Abstract
Rabies kills ∼60,000 people per year. Annual vaccination of at least 70% of dogs has been shown to eliminate rabies in both human and canine populations. However, delivery of large-scale mass dog vaccination campaigns remains a challenge in many rabies-endemic countries. In sub-Saharan Africa, where the vast majority of dogs are owned, mass vaccination campaigns have typically depended on a combination of static point (SP) and door-to-door (D2D) approaches since SP-only campaigns often fail to achieve 70% vaccination coverage. However, D2D approaches are expensive, labor-intensive, and logistically challenging, raising the need to develop approaches that increase attendance at SPs. Here, we report a real-time, data-driven approach to improve efficiency of an urban dog vaccination campaign. Historically, we vaccinated ∼35,000 dogs in Blantyre city, Malawi, every year over a 20-d period each year using combined fixed SP (FSP) and D2D approaches. To enhance cost effectiveness, we used our historical vaccination dataset to define the barriers to FSP attendance. Guided by these insights, we redesigned our vaccination campaign by increasing the number of FSPs and eliminating the expensive and labor-intensive D2D component. Combined with roaming SPs, whose locations were defined through the real-time analysis of vaccination coverage data, this approach resulted in the vaccination of near-identical numbers of dogs in only 11 d. This approach has the potential to act as a template for successful and sustainable future urban SP-only dog vaccination campaigns.
Highlights
Our redeveloped dog vaccination campaign was able to achieve above 70% vaccination coverage among a population of over 40,000 dogs in 11 d compared to 20 d using only fixed SP (FSP) and roaming static point (SP) (RSPs)
In 2019, a total of 32,317 dogs were vaccinated across a combination of FSPs and RSPs, and, in 2020, 37,815 dogs were vaccinated using a similar combination of FSPs and RSPs
Our study site was a well-established field site where we had vaccinated over 70% of dogs annually in the previous 3 y using a combined FSP and D2D approach, with the campaign gaining increasing local engagement and support
Summary
Mass dog vaccination increases the cost efficiency of rabies elimination campaigns compared to the use of PEP alone [3,4,5] While regions such as Central and South America have made successful steps toward rabies control, with several countries declared free of human cases of dogtransmitted rabies [6], sub-Saharan Africa (SSA) and India still carry a disproportionately large part of the global burden of rabies [1]. Annual vaccination of at least 70% of the dog population has been shown to be highly effective at reducing rabies incidence in both human and dog populations and is recommended by the World Health Organization for countries working toward rabies elimination [8, 9] Despite this recommendation being in place for a number of years, global rabies elimination programs have floundered due to a diverse mix of political, technical, and logistical challenges. The most successful vaccination programs, which have achieved vaccination coverages greater than 70% in Malawi [14] and other SSA countries, have been dependent on a combined
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