The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study.

Abstract

Background Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis (PEP) to bite victims, and disease eliminated through dog vaccination. Current PEP use saves many lives, but availability remains limited in many rabies-endemic countries due to high costs, poor access and supply.

Methods We developed epidemiological and economic models to investigate the impact of an investment in PEP by Gavi, the Vaccine Alliance. We modelled PEP use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without immunoglobulin and with and without dog vaccination. We took the health provider perspective including only direct costs.

Findings We predict >1 million deaths will occur in the 67 rabies-endemic countries considered from 2020-2035, under the status quo. Current PEP use prevents approximately 56,000 deaths annually. Expanded access to, and free provision of PEP, would prevent an additional 489,000 deaths between 2020-2035. Under this switch to efficient intradermal PEP regimens total projected vaccine needs remain similar (~73 million vials) whilst 17.4 million more people are vaccinated, making this extremely cost-effective at $635 and $33 per death and DALY averted, respectively. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time horizon; improved PEP access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary PEP use.

Interpretation Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies.

Funding World Health Organization