© G. Sa m pat h, Ind ia 2 01 5 © OIE Philippines projec t 201 4 GLOBAL ELIMINATION OF DOG-MEDIATED HUMAN RABIES Report of the Rabies Global Conference 10–11 December 2015 GENEVA, SWITZERLAND Confe f rence organized by in collaboration with with support of GLOBAL ELIMINATION OF DOG-MEDIATED HUMAN RABIES Report of the Rabies Global Conference 10–11 December 2015 Conference organized by in collaboration with with support of i © K. Hampson, University of Glasgow © World Health Organization (WHO) and World Organisation for Animal Health (OIE), 2016 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). 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WHO/HTM/NTD/NZD/2016.02 ©S geti carnivore disease p roje eren ct Contents Background and conference objectives 1 Session 1: Welcome and scene-setting 2 Session 2: Proof of concept for elimination 3 Session 3: Regional approaches and progress 5 Session 4: Operationalization of dog-transmitted rabies elimination through prevention at source 7 Session 5: Strategies to catalyse action 9 Session 6: The global campaign for rabies elimination 11 Session 7: Aiming for success 13 Session 8: Building a global strategic framework – Global Framework for elimination of dog-mediated human rabies 14 APPENDIX: PARTICIPANT LIST 19 iii Conference agenda Global Elimination of Dog-mediated Human Rabies: The Time is Now 1 SESSION 1: WELCOME AND SCENE SETTING 3 2 SESSION 2: PROOF OF CONCEPT FOR ELIMINATION SESSION 4: OPERATIONALISATION OF DOG–TRANSMITTED RABIES ELIMINATION THROUGH PREVENTION AT THE SOURCE SESSION 3: REGIONAL APPROACH AND PROGRESS 4 SESSION 6: THE GLOBAL CAMPAIGN FOR RABIES ELIMINATION 6 5 7 SESSION 5: STRATEGIES TO CATALYSE ACTION SESSION 8: SESSION 7: AIMING FOR SUCCESS 8 BUILDING A GLOBAL STRATEGIC FRAMEWORK – Global Framework of elimination of dog-mediated human rabies iv Global conference on the elimination of dog-mediated human rabies: the time is now Background and conference objectives Rabies remains an under-reported neglected zoonosis with a case-fatality rate of almost 100% in humans and animals. Dog-mediated human rabies causes tens of thousands of human deaths annually despite being 100% preventable. More than 95% of human cases are caused by the bite of a rabies-infected dog. Dog-mediated human rabies disproportionately affects rural communities, particularly children, and economically disadvantaged areas of Africa and Asia, where awareness of the disease and access to appropriate post-exposure prophylaxis (PEP) can be limited or nonexistent. Unlike for many other zoonoses, the appropriate tools to eliminate dogmediated human rabies already exist. Dogmediated human rabies can be eliminated at source by vaccinating dogs, in conjunction with dog bite prevention, bite management, raising public awareness and improved access to prompt postexposure treatment. It is in this context that the World Health Organization (WHO) and the World Organisation for Animal Health (OIE), in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and supported by the Global Alliance for Rabies Control (GARC), organized the Global Conference on “Global elimination of dog-mediated human rabies: the time is now,” in Geneva, Switzerland on 10–11 December 2015. The conference convened key participants from ministries of health and veterinary services, national rabies coordinators from participant countries, experts from the veterinary and the human health sectors and international organizations, policymakers, nongovernmental organizations, donors and the private sector (see Annex 1). © D. Ellis 2015 The objectives of the conference were: • to disseminate the results of the proof of concept for the elimination of dogmediated human rabies in different settings, and explore expansion and sustainability into other endemic areas; • to build support and the case for investment to progress towards the elimination of dog-mediated human rabies from national, regional, global and other stakeholders including the private sector; • to promote a “One Health” intersectoral collaborative approach between the human and animal health and other sectors; and • to shape the forward vision agenda with shared purpose in collaboration with donors and stakeholders for the elimination of dog-mediated human rabies. Global conference on the elimination of dog-mediated human rabies: the time is now 1 The conference built on the outcomes of a meeting on human and dog rabies vaccines and immunoglobulins (Geneva, 12–13 October 2015).1 A Global Framework for the elimination of dogmediated human rabies prepared from the outcomes of the meeting was presented at the conference for further input and refinement. The conference included PowerPoint presentations, facilitated panel discussions, and open forum question and answer sessions designed to engage participants in the sharing of information, success stories and experiences. The abstracts and presentations are available on the OIE website.2 This report provides an overview of the activities and areas of discussion at the conference, key messages and major outcomes to advance the rabies elimination agenda. “ Think big, g, start small, ll, scale fast “ 1 Human and dog rabies vaccines and immunoglobulins: report of a meeting. