Devex CheckUp: Could Rwanda’s Marburg outbreak speed a new vaccine?

Nearly two weeks into Rwanda’s first outbreak of Marburg — the deadly filovirus with a mortality rate of up to 88% — at least 13 people have died, mostly health care workers. Marburg has a lot in common with Ebola, another filovirus. But Ebola already has a vaccine, and Marburg is a ways away.

A handful of Marburg vaccine candidates are in clinical trials, including one being developed by Sabin Vaccine Institute, a nonprofit that develops vaccines for viruses that disproportionately affect low- and middle-income countries. The vaccine uses the same technology that British pharmaceutical company GSK used for its Ebola Zaire vaccine and is the most advanced in clinical development.

Sabin Vaccine Institute CEO Amy Finan tells my colleague Sara Jerving that she received a call from Rwandan President Paul Kagame's office requesting the vaccine the night before the country announced its current Marburg outbreak. Nine days later, 700 doses arrived in Rwanda, where phase 2 trials are now underway to examine the vaccine’s safety and immune response in humans.

There are several steps left in the process toward a licensed vaccine. Further trials will be needed on Sabin’s shot, while other vaccine candidates against Marburg have just started human trials, or are still in the planning stages.

The outbreak, however, could serve as a means to test candidate vaccines and treatments. The World Health Organization says it is in contact with “all the candidate antiviral and monoclonals and vaccine developers and assessing the availability of doses and suitability for testing during the outbreak.”

Read: How far are we from a licensed vaccine for deadly Marburg?

There’s an app for that

But if you’ve followed our reporting, you’ll know a vaccine’s existence doesn’t guarantee everyone will have access. In Rajasthan, India’s largest state, there are over 70,000 children who have never received a single routine vaccination.

A study published in the medical journal JAMA Network this year also found that 6.7 million children in India between six and 23 months old are zero-food children — those who had not consumed any milk, formula, or food in 24 hours. Extremely underweight children can’t receive a vaccine, and parents of poor families might have to decide whether to miss work to get their children vaccinated or to afford food for the day.

Moreover, India's community health workers are often bogged down by paperwork. In Rajasthan, for example, they are required to manually document all health records.

To help address some of these challenges, Khushi Baby, a nonprofit that began as a classroom project at Yale, developed a mobile application that health workers can use to store a child’s medical record, including immunization coverage. It also helps them keep track of households that need immunization reminders or follow-up care, and alerts them when a child has not received their vaccinations.

The data shows it’s making a difference. Khushi Baby conducted a randomized controlled trial to measure the effectiveness of digital tracking and found immunization rates increased by 12%, and malnutrition decreased by 4% in Rajasthan. The app is now expanding its reach in other states, such as Karnataka and Maharashtra, and it is also helping track multidimensional poverty data in India to help other government ministries design policies accordingly.

Read: How digital record keeping is strengthening community health care in India

+ This story is part of a Devex series on what’s working in global health. These are editorially independent articles supported by funding from the Gates Foundation.

Net positive

In recent years, there’s been an increased call for donors to invest more locally, such as allocating more funding to local organizations and allowing them to lead in shaping and implementing programs in their communities. The U.S. Agency for International Development, for one, promised that a quarter of its funding would go to local groups by 2025, though that’s not going so smoothly.

Now the President’s Malaria Initiative, a U.S. government initiative led by USAID, is trying to head in the same direction. In August, it came out with a vision statement on investing locally and set out medium- and long-term goals, including:

• Increasing the percentage of PMI’s funding going to local groups from 3.5% in 2023 to 10% by the end of 2026.

• Doubling the procurement of malaria commodities that are manufactured in Africa by the end of 2031. In 2023, it sourced about 10% from the continent.

It won’t be easy. There are some challenges, such as the scarcity of WHO-prequalified products that are manufactured in Africa. But Walton says the initiative is working to address them. For example, PMI helped broker an introduction between malaria nets producer Vestergaard and the U.S. International Development Finance Corporation, which are now discussing opportunities to help establish a manufacturing hub in Nigeria for a new generation of bed nets.

Read: US malaria initiative wants to triple local funding by 2026 (Pro)

ICYMI: Africa to get first manufacturing hub for next-generation malaria nets

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This week in numbers

• $250 million. That’s the total grant amount that Melinda French Gates is giving organizations working to address challenges specific to women’s health. French Gates announced an open call for proposals on Wednesday, and those interested can now register and submit an online application by Jan. 10, 2025.

• More than 370 million. That’s how many women and girls across the world have been raped or sexually assaulted before they turned 18, according to the first estimates on sexual violence in childhood released by UNICEF. The data also reveal 240 million to 310 million boys and men have been raped or sexually assaulted in childhood.

• 1,128. That’s how many attacks on health care WHO has recorded in the occupied Palestinian territory since Oct. 7, 2023, totaling 63% of the world’s attacks on health care from that day to now.

• Over $2.2 billion. That’s the amount of pledges WHO has received to date against its $7.1 billion fundraising target to cover its work over the next four years. WHO is holding several investment round events — such as one in Berlin at the World Health Summit next week — in the lead-up to its major pledging event in November. My colleague Andrew Green will be on the ground to give you the latest on the investment round and other global health news coming out of the summit. Say hello to Andrew if you would be there, or have tips!

What we’re reading

Scientists at the University of Oxford are working on a vaccine for ovarian cancer. [BBC]

The Democratic Republic of Congo has launched its first vaccination campaign against mpox. [Al Jazeera]

U.N. officials are alarmed by an almost 40% increase in cholera cases in Sudan in less than two weeks. [ABC News]