Challenging a paradigm: Staggered versus single-pulse mass dog vaccination strategy for rabies elimination.

Background: From smallpox to poliomyelitis, halting contagion transmission through simultaneous mass vaccination is ubiquitous and often perceived as the only possible solution. But implementing mass vaccination campaigns in large populations within a short period poses many challenges. For example, in Arequipa, Peru, sweeping mass vaccination campaigns conducted yearly over a single weekend have failed to achieve the required 'herd immunity' to halt canine rabies transmission. Contrary to the global paradigm of a simultaneous campaign, the 2022 Arequipa rabies campaign was implemented at the sub-district level (patches), with dates of the campaign staggered across 6 months.

Methods: We constructed a stochastic, metapopulation model to examine how the timing of pulsed vaccination campaigns across patches can affect metapopulation dynamics. We explore general metapopulation dynamics for pulsed vaccinations as well as parameterizing the model for canine rabies in Arequipa, Peru. We simulated how the timing of the planned vaccination campaign, staggered over 6 months versus a single yearly pulse, affected the prospects for regional rabies elimination.

Results: Metapopulation dynamics can affect the efficacy of pulsed vaccination campaigns. In the case of Arequipa, Peru, the planned staggered mass dog vaccination campaign has the potential for local elimination with the tradeoffs of increased time to elimination and increased outbreak size due to metapopulation dynamics.

Conclusions: Heterogeneities caused by control strategies enactment at sub-population scales should be accounted for when modeling transmission dynamics. In Arequipa, Peru, although metapopulation dynamics may allow for re-introduction of canine rabies in previously vaccinated patches when mass dog vaccination campaigns are staggered temporally over 6 months, continuous mass vaccination reaching recommended vaccination coverage levels is sufficient to eliminate canine rabies.