Rabies is caused by a dangerous virus. A bite or even a scratch from an infected animal — 99% of the time, it is a dog — and the victim will, after an incubation period of anywhere between a week and a year, develop the disease’s tell-tale symptoms: fever, headache, nausea and death. Despite rabies being 100% preventable on the one hand and South East Asia’s substantial progress in driving down the disease’s burden in recent years on the other, it still remains an issue. More than 26,000 people in the region die of rabies every year. Eight of the 11 countries in the region account for around 45% of the world’s rabies burden, with over 1.5 billion people at risk of exposure. More than 6 million patients receive at least one dose of the rabies vaccine every year.
Targeted and diverse initiatives have achieved strong results. For example, Bhutan, Sri Lanka and Thailand have sharply cut rabies-related infection and mortality using mass canine vaccination campaigns and improving access to life-saving, post-exposure prophylaxis (PEP) treatments. In India, similar initiatives in Goa, Sikkim, Rajasthan, Jharkhand and Tamil Nadu have saved countless lives. All World Health Organisation-South East Asia countries have, meanwhile, phased out the production and use of nerve-tissue vaccines; six have introduced cost-effective, intradermal vaccination schedules to improve the accessibility, affordability and availability of the modern rabies vaccine.
Zero by 2030
But to reach the target of zero human rabies deaths by 2030, intensified action which includes better access to PEP tools is needed. To help make that happen, the World Health Organisation (WHO) convened a meeting in May, in Kathmandu, Nepal, with representatives of rabies-endemic countries from the WHO South East Asia, WHO Western Pacific and WHO Africa. There were also global health partners such as the Global Alliance for Vaccines and Immunisation, or GAVI, the Food and Agriculture Organisation of the United Nations and the World Organisation for Animal Health. Together they will look at how progress against rabies can be accelerated and access to PEP improved.
But a range of measures are needed as the Global Strategic Plan to Prevent Human Deaths from Dog-Transmitted Rabies by 2030 outlines and the South East Asian Region’s own Strategic Framework has long laid stress on.
Canine vaccination
To begin with, vaccinating dogs, a prime reservoir of rabies, is a good point to start from. Sustainable vaccination of at least 70% of the canine population in any given area will achieve herd immunity, thereby ensuring that the transmission of rabies among dogs and then on to humans is no longer a threat. This requires countries to develop efficient vaccine procurement systems as well as sustainable logistics and infrastructure for canine vaccination. It also requires high-level leaders to fully grasp that mass canine vaccination and animal birth control is the most efficient way to prevent dog-mediated rabies.
Addressing sociocultural perceptions and practices associated with the disease is likewise essential. Public information campaigns are critical to building awareness of what responsible dog ownership looks like, and preventing and treating bites or scratches when they occur. Key to this process is increasing awareness of PEP’s life-saving potential and the need to take immediate action once a bite or scratch happens. Importantly, awareness campaigns should be tailored to the needs of children who are particularly vulnerable to the disease.
Sustaining high-level commitment to achieving zero deaths in humans from rabies is fundamental. In this the resolve demonstrated by Princess Chulabhorn of Thailand, who has committed her country to achieving zero rabies deaths by 2020, is to be commended. So too is the high-level commitment of Bhutan and Sri Lanka as well as a number of State governments in India.
Dr. Poonam Khetrapal Singh is the Regional Director for WHO South East Asia
