Table 1.
Key elements within current rabies partnership(s) based on: (1) identified gaps in areas related to canine rabies prevention, control, and elimination; (2) strategies agreed upon to address these gaps; (3) knowledge and resources provided by partners within the coalition; (4) programs established to address these gaps; (5) progress to date.
| Key elements for canine rabies elimination | Gaps identified | Strategy agreed upon | Partners providing expertise to address gap | Program established to address gap | Progress |
|---|---|---|---|---|---|
| Human rabies prevention | Lack of awareness about appropriate rabies prevention strategies | Increase awareness about strategies and prevention behaviors amongst public health practitioners and community members | Health communicators (GARC), global public health organizations, animal welfare organizations | WRD, Rabies Blueprint, GARC newsletter, pilot projects (all), Blue Dog campaigns | Continuing efforts. Canine Rabies Blueprint completed |
| Limited availability, affordability, and accessibility of human biologics | Determine most cost-effective strategies by defining vaccination strategy options and quantifying the vaccine/strategy costs and health impact implications of each designated option | Health economists, global public health organizations, academic partners, vaccine industry, country representatives, regional networks | Evaluate cost effectiveness of different vaccination strategies for pre- and postexposure vaccination (PRP, WHO, BMGF) | Data analyses in progress, some publications under review | |
| Increase/build capacity for local production of human biologics and for implementation of alternative, more cost-effective, vaccination strategies | Global public health organizations (WHO), WHO collaborating centres | PRP | Continuing efforts | ||
| Poor awareness as to effective rabies control strategies | Increase awareness amongst animal health workers and community members | Health communicators (GARC), global public and animal health organizations (WHO, OIE, FAO), WHO collaborating centres, animal welfare organizations | WRD, Rabies Blueprint, GARC newsletter, pilot projects (all) | Continuing efforts. Canine Rabies Blueprint completed | |
| Animal rabies control | Insufficient knowledge of global cost of mass dog vaccination strategies compared to human rabies prophylaxis | Identify, characterize, and compare country and global implementation-related costs associated with each rabies prevention/control option, and impacts of intervention | Health economists, global public health organizations, academic partners, vaccine industry, country representatives, regional networks | Evaluate cost effectiveness of different vaccination strategies for pre- and postexposure vaccination as well as mass dog vaccination (PRP, WHO, BMGF, OIE, FAO) | Data analyses in progress, some publications under review |
| Insufficient local capacity for implementation of large-scale vaccination programs | Strengthen/build national capacity to carry out mass dog vaccination campaigns. Identify opportunities for integrating dog rabies control with other community-led animal or human health programmes | Global public and animal health organizations, academic partners, animal welfare organizations, regional networks | Rabies Blueprint, pilot projects (all), NTD mass drug administration initiatives (WHO), OIE, and FAO initiatives | Continuing efforts. Canine Rabies Blueprint completed | |
| Poor awareness as to ethically acceptable strategies to deal with dog-mediated health issues | Establish capacity in animal welfare and humane dog population management methods | Animal welfare organizations, OIE, FAO, WHO | Pilot projects (all) | Continuing efforts | |
| Unavailability of cost-effective dog population control methods | Institute new research and development efforts in less costly and ethically acceptable dog population control methods | WHO collaborating centres, vaccine industry, animal welfare organizations | Research program led by USDA & CDC, OIE, FAO | Trials initiated | |
| Inadequate emergency plans/poor capacity to deal with unexpected outbreaks (especially reintroductions into rabies-free areas) | Develop emergency response strategies to contain unexpected outbreaks/ reintroductions |
Global public and animal health organizations (WHO, OIE, FAO), academic partners, animal welfare organizations, regional networks | Rabies Blueprint, pilot projects (Bali, KZN) | Continuing efforts. Canine Rabies Blueprint completed | |
| Diagnostics and surveillance/notifiability | Weak surveillance and diagnostic capacity | Strengthen local surveillance and diagnostic mechanisms through knowledge/materials transfer, focusing on available standardised techniques suitable for poorly resourced countries | WHO collaborating centres, academic partners | PRP, Rabies Blueprint, pilot projects (all) | Achieved in some settings, work in progress in others. Canine Rabies Blueprint completed |
| Develop user-friendly field-based techniques for rapid detection and reporting of rabies cases in humans and animals. Harness communication technology to provide critical feedback for clinicians and veterinary officers, and to incentivize reporting. | WHO collaborating centres, academic partners | CDC development of DRIT, VLA serology, and molecular tests, UBS projects, evaluation of field tests | DRIT and rapid tests evaluated, mobile phone systems undergoing evaluation | ||
| Insufficient number of countries where rabies is notifiable | Implement campaigns worldwide to make rabies a notifiable disease | Global public and animal health organizations, GARC | Rabies Blueprint, research and advocacy program within GARC to increase notifiability | Continuing efforts. Canine Rabies Blueprint completed | |
