Rabies remains one of the world's oldest and deadliest zoonotic diseases. Yet, with timely intervention, it is entirely preventable
A new study published in the Journal Vaccine - led by researchers from the University of Glasgow, Ifakara Health Institute, University of Nairobi, University of Edinburgh, and Washington State University - found that improving the delivery and supply chain of human rabies vaccines in Tanzania and Kenya could significantly reduce preventable deaths and make better use of health budgets. The study showed that adopting the WHO-recommended intradermal (ID) vaccination method, which allows a single vial to treat multiple patients, can cut vaccine use by over 55% and reduce stockouts, especially in rural areas.
"I was drawn to work on rabies because of the deeply troubling paradox: we have a highly effective vaccine, yet tens of thousands of people, many of them children, continue to die each year, often in low-resource settings where access to timely care remains out of reach," said Mumbua Mutunga, a PhD Fellow at the University of Nairobi's Center for Epidemiological Modelling and Analysis (CEMA) and co-author of the study.
A Preventable Tragedy
Rabies claims an estimated 59,000 lives globally each year, with 40% of those deaths occurring in children under 15. In Africa, most victims live in rural or marginalized communities, where life-saving care is often out of reach.
The disease turns trusted companions into a deadly threat that rarely leaves survivors.
Rabies has been described as the only infectious disease with a 100% mortality rate in any species, including humans. Transmission takes place when saliva comes into contact with broken skin or the mucous membranes of the eyes, nose, or mouth. Rabies is a severe viral infection that attacks the central nervous system, including the brain and spinal cord, leading to progressive and often fatal inflammation. Once the symptoms appear, the disease is almost always fatal.
To successfully eliminate rabies across Africa, accurate data on its spread, infection rates, vaccine coverage, and treatment effectiveness are essential. This knowledge enables targeted identification of high-risk areas, assessment of control measures, and implementation of fair, evidence-based responses. Mutunga brings her specialized expertise in epidemiological modeling to help guide strategies toward eliminating human rabies deaths by 2030. Their research aims to bring life-saving treatment to Africa's most underserved communities.
This inequity, she said, fuelled her commitment to evidence-based strategies that improve access and save lives.
Mutunga said that despite the availability of an effective vaccine, rabies still kills thousands annually in Africa due to barriers like delayed access to treatment, high costs, and vaccine shortages, particularly in rural and underserved areas where timely care is often out of reach.
"Post-exposure prophylaxis (PEP) is highly effective when given promptly, requiring a series of vaccinations on days 0, 3, 7, 14, and 28 following potential exposure. But in many rabies-endemic regions, patients face frequent vaccine shortages, long distances to clinics, and high costs," she said. "These barriers are especially severe in rural and underserved areas, where dog bites are common and timely care is out of reach. As a result, an entirely preventable disease continues to cause unnecessary suffering and loss of life."
Mutunga said that their modelling study demonstrated how using the World Health Organization's intradermal (ID) rabies vaccination method could greatly enhance access to post-exposure treatment in rural and underserved parts of Kenya. She said that Kenya primarily uses the intramuscular (IM) method, which requires a full vial of vaccine per patient. In contrast, the ID method uses a much smaller dose, allowing one vial to treat multiple patients.
"This not only improves efficiency but can reduce overall vaccine use by over 55%, helping to stretch limited supplies and lower the risk of stockouts even in lower-volume clinics where patients may not come every day," she said. "We also analyzed how vaccines are distributed and restocked across health facilities. Our findings show that bringing rabies vaccines closer to communities by stocking more local clinics can reduce travel time, minimize delays, and ensure quicker access to life-saving care."
Rabies is preventable, but access is hindered by stockouts, high costs, and long travel distances.
But expanding access is only part of the solution.
She said that to prevent shortages, restocking systems must be responsive to local demand. Her team developed simple, data-informed guidelines based on how many bite patients each clinic typically treats. These strategies, she said, helped frontline health workers to estimate how much vaccine they need to keep on hand and when to reorder, ensuring timely care for those at risk."
According to Mutunga, the Centre for Epidemiological Modelling and Analysis (CEMA) worked with international partners, including the University of Glasgow, Ifakara Health Institute, the University of Edinburgh, and Washington State University, to identify practical solutions to these gaps. She said their study confirmed that supply chain challenges such as limited vaccine availability, high costs, and the need to travel long distances prevent many people from accessing timely post-exposure prophylaxis (PEP).
