After-Action Review of the Response to Rwanda’s First Marburg Virus Disease Outbreak, 2024: Lessons for National Health Security and Global Epidemic Preparedness

Introduction: Marburg virus disease (MVD) is a high-consequence viral haemorrhagic fever (VHF) with significant epidemic potential and high case fatality rates. On 27 September 2024, Rwanda confirmed its first MVD outbreak, serving a critical test of its International Health Regulations (IHR, 2005) core capacities. This study analyzes the After-Action Review (AAR) of Rwanda’s response to identify best practices, systemic challenges, and priority actions, classified using a Corrective and Preventive Actions (CAPA) framework to strengthen future preparedness. Methods: A qualitative, participatory AAR, conducted in accordance with the World Health Organization (WHO) methodology, took place from 28–30 January 2025, five weeks after the outbreak was declared over. The review brought together 65 stakeholders representing national and subnational government institutions, health facilities, and partner organizations directly involved in the MVD response. Structured group discussions were organized around nine emergency response pillars and guided by the WHO’s standard five-step AAR inquiry process. Thematic analysis of qualitative data generated during the AAR sessions highlighted operational strengths, weaknesses, and their underlying root causes or contributing factors. All resulting recommendations were classified as corrective or preventive actions to facilitate implementation, monitoring, and follow-up. Results: The outbreak was contained within three months, with 66 laboratory-confirmed cases and 15 deaths (case fatality rate: 22.7%). Key strengths included: (1) rapid Incident Management System (IMS) activation with strong leadership and coordination; (2) timely surveillance and contact tracing, monitoring 1,768 contacts with > 98% follow-up; (3) decentralization of laboratory testing to four provincial hubs, reducing turnaround time from 24 to ~ 8 hours; and (4) rapid deployment of an experimental cAd3-based MVD vaccine using a ring vaccination strategy. Major challenges were: (1) delayed initial detection due to low clinical suspicion; (2) absence of a dedicated VHF treatment facility at onset; (3) suboptimal infection prevention and control (IPC) readiness in non-designated facilities; and (4) lack of routine environmental surveillance for filoviruses. The AAR generated 47 priority actions (22 corrective, 25 preventive) across surveillance, IPC, laboratory, One Health, and community engagement domains. Conclusion: Rwanda’s containment of its first MVD outbreak illustrates how strong leadership, adaptive use of existing health system infrastructure, and targeted innovations can mitigate high-consequence disease threats. The integration of a CAPA framework into the AAR process enhanced the translation of lessons learned into an actionable, trackable roadmap. These findings offer valuable insights for countries at risk of VHF outbreaks and contribute to advancing global health security.