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Rabies, a disease considered all but eliminated in humans in the developing world, still causes significant deaths in poorer countries. According to the World Health Organization, at least 150 people die from rabies every day, with 99% of human rabid deaths caused by bites from infected dogs predominantly in Asia and Africa.

But the success of a pilot programme designed to eliminate rabies in thePhilippines, has given hope to health professionals worldwide. With political will, community participation and modest funding (GBP 0.36 per person for three years), the island of Bohol has succeeded in dramatically reducing the impact of a disease that used to kill 10 people annually.

In recognition of the achievements of the community of Bohol to build a sustainable rabies control program, representatives from 10 countries gathered in the Philippines last week to hear from the locals about the successes, challenges and lessons learned from their project, which has left the island province with only one suspected case of rabies in humans since 2008.

The example provided by the Philippines, a country considered a top 10 rabies hotspot in the region, could provide a much-needed light at the end of the tunnel for many developing countries where rabies, known as the “neglected disease”, has received little attention and few attempts to fight it.

According to Dr Deborah Briggs, of Global Alliance for Rabies Control (GARC), the British NGO which partnered the provincial government in Bohol, rabies has the highest case-fatality rate of any disease that infects humans. She explains: “It generally affects the very poor and the people who get rabies die and therefore disappear. There are no walking wounded.”

The core strength of the country’s holistic, “bottom-up” approach has been a team of 15,000 volunteers, medical staff and other officers, working with dog registration, mass vaccine campaigns and management of stray dogs.

In 2007, the majority of dogs on the island of 1.2 million people were not vaccinated, the life-saving post-exposure treatment was not affordable to the local population, and rabies vaccines were in short supply.

Today, more than 70% of the dogs have undergone mandatory registration and vaccination, and the number of clinics offering post-bite treatment has increased five-fold.

Dr Betsy Miranda, the Asian co-ordinator of GARC, says: “We encourage people to keep dogs only if they can afford to care for them properly. She continues: “And treatment after a dog bite is essential – if you don’t receive a vaccine after being bitten by an infected dog, you will most likely die. The incubation period can be from a few days to a few months.”

As rabies affects mainly children under 15, a public school education campaign has been incorporated into the national curriculum, integrating messages about the disease and how to care for your dog into five different subjects taught to primary school children.

This innovative approach to spreading awareness has been an invaluable tool and one that GARC has begun to emulate in India and Africa. These educational modules are being investigated by rabies experts in other Asian countries as a potential strategy to save the lives of other children living in high risk areas.

Involving departments such as health, medicine, agriculture, environment, education, animal health and the legal system, the Philippine programme also provides a model of what can be achieved when a deep commitment and sense of co-operation exists both across different sectors and within different levels of government.

Briggs says: “Historically, when people have just been given money and told to do it yourself, the programme often fails. So the idea for this project was to create it in a sustainable way and do the planning and implementation as a partnership with government, but also to involve the local community, thereby empowering them to take ownership and feel that this is their programme.”

Renowned author and GARC patron Alexander McCall Smith adds: “This is a disease that is not awaiting its great scientific breakthrough. The means of tackling it are already there. All that is required is the will to do something about it.”

Featured Photo: Noah Seelam/AFP/Getty Images

July 18, 2011

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