NEJM The final months of 2024 brought several developments that will have far-reaching implications for global health delivery efforts in the years to come. Closest to home for those of us in the United States, the results of our federal elections raise the possibility of reduced investment in shared defenses against epidemics and the weakening of American leadership for health security around the world. In the East African country of Rwanda, however, a courageous, unified, and successful response to the global threat posed by a major outbreak of Marburg virus disease (MVD) offers reason for hope, as well as lessons for everyone who seeks to safeguard health equity in a time of ascendant isolationism.
Rwanda’s outbreak was detected in Kigali in late September 2024, with 25 cases confirmed by two referral hospitals within days after the first diagnosis.1 It rapidly became the third-largest outbreak of MVD ever and seemed likely to spread widely; the United States soon recommended against travel to Rwanda. Yet less than 3 months later, the World Health Organization officially declared the outbreak over, with the lowest case fatality rate (CFR) recorded for a MVD outbreak of this size. Understanding how it was so swiftly brought under control and the implications for future epidemic responses requires a turn to history.