Gavi Rabies PEP Study (GVI-RPS) - Rabies PEP Review – phase II : Identification of knowledge gaps in community engagement strategies for awareness-raising to improve rabies PEP vaccine uptake and best practice integration of rabies PEP into EPI

In 2018, the Gavi Vaccine Alliance (Gavi) Board approved the inclusion of Rabies vaccine for Post-Exposure Prophylaxis (Rabies PEP) into the portfolio of vaccines to be funded in the 2021-2025 strategic period (period extended since then). The 2018 Vaccine Investment Strategy (VIS) Rabies learning agenda to generate evidence on Rabies PEP was formulated under the principle of using an appropriate partnership structure to ensure complementarity between donor investments in human and animal rabies control. Evidence indicates that appropriate dog bite wound management and prompt access to quality-assured Rabies PEP is almost 100% effective in preventing human rabies deaths, suggesting a potential for high health impact.

However, significant failures of current health systems such as deficient supply chains and inadequate communication between public health and veterinary services limit access to quality Rabies PEP for exposed patients particularly in rural populations of low- and medium-income countries (LMIC) and lead to high direct and indirect costs of Rabies PEP. Moreover, patients that do present to facilities often fail to receive timely Rabies PEP due to stock-outs, given the supply chain weaknesses and limited procurement of these vaccines that fall outside current Expanded Programme on Immunisation (EPI) management.

When considering the integration of Rabies PEP into EPI, key challenges related to the operationalisation of this intervention are that (1) Rabies PEP vaccine cannot be planned as routine immunisation and should be administered immediately after exposure, (2) the target group is the general population and not only infants, and in some settings (3) Rabies PEP is administrated in clinics or Anti-Rabies Centreoutside of the EPI programme available in the country.

 A rapid scoping review conducted by Swiss TPH as well as stakeholder consultations in mid-2024 established that whereas the board approved learning agenda was obsolete, there were several critical evidence gaps for the Rabies programme to address:
·        Uptake of the rabies vaccine remains suboptimal in many communities

·        Effective strategies for integration of Rabies PEP into the EPI are not well established
 
We are therefore addressing those evidence gaps by responding to two main research questions:
What are the key community engagement strategies that demonstrate positive impact on Rabies PEP uptake?
To what extent Rabies PEP can be integrated into an established EPI programme in Gavi-eligible countries?
 

Those questions and their related sub-questions are first addressed through an extensive literature review on both thematic questions (community engagement and vaccine intervention integration) and completed by exploratory and qualitative implementation research (Assessment, Co-design and Pilot) in three different country settings that are Gavi eligible: Chad, Côte d’Ivoire and Tanzania.

The diversity and the richness of these  settings, together with the strong embedded research collaboration of Swiss TPH and its partners in those countries [Alliance Sahélienne des Recherche Appliquée pour le Développement Durable / Sahelian Alliance of Applied Research for Sustainable Development  (ASRADD) in Chad; Centre Suisse de Recherches Scientifiques (CSRS) in Côte d’Ivoire and University of Glasgow / Ifakara Health Institute (IHI) in Tanzania] will provide a comprehensive and collegial approach to generate usable evidence for Rabies PEP introduction in LMICs.

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