Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog population management (DPM) is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine rabies control. Cheaper, less labor-intensive tools for dog sterilization will be extremely valuable in realizing the potential benefits of reduced population turnover and size. No one DPM tool will fit all situations, but if DPM objectives are achieved dog populations may be stabilized or even reduced, facilitating higher dog vaccination coverages that will benefit rabies elimination efforts.

Increased outbreaks of zoonotic diseases with pandemic potential and the growing threat of antimicrobial resistance have stimulated the uptake and use of One Health approaches across the globe. Collaborative, multisectoral, and transdisciplinary approaches are vital to the effective response to health challenges; however, within One Health initiatives, animal and environmental health voices often remain secondary to human health. This article presents the findings of a transdisciplinary research project investigating the roles and contributions of animal health in One Health initiatives. We combined a multisite case study approach with a literature review, and conducted 22 semi-structured key informant interviews with animal health and One Health experts, with a focus on Ethiopia and Pakistan. Key themes explored were the nature of the animal health sector, animal health workforce, veterinary medicines and vaccines, and coordination and collaboration. Results were triangulated with existing primary and secondary data, reviewed by key stakeholders in Ethiopia and Pakistan, and tested with members of the Action for Animal Health (A4AH) coalition. We found that while One Health has become more interdisciplinary and inclusive at a global level, there remain significant challenges in operationalizing the approach at national and subnational levels. Gaps in governance, political will, and capacity undermine the inclusion of animal health in One Health structures. Power and resources are distributed unequally across One Health coalitions, echoing observations that acknowledge the crucial role of communities in supporting the provision of essential services, while their knowledge and experiences often remain excluded from project and policy development. We conclude that stronger multilevel linkages and engagement between animal health and other sectors are vital to support the implementation of inclusive, well-resourced, and effective One Health approaches.