Research agendas not helping policy makers

A recent paper in Infectious Diseases of Poverty by Yin et al, highlights a disconnect between research being undertaken on rabies in China, and the information needed to reduce its impact.

China has made significant political progress on rabies control in recent years. The State Council issued official notices in 2009 and 2012 underlining rabies control as a priority and providing program objectives for 2015 and 2020. Four ministries have passed specific rabies-related guidelines and regulations, and inter-sectoral collaborative mechanisms have been set up to facilitate control efforts. A much improved surveillance system for human rabies has been developed, although it is still likely to be underreporting and surveillance in dogs remains inadequate.

The authors analyzed 189 medical research articles on rabies in China from 1963 to 2012 and added a further 12 official documents (reports, guidance and legislative documents). They found a huge increase in research into rabies over the last decade, probably related to the reemergence of rabies in China that peaked in 2007.

However, almost all of the research was laboratory (135 articles) or clinic-based (23 articles) and only 31 articles were based in community settings. The authors found no articles on evidence-based control practices (e.g. dog population characteristics or management , tools for monitoring or evaluating control efforts) or on evidence-based advocacy (e.g. estimating the burden or cost of rabies).

They found significant gaps in information and that that prevents the development of comprehensive strategies to reach policy objectives. For example, no research has investigated the exact reasons why cases in humans have fallen in recent years. There is no data on the true incidence and the financial burden of rabies to people paying for post-exposure treatment and related costs, no monitoring of whether PEP availability has improved, or whether dog registration and vaccination procedures are working. Doubts over dog vaccine quality and the adequacy of the supply also persist.

The authors say that there is not enough research on health systems, economic evaluations, and evidence-based control practices to guide effective policies. Operational issues such as

• dog population characteristics,
• cost effective vaccination and education strategies,
• locally adapted dog population management practices, and
• impact assessments of interventions

are still lacking. Only with this type of information can a true national strategy be developed to achieve the goals set by policy makers. 

A similar study in India by Kakkar et al. in 2012 came to the same conclusions.  A total of 93 research articles from 2001 to 2011 showed that most focused on lab-based (57 articles) or clinical facility-based (25 articles) studies, mostly on the development of new interventions. Only 9 (10%) were community-based studies, and less than 10% of the research looked at improving existing interventions or research related to health policy and systems.

This is despite an earlier research prioritization exercise that suggested that socio-politic-economic research, basic epidemiological research and research to improve existing interventions (‘actionable policy-relevant research’) was most needed to effectively control zoonotic diseases.

These authors suggested that the current policy ‘impasse’ and the failure to establish a national rabies control plan for India were partly due to the lack of necessary applied research. They suggest a strategic research agenda, focused on the needs of policy makers is needed.

Jakob Zinsstag, in his editorial in Infectious Diseases of Poverty, points out that for many neglected tropical diseases, scientists (and funding bodies) prefer sophisticated molecular analyses over investigations into effective interventions in communities.

Given that rabies is preventable, he suggests that this continuation of basic research while not engaging in the control of rabies appears almost cynical. He calls for research that translates knowledge into effective action by addressing the social, political, economic and psychological complexity of effective rabies control interventions, with the necessary collaboration between scientists and authorities.

Summarized by Louise Taylor from the publications, which are all freely available via PubMed