1. Historical Context and National Framework

1.1 The Epidemiological Trajectory

Rabies has been a documented public health threat in Kenya for over a century. The first laboratory-confirmed case in a domestic dog was recorded in 1912, followed by the first human case in 1928^[2]. Since the structural adjustment programs of the 1980s led to a collapse in state-sponsored vaccination, the virus has expanded to affect over 85% of Kenya's 47 counties^[3].

1.2 The "Zero by 30" Strategic Plan

Kenya launched its *Strategic Plan for the Elimination of Human Rabies* in 2014, aiming for elimination by 2030^[1]. The strategy relies on mass dog vaccination (70% coverage), Post-Exposure Prophylaxis (PEP) availability, and public education^[1].

Zonation Strategy:

• Zone A (Pilot): Machakos, Makueni, Kitui, Siaya, Kisumu.
• Zone C (Maintenance): Pastoralist ASAL regions like Narok and Kajiado, which face unique logistical hurdles^[1].

2. Protocols in the Human Health Pillar

The human health pillar focuses on clinical management to prevent symptom onset.

2.1 Standard Clinical Guidelines (PEP)

Wound Management: Immediate flushing for 15 minutes with water and soap is mandated to reduce viral load^[9].

Vaccination (Active Immunization): The current standard in public hospitals is the 5-dose intramuscular (IM) "Essen" regimen (Days 0, 3, 7, 14, 28)^[12]. While effective, it is resource-intensive.

Immunoglobulin (RIG): Indicated for Category III exposures (bites/scratches on broken skin). However, studies in Makueni found that 0% of 42 assessed health facilities had RIG in stock^[14]. It is largely inaccessible to rural populations.

2.2 The Shift to Intradermal (ID)

Future planning focuses on the Intradermal (ID) route, recommended by WHO. ID administration uses 60–80% less vaccine volume, significantly reducing costs^[18]. Implementation is currently slowed by a lack of training and appropriate syringes.

2.3 Integrated Bite Case Management (IBCM)

This protocol links health and veterinary sectors. If a biting dog is confirmed healthy by a vet, the patient can stop PEP, saving up to 30% of vaccine stock^[21].

3. The Maasai Pastoralist Context: Narok & Kajiado

3.1 Dog Ecology

In Maasai communities, dogs are essential for guarding livestock but are free-roaming. Vaccination rates in these areas often hover between 2% and 22%, far below the 70% herd immunity threshold^[23].

3.2 Ethnomedicine Barriers

Many bite victims rely on traditional healers due to cost and distance. Common treatments include herbs like Phytolacca dodecandra (Endod) and Acacia nilotica^[31]. These are ineffective against the virus and cause fatal delays in seeking PEP.

3.3 Economic "Financial Toxicity"

PEP is expensive. When public stockouts occur, patients must buy vaccines from private chemists at ~$15-45 USD per dose. Indirect costs (transport) further exacerbate poverty, with families often selling livestock to pay for treatment^[17].

4. Supply Chain & Innovations

4.1 Procurement Challenges

KEMSA (government supplier) offers subsidized rates (~$1.80/dose) but suffers chronic shortages. Counties often fall back to MEDS (faith-based), where prices are significantly higher (~$12.50/dose), draining budgets^[48].

4.2 Drone Logistics (Zipline)

A major innovation is the partnership with Zipline in Kisumu. Autonomous drones deliver vaccines to remote islands and clinics within 45 minutes, bypassing poor road infrastructure^[55].

4.3 Community Health Promoters (CHPs)

The Community Health Promoters Act 2024 formalizes the role of CHPs. While they cannot inject vaccines yet, they are crucial for surveillance using smartphone apps like the Kenya Animal Biosurveillance (KAB) app^[57][62].