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Researchers have proposed a possible new strategy for rabies control policies. By building on pre-existing models, they have found that opting for pre-exposure prophylaxis could be an additional cost-effective tool for rabies management.

Doctor applying cotton pad to a child's arm after a rabies vaccination

Half of the global population are living in countries with significant lifetime risk of rabies. And although the disease is preventable with vaccines, rabies continues to be a significant threat to communities all over the world, causing around 60,000 deaths per year.

Travellers to countries with high rabies incidence are often advised to have pre-exposure prophylactic rabies vaccination (PrEP), but this is rarely available for local residents. Instead, emergency post-exposure prophylaxis (PEP) and vaccination of dogs, the main cause of transmission to humans, has been prioritised due to its lower cost.

In the new study, researchers built on previous models by making two significant changes; considering the value of lives saved by PrEP when PEP access is incomplete, and lower cost manufacturing and delivery of rabies PrEP.

The study found that rabies PrEP costs less than US$1000 per year of life saved (in a range of plausible scenarios), making it cost-effective in settings with modest willingness-to-pay thresholds.

Dr Adam Ritchie, Senior Vaccinologist at the Jenner Institute and first author of the study, said: ‘Our work suggests pre-exposure prophylaxis is an under used tool in the battle against rabies. With various research groups testing cheaper approaches to rabies vaccination and next-generation vaccines in the pipeline, it is a good time to consider how to expand access to PrEP to save lives, especially those of children in rabies endemic areas.’

Rabies PrEP is a tool that policy makers should consider alongside dog-vaccination and improving access to emergency PEP. It has the potential to have the biggest impact in places where maintaining dog-vaccination levels is difficult and/or access to PEP inconsistent.

The models that the researchers have proposed demonstrate that the use of rabies PrEP as a public health intervention could save lives and be cost-effective in a range of plausible scenarios.

Read the full paper on the Elsevier website: https://www.sciencedirect.com/science/article/pii/S0264410X24013859