Volunteer based approach to dog vaccination campaigns to eliminate human rabies: Lessons from Laikipia County, Kenya.

Background: An estimated 59,000 people die from rabies annually, with 99% of those deaths attributable to bites from domestic dogs (Canis lupus familiaris). This preventable Neglected Tropical Disease has a large impact across continental Africa, especially for rural populations living in close contact with livestock and wildlife. Mass vaccinations of domestic dogs are effective at eliminating rabies but require large amounts of resources, planning, and political will to implement. Grassroots campaigns provide an alternative method to successful implementation of rabies control but remain understudied in their effectiveness to eliminate the disease from larger regions. Methodology/Principal Findings: We report on the development, implementation, and effectiveness of a grassroots mass dog rabies vaccination campaign in Kenya, the Laikipia Rabies Vaccination Campaign. During 2015–2017, a total of 13,155 domestic dogs were vaccinated against rabies in 17 communities covering approximately 1500 km². Based on an estimated population size of 34,275 domestic dogs, percent coverages increased across years, from 2% in 2015 to 24% in 2017, with only 3 of 38 community-years of vaccination exceeding the 70% target. The average cost of vaccinating an animal was $3.44 USD with in-kind contributions and $7.44 USD without in-kind contributions. Conclusions/Significance: The evolution of the Laikipia Rabies Vaccination Campaign from a localized volunteer-effort to a large-scale program attempting to eliminate rabies at the landscape scale provides a unique opportunity to examine successes, failures, and challenges facing grassroots campaigns. Success, in the form of vaccinating more dogs across the study area, was relatively straightforward to achieve. However, lack of effective post-vaccination monitoring and education programs, limited funding, and working in diverse community types appeared to hinder achievement of 70% coverage levels. These results indicate that grassroots campaigns will inevitably be faced with a philosophical question regarding the value of local impacts versus their contributions to a larger effort to eliminate rabies at the regional, country, or global scale. Author summary: Given the importance of mass vaccinations of domestic dogs towards eliminating human rabies in Africa and the site-specific challenges facing such campaigns, additional studies on the development and implementation of such efforts are needed. One mechanism of mass vaccination lies in grassroots efforts that often begin at a very local scale and either develop into larger campaigns, remain local, or cease to persist past several years once interest and funding is exhausted. Here, we discuss the development of a grassroots campaign in Laikipia County, Kenya from its local inception to its development into a county-wide rabies elimination effort. Our results highlight challenges associated with achieving the targeted 70% coverage rate, including a need for consistent and systematic demographic monitoring of dog populations, limitations of the central point method, and logistical and financial challenges facing a volunteer-based effort. Serious political commitment from both the local and national governments are necessary to take the budget beyond what a crowdfunded campaign can raise, including availability and access to quality dog rabies vaccines. Without such outside support and substantial time to grow, grassroots campaigns might be better relegated to raising awareness and vaccinating dogs in small communities to protect those communities directly, without contributing to the broader ecosystem-wide transmission-stopping aim often sought by government human health and veterinary organizations. [ABSTRACT FROM AUTHOR]