How pandemic preparedness let Tanzania successfully control a Marburg outbreak
Preparation of patient transport at EAC outbreak simulation exercise
Is pandemic preparedness work paying off for East African countries? The successful containment of a recent Marburg outbreak in Tanzania suggests the answer is yes.
It was the call that Eric Nzeyimana, Principal Health Officer at the East African Community (EAC) Secretariat, hoped he would never get. In March 2023 he was sitting at his desk in Arusha, Tanzania, when he received a call from the country’s Ministry of Health to say there was an outbreak of the deadly Marburg virus. His first reaction was one of both fear and confidence – fear because Marburg causes a deadly haemorrhagic fever, and confidence because of recent EAC success containing the 2022/23 Ebola outbreak in Uganda. ‘I felt we might be able to successfully handle this too,’ says Eric.
Over recent years, member states have strengthened their pandemic preparedness in cooperation with German technical and financial cooperation, provided by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and by KfW Development Bank, both working on behalf of the German government. By the end of the day Eric learned there were already five confirmed cases of Marburg. The fear was that there might be many more cases that hadn’t yet been diagnosed.
Marburg has a mortality rate of up to 88%
Marburg is caused by two zoonotic viruses, the Marburg virus and the Ravn virus, which are closely related to the Ebola viruses. The symptoms are feverishness, weakness, bleeding and diarrhoea. According to WHO, there’s a mortality rate of up to 88%.
Marburg spreads very easily, especially in communities which are not educated and where hygiene is poor. When they see someone bleeding and then dying, local people blame witchcraft.Eric Nzeyimana, Principal Health Officer at the East African Community (EAC) Secretariat
Marburg is transmitted to humans by fruit bats and spreads through direct contact with body fluids of infected persons, but also through contact with contaminated material and surfaces. Bushmeat and markets also play a role in its spread. There are currently no approved vaccines or antiviral treatments against infection. This meant it was vital for the EAC to consistently implement a One-Health multi-sectoral approach, recognising that pandemics are not just a health issue but also affect countries’ economy, trade, agriculture, tourism, immigration and many other sectors.
First outbreak of Marburg in Tanzania
The outbreak was the first time the Marburg virus infection had been reported in Tanzania. Previous outbreaks have been reported in Angola, the Democratic Republic of Congo, Ghana, Kenya, Equatorial Guinea, South Africa and Uganda. In this case, the outbreak was found in the Bukoba district in the Kagera region of north-western Tanzania. This region borders Uganda to the north, Rwanda to the west and Burundi to the southwest. The high mobility of the population within the region meant there was a significant risk of the disease spreading across borders into other countries. Speed was therefore vital if the outbreak was to be contained.
Effective crisis communication in action
Eric immediately implemented the crisis communication model developed by the East African Community Secretariat (which had been developed in the last three years in cooperation with GIZ), quickly alerting other member states and wider stakeholders such as the World Health Organisation, requesting daily updates from Tanzania’s Ministry of Health and convening emergency meetings including with regional technical experts.
Over the last few years, the EAC Secretariat has done a lot of work to help national crisis response teams build up their knowledge and resources and establish good structures and processes. With the outbreak of Marburg in Tanzania, this work really paid off.Eric Nzeyimana, Principal Health Officer at the East African Community (EAC) Secretariat
At the same time, other emergency preparedness measures were implemented including the delivery of three tonnes of protective equipment to the affected area and the arrival of 29 members of the African Health Volunteers Corps (AVOHC) trained in WHO techniques to manage and monitor health emergencies.
Fast deployment of a mobile laboratory
Within 48 hours, one of Tanzania’s two mobile laboratories was deployed to the Bukoba district. These laboratories are part of a network of labs funded by KfW Development Bank on behalf of the German government. In total, nine labs have been provided to EAC countries – two each for Uganda, Kenya and Tanzania and one each for Burundi, Rwanda and South Sudan. Under the three-year project, staff in each country have also been trained by experts from the Bernhard Nocht Institute for Tropical Medicine in how to set up the lab, and use and maintain the equipment. The labs were used extensively by East African countries to support testing during the Covid-19 pandemic. With the Marburg outbreak, they once again played a key role.
