Vaccines and Antivirals: Grand Challenges and Great Opportunities

Nine Dead Of Ebola-like 'eye-bleeding Disease' With Mortality Rate Of 90% In Fresh Outbreak Triggering 'pandemic Fears'

NINE people have died in an outbreak of an eye-bleeding disease in Tanzania, Africa's health agency has announced.

This exceeds the eight suspected deaths reported by the World Health Organization (WHO) earlier this month, which had warned that "more cases" were likely to be identified.

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Ten people have tested positive for Marburg in Tanzania, of which nine have diedCredit: AP

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Tanzania's President, Samia Suluhu Hassan announced the outbreak during a press briefing with WHO Director-General, Dr Tedros Adhanom Ghebreyesus.Credit: Rex

Since the country officially announced the outbreak last week, ten people have tested positive for Marburg virus, a highly infectious disease similar to Ebola.

Of these, nine have died – reflecting the virus's 90 per cent mortality rate.

The cases were reported in the Kagera region of Tanzania.

Located in the northwest of the country, Kagera has a population of nearly three million.

It is connected by train to Dar es Salaam, which has an international airport, raising concerns about the potential for wider spread.

Ngashi Ngongo, from Africa Centre for Disease Control Centre (CDC) told an online briefing that the figures reflected "the very high case fatality of Marburg".

"We are doing everything we can with WHO and all the partners."

He said that teams, including members who had already countered a recent outbreak in neighbouring country, were already "on the ground".

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From the ten cases "about 281 contacts have been listed and are being followed", he said, praising the tracking of the virus so far.

"There have been a total of 31 tests that have been conducted, two confirmed, and 29 I think, that are negative," he said.

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It comes a month after WHO declared the end of a three-month Marburg outbreak in Rwanda which killed 15 people.

Dr Tedros Adhanom Ghebreyesus, from the WHO, previously said the global risk from Tanzania's current outbreak was "low".

"Even though there is no approved treatment or vaccines, outbreaks can be stopped quickly," he said.

"WHO advises against restrictions. Now is the time for collaboration."

Marburg has been flagged by the WHO as a "priority pathogen" with pandemic potential.

Previous outbreaks have seen around half of those infected die, though in places where health care is poor, that has risen to nearly 90 per cent.

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The Ebola-like virus has a 90% fatality rate in some parts of the worldCredit: Getty

What is Marburg virus?

Marburg is a filovirus like its more famous cousin, Ebola.

These are part of a broader group of viruses that can cause viral haemorrhagic fever, a syndrome of fever and bleeding.

Up to 90 per cent of those infected die.

The first outbreaks occurred in 1967 in lab workers in Germany and Yugoslavia who were working with African green monkeys imported from Uganda.

The virus was identified in a lab in Marburg, Germany.

Since then, outbreaks have occurred in a handful of countries in Africa, less frequently than Ebola.

Marburg's natural host is a fruit bat, but it can also infect primates, pigs and other animals.

Human outbreaks start after a person has contact with an infected animal.

It's spread between people mainly through direct contact, especially with bodily fluids, and it causes an illness like Ebola, with fever, headache and malaise, followed by vomiting, diarrhoea, and aches and pains.

The bleeding follows about five days later, and it can be fatal in up to 90 per cent of people infected

The virus is highly infectious spreading among humans through direct contact with bodily fluids such as blood, saliva, muscus.

There is currently no way to cure it, though several vaccines and drugs are under development.

Early symptoms can resemble those of more common illnesses like the flu, including muscle aches, fever, and chills.

Vomiting blood and diarrhoea, and uncontrolled bleeding from the eyes, nose and gums, can emerge in the later stages before - in some cases - death.

Tanzania experienced its first Marburg outbreak in March 2023 in the Bukoba district.

It killed six people and lasted for nearly two months.

Speaking to The Sun following the outbreak in Rwanda, Paul Hunter, a professor of medicine at the University of East Anglia, said cases could "crop up in any country globally".

"The incubation period is between five and 15 days, plenty long enough for someone to get on a plane and fly anywhere in the world," he explained.

The incubation period of a virus is the time between exposure to the bug and the onset of symptoms.

"Airport screening wouldn't eliminate that risk due to the long incubation period," Prof Paul said, as people could be travelling without showing any symptoms.

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Who Is Protecting Americans From Marburg Right Now?

