Developing a Programmatic Understanding of Rabies

Rabies, has been classified as a neglected disease by WHO and is acknowledged as a priority disease by multiple national and international agencies, including PHFI/RCZI. However, despite the increased priority being accorded to rabies, a disconnect among research and policy persists, with policy makers being hesitant of introducing comprehensive rabies control strategies in India and across the world.

In an attempt to bridge this gap PHFI/ RCZI embarked on a series of studies and initiatives, with a view to identify information needs and gaps for conducting assessments of impact of rabies and its interventions in India. Two of the important studies were:

i) Costs Analysis of a Population Level Rabies Control Programme in Tamil Nadu, India

ii) Rabies Control Initiative in Tamil Nadu, India a Test Case for ‘One Health’ Approach, International Health

Next, PHFI/RCZI investigated and responded to some of the barriers encountered in rabies policy making by adopting a multisectoral approach. It undertook an assessment of rabies control initiatives in the state of Tamil Nadu to develop a novel approach to conduct a multi-perspective cost effectiveness analysis to facilitate joint decision-making for rabies prevention and control (click here to access report on National Expert Consultation on Rabies Control in Tamil Nadu in August 2010 and meeting report of ‘Expert consultation on costing of interventions for rabies control’ held in December, 2012)

Applying Multi-Stakeholder Perspectives to Assess Impact of Rabies and its Interventions in Tamil Nadu
Supported by a Grand Challenge award from the Bill and Melinda Gates Foundation, researchers from PHFI, LSHTM & Yale came together in 2012 to develop a One Health framework to assess impacts of zoonoses and their interventions, simultaneously from the perspectives of multiple sectors. Disease transmission and economic evaluation models were finalised with decision analytic techniques to present a series of cost and impact results from the perspectives of different sectors.

Identifying existing information needs for rabies research
To identify existing information needs for rabies research and policy making in India, a national stakeholder meeting on rabies assessment was held in January, 2015. The meeting entailed gathering information, identifying information sources and understanding information needs to fine-tune strategies for rabies control in the country. The study team used local information to develop a disease transmission model describing rabies dynamics in the state of Tamil Nadu, combining it with data from a previously conducted costs analysis. This exercise helped develop an integrative multisectoral cost effectiveness analysis of different rabies control interventions for Tamil Nadu.

A follow-up meeting (click here to access meeting report) was organised with stakeholders on 7th-8th September, 2015 in New Delhi. Experts from the World Health Organisation (WHO), Animal Welfare Board of India (AWBI), Global Alliance for Livestock Veterinary Medicines (GALVmed), National Institute of Veterinary Epidemiology and Disease Informatics (NIVEDI), Federation of Indian Animal Protection Organisation (FIAPO) as well as the Departments of Public Health and Animal Husbandry from the Government of Tamil Nadu brainstormed on the effectiveness of employing multi-criteria decision analysis framework by policy makers to choose suitable rabies control strategies in a given context.

The group analysed the costs and impacts of different combinations of rabies interventions across human, canine and livestock sectors, spread over a 20-year time horizon. They surmised that rabies transmission can be controlled relatively quickly with moderate coverage of canine vaccination. Further, dog bite numbers could be controlled using population control measures. A Policy Brief, brought out by PHFI/RCZI suggests dog bite management as an essential intervention for rabies control, using the Tamil Nadu experience.