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199176/1/ WHO_HTM_NTD_NZD_2015.11_eng.pdf; accessed February 2015) 2 2 http://www.oie.int/eng/RABIES2015/index.html Session 1 Welcome and scene-setting The objective of the first session was to acknowledge the high-level leadership support for the elimination of dogmediated human rabies and the One Health approach. Co-chairs Brian Evans (OIE) and Bernadette Abela-Ridder (WHO) welcomed participants and opened the conference. WHO Director-General Margaret Chan and OIE Director-General Bernard Vallat addressed the conference, followed by remarks by the WHO Department for Control of Neglected Tropical Diseases Director Dirk Engels, the FAO Director of Animal Production and Health Berhe Tekola, the Institut Pasteur Senior Global Affairs Advisor to the Director-General Nadia Khelef, the Global Alliance for Rabies Control (GARC) Executive Director Louis Nel, and the European Commission Veterinary Officer Moritz Klemm. The OIE Director-General Bernard Vallat delivered the keynote address: dog-mediated human rabies elimination is feasible. Brian Evans presented a “start-up” version of the Global Framework as a starting point for input by the participants towards a Framework representing the collective experience and best practices for achieving rabies elimination. A goal of the Framework is to provide adaptable tools and options to advance rabies elimination from being feasible to being achieved. Global conference on the elimination of dog-mediated human rabies: the time is now KEY MESSAGES Session 2 Proof of concept for elimination • The objective of the second session was to share country-level success stories, best practices, lessons learnt and challenges from a variety of starting points and experiences, including the economic aspects and impacts of rabies control programmes, public–private partnerships and cross-sectoral collaboration. • • • • • • • • “ “ • Rabies is a disease of poverty that affects the poorest of the poor, especially children. Rabies is 100% preventable with the available tools and proven approaches. Vaccinating at least 70% of dogs breaks the cycle of rabies transmission: decreasing canine rabies decreases the number of human deaths from rabies. Treatment for human rabies is much more expensive — and often inaccessible — than the cost of programmes for control and prevention of dog rabies (control at source): 10% of the current amount spent on postbite treatment could eliminate dogmediated rabies in affected areas if spent on dog rabies prevention. Multisectoral collaboration and broadbased partnerships are essential. Reporting of incidences of human rabies needs to be enhanced and shared across government levels and sectors using a One Health approach. Rabies elimination can be a model for elimination of other neglected tropical zoonotic diseases. Sustained political will and community involvement are key. Elimination of rabies must be seen as a global public good. This conference is a turning point in the fight against rabies: the time is now to shift from words to action. Let’s put rabies in the history books. Three presentations demonstrated a range of activities and experiences designed to break the status quo in South Africa (Kevin Le Roux), the United Republic of Tanzania (Emmanuel A. Mpolya) and the Philippines (Raffy Deray). Panellists Sarah Cleaveland (United Kingdom of Great Britain and Northern Ireland), Thinlay Bhutia (India) and Veronica Gutiérrez Cedillo (Mexico) provided their perspectives, followed by a facilitated Q&A session. KEY MESSAGES • • • • Champions are central to bringing all sectors together and maintaining effort and focus. Community-wide engagement is key: get everyone involved. Dog-mediated human rabies can be controlled and eventually eliminated by improving dog vaccination coverage and access to PEP. Aiming for 70% dog vaccination coverage for an entire population may not be initially possible for all countries. Strategic dog vaccination targeting 70% coverage in areas of higher rabies’ incidence can also be effective at breaking larger transmission cycles and may be less daunting and more attractive to governments and investors. Global conference on the elimination of dog-mediated human rabies: the time is now 3 “Start small and scale up” allows for incremental growth while systems are developing, success to be demonstrated, momentum