The Africa CDC has slammed the U.S. government’s recent Level 3 travel advisory for Rwanda as unfair and baseless, arguing it undermines Rwanda’s proactive efforts to contain a Marburg outbreak. With rapid testing, vaccinations, and coordinated emergency response measures in place, Rwanda’s leaders insist the country poses no international threat and warn that travel restrictions could stoke panic and discourage transparency in future health crises.
Dr. Jean Kaseya, Director General of Africa CDC, called the US decision “unfair” during a press briefing Thursday, accusing Washington of creating unnecessary panic. On October 7, state department increased the advisory level from 2 to 3, with the caveat to “reconsider travel in Rwanda due to an outbreak of Marburg Virus Disease”.
Kaseya emphasized that Rwanda had taken a transparent and comprehensive approach to controlling the Marburg outbreak, which was declared on September 27.
“Rwanda collaborated with all partners, including the U.S., to show that there is no risk of spreading this disease,” he stated. He pointed to the country’s proactive measures, such as stringent screening processes at Kigali International Airport, effective contact tracing, and cross-border surveillance, as evidence of Rwanda’s commitment to preventing international transmission.
The press conference also featured remarks from Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, who detailed the country’s rapid response efforts, which include intensive testing, vaccination campaigns targeting healthcare workers and high-risk groups, and the use of multiple therapeutic options. “We are working closely with partners across the world… although this is the most dangerous virus in the world, we came up stronger to respond,” said Nsanzimana.
Rwanda has so far confirmed 58 cases of Marburg virus disease, with a case fatality rate (CFR) of 22%. While that is 4-5 times higher than the average CFR of COVID in the first six months of the pandemic, it is significantly lower than the fatality rate of previous Marburg outbreaks in other parts of the Africa region, Nsanzimana contended. Historically, the case fatality rate of Marburg has averaged 50%, according to WHO, although it has varied between 24-88% in different outbreak contexts. The virus, which causes haemorrhagic fever, is in the same family as the virus that causes Ebola virus disease. Bats are regarded as a key virus reservoir.
Rwanda’s use of advanced therapeutics and vaccine trials
Nsanzimana attributed the relatively low fatality rate to the country’s early detection of cases, rapid isolation protocols, and the administration of supportive treatments, such as antiviral drugs and monoclonal antibodies, administered to critically ill patients.
“The earlier you detect, the better the outcome,” he noted, underscoring the importance of prompt diagnosis and immediate response.
Rwanda has also already administered over 200 doses of an investigational Marburg vaccine developed by the Sabin Vaccine Institute, he revealed. The vaccination campaign, which began this week, prioritizes healthcare workers and individuals in close contact with confirmed cases. The minister announced plans to expand the vaccination effort to additional high-risk groups in collaboration with international partners. “Our aim is to vaccinate as many people at risk as quickly as possible,” he added.
Despite the positive strides made, Nsanzimana acknowledged the need for more vaccine doses and indicated that Rwanda is actively working to secure additional supplies to protect healthcare workers and communities.
Rwanda has adopted an open-label approach to the vaccine trial to expedite protection for at-risk groups, Nsanzimana said. But due to the deadly nature of the disease, the initial protocol does not include a delayed-arm trial, but plans are in place to expand the study and consider alternative methodologies as more data becomes available.
“Our focus now is on saving lives and preventing transmission. We can explore more complex trial designs as we move forward,” he said.
Criticism of Travel Bans
Amid growing concerns about travel restrictions, both Kaseya and Nsanzimana argued that imposing travel bans is counterproductive during outbreaks, as they may deter transparency and international collaboration. “Let us be guided by facts and science,” Nsanzimana stated, pointing out that Rwanda’s efforts to contain the virus should be viewed as a model rather than grounds for punitive measures. Kaseya added that the country’s centralized emergency response system and comprehensive cross-border surveillance demonstrate its preparedness and should be encouraged, not penalized.
