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Gavi announces plan to improve global rabies vaccination

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Gavi announces plan to improve global rabies vaccination

Rabies has been in the crosshairs of global healthcare for years. Around the world, the viral infection kills about 70,000 people a year — and since 2015, groups including Gavi, the Vaccine Alliance, have planned to boost vaccine efforts to reduce numbers. At one point, Gavi planned to include human rabies vaccines in its 2021 investment strategy – but then the Covid-19 pandemic got in the way.

Now it’s finally taking action. On Thursday, Gavi announced a plan to expand global access to human rabies vaccines to more than 50 countries. Most of Gavi’s efforts are focused on vaccinating as many people as possible against common viral threats. But rabies faces a different kind of challenge: providing post-exposure prophylaxis vaccines to the right people, at the right time.

Rabies is one of the few diseases that can be effectively treated with vaccines after exposure. Usually transmitted by a rabid dog bite, the virus enters through the bite and travels via peripheral nerves, then through the spinal cord to the brain. Once it reaches the brain, the resulting inflammation is almost always fatal. Post-exposure prophylaxis, administered soon enough after a bite, can slow and stop the virus’s approach to the brain using a combination of wound washing, the rabies vaccine itself, and immunoglobulins.

According to the World Health Organization, 95% of rabies deaths occur in Africa and Asia – largely due to the limited availability of rabies vaccines. In the United States, approximately 60,000 people annually receive post-exposure prophylaxis after possible exposure to rabies, and only one to three cases of rabies occur annually, the vast majority of which are fatal.

Ryan Wallace, deputy chief of the smallpox virus and rabies division at the Centers for Disease Control and Prevention, said that since the rabies vaccine is “responsive” and not “routine” like other scheduled-dose vaccines, problems with procurement and distribution are inevitable . .

“It’s very difficult for a non-routine vaccine to be available anytime, anywhere,” Wallace said. “Many of those 70,000 people who die every year didn’t even ask for a vaccine, they weren’t aware of it, the health services weren’t there, the veterinary services weren’t there, and they didn’t seek it.”

The new program joins the Zero by 30 campaign, a plan outlined in 2018 by WHO and others to end human deaths from dog-borne rabies by 2030. Gavi plans to prioritize reaching under-immunized children and underprivileged communities. Low-income countries can apply for support for the post-exposure prophylaxis vaccine against rabies from July this year, with support based on the budget plan submitted by the country requesting assistance. Gavi will not support immunoglobulins.

Charles Rupprecht, a WHO technical advisor on rabies and former head of the rabies program at the CDC, said there is a misconception about what limits access to human rabies vaccines: It’s not about producing enough vaccines, but rather about providing a way for countries to pay for them.

“There is no real shortage of biologics that manufacturers can produce – neither Big Pharma nor smaller ones in some of the most effective markets,” Rupprecht said. “The difficulty has been trying to define what those markets are, and defining the needs and prioritizing rabies prophylaxis.”

Vaccine banks “can bring lower prices and more stability to vaccine markets,” Wallace said, by purchasing high-quality vaccines in bulk. “Resolving vaccine access issues will take time, but initiatives like Gavi’s human rabies vaccine program are improving access to low-cost, high-quality human rabies vaccines.”

There are challenges that go beyond acquisition. Terence Scott, program director at the Global Alliance for Rabies Control, said the biggest obstacle for governments is distributing vaccines from the national level to the people who need them most.

“We see that in many countries the large district hospital will have vaccines and post-exposure prophylaxis available,” Scott said. “But in the more rural clinics they won’t have access to that.”

In addition to mitigating issues with distribution logistics and supply chain, Scott highlighted the training of medical professionals and the education of at-risk populations as additional prerequisites to ensure Gavi’s proposal is used effectively.

“It has to be a multifaceted approach that includes things like education – teaching people that if they are exposed, they should go to the clinic and seek medical advice,” Scott said.

Despite the potential challenges Gavi faces in implementing the program, Wallace expressed optimism about the eventual outcome.

“Hundreds of thousands of lives will be saved by this program over the next decade,” Wallace said.