A high-level meeting on “Driving progress towards rabies elimination” opened today in Kathmandu, Nepal, attended by participants from countries endemic for rabies as well as local officials and dignitaries, including the Secretary of the Ministry of Health and Population Dr Pushpa Chaudhary, the Secretary of the Ministry of Livestock Development Mr Prakash Mathema and the Minister of State for Health and Population the Honourable Ms Padma Kumari Aryal.
The aim of this two-day meeting is to share the findings of a recent multi-country study sponsored by GAVI, the Vaccine Alliance, as part of its “learning agenda”1. The study helped to generate important collective knowledge (ranging from implementation issues to prospective evaluations and costing) in various settings and has demonstrated the importance of rabies-related data and the need to build capacity, community awareness, education and surveillance.
GAVI launched the rabies learning agenda in 2013 to build the case for including a rabies vaccine as part of its Vaccine Investment Strategy (VIS)2. A positive VIS decision by GAVI’s Board, due later this year, can act as a major catalyst for the global effort to eliminate rabies.
“Rabies is entirely preventable and should not take lives" Dr Ren Minghui, WHO Assistant Director-General for Communicable Diseases, told participants during the meeting’s opening. "While our understanding of the disease and its impact on societies and economies grows each day, public awareness of the disease and the ways to prevent and treat it remain low, making awareness-raising campaigns the cornerstone of any future elimination effort."
The meeting also aims to discuss the global progress of rabies elimination, identify remaining needs and strategize how best to implement the updated WHO guidance on rabies vaccines and immunoglobulins.
The meeting is also being attended by Her Royal Highness Princess Chulabhorn Mahidol of the Kingdom of Thailand, whose continued personal commitment has helped to set 2020 as her country’s target to eliminate the disease.
“It is my hope that the work that has been undertaken and that is continuing [in Thailand] will benefit not only the people and animals at risk of rabies in Thailand but also other countries that need to implement control and preventive measures”.
Her Royal Highness Princess Chulabhorn Mahidol of the Kingdom of Thailand
Progress in overcoming rabies worldwide will be guided by the soon to be published ‘Global strategic plan to end human deaths from dog-mediated rabies by 2030’ (Zero by 30) prepared by WHO, the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the Global Alliance for Rabies Control (GARC).
The plan describes the needed societal changes and inter-sectoral collaboration by prioritizing action that targets both the disease and aligns the response to the strengthening of health systems, through:
- effective use of vaccines, medicines, tools and technologies;
- evidence-based guidance and high-quality data to measure impact; and
- multi-stakeholder engagement to sustain commitment and resources.
In April 2018, WHO published new guidelines on rabies prevention, control and elimination, which include updated recommendations on lifesaving immunization.
Elimination of rabies is technically feasible, and providing access to post-bite treatment (post-exposure prophylaxis, or PEP) is crucial.
Other factors that need to be addressed include sociocultural perceptions and practices, disease awareness and responsible dog ownership.
WHO recommends that, to control and eventually eliminate dog-mediated human rabies, control programmes must ensure that mass dog vaccination campaigns achieve vaccination coverage of at least 70% of free-roaming dogs in a given area and that such campaigns recur annually.
The disease
Rabies, the most lethal virus known to man, occurs in more than 150 countries and territories. The disease is usually fatal once symptoms appear. Dog-transmitted rabies accounts for about 99% of human rabies cases. It is estimated that 59 000 people die from rabies every year.
A disease of poverty, rabies mainly affects the world’s poorest people, who can least afford treatment or care. However, rabies is 100% preventable by reducing the risk of animal bites; ensuring access to life-saving treatment following a bite; and by vaccinating dogs to ultimately eliminate the disease at its animal source.
1A learning agenda is a set of activities that includes specifying research questions that guide evaluation projects in both the short and long term.
2 VIS takes place every five years and sets new priorities for GAVI's vaccine support programmes through in-depth analysis and extensive consultations.