Rabies elimination: an opportunity for social justice
28 September 2019 | Geneva −− Rabies is an entirely preventable disease, yet close to 60 000 people fall victim its wrath each year. These deaths reflect a shortcoming in care, rather than an inevitability. The fact is, lifesaving rabies vaccines have existed for over a century, and their strategic use in disadvantaged communities can eliminate human rabies entirely.
The United Against Rabies (UAR) collaboration aims to achieve just this. They have set a goal to eliminate human rabies deaths by 2030. And, at the center of this goal, is the necessity for increased access and availability of vaccines in rabies-endemic areas.
Impoverished communities in low to middle income countries bear the majority of the global rabies burden. More than 95% of human rabies fatalities come from the continents of Asia and Africa alone. These people, many of whom are children, live in rural and underserved areas where access to vaccines is often limited and treatment results in catastrophic out-of-pocket expenses for those exposed. This perpetuates a cycle of poverty and exacerbates social inequalities. It also dissuades individuals from seeking appropriate medical attention.
If exposed to rabies, individuals should seek care in the form of immediate wound management, rabies vaccinations, and in some cases, rabies immunoglobulins. Historically, the World Health Organization (WHO) has endorsed vaccine protocols involving multiple intra-muscular rabies vaccines. However, new research has demonstrated the efficacy of intra-dermal protocols using less vaccines per individual exposed. This spares lifesaving vaccines and reduces the cost and time of treatment borne by individuals. It also reduces the burden of cost on local health systems and safe-guards against potential vaccine shortages. These intra-dermal vaccine protocols offer a cost-effective opportunity to substantially reduce the rabies burden and bridge the gap in global inequality.
But, access to human rabies vaccines alone is not enough. To achieve complete elimination of human rabies there has to be action to eliminate rabies at its source – dogs.
Up to 99% of human rabies cases are acquired from the bite of an infected dog. Therefore, investment into the elimination of canine rabies will drastically reduce the need for post-exposure prophylaxis (PEP) and make significant headway in achieving zero human rabies deaths by 2030. It is now accepted that vaccination of at least 70% of dogs in at-risk areas is the most effective way of preventing human rabies deaths and, as a result, improving social equity.
Together, with vaccination on both the human and animal front – rabies represents an obtainable opportunity to overcome a social injustice that has long plagued our world. The time for action is now, elimination of human rabies deaths is feasible.
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