and commitment to be built, and communities and stakeholders to be engaged. Declaration of successful areas can be used to garner national support for inclusion of rabies in national health priorities, making budget available not only for PEP but also for procurement of dog vaccines. Vaccine banks provide quality products and stability of supply, ensuring continuity of effort and stimulate expansion. Programmes must include plans for sustainability, contingencies and restart following political turmoil, temporary adjustments in priorities or a natural disaster. Proper data collection, management and data-sharing are important. A reliable baseline of data and information will help strategically target programmes for greatest impact. Mobile phone surveillance is a useful tool. Increased awareness about rabies can lead to increased demand for PEP. Both systems should be developed in parallel. Eventually, demands for PEP should decrease as dog rabies decreases alongside increased vaccination coverage. Switching from intramuscular to intra-dermal administration of PEP significantly reduces costs. • • • • • • 4 © Serengeti carnivore disease project • • • The success of the rabies programme in the United Republic of Tanzania and the province of KwaZulu-Natal in South Africa has led to the formalization of a One Health approach against other zoonotic diseases collaboratively across human health and animal health agencies. It is much more cost effective to vaccinate dogs. Although the initial costs may be high, they do not increase: a break-even point (maybe 10 to 15 years out) is followed by significantly lower costs for maintenance. Appropriate cost analyses and expectations need to be communicated. Dog vaccination is the best way to ensure equity by protecting the whole population, whether PEP is available and affordable or not. “ The vaccinated dog is the soldier in the fight against rabies. “ • Global conference on the elimination of dog-mediated human rabies: the time is now Session 3 Regional approaches and progress © Daniel Stewart The third session showcased success stories on how regional approaches and strategies are implemented and linked. The presentations highlighted the importance of improved coordination and identification of regional needs to achieve elimination goals, as experienced through projects in Europe (Thomas Müller, Friedrich Loeffler Institute), the Americas (Ottorino Cosivi, Pan American Health Organization), the MiddleEast and North Africa (Mohammed Bengoumi, FAO), Asia (Mary Joy Gordoncillo, OIE) and Africa (Louis Nel, GARC). The presentations were followed by a panel discussion and facilitated Q&A session. The panellists were Tu Chang Chun (OIE Reference Laboratory for Rabies, China), Valentina Picot (Fondation Mérieux) and Hervé Bourhy (Institut Pasteur). reservoir in conjunction with dog rabies vaccination campaigns, establishment of a rabies database for surveillance, and long-term political commitment and resources. The PAHO action plan3 to eliminate human rabies transmitted by dogs includes four priority deliverables: access to timely PEP for the population at risk; mass dog vaccination; robust human and dog disease surveillance; and community mobilization. In the Region of the Americas, the public and private sectors provide strong leadership and governance and are responsible for the success of the rabies programmes in the region. Rabies is perceived as both a public health and an animal health issue. In the Asia Region, WHO, OIE and FAO regional offices provide a coordinating mechanism and technical support; the OIE Regional Vaccine Bank benefits the region by providing quality assured, affordable dog rabies vaccines. The Stepwise approach towards rabies elimination and the Blueprint for rabies prevention and control 4 • KEY MESSAGES Regional strategies and tools • Eliminating rabies requires a coherent and sustainable long-term strategy, backed by robust human and animal health systems. • A regional strategy for the prevention and control of rabies should be based on a participatory approach and coordinated interventions by all stakeholders. • The elimination of rabies from large parts of Europe is a result of a stepwise approach that included initial focus on fox rabies elimination as a primary • • 3 http://www.paho.org/panaftosa/index.php?option=com_ docman&task=doc_download&gid=378&Itemid=311 4 www.rabiesblueprint.com Global conference on the elimination of dog-mediated human rabies: the time is now 5 are tools designed to assist countries in developing and implementing sustainable intervention strategies. It includes options and advice on various programmatic aspects, including education and advocacy, surveillance and diagnosis, as well as performance monitoring and assessment including target setting. The goal date