The Philippines is listed as one of the top ten countries carrying the rabies burden. It is estimated that 200 to 300 Filipinos die of rabies infection every year. Can we eliminate it?
BY LYKA MAE P. CHIANG
Rabies is a preventable zoonotic and human infection usually transmitted through the bite or scratch of a rabid animal. Transmission of virus may also occur when infectious material, such as saliva, comes into contact with the victim’s mucous membrane or with fresh skin lesions. In rare cases, it can also be transmitted through inhalation of virus containing aerosol or via infected organ transplants.
According to the World Health Organization (WHO), rabies affects population in more than 150 countries and territories with tens of thousands of worldwide deaths every year. The most highly attributed mortality is found in Asia and Africa.
During the 2017 National Rabies Summit, Dr. Ernesto Eusebio Villalon III, Program Manager for Rabies Prevention and Control Program, highlighted the constant increase of animal bites and human rabies cases in the country.
“In 2016, we had over a million and three hundred thousand bites, and every year, the number increases significantly,” said Dr. Villalon, citing a data from the Department of Health (DOH) Rabies Prevention and Control Program Status.
With the theme, “Rabies: Zero 2020,” the activity is geared towards the elimination of human rabies in the country and the declaration of a rabies-free Philippines by 2020.
In order to attain this vision, the WHO designed a framework called “Global Framework for the Elimination of Dog-Mediated Human Rabies,” which is intended to harmonize actions and provide adaptable and achievable guidance for country and regional strategies.
While rabies can be acquired from various animals such as dogs, cats, raccoons, bats, among others, Dr. Simeon S. Amurao, Jr., Director III of the Bureau of Animal Industry-Department Agriculture (BAI-DA), reiterated that dogs are the main culprit of animal bite cases, and 90 percent of human rabies deaths are due to dog bites. That is why the framework is pertinent to the elimination of dog-mediated human rabies.
Socio-cultural pillar of rabies elimination
Dr. Maria Nerissa Dominguez, National Professor Officer for Emerging Disease Surveillance and Response of WHO, explained the five pillars of the framework namely—socio-cultural, technical, organization, political, and resources.
A successful rabies control entails the efforts of a wide range of stakeholders including the general public. That’s why it is crucial that the at-risk population is aware of the burden of the disease. The sociocultural context influences this target.
“Socio-cultural pillar is more of the community being engaged, being aware, and being on top of the program,” said Dr. Dominguez.
The pillar implements various activities that encourage the public to be responsible pet owners and be mindful of the burden of the disease.
These include building the concept of dog-mediated rabies as preventable; promoting responsible dog ownership; implementing education programs on preventive measures and first-aid treatment; increasing understanding of post-exposure prophylaxis (PEP) imperatives and options; and encouraging the community to get involved in the process of combating dog mediated human rabies.
The pillar visions a community that has a hundred percent awareness of the disease, thus diminishing its morbidity and mortality.
Dogs are naturally born healthy, and just like humans, rabies is a disease they just acquire. A successful elimination of dog-mediated human rabies entails an effective animal health and public health systems.
According to Dr. Dominguez, the technical pillar influences the development of policies and guidelines to support the implementers of the national program, which is why it is aligned with the activities that would improve the welfare of both the people and the animals, some of which are mass dog vaccination and data gathering for proper forecasting to create and sustain logistics required for an effective implementation of the vaccination programs.
It also ensures the capability of quick and accurate rabies diagnosis through a high-end healthcare system. This is due to the fact that many individuals rely on herbal medicines that have no scientific basis when bitten by dogs, thus increasing the risk of dog-mediated human rabies.
Overall, the pillar aims to promote mass dog vaccination as the most effective intervention to achieve dog-mediated human rabies elimination.
In order to attain an effective strategy, joint efforts of groups and individuals are required. The framework made use of One Health, a collaborative, multisectoral, and trans-disciplinary approach—working through national and regional networks—to achieve an optimal health. This creates collaboration among human and animal health sectors and other stakeholders to implement rabies elimination activities.
In this pillar, the framework aims to establish good governance in order to successfully implement activities to the public. It focuses not only on one sector but the nation as a whole by aligning work plans and activities with national and regional priorities to secure harmony.
It also ensures sufficient supply of quality-assured canine rabies vaccines through vaccine banks. Additionally, every plan is made secured that it is properly targeted and will be monitored and evaluated to ensure timely and cost effective delivery.
The One Health approach will be of a great help in this vision as it helps various groups and individual work collaboratively.
Political will is vital to the success of a rabies-free nation vision. Huge bodies’ support can help gain more attraction to the project and assist in the provision of resources as needed, as well as promote the One Health approach.
Dr. Dominguez said there are international bodies that support the national program and recognize it as a national, regional, and global public good. Some of which are the World Organization for Animal Health (OIE), Food and Agriculture Organization of the United Nations (FAO), and WHO.
This pillar is geared towards the collection of greater support from political and international bodies that can help establish and enforce appropriate legal frameworks for rabies elimination, demonstrate the impacts of dog vaccination programs on human lives, and get support for active engagement and commitment to the program and promote exchange of information and experiences to leverage resources.
Rabies elimination is a long-term work thus entails a long-term support. Dr. Dominguez stressed the need for sustained financial support as the cost of some resources, such as the PEP, is excessively high. That’s why the framework includes a pillar that discusses possible methods to attain the needed resources for the program.
Case for investment is the primary source of financial aid suggested by the framework. It aims to persuade countries, policy makers, and donors to invest in the project. Having an established framework can lead to a positive impression during sales talk with the investors.
Another financial source included in the framework is to create business and investment plans. Having a basis for a plan can help avoid errors and negative impact, that’s why it is suggested that the plans must be based on the framework itself in order to know its targets, thus achieving optimal leverage resources and engagement.
Total elimination of dog-mediated human rabies is a vision that entails long work and cooperation. However, it is also a vision that is not impossible to attain. In fact, there are numerous regions in the country that have already achieved a zero-rabies community, proving that all regions of the nation can also follow such big step.
The summit—which was spearheaded by the DOH in collaboration with the Departments of Agriculture (DA), Education (DepEd), the Interior and Local Government (DILG), and other stakeholders—gathered LGUs and members of the National Rabies Prevention and Control Committee (NRPCC) to commend those municipalities that are declared rabies-free as of today and demonstrate the successful implementation of the rabies program in those areas.
“In 2016, we had over a million and three hundred thousand bites; and every year, the number increases significantly”