| Insufficient knowledge of the impact of rabies education in increasing awareness and improving health practices for rabies prevention and control | Demonstrate the effectiveness of educational programs for children in reducing exposure rates in children as well as members of society | GARC, academic partners, country representatives, global public health organizations | Pilot projects (Bohol, Tanzania) | Evaluation in progress | |
| Education | Lack of local capacity to implement rabies education in schools | Implement training of local educators and school heads in rabies education | GARC (educators), country representatives | Research program within GARC | Completed in some settings, work in progress in others |
| Limited availability/accessibility of rabies educational material in poorly resourced countries | Develop rabies educational material compatible with local circumstances and disseminate it through global networks | GARC (educators and health communicators), regional networks, local partners, academic partners, CDC | WRD, Rabies Blueprint, CDC outreach program | Canine Rabies Blueprint completed, continuous production and distribution of educational material | |
| Insufficient coverage of existing rabies education initiatives | Incorporate rabies education into school curricula | GARC (educators), regional networks, country representatives | Pilot projects (Bohol, Tanzania) | Continuing efforts | |
| Insufficient dialogue/information sharing among global rabies workers/leaders | Build global networks and consensus amongst key opinion leaders and experts to speak with one voice about the best approaches for rabies prevention and control, to encourage governments to act on their recommendations, to bring the case for rabies prevention and control to the international community, and to advocate for more financial support for rabies programs | GARC, global public health organizations | PRP, WRD, global health organizations, OIE, FAO | Global networks formed | |
| Advocacy and communication | Lack of accurate data on rabies burden, hence low recognition among public health practitioners and policy makers | Reassess the global burden of rabies, including health impacts and global cost of human prophylaxis—see also human rabies prevention | Health economists, health organizations, academic partners, vaccine industry, country representatives, regional networks | Re-evaluate global economic impact of rabies (PRP, WHO, OIE, FAO, BMGF) | Work in progress |
| Lack of models demonstrating the feasibility and effectiveness of an integrated approach to rabies elimination | Create replicable and sustainable successful models, acting as exemplary show cases | Health organizations, GARC, animal welfare organizations, academic partners, vaccine industry, country representatives | Pilot projects (all) | Pilot projects established and in progress | |
| Lack of involvement of children's health organizations in the global campaign against rabies | Advocacy strategies based on the impact assessment of incorporating rabies education into school curricula—see also education | GARC | Pilot projects (all) | Continuing efforts | |
| Slow translation of research-driven knowledge on rabies and its control into effective public health policy and practical action | Develop communication strategies specifically targeting policy makers | GARC (health communicators), global public health organizations | Global e-communications program within GARC | Continuing efforts | |
| Insufficient engagement of policy makers and communities at risk in rabies prevention and control | Build rabies communication plans into rabies control/elimination programs | GARC (health communicators) | Rabies Blueprint | Canine Rabies Blueprint completed | |
| Social mobilization and community outreach | Insufficient rabies prevention and control efforts because rabies affects “neglected” communities | Empower local communities to express their concerns by giving them a global voice to be heard | GARC | WRD, pilot projects (all) | Continuing efforts |
| Lack of priority given to rabies prevention and control at the central level | Empower local communities to take action and establish their own rabies control programs | GARC | WRD, pilot projects (all) | Continuing efforts, established in some settings | |
| Funding | Existing programs lack of sustainability mechanisms | Develop field programs aimed at examining sustainability and innovative funding mechanisms to support long-term rabies control | GARC, global public health organizations, country representatives | Pilot projects (all) | Pilot projects established, evaluation in progress |
| Lack of models demonstrating the feasibility and effectiveness of an integrated approach to rabies elimination | Use successful pilot projects as exemplary show cases to attract international funding support | Global public and animal health organizations, GARC, animal welfare organizations, academic partners, vaccine industry, country representatives | Pilot projects (all) | Pilot projects established, evaluation in progress | |
| Current global burden data is not sufficient to interest major donors to fund rabies prevention | Reassess the global burden of rabies and establish impact data, [see also human rabies prevention], that will persuade the international funding community that investing in rabies prevention/control is worthwhile | Health economists, global public health organizations, academic partners, vaccine industry, country representatives, regional networks | Re-evaluate global economic impact of rabies (PRP, WHO, OIE, FAO, BMGF) | Work in progress | |
BMGF: Bill & Melinda Gates Foundation; CDC: Centers for Disease Control and Prevention; DRIT: direct rapid immunohistochemical test; GARC: Global Alliance for Rabies Control; FAO: Food and Agriculture Organization; KZN: KwaZulu Natal; NTD: neglected tropical disease; OIE: World Organization for Animal Health; PRP: Partners for Rabies Prevention; UBS: UBS Optimus Foundation; USDA: United States Department of Agriculture; VLA: Veterinary Laboratories Agency; WHO: World Health Organization; WRD: World Rabies Day.