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Fighting Rabies: Notes From the Front Line

Posted: 16/07/11 01:00

When the leading lights in the global fight against rabies gather on the Filipino island of Bohol this week, enjoying the tropical climate and picture-postcard beaches will be the furthest thing from their minds.

The island, a two-hour flight from Manila, is home to a population of just over a million people and, until recently, a burgeoning number of rabies cases that was killing ten people per year - not to mention a large number of animals, whose plight always seems to be forgotten.

A terrible yet preventable disease, rabies has the highest case fatality rate of any infectious disease known to man: up until very recently, when we have seen a handful of treated victims in the US, quite simply no human or animal has ever survived it. It is also a growing problem in many parts of the world; predominantly in Africa and Asia but also in more developed regions such as the US. In total, around 150 people die from it every single day.

Yet the international conference convened by the Global Alliance for Rabies Control (GARC) in Bohol this week will be less focused on the problem of rabies, and more on ways finding a solution to it. For it was here in 2007 that GARC, with the help of the government of Bohol and a shoestring budget launched a scheme to eliminate human and dog rabies that could just prove to be a template for all other infected areas in the world.

In order to eliminate the disease in its entirety, we decided on an inter-sectoral strategy, that's scientist-speak for involving a combination of a number of disciplines, from education and vaccination to post-exposure prophylaxis and community involvement campaigns. And we sought as wide a buy-in from the community as possible so we brought the scientists, health experts, government, vets together with schools and community leaders. By the end, practically the entire population were involved. The results a reduction in the number of rabies deaths to zero in under three years.

How did we achieve this amazing result? First of all, we piloted an educational programme, incorporating basic animal handling and post-bite procedures into the national curriculum. Then, all dog owners were encouraged to get their animals registered and vaccinated: seeing as 99% of all animal - human rabies infections are performed by dogs - our success in getting 70% of all dogs registered was an important achievement.

We were also able to bring on board the island's government, which launched a responsible pet ownership scheme backed by law, and we trained medical staff at local hospitals in provision of modern post-bite treatments and the latest vaccines.
Perhaps most importantly of all, we won the support of Bohol's local communities. Without the eyes and ears of the town folk and villagers for whom keeping an eye out for suspicious animal behaviour had become part of their everyday routine, we were able to magnify the effectiveness of the other measures we had put in place.

This buy-in from the community meant our pilot project was able to completed with a very modest budget, which we calculated to be around 36p per person over three years. Cheap enough, we believe, to merit larger scale schemes in other rabies-blighted areas.

The mood in Bohol this week will essentially be one of optimism. Even with the amazing medical progress being made in the States, we are still years away from a cure for rabies, and in places like Bohol light years away, so it is all the more important that we are able to demonstrate that effectiveness of prevention. Rabies is often called the neglected disease, but at last it feels as if the international community is beginning to wake up to the scale and growth of the problem, and the opportunity we have to defeat it. Let's not neglect this disease any longer.