World Rabies Day 2019

Message from Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region on the occasion of World Rabies Day, 28 September 2019

The world is committed to reaching zero human deaths from dog-mediated rabies by 2030. This is a laudable – and achievable – goal. At present, dog-mediated rabies kills at least 59 000 people annually in over 150 countries across the world. The burden of disease is disproportionately borne by rural poor populations, with approximately half of all cases attributable to children under 15. The WHO South-East Asia Region is particularly affected. More than 26 000 people succumb to the disease annually. Eight of the Region’s 11 Member States account for around 45% of the global burden. Over 1.5 billion people Region-wide are at risk of rabies exposure.

As the theme of this year’s World Rabies Day – ‘Vaccinate to eliminate’ – emphasizes, the best way to tackle the problem is at its source – by vaccinating dogs. The science is clear. By achieving and sustaining vaccination coverage of at least 70% of the canine population in any given area, herd immunity against rabies is achieved. The transmission of rabies between and among dogs – and then on to humans – is no longer a threat. Mass dog vaccination, which is a pillar of the One Health approach, has already spurred significant progress across the Region, with the intervention a core part of national strategic plans.

The drive to vaccinate the virus’ main reservoir – dogs – has occurred alongside several other interventions. For example, all countries have now phased out the production and use of nerve-tissue vaccines. Six have introduced cost-effective intradermal vaccination schedules. Rabies immunoglobulin for post-exposure prophylaxis is more accessible than ever, while efforts to enhance animal birth control are being rolled out. The Tripartite Partnership between the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE) and the World Health Organization continues to work at the human-animal interface to achieve the Global Strategic Plan’s 2030 target. The WHO-supported SAARC Rabies workshop in Kathmandu, Nepal in June was particularly productive.

Though advances have been strong, more are needed. As part of the Region’s quest to sustain and accelerate progress, including via key innovations, Member States should leverage a series of opportunities to increase the coverage of dog vaccination and ensure that the threat of dog-mediated rabies is rapidly diminished.

First, Member States should complete their national action plans. Doing so is crucial to ensuring their efforts to tackle rabies are coordinated, and reflect One Health principles, and that dog vaccination proceeds in a planned manner. While most countries have carried out the ‘step-wise approach towards rabies elimination’ exercise (with technical support from the Global Alliance for Rabies Control, the Tripartite Partnership and the US Centers for Disease Control and Prevention) the uptake of detailed plans will accelerate the progress needed to reach the 2030 target.

Second, funding and buy-in for mass dog vaccination must be secured. Key to doing that is ensuring that all stakeholders are aware of the benefits of dog vaccination, and that all are on board in pursuing dog vaccination as a priority. While ministries of health should help veterinary authorities buy quality dog rabies vaccine through the OIE/WHO mechanism, the animal health sector must be motivated to take full ownership of the issue. That includes by enhancing dog rabies surveillance to evaluate impact and better target subsequent interventions.

Finally, as plans are completed and buy-in secured, all stakeholders should ensure that dog vaccination campaigns are rolled out and/or scaled up in a phased manner. Achieving 70% coverage country-wide is best done via targeted focus, meaning initiatives should first be implemented at the district level and then expanded accordingly. While the oral dog rabies vaccine could spur rapid advances, with several Member States considering its introduction, no time should be wasted in making the most of present tools, which are highly effective when used strategically and as part of a well-planned campaign.

As the Region strives to reach zero human deaths from dog-mediated rabies by 2030, the need for accelerated action is clear. By achieving at least 70% coverage of the dog rabies vaccine, Member States will create a powerful shield against rabies transmission. That shield will mark the difference between success and failure. We have the tools, and the commitment. We also know the next steps. WHO will continue to support Member States as they work to eliminate the threat to health rabies represents and ensure that a problem that is 100% preventable is 100% prevented.

Dr Poonam Khetrapal Singh
Regional Director