| A packed train in Hamburg, a medical student fresh off the plane from Rwanda, a tiny mountainous nation dealing with its first outbreak of a deadly hemorrhagic fever, and now the prospect that a disease that can kill up to 88% of those it infects could be about to spread in Europe. That's not the opening script of some b-grade horror film. It's the news out of Germany and Rwanda this week. The patient in fact tested negative but the momentary panic focused attention on the outbreak of Ebola-like Marburg virus in Rwanda, where it has already killed 11, with 36 confirmed infected. There are no approved vaccines to prevent Marburg, nor are there any therapies authorized to treat the disease. Changing that presents a strange conundrum. No one wants an outbreak of a rare and deadly disease. But those outbreaks could help actually test whether vaccines and drugs work against the virus. Mark Feinberg, the chief executive officer of IAVI, a non-profit vaccine and antibody drug developer, knows better than most how crucial it is to respond quickly when outbreaks occur. He used to work at Merck, where he helped lead efforts to get a vaccine for Ebola virus on the ground during the 2014-2016 outbreak. Those trials supported the first approval of an Ebola shot. This time, potential drugs from Mapp Biopharmaceutical and Sabin Vaccine Institute, which has an experimental vaccine, could be tested in Rwanda. Both companies have said they're in discussions with the Rwandan government or other partners involved in getting the products on the ground. But it's not an easy task. Clinical trials usually take months to set up and years to complete. How do you do that for an outbreak that could be over imminently? For Ebola, studies were initially started in Liberia and Sierra Leone but public health responses brought infections under control, meaning it wasn't possible to do an efficacy trial, says Feinberg. In Guinea, the researchers used a different approach — ring vaccination, which showed that the vaccine worked at preventing Ebola. But it was "only because the outbreak continued at a sufficiently high level in Guinea that it was possible to generate those data," he says. It's also about developers being ready to ferry their product to the heart of the outbreak within days of it starting. For example, IAVI has a Marburg vaccine and while it is going to start manufacturing doses this week, it currently doesn't have vaccines available for testing in humans. "Ideally the funding agencies that support work in this area would not only support the product development efforts, but there would be stockpiles of the vaccines available so that in the case an outbreak arises, they could be rapidly deployed and evaluated," says Feinberg. The problem? This relies on limited funding from government agencies or other global health organizations. "There's not really current interest on the part of multinational pharmaceutical companies or the biotechnology companies, for the most part, to invest in these areas." While Feinberg is confident that Rwanda has the public health resources to respond swiftly to the outbreak, the same can't be said for all nearby countries like the Democratic Republic of the Congo. "If the outbreak extends to the DRC or maybe even came from the DRC, the situation could change significantly in the coming days and weeks," he says. — Ashleigh Furlong | 
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