By Stephanie Psaki

Jan. 27, 2025

Psaki is a former U.S. Coordinator for global health security of the National Security Council.

On Saturday, Jan. 11, as we entered the final week of the Biden-Harris administration, I got a call about a suspected Marburg outbreak in Tanzania. Marburg virus disease is like its close cousin Ebola, but worse. It can have a mortality rate as high as 80% and, unlike at least one strain of Ebola, we do not have an approved vaccine or treatment for Marburg. Our best hope for protecting Americans when an outbreak like this occurs is to stop it at its source. When the World Health Organization heard about the suspected outbreak, one of their first actions was to alert the Centers for Disease Control and Prevention.

The call was not a complete surprise. These outbreaks are increasing in frequency — this was the 12th Marburg or Ebola outbreak we faced during the Biden-Harris administration. But we had made it to January 2025 without a single case of either disease in the United States. One of the reasons we were successful was that we had a plan in place — a playbook — for responding to biological threats, which we implemented quickly and aggressively every time there was a new outbreak. We had partners in place, from WHO to vaccine manufacturers, who were on standby and ready to act. We had emergency funding available that could quickly be redirected. And we had people — at the National Security Council and across federal departments and agencies — who had responded to countless biological threats, could get on a plane at a moment's notice if needed, and, most importantly, who knew how to keep Americans safe.

As I've watched the Trump administration announce a series of actions that undermine our ability to detect and respond to biological threats, including stopping CDC staff from communicating or traveling and sending National Security Council staff home indefinitely, I wonder: Who is protecting the American people from Marburg right now?

Undermining the emergency preparedness system we have in place

In a slew of executive orders released on Jan. 20, the Trump administration announced its intention to withdraw the United States from the WHO, replace the 2024 U.S. Global Health Security Strategy (which closely mirrors a similar strategy released in 2019), and place a 90-day pause on foreign assistance, among other actions. It also put a pause on public communications from CDC and the Food and Drug Administration, and research funding from the National Institutes of Health. The Trump administration's plans will sever ties with critical partners, cut our resources to stop outbreaks before they reach our shores, diminish our access to vital early warning data, slash the pipeline of innovative vaccines and treatments that could be used in an emergency, and hamper the ability of federal agencies to act quickly to warn Americans about emerging threats.

Perhaps the new administration plans to replace these with a new preparedness system, but what about the threats facing Americans right now? The highest responsibility for any administration is to protect the American people. When it comes to emerging biothreats, Americans deserve a government that runs like a well-oiled and efficient machine. We spent the last four years strengthening that machine. Sure, it could still be improved. But to get rid of it with nothing in its place is irresponsible and dangerous.

The playbook

When I got that call about Marburg on a Saturday afternoon, we immediately put our playbook into action. By Sunday morning, we had convened federal departments and agencies to assess the risk to the United States. (Our conclusion: This was a significant biological threat). CDC had a response team up and running by Tuesday, three days after learning of the threat, with support from the U.S. Agency for International Development and the State Department. Staff across the U.S. Government had worked to issue travel guidance to Americans in Tanzania, determine the volume of travel from airports near the outbreak into the United States, and assess whether and how many experimental vaccines and therapeutics we had available for Americans if needed. We remained in close contact with key partners, from the private sector to multilateral institutions, to ensure they were prepared to respond. This — and more — happened within 72 hours, because early, aggressive action is how you protect the homeland. And we had that extra time to prepare because the World Health Organization alerted us to the threat more than a week before the outbreak was announced publicly.

