Gavi's learning agenda drives change for rabies

The efficacy of rabies vaccines has been demonstrated through clinical trials and over a long history of use. Still rabies vaccines are underutilized, particularly due to barriers of high cost and low access, perpetuating rabies as a neglected disease. Rabies kills approximately 59,000 people annually: the majority of deaths occur in rural poor communities and a large proportion of deaths are children under fifteen years of age.

In the effort to improve affordability and access, particularly for vulnerable populations in rabies affected countries, rabies vaccines are a candidate for inclusion in the vaccine support programme through Gavi, the Vaccine Alliance. Every five years, Gavi uses its vaccine investment strategy (VIS) to determine which vaccines are made available through their programme. Rabies vaccines were considered in the past two cycles, 2008 and 2013, but specific challenges and knowledge gaps have postponed its decision on the inclusion until the next VIS in 2018.

However in 2013, Gavi invested in a learning agenda around operational feasibility, public health impact and cost through studies in multiple countries like Bhutan, Bangladesh, Cambodia, Chad, Côte d’Ivoire, India, Kenya, Mali, Nepal and Vietnam.

Looking forward, the efficacy and cost-effectiveness of rabies vaccines is likely to improve as innovative solutions are found. This has already begun: as regimens continue to shift from intramuscular to intradermal administration with cost savings of 60–80%. In the future, thermostable vaccines, innovative procurement and delivery methods and reduced or simplified doses and schedules are likely to improve programme efficiency and efficacy.

With many of the knowledge gaps being addressed through in-country surveys and modelling, it is hoped that Gavi will invest in rabies vaccines in 2018. Support from Gavi would be an essential component in achieving the global target of zero human deaths from dog-mediated rabies by the year 2030.