Mismatch of supply and demand: Marburg virus disease outbreaks need countermeasures but will not provide opportunity for clinical trials

In many ways, Marburg virus disease resembles the more well-known Ebola virus disease: The clinical syndrome is similar, management of outbreaks is similar, and the fear engendered in the population experiencing the outbreak is similar. However, diagnostics, therapeutics, and vaccines to manage patients and outbreaks are not similarly available. These have been developed but not yet approved, as outbreaks have not provided the opportunity to establish an evidence base for regulators to evaluate their use in humans. The history of outbreaks of Marburg virus disease suggests that this opportunity will not come, and so alternative pathways to regulatory approval are needed.