of 2030 for the elimination of dog-mediated human rabies was chosen as it represents both an aspirational and an achievable target for participating countries. It is tied to the United Nations sustainable development goals and is thereby a vehicle for attention and mobilization. • Challenges • Elimination of rabies in dog populations can reveal rabies reservoirs among wildlife (e.g. fox rabies) and the need for other control strategies. • Rabies elimination in the MiddleEast and North Africa is constrained by limited coordination among stakeholders, inadequate communication and awareness of the population at risk, other health and security priorities, and limited human and financial resources. • In Africa, the continent’s size and complexity, language diversity, lack of information and high rabies incidence are challenges. • Rabies remains a challenge in many parts of Asia, particularly in areas of poverty, political instability, suboptimal national health and animal health services, competing priorities, and those for whom cultural influences impact the societal roles of dogs, their ecology and interactions with humans. 6 • In the final stage of rabies elimination in the Region of the Americas it is paramount to maintain the resources provided by the health sector in coordination with other sectors (e.g. veterinary services, education) for reaching the last mile in elimination. Success factors • A regional governance mechanism is instrumental for success, alongside long-term goals, vision and commitment. • The successful coordination between animal and human health sectors at national, regional and global levels sends a clear message that dogmediated human rabies is a global public health concern that requires intersectoral collaboration following the One Health approach. • Attacking rabies at source is key, but the dynamics of the rabies virus have demonstrated that killing dogs does not eliminate rabies. Rather, a vaccinated dog is the “soldier in the fight against rabies.” • The introduction of the more costeffective intradermal PEP vaccines improves accessibility and affordability. • Rabies elimination strategies must be flexible and adaptable to meet the impacts of changing demographics (e.g. population shifts from rural to urban). • The ongoing commitment and participation of many varied partners and stakeholders enables regional capacity to be leveraged and countries to adapt approaches to their circumstances. • Lessons learnt at the country level can inform regional approaches. Global conference on the elimination of dog-mediated human rabies: the time is now • Some 3–4 years of mass dog vaccination in at risk areas can eliminate rabies. However, to avoid reintroducing the virus, programmes must also include strategies for maintenance, including effective and ongoing surveillance. • A key indicator of success is fewer (or ideally zero) human rabies cases. Although many challenges remain in Asia, progress is being made through regional cooperation, intersectoral collaboration, addressing rabies at its source through dog vaccination, and political support for dog-mediated rabies as a public health concern. If you want to go fast, go alone. If you want to go far, go together. “ African Proverb Session 4 Operationalization of dog-transmitted rabies elimination through prevention at source Presentations in this session focused on the “how” of rabies elimination programmes, including mass dog vaccination in at risk areas (Ahmed BeNazir, National Institute of Preventive and © D. Ellis 2015 • • “ Surveillance is crucial — it is a key tool to demonstrate success. Mobile vaccine clinics, easy diagnostic tests, regional coordination, informationsharing and encouraging reporting compliance are all part of an effective surveillance system. Social Medicine, Bangladesh) and dog bite prevention (Daniel Stewart, South Africa). The importance of intersectoral collaboration (Eric Osoro, Ministry of Health Kenya) and education of atrisk populations (Deepashree Balaram, GARC) was highlighted. The facilitated Q&A session and panel discussion included Luke Gamble (Mission Rabies), Rubina Cresencio (Chief Veterinary Officer, Philippines) and Eric Brum (FAO). KEY MESSAGES One Health approach • Mass dog vaccination supported by education, community engagement and a One Health approach are common elements of successful rabies elimination programmes. Global conference on the elimination of dog-mediated human rabies: the time is now 7 • A One Health approach that integrates human, animal and environmental sectors in the management of zoonotic diseases can lead to more rapid detection of and response to outbreaks, fewer human deaths, and improved coordination, documentation, reporting and understanding of animal–human disease linkages. Strong relationships, networking