Conducting Clinical Trials for Sabin’s Marburg Vaccine in Uganda

Dr. Betty Mwesigwa is the principal investigator at the Makerere University Walter Reed Project (MUWRP), in Kampala, Uganda for Sabin Vaccine Institute’s Phase 2 clinical trial for its vaccine against Marburg virus disease. A physician and long-time researcher, Dr. Mwesigwa has led clinical trials for vaccines and treatments for HIV, Ebola, Marburg, Schistosomiasis and COVID-19. Currently she is also the deputy executive director of MUWRP.

Q: Why would you say it’s important for this Phase 2 Marburg vaccine clinical trial and other such research to take place in Uganda?

A lot of the research and products we use in lower and middle-income countries come from abroad. The capacity to produce these things is there. If the research happens locally, it may help us better address vaccine hesitancy here. It may also help improve access to these vaccines if they are eventually produced here.

There has been a history of clinical trials happening among different populations than the ones who will receive the intervention afterwards. At times this reduces trust among those who ultimately receive the vaccine and creates valid doubts regarding whether the intervention would actually work with the target population. It makes the most sense to actually try to do the trials with the populations who will most likely receive the intervention, so that the intervention is tailored to them, and you also build trust while doing the trials.

Q: What is the public interest locally in a vaccine that would protect against Marburg?

We’ve had viral hemorrhagic fevers in Uganda, not just from Ebola and Marburg, but Crimean-Congo hemorrhagic fever and anthrax. I think the COVID-19 pandemic has taught the world a lot and led to efforts to develop infrastructure for manufacturing vaccines in Africa. Public health preparedness and response remains top of mind for all of us.

The general population knows COVID-19 and Ebola a bit more than they know Marburg. So as we talk to people about the Phase 2 Marburg vaccine clinical trial, we make comparisons, saying the disease falls in the same group of illnesses as Ebola. Once the population understands how fatal a disease it is and how commonly it can happen, it hits home.

Q: How do you go about setting the stage for a trial like this and recruiting participants?

We start by ensuring that participants understand the stages of vaccine development. Some of them come in thinking this is already a ready-to-use vaccine. Others hope that it might actually protect them, and then others come for altruistic reasons. Ultimately we want to ensure that the population understands the level of testing very well.

Then the other challenge is retaining participants in the study for the whole year.  Life is not static, so we have put in place a lot of systems that can help us with follow-up.

Q: Do you encounter vaccine hesitancy as you recruit for the trial?

There’s still hesitancy in pockets of people, either because of lack of information, or because the person in the community that they’re listening to is not well informed. So it is important for scientists and researchers like us to engage the community early on, and speak to the leaders in the communities, even as we develop the vaccines.

I think the critical thing that can make a difference is making sure that the messages are consistent, and that the right people are giving the messages. Scientists may not necessarily be the right people to give out these messages, as the community wants to listen to the people they trust. So we need to empower the community leaders, the church leaders, the elders of the clans, and other people in the families that people trust with the right messaging and have them be the ones that speak out, even at the beginning of vaccine development.

Q: What is your hope for this vaccine?

In the scientific and clinical world, we understand very well that Marburg is as dangerous as other viral hemorrhagic fevers. We know that these outbreaks commonly occur in Africa, and in Uganda we’ve had four Marburg outbreaks so far, and each of them has had fatal consequences. What makes this more concerning is that the outbreaks are sporadic. We just don’t know when the next one will happen. We also don’t know how severe the next one will be, and therefore all efforts to prepare and be ready to deal with outbreaks is critical.

Read About the Marburg Vaccine Clinical Trial