Rabies could become a disease of the past. Here's what it would take

A few years ago, as a first year doctor in the Philippines, Ricky Dann Marquez had to pin a teenage patient’s hands to the hospital bed.

“It was terrible. It was terrible,” he says.

The worry was that the girl would thrash about, bite someone — or worse. “We had to tie the patient to the bed so that she would not strangle anyone,” Marquez says.

The girl’s mother informed Marquez that, a month ago, a stray dog bit her daughter — and, recently, she’d started acting strangely. She was uncontrollably aggressive and irrationally afraid of water.

She had rabies. The family did not know to seek out rabies shots for their daughter immediately after the dog bite. If they had, she’d likely be just fine. But now that she had symptoms, it was too late. There was nothing Marquez could do. Rabies tops the list of the world’s deadliest diseases with a nearly 100% fatality rate if the person bitten does not get immediate treatment.

“Her mother was just watching her at the bedside, telling her that she loves her,” Marquez recalls. “That was the most heartbreaking part when the mother was telling her goodbyes to her daughter.”

Each year, about 60,000 families say goodbye to a relative dying from rabies. And that number could be a “gross underestimate,” according to the World Health Organization, since many cases go unreported.

The vast majority of the recorded cases — a whopping 95% — are in Asia or Africa. The heaviest burden is borne by those living in poverty in rural areas, where stray dogs roam and vaccines may not be readily available or may cost more than people can afford to pay.

In Gabon, the four-dose regimen could run $25 per inoculation if the patient doesn’t have insurance coverage, according to Dr. Annick Mondjo, deputy coordinator for the country’s rabies elimination program. Plus, she says, the vaccine must be kept cold and many far-flung communities don’t have the necessary refrigeration.

As a result, she says, after a dog bite many families rely on hope — “hope that the dog is not a rabid dog.”

A new commitment

Now a new program offers a different kind of hope.

Starting this month more than 50 lower-income countries will be able to apply to Gavi, the Vaccine Alliance for financial aid to pay for the human vaccine and related supplies, like refrigeration. This initiative, which was delayed several years by the COVID pandemic, is aligned with the Zero by 30 campaign, a plan spearheaded by WHO and others aimed at ending rabies deaths caused by dogs by 2030.

“It will be a game changer,” says Terence Scott, the director of programs at the Global Alliance for Rabies Control. “It’s huge in terms of having access to that post-exposure prophylaxis — to the vaccine itself.”

However, he calls the human rabies vaccine an “interim” approach. He hopes that the Gavi announcement will push decision makers and political leaders to take another step: “We need to address the disease at its source.”

His goal is to stop rabies before it reaches people.

Aiming for dogs

 In the past four decades, North and South America have proven that rabies can be controlled. The region has slashed the number of human rabies cases by over 95%. Between January 2023 and early May 2024 the two continents had just nine cases of rabies caused by dogs.

“We have all the tools available to eliminate rabies,” says Marco Vigilato, who coordinates the Pan American Health Organization’s rabies elimination program.

One of the most essential tools, he says, is not the human rabies vaccine but the dog rabies vaccine.

According to WHO, up to 99% of human rabies cases come from dogs — it could be a bite, a scratch or even a lick, since the virus is in a rabid dog’s saliva and can make its way into a small cut in the skin.

That’s why Vigilato says public health money —- usually earmarked for humans —- should also go toward animals.

“Canine rabies kills people, so this is a public health problem,” he says.

He lauds the success of regular, mass dog vaccination campaigns that are free for dog owners — and that enlist not only veterinarians, Vigilato says. Doctors, dentists and nurses join the effort, as do police and army personnel.

Others have taken note, including Kenneth Chawinga,who wanted to see if what had worked in the Americas might work in Zambia.

In 2018, when he was the district veterinary officer in Kabwe District in central Zambia, he realized his community was spending so much money on vaccinating people after they’d been exposed to rabies that it would be cheaper to vaccinate the thousands of dogs in the district.

But, he says, before he could launch a mass dog vaccination, he needed to confront another challenge. In his rural area, where dogs are often used for hunting, there was a myth floating around.

“[They] think, if you vaccinate their dogs, then they would become weak. They wouldn't be strong hunters,” he says.

After convincing a local company to pay for the vaccines, he reached out to the community, he says, “through the local radio station and through the traditional leaders, because these have got influence, especially in rural areas.”

Pet owners came to public vaccination events. The vaccinators also hit the streets to give shots to free roaming dogs. He estimates that they’ve reached more than 70% of dogs in the district.

And Chawinga says it's made a difference.

“For a year now, we have not received a case of rabies in humans,” says Chawinga, who now works for Zambia’s Department of Veterinary Services. Vaccinating dogs “is not only the cheapest option, it's also the most effective one.”

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