What’s so special about 2030?

Opinion Piece – Prof Louis Nel, Executive Director, GARC  

On December 10 and 11 this year, the global rabies community will meet in Geneva to set into motion a plan to eliminate rabies. The conference, called Global elimination of dog–mediated human rabies – The Time Is Now, will acknowledge that the world has a window of opportunity to defeat the scourge of rabies for once and all.

The global community has agreed a target of 2030 to achieve health for all, under the United Nations Sustainable Development Goals; and a priority is to eliminate neglected tropical diseases, of which rabies is one. The Time is Now conference presents a unique opportunity to demonstrate national and regional commitment to the elimination of dog-transmitted human rabies by 2030. 

At the regional level, in 2014, the countries of the ASEAN (Association of Southeast Asian Nations), launched a rabies elimination plan anchored on a “One Health “approach through the use of STOP pillars (S-Socio cultural; T-Technical; O-Organizational and One Health Framework; P-Policy and Legislative). Some 608 million people are at risk of rabies in these countries, with dogs remaining the most important maintenance host and 96% of documented human cases due to contact with infected dogs.

In June 2015, the countries of Africa launched the Pan African Rabies Control Network (PARACON) which similarly seeks to adopt a stepwise One Health approach to eliminate dog and human rabies from the continent and freeing the estimated 1 billion people from the risk of rabies.

A broad target date within 15 years to end the scourge of human rabies is a good thing, but equally, it is an ambitious effort that will require great concentration and political will to achieve.  So why set a target? For one thing, it is because rabies causes 59,000 entirely preventable deaths a year, and it has far-reaching consequences for the health and economies of the countries where it still occurs. The costs run into the billions of dollars annually, and these losses feed into the downward spiral of suffering, poverty and ill health.  A leisurely approach to the disease is not an option.

Countries and regions that have successfully brought rabies under control are lending their experience in bilateral collaborations to those still fighting the disease. This support is evident in various regional rabies networks, such as ASEAN, PARACON, Middle East and Eastern Europe Rabies Expert Bureau (MEEREB),  South Asian Association for Regional Cooperation (SAARC), Rabies in Asia (RIA) and Meetings of Directors of National Programs for Rabies Control in Latin America (REDIPRA) among others. Against this plurality of effort and commitment, fifteen years should give enough time for the world to eliminate dog-transmitted human rabies. We know from pilot projects that vaccinating a minimum of 70% of dogs annually for three years can break the cycle of transmission of canine rabies. If comprehensive efforts started today, each country would have five cycles to attempt to eliminate rabies; more realistically, 15 years provides even the most challenged countries with the opportunity (with support) to upgrade their health infrastucture in order to implement and execute rabies action plans.

Finally, the elimination of rabies is an eminently suitable marker for the success of broader disease monitoring, surveillance and elimination efforts. It has been demonstrated that targeted and sustained dog vaccination will have a major effect and can achieve total elimination of dog rabies. If dog rabies can be effectively controlled globally, the effort will yield added benefits of improved healthcare systems. Indeed, given the nature of dog rabies as a classical zoonosis, succesful control and elimination of this disease will exemplify a bold new era in global disease control, embracing and sanctioning the value and viability of the One Health approach.