{
    "abstract": "Rabies causes thousands of deaths annually in low- and middle-income countries. Despite effective vaccines for post-exposure prophylaxis (PEP), their expense, coupled with supply chain failures, leads to stockouts and preventable deaths. Investment by Gavi, the Vaccine Alliance, aims to improve access to post-exposure vaccines. We evaluate PEP demand in Tanzania and Kenya and examine stock management strategies for improving supply chains in Gavi-eligible countries.\nWe fitted negative binomial distributions to five years of bite patient data from Tanzania (6646 patients, 20 districts) and Kenya (199,112 patients, 47 counties) to parameterise simulations of post-exposure vaccine demand under WHO-recommended intramuscular (IM) and intradermal (ID) regimens. We compared simulated vaccine use, stockouts, and the impact of stock management strategies across the observed range in demand.\nBite patient incidence varied dramatically; demand surges far exceeded monthly averages (in 6\u00a0% of months exceeding 3\u00d7 average monthly bite patient presentations) and were most extreme in low-incidence settings. ID vaccination reduces vial use by >55\u00a0% and reduces stockout risk. Under ID vaccination vial savings are greatest in high-throughput settings, whilst risk mitigation is maximised in low-throughput settings. Decentralizing PEP to more facilities improves access, though reduces vial-sharing opportunities and so increases vial use. Resilient supply chain strategies were identified according to patient throughput, allowing for adaptation to changing demand.\nID vaccination reduces vial use and stockouts, even in low-throughput settings. Tailoring stock management-through adjusted alert thresholds and restocking volumes-can simplify the integration of rabies vaccines into essential immunisation supply chains, improving their availability and preventing unnecessary deaths. However, logistical trade-offs must also be considered.",
    "authors": [
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.. Electronic address: m.luka.1@research.gla.ac.uk.",
            "firstname": "Martha M",
            "initials": "MM",
            "lastname": "Luka"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.",
            "firstname": "Elaine A",
            "initials": "EA",
            "lastname": "Ferguson"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.",
            "firstname": "Eleanor",
            "initials": "E",
            "lastname": "Rees"
        },
        {
            "affiliation": "Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, Tanzania.",
            "firstname": "Husna",
            "initials": "H",
            "lastname": "Hoffu"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.; Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, Tanzania.; College of Veterinary Medicine & Biomedical Science, Sokoine University of Agriculture, Morogoro 67804, Tanzania.",
            "firstname": "Joel",
            "initials": "J",
            "lastname": "Changalucha"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.; Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, Tanzania.",
            "firstname": "Kennedy",
            "initials": "K",
            "lastname": "Lushasi"
        },
        {
            "affiliation": "Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, Tanzania.",
            "firstname": "Lwitiko",
            "initials": "L",
            "lastname": "Sikana"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.; Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, 00202, Kenya.",
            "firstname": "Mumbua",
            "initials": "M",
            "lastname": "Mutunga"
        },
        {
            "affiliation": "Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, 00202, Kenya; Institute of Immunology & Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, Scotland, UK.; Paul G Allen School for Global Health, Washington State University, Pullman, WA 99164, USA.",
            "firstname": "S M",
            "initials": "SM",
            "lastname": "Thumbi"
        },
        {
            "affiliation": "School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK.",
            "firstname": "Katie",
            "initials": "K",
            "lastname": "Hampson"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/j.vaccine.2025.127108",
    "journal": "Vaccine",
    "keywords": [
        "NTDs",
        "Post-exposure prophylaxis",
        "Rabies vaccines",
        "Supply chains",
        "Zero by 30"
    ],
    "methods": null,
    "publication_date": "2025-04-25",
    "pubmed_id": "40274463",
    "results": "Bite patient incidence varied dramatically; demand surges far exceeded monthly averages (in 6\u00a0% of months exceeding 3\u00d7 average monthly bite patient presentations) and were most extreme in low-incidence settings. ID vaccination reduces vial use by >55\u00a0% and reduces stockout risk. Under ID vaccination vial savings are greatest in high-throughput settings, whilst risk mitigation is maximised in low-throughput settings. Decentralizing PEP to more facilities improves access, though reduces vial-sharing opportunities and so increases vial use. Resilient supply chain strategies were identified according to patient throughput, allowing for adaptation to changing demand.",
    "title": "Optimising human rabies vaccine supply chains: A modelling study.",
    "xml": "<Element 'PubmedArticle' at 0x788505991300>"
}