"To address these issues, we explored the impact of integrating rabies vaccines into routine supply chains and making PEP available at more local clinics," she said. "This approach can bring treatment closer to those most at risk, which will improve access and reduce delays, especially in the rural areas."
Mutunga said that they also evaluated the benefits of adopting the World Health Organization's (WHO) recommended intradermal (ID) vaccination method, which uses less vaccine per patient. The switch could reduce the overall vaccine usage by more than 55%, which would ease the pressure on supply chains and help to prevent shortages. To ensure clinics are well-prepared, the team developed simple but specific restocking guidelines designed for the average number of patients each facility sees.
Key Findings
"One of the most surprising and concerning findings is that nearly 59,000 people (mostly in low and middle-income countries) still die from rabies each year, despite the existence of highly effective vaccines," she said. "These deaths are entirely preventable, but they continue to occur due to gaps in accessing treatment quickly and consistently."
Mutunda said that this is a gap that policymakers can and must close.
She said that with strategic investment and data-driven planning, countries can ensure that rabies vaccines are not only available but also reliably accessible at the point of need. Integrating rabies prevention into routine health systems, especially at the community level, offers a powerful opportunity to save lives.
"By strengthening these systems, we can move closer to a future where no one dies from a disease we already know how to prevent," she said.
She described Gavi's support for rabies control as a "game changer and a real chance to save lives across Africa. But to make the most of this opportunity, governments need to make sure rabies vaccines are part of their national immunization supply chains. She said that this would help clinics, especially in rural areas, have reliable and equal access to vaccines when people need them.
"Another important step is for countries to start using the World Health Organization's recommended intradermal (ID) method for giving the vaccine. This approach uses much smaller doses, meaning one vial can treat more people. It's a smart way to stretch limited supplies and make treatment more affordable," said Mutunga.
Mutunga said that with effective strategies and partnerships, it is possible to eliminate human rabies deaths by 2030.
"But stopping rabies isn't just about treating people after they've been bitten. Vaccinating dogs is key, since most human rabies cases come from dog bites. To truly break the cycle of rabies, we need joint efforts between health workers, vets, and environmental experts - a strategy known as One Health. With the right plans and partnerships, we can stop this deadly disease and reach the goal of zero human rabies deaths by 2030."
Is "Zero by 30" Achievable in Africa?
"Yes, Africa can definitely meet the Zero by 30 target," said Mutunga. "The vaccine works, and the tools to stop rabies already exist. What's missing is fair access. In many places, clinics are too far, vaccines are too expensive, or they aren't available when people need them most."
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Zero by 30 is the global strategic plan to end human deaths from dog-mediated rabies by the year 2030. This initiative is led by the World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization (FAO), and the Global Alliance for Rabies Control (GARC) to eliminate human deaths from dog-mediated rabies by 2030. The plan is structured around a pragmatic, three-phase approach: Start Up (2018–2020), Scale Up (2021–2025), and Mop Up (2026–2030), focusing on country-led strategies, mass dog vaccination, improved access to post-exposure prophylaxis (PEP), and strengthened health systems.
However, the path to "Zero by 30" in Africa is uneven.
The continent has the opportunity and tools to eliminate human deaths from dog-mediated rabies, but reaching the goal by 2030 will require a significant and coordinated acceleration of efforts at both national and regional levels.
She said that achieving this goal will require a coordinated and data-driven approach that gives priority to both human and animal health. According to Mutunga, the new momentum from Gavi's investment in rabies vaccines, countries now have a huge opportunity to scale up access.
"If we can get rabies vaccines into national immunization programs, adopt dose-sparing intradermal delivery methods, and make our vaccine supply chains stronger, we can reach more people efficiently and affordably. We must also not forget to scale up mass dog vaccination, which is the only way to eliminate the source of most human rabies cases. Sustainable impact can only be achieved through a One Health approach that combines human, veterinary, and environmental health."
"Africa has the tools, the knowledge, and now the global support. What we need now is strong political will, sustained investment, and community-level engagement. If all of these align, Zero by 30 is within reach," said Mutunga.