Pascal Kanyinyi is the KfW portfolio co-ordinator for the EAC health sector cooperation including the Mobile Labs project. He says, ‘Before, samples had to be sent to a fixed lab in a city. Getting the results could take several days and during this time you could get more cases and still not know what you’re dealing with.’ He adds, ‘With a mobile lab you can start testing immediately close to the site of an outbreak, transferring results in real time to a country’s central laboratory and to government agencies with the mandate to introduce lockdowns and other measures.
Compared to the past, the response to the Marburg outbreak was very quick.Pascal Kanyinyi, portfolio KfW co-ordinator for EAC health sector cooperation
Trained health workers are ready to respond to outbreaks
Another factor that played a key role in helping Tanzania to successfully contain the Marburg outbreak was the availability of health workers trained to respond to outbreaks. Over the last few years, hundreds of lab technicians and health workers including those working at the Bukoba treatment centre where patients were treated have taken part in pandemic simulation exercises.
For example, in 2019, more than 200 outbreak first responders from all EAC partner states took part in a 4-day cross-border exercise simulating the outbreak of a highly infectious viral disease. This was initiated by GIZ on behalf of the German government as part of its ‘Support to Pandemic Preparedness in the EAC Region’ project. Implemented together with the EAC and WHO, the exercise enabled participants to test their technical skills and the way they practically respond in a highly realistic outbreak simulation. Other simulation exercises have included a table top exercise in Arusha and a simulation at Kilimanjaro International Airport. With the Marburg outbreak, further training was given to Tanzania’s health experts in disease outbreak containment.
There is no better way to test your abilities and to learn than in a realistic simulation where you have to put your expertise and skills into practice. The experience and knowledge gained in such a training will be “burned” into your memory!Burkard Kömm, Programme Manager, Support to Pandemic Preparedness in the EAC Region
Pandemic-ready plans, processes and structures
The simulation exercises enabled each EAC member state to test their national pandemic response plans and structures. For example, following the 2019 exercise, all member states reviewed and refined their pandemic preparedness plans based on the feedback they received from the exercise facilitators and evaluators.
The EAC Secretariat was also able to test its processes for communicating with member states and coordinating regional action to combat disease outbreaks effectively. These processes have since been tested several times in real-life scenarios – by Covid-19, by the 2022/23 Ebola outbreak in Uganda and most recently by the Marburg outbreak in Tanzania. In the case of the Marburg outbreak, for example, the EAC Secretariat rapidly convened virtual meetings of technical health experts and also both virtual and physical multi-sectoral meetings of officials in ministries like trade and transport as well as health.
Effective communication at a regional level enabled us to share information and agree on a Regional Response Plan. It also helped us solve issues with multi-sectoral dimensions like the closing and re-opening of borders.Eric Nzeyimana, Principal Health Officer at the East African Community (EAC) Secretariat
Marburg outbreak declared ‘over’ in less than three months
Together, these pandemic preparedness measures enabled Tanzania to successfully contain the outbreak. On 2 June 2023, less than three months after the first case was detected, the outbreak was declared over. In total, nine cases (eight confirmed and one probable) were recorded, including six deaths. Eric Nzeyimana describes the successful containment as tremendously encouraging.
This outbreak has shown us that there is good capacity to quickly respond and contain outbreaks. The mobile labs, the trained people, the use of the WHO model to respond to outbreaks, the awareness of ministers of health and leaders at a high level including the head of state – all these played a part.Eric Nzeyimana, Principal Health Officer at the East African Community (EAC) Secretariat
What’s next in Germany’s support to EAC’s pandemic preparedness?
According to BurkardKömm, ongoing cooperation projects will further strengthen the ability of East African countries to respond to outbreaks of infectious diseases individually and jointly. For example, plans are underway to establish a regional pool of EAC experts who can be rapidly deployed to a disease outbreak area. German support is helping to establish this regional pool, facilitating training measures and working to intensify cooperation between the EAC Secretariat and continental and global partners, particularly Africa CDC and WHO.
Effective cooperation and coordination of relevant experts and institutions is key to responding successfully to an outbreak of a highly infectious disease – at a local, national, regional and global level alike!Burkard Kömm, Programme Manager, Support to Pandemic Preparedness in the EAC Region