Inside a small vaccine developer’s ‘lightning speed’ Marburg response

Amy Finan, who heads the US-based Sabin Vaccine Institute, was on a family vacation near the Grand Canyon in September when she got a surprise call from a Rwandan number. 

She’d heard rumours that people there might be getting sick with the Marburg virus, a deadly Ebola-like disease with no approved vaccine or antiviral treatment – but nothing was confirmed.

So she stepped out of her car to pick up the phone on the side of a motorway, and with massive trucks speeding by, discussed the growing health crisis with the office of Rwandan President Paul Kagame.

It was the first of what has become a daily call with one goal: “to contain a lethal disease outbreak and prevent further loss of life,” Finan told Euronews Health.

Ten days after Rwanda went public with its Marburg outbreak on September 26, dozens of frontline health workers were being vaccinated with Sabin’s experimental vaccine, which has shown promising results in early studies but hasn’t yet been greenlit by any government.

“We moved with lightning speed to prepare shipments, finalise protocols, and secure the necessary regulatory, business, and legal approvals,” Finan said.

The nonprofit vaccine developer has now sent about 1,700 shots to Rwanda, where Marburg cases have been mostly concentrated among health workers who got the virus while treating sick patients.

How Rwanda contained Marburg

As of October 24, 64 cases have been detected and 15 people have died, making it one of the biggest Marburg outbreaks since the virus first emerged in Germany in 1967.

The first patient in Rwanda is believed to be a 27-year-old man who came into contact with fruit bats in a cave.

Despite the size, it’s also one of the least lethal outbreaks in history, given case fatality rates in prior surges have ranged from 24 per cent to 88 per cent.

Now, with a dwindling number of infections reported in the past two weeks, the Africa Centres for Disease Control and Prevention (Africa CDC) says the outbreak has been “controlled”.

Rwanda has one of the strongest health systems in the region, and quickly shored up its critical care facilities and implemented infection control measures to stop the spread of the virus, which can cause fever, chills, headache, vomiting, diarrhoea, rash, and other symptoms that appear two to 21 days after exposure.

What widespread vaccine deployment can tell us

Sabin, which has a research staff of about 15 people, also has a hand in the country’s rapid response – but it’s an unusual case study that may not exactly be replicable in other infectious disease outbreaks.

That’s because the Rwandan government opted to give the experimental shot to all high-risk health workers and people in contact with confirmed cases, rather than the typical protocol of giving some people the vaccine and some people a placebo shot.

Notably, Rwanda launched the first-ever clinical trial to test Marburg treatments earlier this month, the type of standardised approach that it decided against for the Sabin vaccine.

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The decision to offer the vaccines widely means researchers won’t actually know whether it protects people against infection or not. Instead, they will be testing the vaccine’s safety and whether it prompts an immune response, Finan said.

Thus far there have been no safety concerns in the ongoing stage two trials in Uganda and Kenya, with interim results expected next year, and Finan said the Sabin institute will also launch another study in the US in 2025.

It “remains to be seen” whether Sabin will send more vaccines to Rwanda, Finan said, and “we will work together to decide next steps as appropriate”.

The speedy mobilisation has been possible because of existing partnerships with health authorities and companies, Finan said, and because vaccines that were readily available to ship and the existing trial data supported the country’s immunisation plan.

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Most of all, she said the response underscores that small organisations can play an outsized role in containing a lethal infectious disease outbreak.

“At the end of the day, it all comes down to the people, listening to the country’s leadership, and trust among the partners,” Finan said.