Marburg and Ebola represent a significant risk, to be sure, but they are known threats. Next time, we could be facing an unknown pathogen that a country may not even acknowledge, in which case the WHO will likely have much more luck than the U.S. In gaining access and information. It could be a deliberate threat from an adversary, which the adversary might deny, and the world would look to the WHO as a neutral trusted voice. Or it could be a lab accident, which could be prevented with better guidance and training, and contained more quickly if we have eyes and ears on the ground. To stop biological threats from coming to the United States, we need to know about them early, we need partners and resources to help quickly contain them, and we need countermeasures to respond. That was our plan to keep Americans safe. It worked for the last four years, and it's our best bet to keep Americans safe for the next four. What needs to happen in the next few days to protect Americans? The Marburg outbreak has continued to evolve since the transition last week, but we have little visibility into what is happening. Scientific experts across the U.S. Government have lost access to many of the tools they would normally use to protect Americans. Those tools, those data, would be needed for CDC to decide whether to elevate their travel health notice warning Americans who are planning travel to the affected region. If I were still at the White House, I would be asking the Department of Homeland Security and CDC to follow up with travelers who recently arrived from the region to check whether they have symptoms of Marburg. I would ask USAID and CDC whether they have staff, resources, or supplies (diagnostic tests, for example) that they can surge to the response to help contain the outbreak before it spreads. I would ask the State Department to reiterate the U.S. Offer of help to contain the outbreak to the government of Tanzania. And I would ask the Department of Health and Human Services whether we have vaccines or therapeutics that we can offer Tanzania to help contain the outbreak quickly. I would be on the phone with WHO leadership to get the latest information on the outbreak, including from Director-General Tedros Adhanom Ghebreyesus, who traveled to Tanzania last week to help with the outbreak response. And I would be calling our closest outside partners — from industry to multilateral institutions — to ask what resources they can deploy quickly to protect Americans. It is unclear whether anyone is making those calls now. With CDC travel cancelled, the world's leading experts on containing outbreaks are unable to head to Tanzania to help. And with the WHO relationship severed, it is hard to imagine that anyone is speaking to Dr. Tedros. These outbreak responses are hard enough to get right when you have the support of political leadership to act quickly. There are plenty of experienced civil servants who know how to contain this outbreak, but if their ability to take quick decisive action is hampered even for a few days the window for quick action might close. Now is not the time to demolish our well-oiled machine. Instead, the United States should do what it does best — drive an effective and efficient response to stop outbreaks at their source. Because that's the best way to save lives around the world, and to protect our homeland too. Stephanie Psaki served on the National Security Council of President Biden's White House, most recently as U.S. Coordinator for global health security.

First Effective Ebola Treatment A Step Closer After Breakthrough Trial

Clinical trials of four experimental treatments for Ebola in the Congo have been halted early after two of the drugs showed compelling benefits in a breakthrough against the deadly virus.

In an extension of the original study patients have immediately been switched to receive either Regeneron's REGN-EB3 or Ridgeback's mAb114 after they were found to block the virus' progression.

The two monoclonal antibodies outperformed Mapp's ZMapp and Gilead's remdesivir in the trial, with REGN-EB3 eliciting the lowest overall death rate – at 29% – while mAb114 achieved a mortality rate of 34%.

Initially, the Ebola trial, which began in November 2018, involved three drugs – mAb114, remdesivir and ZMapp. The World Health Organization (WHO) then assessed all preclinical and clinical data on all available investigational products, and recommended the addition of REGN-EB3 as a fourth treatment.

The Pamoja Tulinde Maisha (PALM [together save lives) randomised, controlled trial was run in the Democratic Republic of the Congo (DRC) as part of the emergency response to an ongoing Ebola outbreak in the country's North Kivu and Ituri Provinces.

The trial's independent data and safety monitoring board (DSMB) and the study leadership decided preliminary analysis of the existing data was compelling enough to halt the original trial and focus on the two successful candidates.

The study was co-sponsored and funded by the INRB and the National Institute of Allergy and Infectious Diseases (NIAID) of the NH, and carried out by an international research consortium coordinated by the WHO.

Neil Stahl, executive vice president of research and development at Regeneron, said: "The Regeneron team worked tirelessly to discover, develop and produce REGN-EB3 in record time utilising our VelocImmune-based technologies.

"We are moved to know our therapy is helping save the lives of people facing this deadly infectious disease. We look forward to reviewing the trial data and are working with governments and other collaborators, including BARDA (Biomedical Advanced Research and Development Authority), to make REGN-EB3 available for the current outbreak and future use."

The other successful investigational drug, mAb114, was developed by the US National Institutes of Health (NIH), which isolate an antibody retained by a human Ebola survivor and licensed it to Ridgeback for further development in 2018.

Wendy Holman, CEO and co-founder of Ridgeback Biotherapeutics, said: "I am very proud of what the Ridgeback team has accomplished in less than a year and we will continue to concentrate on ensuring that mAb114 is available to respond to the current and any future outbreaks."

The complete results will be submitted for publication in the peer-reviewed medical literature as soon as possible.

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