pandemic treaty negotiations. Article 5 of the WHO’s draft pandemic agreement calls for countries to adopt a comprehensive One Health framework, but many African nations are hesitant
The draft pandemic treaty urges countries to develop policies addressing disease emergence at the human-animal-environment interface. This includes funding surveillance, community engagement, and training for high-risk workers.
However, some African nations are wary of potential financial burdens and enforcement mechanisms. Historically, the WHO and international donors have provided significant outbreak response support, but funding uncertainties cast doubt on future assistance.
The U.S., which contributes 25% of the WHO’s emergency budget, is set to exit the global body in January, reducing resources for outbreak containment. Additionally, U.S. funding through the United States Agency for International Development (USAID) has dwindled since the Trump Administration cut epidemic preparedness programs.
Recognizing these funding gaps, the African Union recently approved the establishment of an African Epidemics Fund, managed by the Africa Centres for Disease Control and Prevention (Africa CDC). However, the fund’s sustainability remains uncertain, especially given previous U.S. pledges of $500 million to Africa CDC that may now be in jeopardy.
Rwanda’s management of the Marburg outbreak provides a compelling case for the One Health approach, demonstrating how coordinated efforts across human, animal, and environmental sectors can limit disease transmission. However, while Rwanda’s model is commendable, broader adoption of such strategies across Africa remains in question due to financial and policy challenges.
As the pandemic treaty negotiations continue, the balance between global health security and national sovereignty will be critical in shaping future outbreak responses. Rwanda’s experience highlights both the promise and complexities of implementing One Health strategies in real-world settings.
