Elimination of Dog-Mediated Human Rabies Deaths by 2030: Needs Assessment and Alternatives for Progress Based on Dog Vaccination

Abstract

BackgroundRabies imposes a substantial burden to about half of the world population. The World Health Organization (WHO), World Organization for Animal Health, and the Food and Agriculture Organization have set the goal of eliminating dog-mediated human rabies deaths by 2030. This could be achieved largely by massive administration of post-exposure prophylaxis—in perpetuity—, through elimination of dog rabies, or combining both. Here, we focused on the resources needed for the elimination of dog rabies virus by 2030.Materials and methodsDrawing from multiple datasets, including national dog vaccination campaigns, rabies literature, and expert opinion, we developed a model considering country-specific current dog vaccination capacity to estimate the years and resources required to achieve dog rabies elimination by 2030. Resources were determined based on four factors: (a) country development status, (b) dog vaccination costs, (c) dog rabies vaccine availability, and (d) existing animal health workers. Our calculations were based on the WHO’s estimate that vaccinating 70% of the dog population for seven consecutive years would eliminate rabies.FindingsIf dog rabies vaccine production remains at 2015 levels, we estimate that there will be a cumulative shortage of about 7.5 billion doses to meet expected demand to achieve dog rabies elimination. We estimated a present cost of $6,300 million to eliminate dog rabies in all endemic countries, equivalent to a $3,900 million gap compared to current spending. To eliminate dog rabies, the vaccination workforce may suffice if all public health veterinarians in endemic countries were to dedicate 3 months each year to dog rabies vaccination. We discuss implications of potential technology improvements, including population management, vaccine price reduction, and increases in dog-vaccinating capacities.ConclusionOur results highlight the resources needed to achieve elimination of dog-mediated human rabies deaths by 2030. As exemplified by multiple successful disease elimination efforts, one size does not fit all. We suggest pragmatic and feasible options toward global dog rabies elimination by 2030, while identifying several benefits and drawbacks of specific approaches. We hope that these results help stimulate and inform a necessary discussion on global and regional strategic planning, resource mobilization, and continuous execution of rabies virus elimination.

Estimating the effectiveness of vaccine programs in dog populations

“…Campaigns considered in this analysis reflected heterogeneous populations of dogs and campaigns: dog confinement rates varied from 15% to 80%, vaccination strategies included CP, DD, ORV and CVR and programs had varying levels of vaccination experience [20]. Despite this heterogeneity, the tool gave accurate predictions of dog vaccination coverage, often within 6% of the field-derived vaccination coverage estimates.…”

“…Respondents were neither given access to the vaccination tool nor were they allowed to alter input data based on model output. Coverage estimates for each campaign were also modelled using input values derived from the GDREP (Box 1) [20]. …”

Trends and spatial distribution of animal bites and vaccination status among victims and the animal population, Uganda: A veterinary surveillance system analysis, 2013 – 2017

“…Regardless, findings from this study provide important information for Uganda. Vaccinating pets is one of the most important ways to prevent rabies infections among both animals and humans (7,22). However, there are clear gaps in pet vaccination in Uganda; fewer than one in ten pets were vaccinated in our analysis.…”

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014–2015

“…Using intradermal regimes instead of intramuscular regimes of PEP administration could reduce the direct cost of vaccines by 60–80% 1,18. There is limited evidence that dog population management methods are effective at reducing the rates of dog rabies, although theoretically they could support vaccination campaigns; however, these programs can be very costly 35–37. Animal surveillance and control are usually in the realm of the ministry of agriculture, but a substantial share of the costs from rabies exposures fall on the ministry of health, which makes coordinating rabies prevention challenging.…”