Achieving Zero Rabies deaths through One Health Approach

Every year, an estimated 59 000 people in 150 countries die of rabies, one of the oldest and most terrifying diseases known to mankind. Rabies is caused by infection with a lyssavirus, spread via bites and scratches of infected animals. Dogs are responsible for 99% of human cases. Around 95% of human cases are occurring in the regions of Africa and Asia disproportionally affecting rural poor populations. Approximately half of the cases attributable to children under 15 years. The economic burden of rabies is estimated at 8.6 billion US dollars per annum, a significant cost on the shoulders of the world’s poorest and most disadvantaged communities.

Nearly 45% of rabies deaths occur in Asia. More than 1.4 billion people in the South-East Asia Region are at risk of rabies infection. Of the 11 Member States in the region, eight Member States are endemic for rabies while India accounts for 59.9% of rabies deaths in Asia and 35% of global deaths.

In February 2015, the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (WOAH) and the Global Alliance for Rabies Control (GARC) united to launch the “End Rabies Now” campaign, which proposed a goal of zero human rabies deaths by 2030. The goal is aligned with the United Nations Sustainable Development Goal (SDG) 3, specifically the targets 3.3, and 3.8, ending the neglected tropical diseases and achieving universal health coverage are highlighted respectively. As rabies disproportionately affects poor and rural communities, eliminating human deaths from rabies is also consistent with SDG 1 to “end poverty in all its forms”. The goal of zero human rabies deaths by 2030 was adopted by the “Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030” which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups, including rabies.

Sri Lanka has achieved successful reduction of human rabies deaths from 377 (2.9 per 100 000 population) in mid 1970s to 31 in 2021. Application of strong public health interventions such as dog vaccination and rabies Post-Exposure Prophylaxis (PEP) are the key pillars of this success story.

Engaging communities to build awareness on rabies, vaccination of dogs to prevent human disease, surveillance, and canine population control requires close One Health collaboration between, at a minimum, the human and veterinary health sectors. Sri Lanka has been in the forefront of initiating an integrated One Health approach towards rabies prevention, control and disease management. 

WHO Sri Lanka partnered with Public Health Veterinary Services, Ministry of Health (MoH) for the development of the National Strategic Plan (NSP) 2022-2026 for elimination of dog- mediated human rabies through One Health approach. Together with the MoH, organizations representing animal health and wildlife, local governments, education sector, academia, research, Sri Lanka Police, Information and Communication Technology, Government Information, Agriculture, Non-Governmental Organizations (NGOs), Community-Based Organizations (CBOs) and vulnerable population groups participated in the development process of NSP. The National Strategic Plan for elimination of dog-mediated human rabies 2022-2026 recommends evidence-based coordinated actions focused on eliminating dog-mediated human rabies by 2025 under three key objectives:

1. Strengthen leadership, legislation, stewardship, and management functions of the elimination of human rabies.
2. Ensure the delivery of comprehensive services to eliminate human rabies, and to promote health and
3. Empower communities towards active participation in the elimination of human rabies.

WHO further supported rabies field surveillance by providing tool kits, IT equipment for the implementation of web-based surveillance system and logistics for the dog vaccination programmes. WHO Sri Lanka also continues to provide technical guidance for the rabies control programme in Sri Lanka to achieve its mission and become one of the pioneer countries reaching its elimination targets set at 2025 well ahead of the global timeline.  

Caption: Rabies National Strategic Plan presentation- multistakeholder debriefing meeting 

Photo credits: Public Health Vetanirary Services

Caption: Anti-rabies vaccination of stray dogs