Rabies is included in the neglected tropical disease roadmap of WHO. As a zoonotic disease, it requires close cross-sectoral coordination at the national, regional and global levels.
Global level activities
In December 2015, a global framework to reach zero human rabies deaths by 2030 was launched by WHO and the World Organisation for Animal Health (OIE), in collaboration with the Food and Agriculture Organization of United Nations (FAO) and the Global Alliance for Rabies Control. This initiative marks the first time that both the human and animal health sectors have come together to adopt a common strategy against this devastating and massively neglected disease.
Monitoring and surveillance of the disease should be a central element of every rabies programme. Declaring a disease notifiable is crucial to establish functional reporting. This should include mechanisms for the transmission of data from the community level to the national level and on to the OIE and WHO. This will provide feedback on programme efficacy and allow for actions to be taken to improve areas of weakness.
Stockpiles of dog and human rabies vaccines have had a catalytic effect on rabies elimination efforts. WHO, with partners, is working to forecast the global need for human and dog vaccines and rabies immunoglobulin, to understand the global manufacturing capacity and to explore bulk purchasing options for countries through WHO/UNICEF (human vaccine and RIG) and OIE/WHO (animal vaccine) mechanisms.
In 2016, the WHO Strategic Advisory Group of Experts on Immunization (SAGE), established a working group on rabies vaccines and immunoglobulins. The working group is currently reviewing the scientific evidence and the relevant programmatic considerations for their use and best vaccine regimens as well as evaluating the potential impact of new biologicals. The proposed recommendations resulting from this work will be considered by SAGE in October 2017 to update WHO’s position on rabies immunization.
With the support of WHO, selected countries in Africa and Asia are conducting prospective and retrospective studies to gather data on dog bites and rabies cases, PEP treatment and follow-up, vaccine needs, and programme delivery options. This information will provide further evidence to support the need for investment in rabies programmes and will inform the vaccine investment strategy of the GAVI Alliance in 2018.
Regional and country examples
Since 1983, countries in the Region of the Americas have reduced the incidence of rabies by over 95% in humans and 98% in dogs. This success has been achieved mainly through the implementation of effective policies and programmes that focus on regionally coordinated dog vaccination campaigns, raising public awareness, and widespread availability of PEP.
Many countries in the WHO South-East Asia Region have embarked on rabies elimination campaigns in line with the target of regional elimination by 2020. Bangladesh launched an elimination programme in 2010 and, through the management of dog bites, mass dog vaccination, and increased availability of vaccines free of charge, human rabies deaths decreased by 50% between 2010–2013.
Great strides have also been made in the Philippines, South Africa and Tanzania where proof of concept projects, as part of a Bill & Melinda Gates Foundation project led by WHO, recently showed that a reduction in human rabies cases is possible through a combination of interventions involving mass dog vaccination, improved access to PEP, increased surveillance and raising public awareness.
The key towards sustaining, and expanding the rabies programmes to adjacent geographies has been to start small, catalyse local rabies programmes through stimulus packages, demonstrate success and cost-effectiveness, and ensure the engagement of the government and affected communities.
WHO with its partners, FAO, OIE and the Global Alliance for Rabies Control is developing a costed action plan to reach zero human deaths by 2030. This plan covers policy, human and animal interventions, awareness raising and advocacy, capacity building, and the respective resources needed for elimination of the disease in countries still suffering from rabies.
