Abstract
As canine rabies control in Africa and Asia transitions from research-led proof-of-concept studies to government-led programs for elimination, experience and evidence of their impact and costs must be shared for the benefit of future programs. The Ilocos Norte Communities against Rabies Exposure project was implemented in April 2012 by the provincial veterinary and health offices and supported by many other partners. It delivered a comprehensive dog vaccination program and increased awareness of the need for postexposure prophylaxis (PEP), aiming to eliminate human and animal rabies cases from Ilocos Norte by 2015. Prior to the intervention, confirmed rabies cases in dogs were between 19 and 50 per year (2008–2011). The primary outcome of the project was a reduction in rabies cases in both dogs and humans to 0 in 2014 and 2015, which has subsequently been maintained. Animal bite consultations increased significantly during the project. Economic data for the dog vaccination and PEP components of the project were collated for two sites: Laoag City (an urban setting) and Dingras Municipality (a rural setting) between 2012 and 2014. The average programmatic cost of vaccinating each dog was $4.54 in Laoag City and $8.65 in Dingras, and costs fell as the project reached more dogs. The average costs of providing PEP were $69.72 per patient and $49.02 per patient for the two sites, respectively, again falling as the project reached more people. External donor contributions contributed less than 20% of dog vaccination costs and less than 1% of PEP costs. The project demonstrated that rabies elimination can be achieved in a short period of time, with concerted effort across multiple sectors. A lack of clear dog population estimates hampered interpretation of some aspects of the programme. From 2016, the provincial government has assumed complete responsibility for the programme and must now continue the vaccination and surveillance efforts. Although safeguards are in place, reintroduction from surrounding areas remains a threat, and vigilance must be maintained.
Highlights
Most canine rabies-endemic countries have been implementing rabies control efforts for decades
Lessons learned from governmentled programs in how they implement these pillars and their successes and costs will benefit rabies elimination programs planned elsewhere and enable the faster scale up of programs necessary to reach rabies elimination
Before the implementation of the Communities against Rabies Exposure (CARE) project, sporadic vaccination and emergency interventions produced some reduction in canine rabies case numbers, but failed to reduce them to zero
Summary
Most canine rabies-endemic countries have been implementing rabies control efforts for decades. Success at scale has been achieved in Latin America, where major canine vaccination efforts have led to the elimination of the public health threat in many countries [7]. The global framework for rabies elimination developed at the December 2015 meeting is based on five essential program pillars: socioeconomic, technical, organization, political, and resource, to reflect the range of interventions necessary to ensure successful elimination [11]. A previous rabies prevention and elimination project, which was implemented from 2007 to 2009 on the island of Bohol in the Philippines, proved effective within 2 years [9]. All activities implemented were anchored on the Philippines National Rabies Prevention and Control Program, which is well supported by legislation
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