Rabies is a terrifying disease that kills approximately 60,000 people worldwide each year. Though scientific innovation has created vaccines that are effective before and after exposure to the virus, there is no way to cure rabies once symptoms have begun. Rabies is a zoonosis, meaning that it is transmitted from animals to humans. Rabies is a threat in about 150 countries, but its fatalities are constrained to the developing world with 95% of rabies cases occur in Asia and Africa. Over 99% of deaths from rabies occur in developing countries, one-third in China and India alone.
Rabies is a neglected disease and most commonly affects poor, young, and vulnerable populations. Children are particularly at risk– 40% of those bitten by a suspected rabid animal are under 15 – and the risk is highest in rural areas, where required vaccines may not be readily available. While rabies is always present in the wild, most human cases are caused by dog bites. Canine rabies threatens more than 3 billion people in Asia and Africa.
“This is a disease of the poorest of the poor who can’t afford the vaccine.” – Dr. Herve Bourhy of France’s Pasteur Institute.
According to the World Health Organization (WHO)’s Regional Office for South-East Asia, 45% of human deaths from rabies occur in Asia. Rabies is endemic in 8 countries in the region, and only 4 nations have nationally coordinated rabies control strategies. The 2012 Strategic Framework for Elimination of Human Rabies Transmitted by Dogs in the South-East Asia Region argues that “although rabies is preventable, the high cost of modern rabies vaccines, compounded by the lack of education and awareness about rabies, limits the use of post-exposure prophylaxis (PEP).”
India is a global rabies hot spot and seems to be taking action against this dreaded disease. The country launched a pilot rabies control program in 2008, which expanded to a nation-wide program from 2012-2017. However, many challenges lie ahead as only 20% of people get treated for rabies after being bitten by an animal. Government General Hospital in India recorded 4,000 cases of animal bites in the first 8 months of 2013 and treats dozens of patients for dog bites every day.
Previous blogs have argued for the mobilization of civil society and use of innovative public-private partnerships to find solutions to global challenges; these strategies are particularly relevant in the fight to eliminate human rabies. The WHO argues, “rabies control requires the active involvement of communities and NGOs. Initial management of animal bites, timely, adequate, and complete PEP for victims of animal bites and educating communities on the regular immunization of dogs are some of the activities where NGOs, civil society, and local community groups can play a crucial role.”
Such innovative private-public partnerships are already taking place in India, with positive effects. Worldwide Veterinary Services (WVS), a UK-based NGO, has implemented several anti-rabies programs in India in partnership with government agencies, the private sector, and civil society. Mission Rabies, a WVS program in India, was launched in September 2013 and will operate over 3 years to reduce the incidence of rabies in both humans and animals across India. In its first year, Mission Rabies vaccinated over 60,000 dogs in 12 of India’s worst affected areas over 28 days- that’s one dog every 40 seconds – using both overseas volunteers and local staff. The program managed to achieve a 70% coverage rate, which is the level the World Health Organization recommends to control the disease. Programs like Mission Rabies, besides preventing future human rabies cases, are cost-effective and have the potential to save national governments money. The Indian government currently spends over US $25 million annually on post-exposure rabies vaccinations, while the cost of Mission Rabies is US $5 million.
According to the World Health Organization, vaccinating dogs is the most effective way to prevent human cases of rabies around the world. Over 20 million people are vaccinated after being exposed to rabies around the world at a cost of US $100; canine vaccinations can cost as little as US $0.50 per dog. The WHO has proposed a goal to eliminate human rabies from dog bites in South-East Asia by 2020, with a 5-year plan (2012-2016) to halve number of human rabies fatalities in affected countries. However, a variety of challenges still exist that will make this a difficult goal to reach, including lack of political support, little community involvement, and the need for more disease surveillance, health education, and coordination between civil society, governments, and local communities.