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Rabies experts urge Gavi to implement PEP investment

By: United Against Rabies


The global Zero by 30 target will not be met without Gavi’s investment in human rabies vaccines. Experts issue an urgent Call to Action to all stakeholders.

Experts from the United Against Rabies Forum alongside the World Health Organization (WHO), World Organisation for Animal Health (WOAH) and Food and Agriculture Organization (FAO) collaborating institutions met in Paris on 12-16 December 2022 noting the lack of progress towards achieving the globally agreed goal of ending all human deaths from dog-mediated rabies by 2030.

Together they set out the global imperative to scale up political commitment, increase resource allocation, and take urgent action to eliminate human rabies deaths.

The group of experts wish to emphasise that the rabies virus is the deadliest of all zoonotic pathogens, both in terms of disease burden and case fatality rate. Yet human rabies deaths are entirely preventable. Deaths are the direct result of health inequalities in access to vaccines, related services and awareness.
WHO Rabies Modelling Consortium predicted that more than 1 million deaths, nearly half of which are children, will occur in 67 rabies-endemic countries from 2020 to 2035, if nothing changes.

Call to Action

We call on all stakeholders to take urgent action on the shared vision set out in the United Nations Sustainable Development Goals, and the ‘Zero by 30: The Global Strategic Plan to end human deaths from dog-mediated rabies by 2030’ and be mutually accountable for its

We especially call upon Gavi – The Vaccine Alliance to roll out implementation and support for distribution of human rabies post-exposure vaccines as agreed in their 2021-25 Vaccine Investment Strategy. Without the realisation of this commitment, the target of ending human rabies deaths by 2030 will not be realised.

Why eliminate rabies?

Rabies is fatal after the onset of symptoms, but it is also 100% vaccine preventable. It kills more than 59,000 people globally, and almost half of these victims are children under 15 years old. Rabies virus infections are estimated to have a greater burden in terms of 3.5m Disability-adjusted life years (DALYs) than many prominent diseases that receive significant
global funding.

Rabies deaths are completely preventable through using timely vaccines in humans, especially when accompanied by effective dog rabies vaccination campaigns. Human rabies post-exposure vaccines are on the WHO essential drug list yet poor access to these vaccines underlie almost every human rabies death. Hundreds of thousands of people are exposed to a suspected rabid dog each year worldwide but most of them are unable to access quality rabies vaccines. Accessibility barriers include high cost and lack of availability and knowledge about rabies post-exposure treatment recommendations.

It is currently estimated that five million human rabies vaccine vials are administered each year across Gavi-eligible countries, resulting in the direct prevention of 56,000 human rabies deaths. This 56,000 is in addition to the 60,000 deaths that more accessible human rabies
vaccines would prevent.

Furthermore, the COVID-19 pandemic has devastated many rabies control programmes, causing the re-allocation of the very limited resources that were used for dog vaccination campaigns and the delivery of human vaccines.

The cost of rabies in terms of lost livelihoods and high cost of emergency post-exposure vaccination is estimated to be around US$8.6 billion per year – significantly more than the cost of rabies control. National income and human capital benefits will improve when countries are able to eliminate human rabies deaths.

Delivering effective rabies control programmes requires a One Health approach, bringing together expertise and capacity from the fields of human, animal and environmental health. Rabies elimination strategies offer a road map for successful operationalisation of the One Health model.

Our Partnership and Commitment to Rabies Elimination

Together, we are committed to working in partnership (governments, international organisations, WOAH Reference Laboratories, WHO Collaborating Centres, FAO Reference Centres, academia, private sector and civil society) and with at risk populations to accelerate progress towards eliminating human deaths from dog-mediated rabies.

We are committed to support the development of innovative, cross-cutting programmes that integrate and mainstream rabies elimination objectives and outcomes by efficiently leveraging investments in One Health; Universal Health Coverage; Health Systems Strengthening; animal and livestock programmes; human and animal disease surveillance; and, environmental programmes.

Members of WOAH Rabies Reference Laboratories, WHO Collaborating Centres and FAO Reference Centres are specifically committed to:

  • Build and strengthen laboratory capacity to ensure timely risk-based administration of
    human post exposure vaccination for at-risk individuals, while limiting the use of vaccines
    in those who do not fit WHO exposure criteria.
  • Increase availability of rapid diagnostics and assays leading to better official notification
    of animal rabies.
  • Invest in essential research to improve detection of human rabies deaths and support
    countries to build effective rabies surveillance systems and inform rabies control
  • Improve country awareness and ability to report official data through appropriate
    channels, thereby improving global rabies reporting.
  • Continue to develop vaccine implementation guidance to aid governments in identifying
    the vaccine provision methods that work best for their at-risk populations.10
  • Develop a DHIS2 Clinic-Based Risk Assessment Tool that will make compliance with WHO
    exposure criteria and vaccine recommendations easily implementable for participating
    Ministries of Health.
  • Develop a wide range of implementation strategies and evaluate the benefits and
    limitations of these differing methodologies.

UAR Forum Members are committed to:

  • Support the scale up and implementation of evidence based, cost effective and
    sustainable approaches to rabies elimination, specifically mass dog vaccination
  • Support governments to develop solutions to monitor the use and impact of rabies
  • Work with communities to raise awareness of rabies and what to do in the event of dog
  • Leverage the new technologies for rabies surveillance and control systems.
  • Enhance the countries’ workforce and research development in rabies control.

What more will it take?

We call on Governments to specifically commit to provide strong national leadership to develop, strengthen and implement high quality, validated, costed national rabies elimination plans and mobilise domestic resources for them.

We call on donors and development agencies to specifically commit to support countries as they reinforce and implement sustainable national rabies elimination plans. This includes mobilising and aligning international resources; empowering country-led coordination arrangements to support the effective delivery of resources; facilitating mutual learning; and, promoting South-South knowledge sharing and technical assistance.

We call on Gavi-The Vaccine Alliance to set a clear and ambitious timeline for the roll out of rabies essential medicines in line with the commitment approved in the Gavi Vaccine Investment Strategy 2021-25. This is vital to fill the on-going rabies vaccine gap which cannot otherwise be filled with existing resources. Without Gavi support, the goal of eliminating human rabies deaths by 2030 will not be achieved.

Making the beginning of the end for rabies

Together we can end human deaths from rabies. Consigning rabies deaths to the history books will ensure that the next generation of children will not live in fear. But it will require sustained commitment and ensuring that all endemic countries have access to affordable and quality human rabies biologicals and rabies vaccines for dogs.

Finally, we are committed to capitalising on previous achievements, driving forward this agenda and holding ourselves to account by holding a global stock-take meeting annually under the leadership of the FAO, WHO, WOAH and the United Against Rabies Forum.