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            <funder>This work is supported by a grant from WHO to the Universities of Glasgow and Cambridge. KH and RMa were supported by the Wellcome Trust (207569/Z/17/Z), with additional funding for RMa from Stuart H Leckie. The Wellcome Trust through Afrique One ASPIRE also supported MLe and several unpublished studies and the UBS Optimus Foundation supported LT and SJ. The Gavi learning agenda on rabies supported many of the unpublished studies that contributed data. The Swiss National Science Foundation supported MLa. The Institut Pasteur financed studies in Cambodia.</funder>
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                <title level="j">The Lancet Infectious Diseases</title>
                <imprint>
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                  <biblScope unit="volume">19</biblScope>
                  <biblScope unit="issue">1</biblScope>
                  <biblScope unit="pp">102-111</biblScope>
                  <date type="datePub">2019-01</date>
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              <classCode scheme="mesh">Animals</classCode>
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              <classCode scheme="mesh">Rabies / prevention &amp; control*</classCode>
              <classCode scheme="mesh">Rabies / virology</classCode>
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              <classCode scheme="mesh">Rabies Vaccines / economics*</classCode>
              <classCode scheme="mesh">Rabies Vaccines / therapeutic use</classCode>
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              <classCode scheme="mesh">Rabies virus / isolation &amp; purification</classCode>
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              <classCode scheme="mesh">Dog Diseases / prevention &amp; control*</classCode>
              <classCode scheme="mesh">Dogs</classCode>
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              <classCode scheme="mesh">Post-Exposure Prophylaxis / economics*</classCode>
              <classCode scheme="mesh">Post-Exposure Prophylaxis / methods</classCode>
              <classCode scheme="mesh">Quality-Adjusted Life Years</classCode>
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              <classCode scheme="mesh">Rabies / mortality</classCode>
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              <p>Background: Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply.Methods: We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs.Findings: We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use.Interpretation: Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies.Funding: World Health Organization.</p>
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              <addrLine>Pullman, WA</addrLine>
              <country key="US"/>
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            <address>
              <addrLine>1 pho Yersin Hanoi 10000</addrLine>
              <country key="VN"/>
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            <ref type="url">https://pasteur-network.org/fr/membres/asie/nihe/</ref>
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            <address>
              <addrLine>Cette structure regroupe l'ensemble des structures créées pour la reprise des données ProdInra</addrLine>
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          <orgName>Institut Pasteur du Cambodge</orgName>
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            <address>
              <addrLine>BP 983 - 5 , Boulevard Monivong, Phnom Penh</addrLine>
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            <ref type="url">http://www.pasteur-kh.org/</ref>
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          <orgName>Pasteur Network (Réseau International des Instituts Pasteur)</orgName>
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              <addrLine>25, rue du Dr Roux 75724 Paris Cedex 15</addrLine>
              <country key="FR"/>
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            <ref type="url">https://pasteur-network.org/</ref>
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