When Rwanda’s Ministry of Health confirmed the country’s first-ever outbreak of Marburg virus disease (MVD) in September 2024, alarm spread quickly, both within the country and across the globe. Clinically similar to Ebola, MVD has, in past outbreaks, claimed the lives of up to 88 percent of those infected.
Though the virus was first identified in Europe in the 1960s and has surfaced in sporadic outbreaks across sub-Saharan Africa, this outbreak was different. It was the third largest outbreak of MVD ever, and nearly 70 percent of confirmed cases were among healthcare workers, leading many experts to believe that the disease was spreading silently through clinics and hospitals before any initial diagnoses were made. With no approved MVD vaccine or antiviral treatments, and with little public awareness of the disease, the government of Rwanda had to both educate and protect its citizens, while also facing an outbreak of mpox, a viral disease related to smallpox.
The Rwanda Ministry of Health hosted a press conference in September 2024 to inform the public of the MVD outbreak. Photo courtesy of the Rwanda Ministry of Health
Healthcare workers across Rwanda shared information at community gatherings about how to stop the spread of mpox. Photo courtesy of the Rwanda Ministry of Health
Fortunately, Romuald Niyogisubizo, a community and environmental health officer stationed at one of the 520 government-supported health centers in Rwanda, was prepared. In May 2024, prior to either outbreak, he attended a Risk and Crisis Communications (RCC) Workshop, led by the Research Innovation and Data Science Division (RIDS) in the Rwanda Biomedical Centre (RBC) and the CDC Foundation.
“Teaching us about good communication—that is something that I really needed,” said Niyogisubizo. “Without good communication, even the best interventions are likely to fail.”
Supported by Bloomberg Philanthropies’ Data for Health Initiative, the RCC Workshop provided essential tools and strategies specifically for health professionals and media personnel in addressing public health emergencies and developing communication plans. The main lesson Niyogisubizo took from the workshop: You have to be first, be right and be credible.
Romuald Niyogisubizo (right) attended the RCC workshop in May 2024, prior to either outbreak.
The RCC workshop in May 2024 took place prior to either outbreak.
“I cannot get that out of my mind,” Niyogisubizo said. “I now know that I have to share information with my community first. I have to tell them what is right, and I have to tell them what is so far not known.”
It was Niyogisubizo’s job to develop those messages and share them with the community before misinformation could spread.
“I did not have time to prepare, but those three things: being first, being right and being credible—are in my mind,” said Niyogisubizo. With that knowledge, his first step was to gather all known information about mpox and later MVD to draft efficient and transparent messaging.
To disseminate those messages, Niyogisubizo collaborated with the cooperative president, who works with the six cell coordinators in Nyigisubizo’s catchment area. These cell coordinators are each responsible for a group of village coordinators who, in turn, oversee a network is made up of 132 CHWs who provide direct messaging to community members.
Next, Niyogisubizo turned to WhatsApp—an effective way to reach a young demographic that relies significantly on their phones to receive news. He shared up-to-date information about the outbreaks with local leaders, youth and community members, all who knew him as a trustworthy source of information.
I did not have time to prepare, but those three things: being first, being right and being credible—are in my mind.
Finally, Niyogisubizo began regularly attending community gatherings to ensure those far from local health centers were still connected and aware of the crises. The outreach proved successful and word quickly spread on how community members could protect themselves from the threats, checking the spread of both diseases. Rwanda’s robust and immediate response reduced MVD cases by half within two weeks of the outbreak and by 90 percent before the outbreak was declared over in December 2024.
Once the outbreaks ended, Niyogisubizo had time to reflect on what these experiences had taught him.
Romuald Niyogisubizo shared critical information about the outbreaks with healthcare workers and community members.
Butaro District Hospital in Rwanda. The MVD outbreak began spreading through hospitals before diagnoses were made. Photo credit: Juan Arredondo for the Bloomberg Philanthropies Data for Health Initiative.
“Before the workshop, I believed including complicated numbers and complicated medical terms would make the message feel like it was more serious,” he explained. “But whenever I'm preparing a message now, I say, ‘How do I make a grandma in the countryside—who is illiterate, who does not even know anything about English—how am I going to make her understand what is going on?’”
Designed to help public health professionals communicate quickly and effectively in times of crisis, the RCC Workshop prepared Niyogisubizo to respond to the MVD and mpox outbreaks. The lessons he learned from both the workshop and the outbreak response, Niyogisubizo said, will stay with him.
“Now, even when I sit in my office, I'm thinking, ‘What if something happens again? What can I do? What will I do?’” Niyogisubizo said. “Even if something comes tomorrow, I feel that I am ready to act.”
