RCZI organises expert meeting to assess impact of rabies and its interventions

More than 50% of the global burden of rabies is shouldered by countries in the South Asia region where inspite of the longstanding nature of the problem and presence of effective intervention strategies for rabies control, rabies continues to remain a major public health challenge. Most countries in the region are yet to develop sustainable, population-level rabies control strategies, such as routine availability of post exposure prophylaxis (PEP) in humans, dog immunization and dog population control.

The Issue
Multiple studies have shown India as contributing the greatest share of rabies in the world. Consequently, rabies has been identified as a priority zoonoses to be addressed across multiple fora at the national as well as global levels. However, despite the increased priority accorded to rabies, a disconnect among research and policy persists and policy makers remain hesitant about introducing comprehensive rabies control strategies in India as well as internationally.

In the context of India, with the exception of a costs analysis study conducted by the Public Health Foundation of India (PHFI)/Roadmap to Combat Zoonoses in India (RCZI) Initiative, so far, no economic evaluation has been conducted on rabies control. Lack of availability of valid and quality data to inform studies which research cost-effectiveness of infectious disease has further deepened knowledge gaps.

Finding a solution
The RCZI, through its work on developing a strategic research agenda, a Tamil Nadu case study of rabies control and costing study on rabies intervention has generated meaningful rabies-related dialogue, drawing attention to the huge mismatch in funds required for delivering interventions from the animal and human sides. The group proposed a decision analytical tool, bringing together information from all sectors while ensuring effective collaboration.

Recognising the need for a shared methodological approach, the Bill & Melinda Gates Foundation announced a Grand Challenges Award to develop a combination One Health metric that could offer a way of measuring impact of zoonoses and their interventions across multiple sectors. PHFI/RCZI responded to this call and was mandated the task of developing a novel approach to conduct an integrated cost effectiveness analysis tool to facilitate joint decision-making for rabies prevention and control across multiple sectors in India.

Bringing experts together
As a preliminary step to finalising a framework, PHFI/RCZI organised a brainstorming meeting in New Delhi in January, 2014 on identifying information needs and gaps for conducting assessments of impact of rabies and its interventions in India (click here for meeting report). The meeting brought together experts from the human, wildlife and animal sectors, with the aim to encourage sharing and discussion on recent developments in rabies while identifying potential resources/information sources, providing clarity on transmission routes and most importantly, outlining working relationships between sectors.

The meeting saw active discussions on the One Health Approach, with views on how the disease originates in some sectors and crosses species barriers. Experts from animal, human and wildlife sectors opined that there was urgent need to overcome the existing challenge of minimal research in the field of transmission dynamics of rabies in different species in India. They emphasised the need for the livestock and wildlife sectors to review their research agendas and identify new areas of research that could provide valuable inputs on control and prevention efforts.

Setting an agenda
A follow-up meeting is being held in New Delhi on 6th-7th September, 2015 where the group will meet once again. The RCZI team will share their experience of conducting the analysis with principle stakeholders with the following objectives:

1- Critique limitations of existing evidence base in informing rabies policy discussions in India

2- Discuss preliminary findings from multi-stakeholder perspective cost effectiveness analysis

3- Brainstorm implications of analytic methods and results from the point of view of different stakeholders

The meeting will result in an improved understanding of how the costs and benefits of rabies control strategies are spread across different sectors. The improved understanding is expected to enable experts to contrast the usefulness of different rabies control strategies and identify priority interventions.

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