Can dog rabies be eliminated in Africa?

In this post Gaudenz Metzger from the University of Basel interviews Jakob Zinsstag, a trained veterinarian and professor of epidemiology – discussing Professor Zinsstag’s career, rabies and Basel’s new FutureLearn course One Health: Connecting human, animals and the environment.

Although rarely present in Europe today, rabies is still a global public health threat. According to the WHO, 59,000 people per year die from rabies, of that number over 95% are in developing countries in Asia (60%) and Africa (36%). Rabies is a viral zoonotic disease maintained in domestic and wild carnivores all over the world. It is transmitted to humans mostly through dog bites. While effective vaccines are available to interrupt dog rabies transmission and protect exposed humans, control and elimination of dog rabies is not simply an operational problem. It is a science challenged by the complexity of the processes involved and by the fundamental properties of dog rabies biology.

In light of this I chatted to Jakob Zinsstag, one of the educator’s on our new course, asking him about how as a world we can tackle this problem.

Gaudenz Metzger (GM): Professor Zinsstag, can you tell us first a little bit about your work and your initial motivation for becoming a veterinarian?

Jakob Zinsstag (JZ): I was equally interested in many different fields like physics, chemistry, philosophy and theology. In the end, the choice of an academic field which is related to an outdoor activity was very appealing because I love to be outdoors. Later, I missed the challenge of thinking beyond only large animal internal medicine, and it was then that I discovered epidemiology and the many related statistical and mathematical methods. So moving on from examining individual animals, I started to look at the health of populations.

GM: Dog rabies has been markedly reduced or even eliminated in several countries. Yet, its control is stagnating and rabies is even re-emerging in many parts of the world, especially in Africa and Asia. Why is this?  

JZ: The elimination of rabies requires a highly concerted regional effort between affected countries, a well organized veterinary system with effective surveillance and response systems, a good understanding of the ecology and the social and cultural aspects related to the disease and also financial means, which are all part of what we call a science of rabies elimination. This convergence of requirements is not present in many low and middle income countries of Africa and Asia.

GM: In the upcoming FutureLearn course One Health: Connecting humans, animals and the environment you are promoting the One Health concept, an approach to human and animal health that attempts to overcome narrow disciplinary boundaries. Can you tell us a little bit more about the concept and how it relates to the problem of rabies?

JZ: One Health is the synergism or added value resulting from a closer cooperation of physicians and veterinarians and related disciplines. We need integrated human and animal health research methods to assess and demonstrate such an added value in terms of better health, lives saved, financial savings and improved ecosystem services. This course introduces learners to the conceptual thinking and provides methods for assessment of integrated approaches to health. For example, for rabies we generate mathematical model frameworks which are able to simulate the transmission of rabies between animals and humans. With such models we can simulate interventions in humans alone or in both animals and humans and show under which conditions rabies can be eliminated at the lowest cost. For instance, the cumulative cost of mass vaccination of dogs becomes less costly than the cumulative cost of human post-exposure prophylaxis after a certain time period. This information can only be obtained through applying such integrated animal-human health assessment methods.

GM: Do you think dog rabies elimination is achievable in developing countries? If so, which essential requirements would have to be fulfilled to eliminate the disease?

JZ: We are currently preparing a plan for the regional West and Central African dog rabies elimination in collaboration with the newly created Pan African Network for Rabies Control (PARACON) and the Global Alliance for Rabies Control (GARC). This requires ecological studies and financial budgeting for entire countries, the establishment of effective surveillance and response systems and regional coordination. It is clear that this requires a major effort, but we believe it is feasible. Dog rabies has been nearly eliminated from Latin America by a well coordinated regional effort. In Africa, Rinderpest has been eliminated and polio is almost wiped out. We believe that the competence for effective control can be built up and that an effective regional coordination is possible. We are also working with new financial instruments like Development Impact Bonds, which share the risk between private investors, institutional donors and national governments.

GM: For western countries, rabies may not be a serious health threat at the moment, but other zoonotic diseases like avian influenza or Q fever have occurred. They spread fast due to interconnected ecosystems and the close connection between human and animals. What can we learn from the rabies example to prevent, treat and control diseases in the future?

JZ: The example of a One Health approach to rabies control can be adapted to virtually every zoonotic disease. In the end, everything depends on a better willingness to collaborate between physicians and veterinarians. This is still needed in developing and industrialized countries. There is quite a long way to go, but the movement has started and cannot be stopped.  

Learn more about One Health with the new course, One Health: Connecting human, animals and the environment (plus, as part of the course, there’s also a chance to win one of three travel grants to allow you to travel to Switzerland to meet the educators and take part in a hackathon).