Rabies

From concept to completion: the rabies control pilot project supported by the Bill & Melinda Gates Foundation

Background

From 2009 to 2013, the World Health Organization (WHO) led a pilot project funded by the Bill & Melinda Gates Foundation in three candidate territories known to have a high prevalence of canine rabies: KwaZulu-Natal province in South Africa; the south-eastern part of the United Republic of Tanzania and the Visayas archipelago in the Philippines.

Objective

The objectives of the project were:

  • to demonstrate that human rabies can be prevented through the control of rabies in dogs using a One Health approach combining global public and veterinary health; and
  • to collect valuable evidence for the efficacy and feasibility of this strategy for use worldwide.
Strategy

The strategy was to make existing control measures sustainable in the three territories and to demonstrate the feasibility, cost–effectiveness and benefits to human health from elimination of canine rabies.

The tactical choice of project regions – in East Africa, South Africa and an Asian archipelago – was intended to compare data by various geographical, demographic, cultural and organizational factors.

The five objectives underpinning the rabies control strategy in each area were:

  • to collect baseline data
  • to improve the delivery of post-exposure prophylaxis (PEP) and pre-PEP according to WHO guidelines
  • to evaluate domestic dog rabies control plans
  • to improve surveillance and diagnostics; and,
  • to ensure long-term sustainable rabies control.
Key outcomes

Data gathered during the pilot project demonstrated that rabies control policies are effective and feasible. The key outcomes of each project area are as follows:

  • The Philippines
    • Increased coverage of dog vaccination with associated decreases in the numbers of positive canine rabies cases and human rabies deaths (comparing 2008 and 2013 data);
  • KwaZulu-Natal
    • Elimination of human rabies (the last human cases were recorded in 2013), improved rabies information databases and extension of control strategies to some neighbouring regions.
  • United Republic of Tanzania
    • Elimination of human and dog rabies in Pemba Island (zero cases reported since 2014); improved data availability through mobile phone-based surveillance; demand for human PEP in most areas reduced as dog vaccination campaigns improved.
Key lessons learned
  • Success breeds success. Rabies “champions” enhance participation in campaigns at local and national levels.
  • Projects must be kick-started. Funding catalyses implementation of national rabies control strategies. The “Just Start!” motto encourages action and the belief that any action, no matter how small, is better than no action.
  • Data collection is essential. Data are used to determine strategies for resource allocation and funding as well as to monitor project progression or new outbreaks. The processes of data collection were improved and refined as the project progressed.
  • International support is important. WHO and the Bill & Melinda Gates Foundation gave weight to the campaign and helped to drive action on the ground.
  • Political support directly affects project success. Committed, enthusiastic local leadership in the United Republic of Tanzania was key to mobilizing resources and achieving vaccination targets.
  • Organizational structure contributes to the success of project implementation. Staff training and effective planning and budgeting are essential to the success of a project.
  • External factors can significantly impact a project’s success. Adverse weather conditions (such as Typhoon Haiyan in the Philippines in 2013), disease outbreaks and events (such as the Philippines’ local government elections during March–May 2013) can impact implementation by halting projects or diverting financial and human resources from rabies control projects to other areas. Planning should include a disaster preparedness plan, or alternative strategies in response to potential external factors.
Looking ahead
  • At national level
    • Maintain the rabies control policies and successes when the funding from the Bill & Melinda Gates foundation ends.
  • At local and national levels
    • Sustain the rabies elimination gains through strong financial and political support and ownership of programmes.
    • Use the WHO Rationale for investing in the global elimination of dog-mediated rabies as evidence for the feasibility of implementation of rabies control worldwide.

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WHO–Bill & Melinda Gates Foundation joint project

A project funded by the Bill & Melinda Gates Foundation and coordinated by WHO