An Implementation Science Framework to Understand Low Coverage in Mass Dog Rabies Vaccination

Area of Science:

• Veterinary Public Health
• Epidemiology
• Implementation Science

Background:

• Dog-mediated human rabies remains a significant public health concern in many parts of Africa, Asia, and Latin America.
• Mass dog vaccination (MDV) is a crucial One Health strategy for rabies elimination, but achieving sustained coverage is challenging.
• The Consolidated Framework for Implementation Research (CFIR) can identify barriers to effective MDV campaigns.

Purpose of the Study:

• To apply the CFIR to understand barriers faced by stakeholders in dog rabies vaccination campaigns in Arequipa, Peru.
• To identify factors contributing to decreased mass dog vaccination campaign (MDVC) effectiveness post-COVID-19.

Main Methods:

• Seven focus groups (n=56) explored community perspectives on rabies and vaccination.
• A workshop with public health personnel (n=69) examined factors affecting MDVC post-COVID-19.
• The CFIR framework was used to analyze barriers across five domains: innovation, outer setting, inner setting, individuals, and implementation.

Main Results:

• Community barriers included poor communication, short vaccination schedules, and fragmented collaboration.
• Individual-level barriers involved decreased rabies risk perception, prioritization of human COVID-19 vaccination, and time constraints due to pandemic-related financial impacts.
• Implementer and authority barriers included insufficient materials, unclear roles, lack of evaluation time, financial constraints, and fragmented institutional commitment.

Conclusions:

• Key barriers to MDVC in Arequipa, Peru, were identified across community, individual, and implementer levels.
• Co-designed strategies to enhance MDVC participation include strengthening municipal alliances, improving publicity, training vaccinators, and extending campaign hours.