Dog mediated rabies still kills more than 60’000 people every year. This indicates a significant failure of current health systems in developing countries, with very poor access of exposed patients to quality rabies postexposure prophylaxis (PEP). This lack of accessibility is mainly due to inadequate supply chains and insufficient communication between public and animal health services. To address this problem, we aim to establish a blockchain (BC) One Health intervention approach coupled with an algorithm for PEP decision adapted to local African settings in accordance with the WHO-OIE-FAO goal of zero human rabies deaths by 2030 in close collaboration with public and animal health authorities in Côte d’Ivoire and Mali, where we established baseline PEP coverage in the last three years. We aim in chronological order:
1) To establish a BC sustainable supply of PEP under the new Gavi rabies vaccination investment strategy in close collaboration with all involved stakeholders. The project includes a social transdisciplinary stakeholder process and a technological BC development and testing using an interrupted time series step-wedge design.
2) To initiate a shortened intradermal post-exposure prophylaxis (ID-PEP) protocol for all rabies-suspected bite victims, according to the recently WHO recommended scheme, which is not yet universally applied in West and Central Africa.
3) To establish and ensure a high level of communication and participation between all stakeholders by BC controlled communication of relevant information and alerts between local health providers and health and veterinary authorities.
4) To implement rapid decentralized animal rabies diagnostic tests adapted to African settings to inform and accelerate therapeutic decisions.
5) To ensure the validity of the approach, by monitoring patient compliance with ID-PEP, clinical outcome of bite wound healing, and absence of clinical rabies through mobile technologies and health center visits. When possible, human samples will be collected for intra-vitam diagnosis to develop a point of care test.
6) To perform a comprehensive analysis of access, coverage and effectiveness of BC secured ID-PEP, including an economic analysis of the incremental cost-effectiveness of the new technology against currently established baseline performance in the same study areas, assuming endemic stable transmission of rabies.
We expect a proof of principle of cost-effective high coverage of ID-PEP for rabies suspected patients that can be scaled to national level and contextually adapted to other African countries. In this way, EDCTP will significantly contribute to the goal of zero human rabies deaths and operationalize the Gavi strategy.
This project is coordinated by Swiss Tropical and Public Health Institute (Swiss TPH), Switzerland, Professor Jakob Zinsstag