Rabies care in Malawi is slowed by long, multi-step pathways to treatment

Rabies kills despite being preventable, and a new study from Malawi argues that the problem lies less in the medicine itself than in the journey patients must take to receive it. Researchers set out to explore the constraints to effective bite-case management and rabies post-exposure prophylaxis, known as PEP, in Malawi, where the disease disproportionately affects rural and resource-limited communities across Africa and Asia.

The team conducted interviews and focus group discussions with three groups whose decisions shape a bite victim’s fate: human health care providers, animal health officers, and dog-bite victims themselves. Using these conversations, they mapped the pathways, barriers, and bottlenecks that determine whether an exposed person actually receives PEP in time. Timely treatment can prevent rabies in exposed humans, but only if the vaccine is available and people know where to seek it.

What emerged is a picture of an access pathway that is cumbersome, multi-step, and often lengthy. Before any PEP is provided, the route begins with a veterinary risk assessment and referral. That means a bitten person’s treatment depends not only on health workers but on veterinary staff and a hand-off between sectors, each of which can add delay.

The study found that training of service providers was poor and that protocols were inconsistent, so the care a victim received could vary depending on where and from whom they sought help. One Health coordination between the animal health and public health sectors was limited, undermining the joined-up response that bite-case management ideally requires. Beyond these structural issues, the researchers documented more practical obstacles: vaccines were unavailable at times, funding was insufficient, there were shortages of assistant veterinary officers, health facilities were far away for many people, and community awareness of what to do after a bite was lacking.

The authors conclude that simplifying the pathway to PEP for bite victims may reduce rabies deaths in Malawi. That simplification, they argue, would require clear service pathways and protocols, trained staff, and sufficient resources across settings and sectors. They also point to structured two-way information sharing between the animal health and public health sectors, grounded in a One Health framework, as a way to reduce delays, improve patient care and follow-up, and support vaccine forecasting and procurement.

By highlighting the PEP access pathway and the intersectoral communication systems around it, the study frames these as actionable entry points for improving equitable and timely access to rabies PEP in Malawi. The findings are qualitative in nature, drawn from the perspectives of providers, veterinary officers, and bite victims rather than from clinical outcome data, so they describe how the system works and where it fails rather than measuring how many deaths simpler pathways would prevent.

Subject of Research: Barriers to accessing rabies post-exposure prophylaxis in Malawi

Article Title: Delays, detours, and gaps – a one‑health study on access to rabies post‑exposure prophylaxis in Malawi

Article References: Phiri, B., Johansen, T. B., Wolff, C., Chinkonda, B. E., Nkhoma, J., Mazeri, S., Ruano, A. L., Njunga, G., Maluwa, A., & Jørgensen, H. J. (2026). Delays, detours, and gaps – a one‑health study on access to rabies post‑exposure prophylaxis in Malawi. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03067-8

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03067-8

Keywords: rabies, post-exposure prophylaxis, Malawi, One Health, dog bite, vaccine access, health systems, veterinary risk assessment, intersectoral coordination, community awareness, Delays, detours