Rabies prevention and control in the WHO African Region

Overview

Rabies is a neglected zoonotic disease caused by lyssaviruses and transmitted to humans primarily
through the bites or scratches of infected animals, most often dogs, which account for up to 99% of
cases. Once clinical signs appear, the disease is invariably fatal; however, rabies is entirely
preventable. The true global burden of dog-mediated rabies remains uncertain. While 59 000 annual
human deaths are the most cited estimate, numbers vary widely across modelling studies. This
spread reflects not only methodological differences but the limitations in the surveillance data on
which these models rely. More than 95% of dog-mediated rabies deaths occur in Africa and Asia,
disproportionately affecting children and rural communities with limited access to healthcare.

In 2018, Member States, together with the World Health Organization (WHO), the Food and
Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health
(WOAH), and the Global Alliance for Rabies Control, launched the Zero by 30 strategy: a global
strategic plan to end human deaths from dog-mediated rabies by 2030. Bringing together
multisectoral stakeholders under a One Health approach — including governments, vaccine
producers, researchers, civil society, and development partners — the United Against Rabies Forum
was established to accelerate progress through improved coordination and planning.

Achieving this goal requires strong community engagement, scaling up dog vaccination, and
ensuring the availability of biologicals and services for at-risk populations. To support these efforts
and monitor progress, robust surveillance and reporting systems for humans and animals are
essential. Recent WHO tools include post-exposure prophylaxis (PEP) decision trees for risk
assessment, case investigation forms, and the integrated bite case management (IBCM) checklist to
help countries build these capacities. In June 2024, Gavi, the Vaccine Alliance, announced
expanded access to human rabies vaccines for PEP, offering countries an opportunity to request
support; although its strategy has since evolved, scaling up PEP delivery within health systems
boosts surveillance and rabies programmes.