The WSU Paul G. Allen School for Global Health is working with international partners to eliminate rabies as a cause of human suffering and death by 2030 as part of the “Zero by 30” campaign launched by the World Health Organization, World Organization for Animal Health, and the Food and Agriculture Organization.
Rabies is one of the deadliest diseases on the planet. Once clinical signs appear, the disease is almost always fatal. Every year, rabies kills more than 60,000 people, mostly in Africa, India and other parts of Asia. More than 99% of the cases are contracted from a dog bite.
Since the disease is preventable in Africa and Asia when 70% of dogs are vaccinated regularly, to reach the goal of eliminating human death from canine rabies, the global focus needs to be on decreasing the cost of vaccinating dogs and increasing access.
The WSU rabies vaccination programs, currently in Kenya and Tanzania, focus on scientific research and in-country program development to enable more communities to be reached with vaccination campaigns in the most cost-effective manner.
WSU’s faculty are looking at the problem from two perspectives:
- In Tanzania, researchers focus on questions related to the vaccine, its efficacy under different storage and distribution conditions, and developing cost-effective approaches to deliver the vaccine at scale across remote landscapes.
- In Kenya, the focus is on strategies and tools countries can use to design mass-dog vaccination campaigns and surveillance for rabies in people and their animals where limited, or no, resources have been previously deployed.
The WSU Rabies Vaccination Program is aligned with the Global Alliance for Rabies Control, the World Health Organization, the World Organization for Animal Health, the Centers for Disease Control, the Food and Agriculture Organization of the UN, MSD Animal Health, and the World Veterinary Association. Research discoveries are broadly shared to improve mass-dog vaccination campaigns run by governments, nonprofit organizations, and other groups around the world.
Why hasn’t rabies been eliminated?
The vaccine to prevent rabies has been around for more than 100 years – it is a proven method for preventing both human and canine rabies. That is why human death from canine rabies in the developed world is virtually nonexistent, but the challenge arises in countries with insufficient veterinary infrastructure and financial investments required to vaccinate enough dogs to break rabies transmission chains.
To eliminate human deaths from canine rabies by 2030, three factors are important:
- The average cost of vaccinating dogs must decrease.
- The number of vaccines available for vaccinating dogs needs to increase and reach areas endemic for rabies.
- The animal health workforce needs to be mobilized for vaccinating dogs in developing countries.
The work of the WSU Rabies Vaccination Program focuses on research to decrease the average cost of implementing vaccination campaigns and to design strategies that will enable countries to complete rabies elimination campaigns.
What is WSU doing in Tanzania to eliminate rabies?
A series of rabies outbreaks in the 1980s and 1990s led to the local extinction of African wild dogs in the Serengeti National Park. As a result of these outbreaks, the original goal of the Tanzanian program was to protect wild carnivore species like African wild dogs and lions in the Serengeti National Park from rabies. However, what began as an initiative to save wildlife soon transitioned into a program to protect people.
It was discovered the source of the outbreaks in wildlife species was not a wildlife reservoir but the domestic dogs living around the park. Research demonstrated vaccinating the dogs living around the perimeter of the Serengeti not only eliminated the disease in the dogs but also controlled the disease in the wildlife species. A decade after vaccination campaigns began packs of wild dogs returned to the national park.
The number of cases of human rabies deaths in the research area since has drastically decreased. The vaccination team created a cordon sanitaire – a rabies free zone – that covered approximately 11,000 square kilometers.
“Human incidence of rabies in the vaccination zone has been reduced to almost zero since the project began,” said Dr. Felix Lankester, WSU clinical assistant professor and director of the Serengeti Health Initiative. “Before the program, there would have been 50 to 100 cases of rabies each year and most people would have witnessed someone with the disease.”
Today, the focus of the program in Tanzania is to research ways to decrease the cost of delivering the vaccine to communities, especially in rural areas. Each year, the team visits 180 villages in seven districts adjacent to the Serengeti and vaccinate an average of 300 dogs per day.
Because of the long-term commitment to the program, these communities provide a consistent platform for research. For example, Dr. Lankester completed a study demonstrating the rabies vaccine used to inoculate dogs is thermo-tolerant and can be stored for extended periods of time outside of refrigeration units without losing its ability to protect dogs against rabies. Follow-up studies are focusing on using the thermo-tolerant vaccines to create efficient vaccination programs that can be used to deliver vaccines cheaply to rural communities throughout the year.
What is WSU doing in Kenya to eliminate rabies?
The program in Kenya represents the second phase of the work by WSU faculty to identify community-based programs that are replicable across a country and the globe.
The research underway by Dr. Thumbi Mwangi, assistant professor in the Paul G. Allen School for Global Health, is in creating strategies and tools governments can use to determine the resources needed to undertake a rabies elimination campaign.
In Kenya, the team started in two regions that included both rural and urban communities. One of the first questions they needed to answer was how to estimate the ratio of dogs to humans and estimate dog populations in each region. They also knew the most cost-effective way to vaccinate is to have people bring the dogs to you. But, who would bring the dogs and how far would they travel?
Through the studies, Dr. Mwangi calculated human-to-dog ratios for both urban and rural environments and determined children – not adults – bring the dogs to the vaccination clinics. When vaccination clinics are designed around school holidays and located in easy-to-access locations, the likelihood of reaching the 70% threshold to break the transmission cycle increases greatly.
Most countries with a high incidence of rabies have limited resources to put toward public health initiatives. Knowing this, the team created a planning tool countries can use to estimate resources, both financial and staff, needed to design and execute rabies elimination programs. They have also developed enhanced surveillance systems for rabies in dogs and people in health facilities and communities required to measure the impact of vaccination campaigns and provide rabies burden data that help governments prioritize rabies elimination. The campaign in Kenya also includes an enhanced education campaign for dog bite victims and updated human health systems for easier access to post-exposure prophylaxis.