In remote villages across Kenya and Tanzania, a single dog bite can trigger a deadly countdown. Despite being entirely preventable, rabies continues to claim lives, especially in rural areas.

According to the World Health Organisation (WHO), rabies kills nearly 59,000 people globally each year, primarily in low- and middle-income countries. In Kenya, approximately 2,000 people die from the disease annually, many of them children.

However, a new study published in the journal Vaccine offers hope. Led by researchers from the University of Glasgow, Ifakara Health Institute, the University of Nairobi’s Centre for Epidemiological Modelling and Analysis (CEMA), the University of Edinburgh, and Washington State University—with support from the Wellcome Trust—the study presents a practical roadmap to revolutionise rabies vaccine delivery.

At the heart of this breakthrough is the WHO-recommended intradermal (ID) vaccination method. Unlike traditional intramuscular vaccines, which require a full vial per patient, the ID method uses a fraction of the dose—allowing one vial to treat multiple patients. This reduces vaccine usage by over 55 per cent.

“This approach dramatically reduces stockouts, especially in rural clinics that don’t serve many patients daily,” said Martha Luka, lead author and postgraduate researcher at the University of Glasgow. “By improving stock management and adopting dose-sparing techniques, countries can protect more people using fewer resources.”

Rabies is a viral zoonotic disease transmitted through bites or scratches from infected animals—mainly dogs. It causes progressive and fatal inflammation of the brain and spinal cord. Once symptoms such as anxiety, hallucinations, or paralysis appear, the disease is almost always fatal.

Yet rabies is entirely preventable through post-exposure prophylaxis (PEP), a series of timely vaccinations administered after exposure. The major barrier, however, is access.

The new study’s modelling—based on real-world data from Kenya and Tanzania—highlights systemic flaws: centralised vaccine distribution, unpredictable restocking, and high patient costs. In Tanzania, for example, rabies vaccines are often available only in major hospitals, leaving rural communities exposed.

Kennedy Lushasi of the Ifakara Health Institute, a co-author of the study, emphasised the need to decentralise PEP services. “We’ve developed simple, setting-specific stock rules to guide facilities on when and how much to reorder,” he said. “If we integrate vaccines into routine supply chains and make them available at local clinics, we can save lives.”

According to WHO, rabies remains a neglected tropical disease despite the existence of effective vaccines and treatments. Nearly all human rabies cases—99 per cent—are linked to infected dog bites, and nearly 40 per cent of fatalities are children under 15.

“Rabies surveillance remains a major challenge in Kenya. Many cases go undocumented due to weak reporting systems and a lack of integration between human and animal health data,” Luka said. “Modelling studies estimate up to 1,100 rabies-related deaths in Kenya annually, most of which are preventable and go unreported.”

She added: “The highest burden is in rural and peri-urban counties, where access to PEP is limited. Counties like Siaya and Makueni may report higher case numbers not necessarily because they have more cases, but because their surveillance systems are stronger. Other counties likely underreport due to limited diagnostic capacity.”

Children are particularly at risk. They are more likely to interact with dogs and less likely to report bites promptly. Rural residents also face long journeys to access PEP and often must pay out-of-pocket costs, further delaying treatment.

To address this, Kenya’s Ministry of Health has launched a strategic plan to eliminate dog-mediated human rabies by 2030. The plan focuses on mass dog vaccination, timely PEP access, and public awareness campaigns.

“Rabies elimination is achievable,” said Mumbua Mutunga, a PhD fellow at CEMA and study co-author. “But it requires strategic investment and data-driven planning.”

Recent support from Gavi, the Vaccine Alliance, is timely. Gavi has committed to expanding rabies vaccine access across Africa and Asia. This includes integrating rabies vaccines into national immunisation supply chains and supporting mass dog vaccination campaigns.

“Gavi’s investment is a transformative milestone for public health,” said Mutunga. “With the right supply chain strategies, we can shift from reactive to proactive rabies prevention—saving thousands of lives.”