In the US, cases of dogs infected with the rabies virus being brought into the country are significant enough to warrant national headlines and a year-long dog importation ban on dogs from hundreds of countries worldwide.

Yet, in India, rabies does not get much media attention but it accounts for a shocking total of 20,000 human deaths each year – that’s more than 50 a day.

While the US has eliminated the dog rabies virus variant and is able to keep it controlled through active border controls, surveillance and comprehensive dog vaccination programmes, rabies in India, and at least 100 other countries throughout the world remains a significant challenge.

In these countries, people are forced to live alongside one of the deadliest diseases known to humankind. Rabies is 99% fatal to humans once symptoms appear. By the time a person shows symptoms of the virus, it is usually too late for effective treatment.

This is despite the fact that the first vaccinations for rabies date back to the 19th century.

This imbalance can, and needs to be, addressed. Although there is far less global competition for rabies vaccines than for COVID-19 vaccines, many countries are still not benefitting from the full suite of inexpensive and effective rabies control tools that exist throughout the world.

Applying what works

By combining what we already know works in controlling rabies and the extensive lessons of the COVID-19 pandemic, we can ensure the countries that need vital vaccines and resources can get them.

Firstly, knowing where the disease is most prevalent is crucial to directing vaccines, mass vaccination efforts, and other tools and resources, to effectively control rabies. 

Measures such as the Global Alliance for Rabies Control’s Rabies Epidemiological Bulletin (REB), which provides comprehensive rabies data, particularly for countries who do not have the resources or capacity to build their own systems, are leading the way in surveillance.

Likewise, technical innovation in health information systems and in-field diagnostics can also allow resource-poor countries the opportunity to build their own rabies surveillance systems in a timely and efficient manner, tracking and containing the spread of the virus.

The Community-Based Rabies Surveillance (CBRS) system, which has been used by GARC in the Philippines, links information about the biting animal from the field to laboratory and pairs this with human treatment data from clinics.

This ensures that the best treatment decisions are made, and that dog vaccinations are carried out where the rabies exposure occurred to prevent further cases in the future.

Animal health is a cornerstone of public health

Secondly, much as the COVID-19 pandemic has been managed at a country level, efforts to combat and control rabies need to be led by countries and fine-tuned to address the specific challenges that are faced in different regional contexts.

Rabies-affected countries need to be encouraged to build their own national strategies that address their unique challenges, whether they are related to funding for surveillance and rabies control, the availability of expertise or access to community animal health workers.

Finally, governments and health authorities must adopt a “One Health” outlook and prioritise animal health as a cornerstone of public health, ensuring that the vaccination of dogs can continue amid lockdowns and other restrictions that have arisen during the pandemic.

Improving the coordination between sectors and departments will be key to a holistic vision of public health which treats the disease at source, in the dogs, alongside access to human vaccines.

If dog vaccination coverage is low, particularly because of a slowdown in vaccinations during the pandemic, it is essential that dog bite victims, who may be exposed to rabies, can receive quick and life-saving treatment.

Effective surveillance

Ultimately, the persistence of rabies clearly illustrates how difficult it is to control a zoonotic disease, especially one which requires the close cooperation of countries across animal and human health departments.

Despite these difficulties, this approach is essential to create a more robust and resilient health infrastructure, for rabies and beyond.

The countries that have ended human deaths from dog rabies have done so in large part thanks to dog vaccination, access to crucial human post-exposure treatment and surveillance to monitor the disease and ensure that it is not being introduced into rabies-free zones.

That is why we must continue to strive to provide countries with support for vaccine-led strategies alongside more effective surveillance for the disease, which have also formed the centrepiece to the response of the current Covid-19 pandemic.

Rabies, despite its long history, is no less a deadly threat. Yet, while most governments have accepted that “Zero Covid” is not possible, the elimination of rabies is entirely possible through proven methods such as dog vaccination, as long as every country is adequately prepared with the tools and resources we know can work.

Professor Louis Nel is the Executive Director of the Global Alliance for Rabies Control.

Image Credits: WHO/ Daniel Stewart.