A One Health approach to rabies elimination
Rabies is one of the oldest diseases on the planet, first recorded in 2202 BC. Despite occurring in more than 150 countries, it is a disease that remains largely under the radar. Yet, rabies causes an estimated 60,000 deaths per year with the highest case fatality rate of any disease. However, the number of deaths is likely to be much higher than this figure, as surveillance of the disease is weak and treatments often unavailable, especially to the poorest. The path to death is a terrifying one causing aggression, intense fear, hydrophobia, aerophobia and paralysis. A huge psychological burden is left with grieving families who have witnessed their loved ones go through this trauma.
In 2018, Sarah Beeching meet Professor Sarah Cleaveland from the University of Glasgow, one of the world’s foremost experts on rabies. Professor Cleaveland was awarded the Leeuwenhoek Medal for her pioneering work towards the eradication of rabies in 2018 and her lecture at the Royal Society sparked Oshun’s interest in trying to find a pathway to finally end the disease.
Sarah Cleaveland said:
“The reason we don’t hear about this disease is that rabies doesn’t affect people with influence. The people who die are those in the most impoverished communities in the world, most often in rural areas. There are two reasons for this. It is in rural areas where we have the highest incidence of dog rabies, and these are the people who face the greatest challenge in accessing life saving vaccine. And this is why rabies is a disease of poverty.”
In almost all cases canine dogs are responsible for rabies virus transmission to humans. Though rabies does exist in other wildlife it is very rare that other animals bite people. Tackling rabies in dogs is the route to eliminating rabies in humans, hence a One Health approach to the disease is required, working across human and animal health sectors. Mass vaccinating dogs – to achieve at least 70% coverage - will provide herd immunity in the canine population and break the cycle of transmission from dogs to humans. The cost of dog vaccination is a fraction of the cost of human prophylaxis or post exposure treatment.
So why doesn’t this happen? The answer is both simple, and complex. At a basic level the disease is invisible, poor surveillance, lack of data, no diagnostic tests prior to the arrival of clinical symptoms at which point no treatment is possible. Lack of data makes it difficult to show the scale of the problem or make the case for eradication. And this leads inevitably to insufficient resources either in the human health sector, where other priorities prevail, or in the animal health sector, where dogs are not considered a ‘productive’ animal. Rabies falls through the cracks.
Oshun Partnership is working with the World Health Organization and the University of Glasgow to understand the market failures in tackling rabies and identify opportunities to mobilise support for rabies elimination.
Sarah Beeching, Oshun’s Executive Director said:
‘Next year we have a real opportunity. For the first time, Gavi, the vaccine alliance, will put human post exposure prophylaxis on the list of vaccines for Gavi-eligible countries. But we can’t just tackle the consequences of a rabid dog bite, we need to tackle rabies in dogs. For this we need political leadership at the highest levels. At the Commonwealth Heads of Government meeting in Kigali in June 2020 we hope leaders will commit to consigning this horrendous disease to the history books.’