Spatially responsive mass vaccination strategies for urban rabies

Spatially Responsive Mass Vaccination Campaigns for Urban Rabies
SUMMARY
Epidemics of vaccine-preventable zoonotic diseases are ongoing in major urban centers across Latin
America and worldwide. Mass vaccination campaigns can prevent and control epidemics of infectious
diseases among humans and animals. The realities of mass vaccination efforts, however, often fall short
of their promise. In place of high and even vaccination coverage, many campaigns leave spatial 'pockets'
of under-vaccinated individuals. Pathogens, taking advantage of these under-vaccinated areas, can
persist, diversify, and re-emerge. Modern computational approaches can mitigate geographic inequities
through the careful placement of vaccination sites, increasing demand for vaccination. However,
increased demand creates long queues for service, an additional barrier to receiving vaccination.
The main hypothesis of our study is that participation in mass vaccination campaigns can be
significantly increased through spatially responsive vaccination strategies. These strategies have the
potential to maximize coverage, reduce spatial heterogeneity, minimize waiting time at vaccination sites,
and increase equity in access to immunization in hard-to-reach populations. We test our methods in the
context of an ongoing canine rabies epidemic in the city of Arequipa, Peru.
In the first aim we compare the coverage and spatial equity of a new vaccination strategy,
incorporating spatial optimization and queueing theory, to current practice through a stepped-wedge
cluster randomized trial. In the second aim we develop and test data-driven methods to reach
underserved populations through mop-up “precision vaccination” campaigns. In the third aim we assess
the acceptability, scalability, and transferability of spatially responsive vaccination strategies for local,
regional, and national stakeholders.
Our work will lead to new principles and practices that bridge operational research and zoonotic
disease epidemiology to better guide vaccination programs. It will allow for the design of effective
elimination strategies that will take into account access to healthcare and spatial behavior of vaccinators.

Grant Number: 5R01AI168291-04
NIH Institute/Center: NIH
Principal Investigator: Ricardo Castillo Neyra