The Africa CDC chief emphasized that travel advisories based on limited evidence could harm not only the affected country but also the global community by discouraging other nations from reporting outbreaks in a timely manner. He disclosed that following discussions, the U.S. government had agreed to consult with Africa CDC before issuing any future travel-related advisories regarding the continent. “We need to ensure that decisions are based on evidence and consultation with local health authorities,” Kaseya said. US officials have also praised Rwanda’s rapid outbreak response, in comments like one from Rwanda’s US Amassador Eric Kneedler on X, who called it a “model” for the region.
Rwanda’s approach to managing this outbreak serves as a model for the region, including the clear commitment to safeguarding citizens and resilience in tackling health challenges. Together, we will #EndMarburg pic.twitter.com/3kp7n1s9MW
— Ambassador Eric Kneedler (@USAmbRwanda) October 9, 2024
Strengthening Cross-Border Cooperation and Surveillance
Kaseya and Nsanzimana also highlighted the need for cross-border cooperation and surveillance efforts aimed at containing the Marburg virus and preventing regional spread. Kaseya announced that Africa CDC is deploying rapid diagnostic testing and bolstering surveillance capabilities in neighboring countries to ensure that any potential cases are quickly identified and isolated. He revealed that more than 5,000 test kits have already been distributed to high-risk areas, and plans are underway to establish rapid testing stations at key border points.
Rwanda also revealed it has set up a centralized emergency response center that integrates all relevant services, including health workers, the military, police, and ambulance services. This coordinated approach, the minister said, allows for rapid deployment of medical personnel and other resources across the country. “The mechanism they put in place is impressive,” Kaseya said. “When a call comes in, they can locate an ambulance anywhere in the country, not just in Kigali, and deploy personnel quickly.”
Ongoing Mpox Outbreak: A Public Health Concern
At the briefing, Kaseya also stressed that the ongoing mpox outbreak remains a significant public health issue across the continent, with 3,186 new cases and 53 deaths recorded during the last week of September across Africa. The Democratic Republic of Congo (DRC), Nigeria, Uganda, and other nations are grappling with the virus, which continues to spread due to limited testing capabilities and low vaccination rates. Neighboring Republic of Congo, reported its first mpox case in the capital of Brazzavile, after six weeks of no case reports..
The lack of sufficient laboratory infrastructure was highlighted as a major challenge in countries like Liberia and the DRC, where low testing rates hinder accurate tracking of the outbreak. “The outbreak is still there, still increasing, and we need to stay focused to stop it,” Kaseya warned, urging affected countries to prioritize improving laboratory capacity and access to diagnostics.
Mpox Vaccination Campaigns Underway in the DRC
During the briefing, officials provided updates on the mpox vaccination rollout in the DRC, where a campaign targeting high-risk regions commenced on October 5. The first phase has seen 1,654 individuals vaccinated in DRC’s eastern regions such as North Kivu, South Kivu, where M23 militias control much of the territory. Kaseya acknowledged the logistical challenges faced during the rollout, particularly the distribution of vaccines to remote and conflict-prone regions. He commended the DRC government for prioritizing vaccination in areas with the highest burden of cases and reiterated Africa CDC’s commitment to supporting similar efforts in other affected countries, including Nigeria and the Central African Republic.
Calls for Regional and Global Solidarity
Calling for greater regional and global solidarity in the fight against disease outbreaks, Kaseya and Nsanzimana both emphasized that health crises in one region can quickly affect others.
In addition to pressing the US to lift its Level 3 travel advisory, the Africa CDC director repeated his commitment to working with the World Health Organization and other partners to strengthen outbreak response systems across the continent. This includes pushing for the finalization of a global pandemic agreement that would accelerate knowledge transfer, ease intellectual property restrictions on developing countries’ use of new and patented drug formulations, and facilitate local manufacturing of vaccines and therapeutics in Africa.
“The travel ban is not a solution,” Kaseya stated, calling for continued collaboration and evidence-based decision-making. “Let us continue to work in solidarity. We are one planet, and we must face these challenges together.”
Image Credits: Africa CDC, US State Department , WHO, Africa CDC .
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