Resources: Articles
The End of Rabies Suffering Starts with Animal Vaccination
by Carel du Marchie Sarvaas, HealthforAnimals
This month, we mark another World Rabies Day – a day of action and awareness for the prevention of a disease that still kills tens of thousands of people each year.
As impressive as this globally-coordinated series of activities is, we must hope that World Rabies Day is no longer needed a decade from now.
The target agreed by the World Health Organization, the World Organisation for Animal Health, the UN Food and Agriculture Organization and the Global Alliance for Rabies Control (which coordinates World Rabies Day), is to reduce human deaths from canine rabies to zero by 2030.
While many health professionals think of rabies as a problem of the past, the 2030 target highlights the devastating impact the disease still has in many parts of the world. Africa and Asia account for 99 percent of human deaths from a disease that disproportionately impacts poor, rural communities[1].
What’s more, one of the cruellest dimensions of rabies is its impact on the young; 40 percent of victims are children under 15 and so these communities face huge emotional and economic hardship as their young people are lost to an entirely preventable disease[2].
It’s been more than a century since Louis Pasteur and his colleagues developed a vaccine for a disease whose dramatic symptoms plagued communities and horrified the 19th century scientific community.
Today, people affected by rabies are no longer fated to the suffering that characterised Pasteur’s era. Instead, victims in many parts of the world simply do not have access to the post-exposure treatments that can be the difference between life and death[3].
What’s more, the problem isn’t dealt with at the source in many parts of the world. Looking purely at the economics, the cost of vaccinating dogs is minimal (as little as $0.57 per treatment in India), when compared against the US$1.7bn spent in treating people who contract rabies.
Research and modelling suggests that vaccinating 70 percent of the dog population in any given region is enough to eliminate canine rabies, regardless of the number of dogs[4].
Clearly, this kind of vaccination coverage represents a major logistical challenge, particularly in those parts of the world where veterinary infrastructure is lacking. Even smaller-scale programmes require considerable investment and patience from public and private sectors before results are achieved[5].
The task of eradication may be made more complex by the unique cultural environment. In Bali, for instance, the population may be reluctant to reduce the free-roaming tendencies of its dogs, who serve an important cultural purpose as the protectors of property[6].
But vaccination can also go with the grain of the culture, rather than against it. In Kenya, clever officials often time organize vaccination drives around the school holidays. Children have the strongest relationships with the local dogs, so they are best placed to safely collect and lead them to vaccination sites.
It’s a colourful, touching example of the human-animal bond, but also an eminently practical response to the inherent challenges of vaccination. And there are other positive precedents we can look to.
The extraordinary reduction of canine rabies in the Latin America and the Caribbean region (LAC) was born out of a regional, political commitment made in the 1980s to control the disease.
It demonstrated how campaigns can be effective when a long-term strategy that outlines clear steps towards eradication is put in place. This allowed animal medicines companies to plan ahead and ensure they could deliver vaccinations when they were urgently needed.
As a result, national and subnational programmes have delivered more than 51 million doses of canine vaccine annually, along with improved diagnosis and surveillance. Together, these have resulted in a plunge from 25,000 cases of laboratory-confirmed dog rabies in 1980 to fewer than 300 in 2010[7].
In each one of the WHO’s best practice examples of disease control – in The Philippines, Tanzania and Bangladesh – mass, coordinated vaccination and management was an essential driver of success.
These programmes all shared a sense of scale, operating over multiple territories, along with a coordinated network of professionals and sustained investment and effort over the course of years.
Education also has a role to play, in simple strategies like teaching children about the body language of aggressive dogs, and it’s exactly this kind of awareness that the Global Alliance for Rabies Control (GARC) hopes to foster through World Rabies Day.
Examples across the world show that vaccines combined with investment, patience and political will, can consign rabies to history.
So there is hope for all of us that you won’t be reading about World Rabies Day 20 years from now.
Carel du Marchie Sarvaas is the Executive Director of HealthforAnimals, the global animal medicines association.
References
[1] Knobel DL et al., 2005; WHO, 2013a; Hampson K et al., 2015; Sambo M et al., 2013.
[2] OIE, WHO and Food and Agriculture Organization of the United Nations (2015) Rabies: rationale for investing in the global elimination of dog-mediated human rabies.
[3] Knobel DL et al., 2005; WHO, 2013a; Hampson K et al., 2015; Sambo M et al., 2013.
[4] OIE, WHO and Food and Agriculture Organization of the United Nations (2015) Rabies: rationale for investing in the global elimination of dog-mediated human rabies.
[5] Townsend SE et al., 2013
[6] http://bawabali.com/bali-heritage-dog/2585-2/
[7] Vigilato MAN, Clavijo A, Knobl T, et al. Progress towards eliminating canine rabies: policies and perspectives from Latin America and the Caribbean. Philosophical Transactions of the Royal Society B: Biological Sciences. 2013;368(1623):20120143. doi:10.1098/rstb.2012.0143.