The director general of the Africa Centers for Disease Control and Prevention and Rwanda’s health minister on Thursday criticized the U.S. government’s decision to urge Americans to avoid travel to Rwanda due to the country’s ongoing Marburg outbreak .
Calling the travel warning a travel ban — it’s not — Jean Kaseya, head of the Africa CDC, suggested the U.S. action was counterproductive and unfair for a country that has been transparent about its efforts to contain the first confirmed Marburg outbreak within its borders to suppress.
“Rwanda is applying transparency to this outbreak. And when a country practices transparency, the country will… [should not] be punished,” Kaseya said during a press conference.
The USA Ministry of Foreign Affairs and the Centers for Disease Control and Prevention issued Level 3 travel advisories for Rwanda on Monday in response to the Marburg outbreak, which has resulted in 58 confirmed cases and 13 deaths to date. For the second day in a row, no new cases or deaths were reported Thursday. The number of people who have recovered has risen to fifteen.
A level 3 advice is not a travel ban. It advises people to postpone or cancel unnecessary trips to the country to which the advisory has been assigned. Both the State Department and the CDC have Level 4 advisories that they use to tell Americans not to travel to a destination due to safety concerns or risks of disease transmission.
The Africa CDC issued a statement on Tuesday urging countries not to impose travel restrictions on African countries fighting MPOX outbreaks, or in the case of Rwanda, Marburg. It noted that travel restrictions violate the WHO’s International Health Regulations, which require countries to be transparent about the disease threats they face but also seek to protect countries dealing with outbreaks from retaliation by other countries because they have been transparent.
The WHO announced this on Thursday interim guidance for travel during filovirus disease outbreaks — Marburg is caused by a filovirus. It includes advice on screening people leaving an area where a filovirus outbreak is underway, and what people returning from an affected area should do if they develop symptoms within 21 days of their return. No US travel advisories are listed.
Rwandan Health Minister Sabin Nsanzimana said the country is conducting active exit screening and has barred people who have contacts of confirmed cases from leaving the country while they are within the incubation period of the disease, 21 days after exposure.
“This is our responsibility under the International Health Regulation, that we protect our community, our people here, but also the people of the world,” Nsanzimana said. “The sooner we stop this, the better for everyone.”
Kaseya complained that the U.S. action was taken without consultation with or prior notice to the Africa CDC or the Rwandan government, a move he called disrespectful. He said he complained to senior U.S. officials and received what he characterized as a “clear commitment” that such a move would not be made in the future without consultation.
Marburg is caused by a virus related to the viruses that cause Ebola. The diseases manifest and spread in similar ways, and have similarly high mortality rates. Although there are two approved vaccines for the Zaire Ebola virus, there are no approved vaccines or medications for Marburg.
However, an experimental vaccine is being developed by the Sabin Vaccine Institute that Rwanda is using. The US government shipped 700 doses of the vaccine – used in a one-dose regimen – to Rwanda over the weekend. Another 1,000 doses will arrive on Saturday, the institute told STAT.
The vaccine is currently being tested for safety and immunogenicity – the ability to induce an immune response – in a Phase 2 clinical trial being conducted in Kenya and Uganda.
The Rwandan Ministry of Health’s update on Thursday said 346 doses have been administered so far to people exposed to confirmed cases, particularly those working in two hospitals in Kigali where the risk of exposure is considered high.
“Our goal is to save as many lives as possible as quickly as possible and also stop the spread,” said the Health Minister. “Because if it penetrates too far into the community, that’s the worst case scenario. … Time and speed are very important.”
Nsanzimana, who said the origins of the outbreak were still being investigated, said all new cases that have occurred since the outbreak was declared on September 27 were among healthcare workers or their contacts.
WHO has been working for a number of years to prepare countries to be able to test experimental vaccines in situations like this, including developing a number of clinical trial protocols that can be pre-approved. But for now, Rwanda is using the vaccine in an open-label approach, Nsanzimana said — giving it to anyone known to have been in the virus’s path.
One of the proposed trial designs is a so-called delayed ring vaccination trial, in which people who were in contact with a confirmed case are vaccinated immediately or with a delay. This is the design used to prove that the first approved vaccine against the Zaire Ebola virus, Merck’s Ervebo, actually works.
Nsanzimana said Rwanda could later consider switching to a delayed ring vaccination, but for now it is focusing on vaccinating those most at risk. “Saving lives is important to us. Postponement also has its challenges and consequences,” he said when asked about the decision.