A model for transformation and accomplishment
The national rabies elimination strategy has two components:
- implementing mass dog vaccination campaigns
- introducing intradermal rabies vaccination following dog bites in health facilities throughout the country.
The Bangladeshi Health Department phased out nerve tissue rabies vaccine in 2011, in line with the recommendations of the World Health Organization.
The success of the strategy relies on ensuring a high standard of care for patients who have been bitten, which is accessible and affordable to the 300 000 rural poor who are at a “high risk” of exposure. Bangladesh is proud that all of its 60 districts now have at least one centre providing wound management and post-exposure prophylaxis to bite victims by trained nurses and physicians to more than 250 000 patients, with no out of pocket expense to the patient. Through multisectoral coordination and support from its development partners, Bangladesh has improved the equity and accessibility of vaccines to the rural poor, which has led to a decreased reliance on alternative practices.
The expansion of mass dog vaccination has reaffirmed how a multisectoral, One Health approach combining innovation, capacity-building and comprehensive implementation can lead to effective rabies elimination strategies. From a small pilot project in a remote small municipality, namely Cox’s Bazaar, which started in 2011, a programme has emerged that benefits 65 district municipalities and six entire districts.
The combined impact of post-exposure prophylaxis and mass dog vaccination has resulted in a consistent decrease in the annual incidence of rabies from over 2000 before 2010 to 1500 in 2012 and 200 in 2015. This unprecedented achievement resulted from political commitment and appropriate budget allocation, which rose from US$ 0 in 2010 to US$ 7 million (2011–2016) and subsequently to US$ 33 million (2017–2022) of the five-year health sector plan, respectively. Bangladesh is continuing to work towards its goal of eliminating rabies by 2020, with plans to conduct three further rounds of mass dog vaccination targeting 1.6 million dogs by 2020. Overall, Bangladesh has demonstrated that with an effective strategy, well-devised action plans, and trained human resources supported by a sufficient budget, significant progress can be made towards decreasing the global burden of rabies.
Bangladesh has now become a role model for the global rabies elimination programme.