Applied research “Towards Elimination of Dog Mediated Human Rabies”

In late 2015, a global goal of an end to human rabies mediated by dogs was set for 2030.  Over the last few months, thirteen papers have been published as part of the research topic “Towards Elimination of Dog Mediated Human Rabies” in the Journal Frontiers in Veterinary Science. Comprising 8 original research articles, 4 perspective pieces, and 1 review, the collection brings together the experience and lessons learned from rabies control programmes small and large, research aimed at improving the design and cost effectiveness of rabies control programmes, and analysis of the resources needed to expand rabies control efforts if the global goal is to be reached.

We have the tools necessary, but an overview by Fahrion et al. highlights the gaps that need to be filled in order that these can be used widely enough to achieve the 2030 elimination goal. This article also discusses possible solutions to the socio-political, organizational, technical and resource-linked problems that are being developed by many different stakeholders. It highlights the need for the type of applied research featured in all of the other papers - that aimed at supporting and guiding more effective rabies control efforts across the world.

Evidence that rabies can be locally eliminated is now building in a variety of settings, demonstrated here by Byrnes et al. from their first state-wide programme in Sikkim, India, successfully applied in a One Health approach. Valenzuela et al. describe how the elimination of human and animal rabies cases was achieved after just two years of implementing a more comprehensive program and calculate the costs involved. A larger scale program built almost from scratch across the whole of SE Tanzania is described by Mpolya et al. Here, comprehensive mass dog vaccination programs and the successful transition to intradermal PEP delivery reduced bite exposures and human deaths significantly, and elimination was achieved on Pemba Island. In all these cases the challenge of sustaining the programmes’ progress in situations surrounded by rabies endemic areas is significant.

From any project there are lessons to be learned that can be used to support efforts elsewhere, but those described by Vilas et al. derived from the rabies control programs across Latin America and Caribbean are some of the most relevant for global elimination goals. One of the key messages is the need for regional strategies to recognize that countries can vary enormously in their capacity control rabies and plan accordingly.

If we are to reach the 2030 goal, then time and resources must not be wasted and several of the papers help to identify ways of designing more cost-efficient strategies. The availability of high-quality surveillance data to support control efforts is absolutely vital. Scott et al. describe a new rabies epidemiological bulletin for Africa that will start to address the huge knowledge gaps on this continent, enable better advocacy for rabies control to be initiated and provide timely analysis of progress. Effective surveillance at the local level requires sustainable community engagement, and Brookes et al. conclude that trust in authorities and the ability of veterinary services to respond to notifications are critical in achieving this.

All too often, the important job of assessing the vaccination coverages achieved in free-roaming dogs is neglected. A variety of methods to do this are tested in the paper by Sambo et al. Using a theoretical model approach, Leung and Davis evaluated vaccination needs in stray dogs when efforts are also addressed in vaccinating owned dogs. They showed that the most critical subpopulation to be vaccinated is the free-roaming owned dogs. By interviewing communities after vaccination programs in Bali, Arief et al. were able to suggest ways to refine the vaccination strategy (to focus more on the vaccination of free-roaming dogs) and identified the value that clearly identifying vaccinated dogs to the community could have in building community engagement.

The relative cost effectiveness of different strategies is always an important factor in the design of programs. Mindekem et al. find that based on their experiences in Chad, a One Health strategy, which combines canine vaccination with the provision of PEP, is more cost-effective in the long term than relying on PEP provision alone, and with ideal One Health communication across the sectors the highest cost-effectiveness can be reached.

Securing sufficient financial support to ensure that comprehensive vaccination plans can move forwards is frequently a stumbling block. Welburn et al., consider whether innovative finance mechanisms such as Development Impact Bonds could help to fill this funding gap. Such mechanisms would allow governments or external donors to pay for rabies elimination implementation only once satisfactory results have been achieved, with investors taking on the risks and therefore ensuring stricter management of program delivery.

The capacity and funding needs to deliver elimination at the global level are estimated in a paper by Wallace et al.  It draws on multiple datasets to calculate how veterinary capacity, vaccine production and investment must be increased to meet the anticipated needs based on the current situation in each country. The paper, like each on in this issue hopes to stimulate and inform the necessary discussion on global and regional strategic planning, resource mobilization, and continuous execution of rabies virus elimination that will be necessary to reach the 2030 goal.

 

Contributed by Louise Taylor (GARC), Salome Dürr (University of Bern, Switzerland), Anna Fahrion (WHO), and Lea Knopf (WHO) who jointly edited the research topic.  When the collection is finalized, it will be published as an ebook which will be free to download.