A social justice perspective on access to human rabies vaccines

Wentworth, Diorbhail; Hampson, Katie; Thumbi, Samuel M.; Mwatondo, Athman; Wambura, Gati; Chng, Nai Rui

doi:10.1016/j.vaccine.2019.01.065

Cited by 30 publications

(27 citation statements)

References 21 publications

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“…Some people reported that rabies vaccine injections were painful and difficult to tolerate [ 19 ]; parents reported desperation when they see their children in pain because of a vaccine [ 17 ]. In some settings (although not in Peru), rabies vaccines were expensive for the patients, creating a social justice issue for bite victims and their communities, which are often least able to afford care and most vulnerable to rabies mortality [ 20 ]. Unfortunately, despite aggressive and successful dog vaccination programs [ 21 , 22 ] and drastic reduction of rabies virus transmission in many countries [ 22 – 24 ], it is estimated that, globally 59,000 humans die of rabies every year [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic

Castillo-Neyra¹,

Buttenheim²,

Brown³

et al. 2020

PLoS Negl Trop Dis

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A canine rabies epidemic started in early 2015 in Arequipa, Peru and the rabies virus continues to circulate in the dog population. Some city residents who suffer dog bites do not seek care or do not complete indicated post-exposure prophylaxis (PEP) regimens, increasing the risk of human rabies. The objectives of our study are to qualitatively assess knowledge about rabies, and preventive practices, such as rabies vaccine administration, following a dog bite. We conduct eight focus group discussions in peri-urban and urban communities with 70 total participants. In our results, we observe low awareness of rabies severity and fatality, and different practices following a dog bite, depending on the community type: for example, whereas participants in the urban communities report cleaning the wound with hydrogen peroxide rather than soap and water, participants in peri-urban areas cover the wound with herbs and hair from the dog that bit them. Misconceptions about rabies vaccines and mistreatment at health centers also commonly prevent initiating or completing PEP. We identify important behavioral and structural barriers and knowledge gaps that limit evidencebased preventive strategies against rabies and may threaten successful prevention of dogmediated human rabies in this setting.

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Section: Introductionmentioning

confidence: 99%

Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic

Castillo-Neyra¹,

Buttenheim²,

Brown³

et al. 2020

PLoS Negl Trop Dis

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show abstract

“…It has been estimated that, if dog vaccination and PEP provision levels do not increase, more than 1 million people will lose their lives to rabies between 2020 and 2035 (21). Moreover, the status quo of PEP supply, whereby treatment costs are the responsibility of the bite victims and their families, who are often unable to pay in the face of this life-threatening disease, has been characterized as unjust, unfair, and unworkable (22). This health care failure highlights the need for urgent action in this space, particularly as a highly effective preventive vaccine has been available for more than a century (23).…”

Section: Discussionmentioning

confidence: 99%

Using data-driven approaches to improve delivery of animal health care interventions for public health

Mazeri

Bailey²,

Mayer³

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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Rabies kills ∼60,000 people per year. Annual vaccination of at least 70% of dogs has been shown to eliminate rabies in both human and canine populations. However, delivery of large-scale mass dog vaccination campaigns remains a challenge in many rabies-endemic countries. In sub-Saharan Africa, where the vast majority of dogs are owned, mass vaccination campaigns have typically depended on a combination of static point (SP) and door-to-door (D2D) approaches since SP-only campaigns often fail to achieve 70% vaccination coverage. However, D2D approaches are expensive, labor-intensive, and logistically challenging, raising the need to develop approaches that increase attendance at SPs. Here, we report a real-time, data-driven approach to improve efficiency of an urban dog vaccination campaign. Historically, we vaccinated ∼35,000 dogs in Blantyre city, Malawi, every year over a 20-d period each year using combined fixed SP (FSP) and D2D approaches. To enhance cost effectiveness, we used our historical vaccination dataset to define the barriers to FSP attendance. Guided by these insights, we redesigned our vaccination campaign by increasing the number of FSPs and eliminating the expensive and labor-intensive D2D component. Combined with roaming SPs, whose locations were defined through the real-time analysis of vaccination coverage data, this approach resulted in the vaccination of near-identical numbers of dogs in only 11 d. This approach has the potential to act as a template for successful and sustainable future urban SP-only dog vaccination campaigns.

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“…Such a perspective, however, fails to consider the impact of rabies on individuals from rural backgrounds, particularly children [8], and the near certainty of death in the absence of access to treatment before symptoms appear. As an entirely vaccine-preventable disease disproportionately affecting the poor in low-and middle-income countries, preventing unnecessary human rabies deaths and suffering by addressing barriers to access to human PEP is an important means of achieving social justice [167]. At the same time, the cost of human PEP provision can be substantial (30 million US dollars over an unspecified timeframe in India, by one estimate) [143].…”

Section: Discussionmentioning

confidence: 99%

Rabies as a Public Health Concern in India—A Historical Perspective

et al. 2020

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India bears the highest burden of global dog-mediated human rabies deaths. Despite this, rabies is not notifiable in India and continues to be underprioritised in public health discussions. This review examines the historical treatment of rabies in British India, a disease which has received relatively less attention in the literature on Indian medical history. Human and animal rabies was widespread in British India, and treatment of bite victims imposed a major financial burden on the colonial Government of India. It subsequently became a driver of Pasteurism in India and globally and a key component of British colonial scientific enterprise. Efforts to combat rabies led to the establishment of a wide network of research institutes in India and important breakthroughs in development of rabies vaccines. As a result of these efforts, rabies no longer posed a significant threat to the British, and it declined in administrative and public health priorities in India towards the end of colonial rule—a decline that has yet to be reversed in modern-day India. The review also highlights features of the administrative, scientific and societal approaches to dealing with this disease in British India that persist to this day.

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A social justice perspective on access to human rabies vaccines

Cited by 30 publications

References 21 publications

Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic

Behavioral and structural barriers to accessing human post-exposure prophylaxis and other preventive practices in Arequipa, Peru, during a canine rabies epidemic

Using data-driven approaches to improve delivery of animal health care interventions for public health

Rabies as a Public Health Concern in India—A Historical Perspective

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