DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY

Scaling up One health Systems (SOS-rabies): Implementation research for rabies elimination in East Africa

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Description

Rabies kills tens of thousands of people every year despite effective vaccines that prevent human infection and interrupt transmission in animals having existed for over a century. Although vaccine-preventable, rabies has been neglected in low-and-middle-income countries. To change this, WHO and partners launched a global strategic plan to end human deaths from dog-mediated rabies by 2030 ('Zero by 30'). To achieve this goal access to life-saving post-exposure vaccines must be improved to ensure people bitten by rabid animals do not develop this fatal disease. However human vaccines alone will not impact rabies spread in domestic dog populations responsible for maintaining circulation. Dog vaccination must be scaled up and sustained to interrupt transmission. Gavi, the Vaccine Alliance, is poised to invest in post-exposure vaccines, with rollout in the first low-income countries from mid-2025. Gavi's investment is expected to catalyse action on dog vaccination, leveraging momentum so countries scale up strategies for rabies elimination. Tanzania has the potential to be an early-adopter country of Gavi-vaccine investment There is an urgent need for research to inform rabies vaccines rollout, both post-exposure prophylaxis and dog vaccination, to maximise their reach and impact. At this pivotal time, SOS-rabies will undertake high-impact implementation research in Tanzania aiming to reduce the rabies burden and strengthen One Health systems and capacity. Our objectives are to: Design tools to guide short and long-term planning for interventions to eliminate rabies; Develop training materials and guidance to support their scaling up; Evaluate the impact of these interventions as they are rolled out. The team will capitalise on Integrated Bite Case Management (IBCM), a One Health approach to rabies surveillance recommended by WHO. IBCM is currently being implemented as a research platform across five regions of Tanzania where rabies is endemic. Using IBCM, we will examine demand for post-exposure vaccines and synthesise learnings about current bite patient management practices, surveillance and reporting and how they can be improved. From modelling these data we will optimise supply chain design for decentralising access to post-exposure vaccines, while ensuring resilience to stockouts and feasibility of health system integration. We will develop and test tools, training and guidance to support intervention rollout, including the development of a modelling framework to forecast impacts and the use of dashboards to track impacts, including deaths, exposures and vaccine demand. Rollout policy and operational uncertainty however means that health system adaptation will be key. Employing the SOS-rabies toolbox, we will use Developmental Evaluation to support health system learning and evaluate the impacts of interventions to improve access to post-exposure vaccines and scale up mass dog vaccination. Taking a participatory and systems-based approach will facilitate learning and adaptation as this complex set of interventions is delivered across settings. Through continued engagement with stakeholders like community beneficiaries, frontline health and veterinary workers, health systems managers, national decision-makers and international policymakers, we will review data, co-design solutions to address challenges, and generate continual learning of what works. In Tanzania, we will strengthen scientific capacity and health systems; support adaptation and optimization of One Health interventions, and build political, programmatic and public support and ownership to achieve and sustain rabies freedom. Overall, our embedded collaborative research will generate transferable lessons and best practices for scaling up rabies prevention, control and surveillance, feeding into Gavi's investment on rabies, and redressing long-standing vaccine inequities.

Objectives

Rabies kills tens of thousands of people every year despite effective vaccines that prevent human infection and interrupt transmission in animals having existed for over a century. Although vaccine-preventable, rabies has been neglected in low-and-middle-income countries. To change this, WHO and partners launched a global strategic plan to end human deaths from dog-mediated rabies by 2030 ('Zero by 30'). To achieve this goal access to life-saving post-exposure vaccines must be improved to ensure people bitten by rabid animals do not develop this fatal disease. However human vaccines alone will not impact rabies spread in domestic dog populations responsible for maintaining circulation. Dog vaccination must be scaled up and sustained to interrupt transmission. Gavi, the Vaccine Alliance, is poised to invest in post-exposure vaccines, with rollout in the first low-income countries from mid-2025. Gavi's investment is expected to catalyse action on dog vaccination, leveraging momentum so countries scale up strategies for rabies elimination. Tanzania has the potential to be an early-adopter country of Gavi-vaccine investment There is an urgent need for research to inform rabies vaccines rollout, both post-exposure prophylaxis and dog vaccination, to maximise their reach and impact. At this pivotal time, SOS-rabies will undertake high-impact implementation research in Tanzania aiming to reduce the rabies burden and strengthen One Health systems and capacity. Our objectives are to: Design tools to guide short and long-term planning for interventions to eliminate rabies; Develop training materials and guidance to support their scaling up; Evaluate the impact of these interventions as they are rolled out. The team will capitalise on Integrated Bite Case Management (IBCM), a One Health approach to rabies surveillance recommended by WHO. IBCM is currently being implemented as a research platform across five regions of Tanzania where rabies is endemic. Using IBCM, we will examine demand for post-exposure vaccines and synthesise learnings about current bite patient management practices, surveillance and reporting and how they can be improved. From modelling these data we will optimise supply chain design for decentralising access to post-exposure vaccines, while ensuring resilience to stockouts and feasibility of health system integration. We will develop and test tools, training and guidance to support intervention rollout, including the development of a modelling framework to forecast impacts and the use of dashboards to track impacts, including deaths, exposures and vaccine demand. Rollout policy and operational uncertainty however means that health system adaptation will be key. Employing the SOS-rabies toolbox, we will use Developmental Evaluation to support health system learning and evaluate the impacts of interventions to improve access to post-exposure vaccines and scale up mass dog vaccination. Taking a participatory and systems-based approach will facilitate learning and adaptation as this complex set of interventions is delivered across settings. Through continued engagement with stakeholders like community beneficiaries, frontline health and veterinary workers, health systems managers, national decision-makers and international policymakers, we will review data, co-design solutions to address challenges, and generate continual learning of what works. In Tanzania, we will strengthen scientific capacity and health systems; support adaptation and optimization of One Health interventions, and build political, programmatic and public support and ownership to achieve and sustain rabies freedom. Overall, our embedded collaborative research will generate transferable lessons and best practices for scaling up rabies prevention, control and surveillance, feeding into Gavi's investment on rabies, and redressing long-standing vaccine inequities.

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Location

The country, countries or regions that benefit from this Programme.

Tanzania

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