In the WHO South-East Asia Region, rabies has been tamed. Intensified action can conquer it altogether
Rabies can be an especially fatal virus. One bite or scratch from an infected animal – 99% of the time 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. That needn’t be the case. If immediate post-exposure action is taken – including extensive washing and treatment of the wound, as well as several rounds of rabies vaccine that meets WHO standards – all will be well; not a single symptom will develop.
Despite rabies being 100% preventable, and despite the South-East Asia Region’s substantial progress in driving down the disease’s burden in recent years, it remains an issue: More than 26 000 people in the Region succumb to it annually. Eight of the Region’s 11 countries account for around 45% of the world’s rabies burden, with over 1.5 billion people at risk of rabies exposure. More than 6 million patients receive at least one dose of rabies vaccine every year.
Targeted and diverse initiatives have achieved strong results. Bhutan, Sri Lanka and Thailand, for example, have obtained sharp declines in rabies infection and mortality following mass canine vaccination campaigns and providing improved access to life-saving post-exposure prophylaxis (PEP) treatments. Similar initiatives in the Indian states of Goa, Sikkim, Rajasthan, Jharkhand and Tamil Nadu have likewise saved countless lives. All Member countries have meanwhile phased out the production and use of nerve-tissue vaccines, while six have introduced cost-effective intradermal vaccination schedules able to improve accessibility, affordability and availability of the modern rabies vaccine.
But to achieve zero human rabies deaths by 2030, as per the Sustainable Development Goal target, intensified action – including better access to PEP tools – is needed. To help make that happen, WHO has convened a meeting in early May in Kathmandu, Nepal, with representatives of rabies-endemic countries from the WHO South-East Asia, WHO Western Pacific and WHO Africa regions gathering alongside global health partners such as Gavi, the Vaccine Alliance, the Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE). Together they will look at how progress against rabies can be accelerated and access to PEP improved.
As crucial as increased access to PEP is, however, achieving our target requires action across all sectors and at all levels of society. To that end, adopting a ‘One Health’ approach that identifies and controls multiple risks at the human-animal interface is crucial. As the Global Strategic Plan to End Human Deaths from Dog-Mediated Rabies by 2030 outlines, and as the South-East Asia Region’s own Strategic Framework has long stressed, that means implementing a range of simple though highly effective policies.
Vaccinating Rabies’ prime reservoir – dogs – is a good place to start. Sustainable vaccination of at least 70% of the canine population in any given area will achieve herd immunity, thereby ensuring the transmission of rabies between and among dogs – and then on to humans – is no longer a threat. That requires Member countries to develop efficient rabies 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 cost-effective way to prevent dog-mediated rabies.
Addressing socio-cultural 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 (including the need for vaccination), as well as 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 is incurred. 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 human rabies deaths is fundamental. To that end, the resolve demonstrated by Her Royal Highness 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 India’s state governments. In support of their efforts, WHO South-East Asia has worked with Member countries, as well as regional organizations such as the Association of South-East Asian Nations (ASEAN) and the South Asian Association for Regional Cooperation (SAARC), to enhance high-level buy-in and ensure rabies’ unnecessary burden is tamed and ready to be conquered altogether.
That outcome is readily achievable. With better access to PEP tools and the intensified and sustained application of diverse preventive policies, rabies’ burden in the South-East Asia Region can be lifted, and tens of thousands of lives saved every year. Reaching zero human rabies deaths is a mission that is both possible and necessary. It is a mission to which WHO South-East Asia and its partners are fully committed.