Eliminating rabies: potential investment in life-saving vaccines can bolster prospects for zero human rabies deaths
12 December 2018 | Geneva –– The World Health Organization (WHO) has welcomed the approval, in principle, of a future investment strategy of Gavi, the Vaccine Alliance, aimed at expanding their portfolio to include human rabies vaccines.
During a meeting at the end of November 2018, the Gavi Board deliberated the role it could play in scaling up rabies post-exposure prophylaxis (PEP)1 in countries where Gavi runs other vaccine programmes.
“Key barriers to rabies prevention are the limited supply and high costs of post-exposure prophylaxis, which are largely borne by patients,” said Dr Bernadette Abela-Ridder, Team Leader of the Zoonotic Neglected Tropical Diseases unit, WHO Department of Control of Neglected Tropical Diseases. “This decision by Gavi will have far-reaching impact and save lives, notably of children in underserved populations”.
WHO believes that greater availability and use of human vaccines will impact supply chain management and therefore contribute to strengthening health systems. It will also make resources available for mass vaccination of dogs, which is an essential next step from disease preparedness and response to disease prevention and elimination.
In 2018, WHO and partners launched a global strategic plan to end human deaths from dog-mediated rabies by 2030 through three key measures: health education for dog bite prevention, mass dog vaccination and improved access to post-exposure prophylaxis in humans.
“Support from Gavi can stabilize vaccine prices and promote vaccine demand and production,” said Dr Abela-Ridder. “It can also encourage other producers to come to market and develop new products, thus ensuring the availability and supply of WHO prequalified vaccines at affordable prices.”
Gavi investment in vaccines can be transformative not only for rabies elimination specifically but also for household finances generally. It would decrease the risk of catastrophic health expenditures, which is a key indicator of the universal health coverage framework (United Nations Sustainable Development Goal 3, target 3.8).
A final decision on the inclusion of the rabies vaccine in Gavi’s Vaccine Investment Strategy will be taken at the next Board meeting in June 2019 as part of broader decision-making for the next five-year strategic period 2021–2025.
Rabies is an infectious viral disease that is almost always fatal following the onset of clinical symptoms. In up to 99% of cases, domestic dogs are responsible for transmission of rabies virus to humans. It is spread to people through bites or scratches, usually via saliva.
Rabies predominantly affects poor and vulnerable populations who live in remote rural locations.
Although effective human vaccines and immunoglobulins exist for rabies, they are not readily available or accessible to those in need.
Globally, rabies deaths are rarely reported and children between 5–14 years are frequent victims.
Treating rabies exposure in Africa or Asia – where the average daily income may be as low as US$ 1–2 per person – can represent a catastrophic financial burden. The average cost of rabies PEP is US$ 40 in Africa, and US$ 49 in Asia.
Every year, more than 15 million people worldwide receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually.
1 Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after likely exposure to rabies virus. PEP prevents the negative consequences of rabies virus on the central nervous system, which usually result in imminent death. Rabies PEP consists of (i) extensive washing of the wound as soon as possible after an exposure; (ii) a course of potent and effective anti-rabies vaccine that meets WHO standards; and (iii) the administration of rabies immunoglobulin (RIG), if indicated.
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