and information-sharing across sectors are crucial to sustaining an effective One Health approach. There are many organizations and individuals advocating rabies elimination who are ready to help catalyse country efforts. • • Start small and scale up • It is important to build capacity through pilot projects and then scaleup campaigns to expand coverage. • Vaccine banks for animal rabies have contributed significantly to the successful expansion of programmes in countries such as Bangladesh, the Philippines, South Africa and Sri Lanka. Mass dog vaccination • Roaming dogs (not owned or loosely owned) are a common feature of dog populations in Asia and Africa. These dogs are vulnerable to rabies while simultaneously exposing humans and other animals to the virus. Mass vaccination of roaming dogs has been shown to contribute to consistent reduction and elimination of rabies. • To be effective, mass dog vaccination programmes must be cost effective, affordable, reproducible and adequately resourced to achieve sufficient coverage throughout the 8 • project site and a sustainable strategy for maintenance of the progress gained. Mass dog vaccination programmes against rabies are in the public health interest. Education and awareness • Dog behaviour and bite prevention education is an essential extension of a rabies vaccination project and can decrease both the incidence of human rabies and the financial burden of treating dog bites. Such education needs to be targeted at both children and adults. • Increasing awareness of rabies prevention and control in communities includes education and information on responsible pet ownership, how to prevent dog bites and what to do if bitten. Engagement and ownership of the programme at the community level increases reach and uptake of messages. • Paradoxically, increased public awareness and improved PEP distribution lead to an increase in demand for PEP, even though rabies incidence may be declining in the area. Community engagement • Building and maintaining community engagement and empowering atrisk communities generate behaviour change within the community. • Examples of effective communitybased engagement and education approaches include: integrating rabies education into the school curricula; teacher training; police involvement; edutainment, such as storytelling, theatre, colouring books; and involving community volunteers in dog Global conference on the elimination of dog-mediated human rabies: the time is now 6 vaccination, conducting dog surveys, and participating in early warning and rapid response systems at the village level. • Session 5 Strategies to catalyse action • © Serengeti carnivore disease project The objective of the fifth session was to identify existing strategies and tools to support country efforts in dog-mediated human rabies elimination and to highlight the challenges and barriers to be overcome. Presentations focused on vaccine banks and vaccine quality (Alain Dehove, OIE), the impact of the rabies vaccine bank from the recipient country perspective (Rubina Cresencio, Philippines), access to vaccines and immunoglobulins (Bernadette Abela-Ridder, WHO) and the role of private veterinarians in rabies elimination (René Carlson, World Veterinary Association). Thee panellists were Steven McIvor (WAP), Carel du Marchie Sarvaas (HealthforAnimals) and Katinka de Balogh (FAO). • KEY MESSAGES Strengthening access to quality and affordable vaccines and immunoglobulins • Countries require easy access to highquality, affordable human and dog vaccines and immunoglobulins to successfully eliminate rabies. • Since 2012, OIE has provided more than 13 million doses of rabies vaccines for dogs in 17 countries, mainly in SouthEast Asia. 7 OIE regional vaccine banks can hold ready-to-use, formulated vaccines, production on demand when needed and replenishment mechanisms to ensure emergency access as well as delivery of small or large quantities. Limited physical stocks allow for urgent deliveries. Regional vaccine banks enable economies of scale, synergies and leveraging of results while contributing to harmonization and coordination of global and regional control programmes. In addition, they allow for multi-party vaccination • campaigns, public–private partnerships and the possible involvement of nongovernmental organizations. The vaccine bank mechanism can also be used to facilitate the purchase of vaccines by countries or by international organisations. Sufficient dog vaccine coverage in priority areas of the Philippines led to a significant reduction in dog rabies cases and in human rabies cases. The quality of the vaccines was assured by the use of the OIE Rabies Vaccine Bank for Asia, which also provided an efficient procurement process delivering quantities required for good coverage. Global conference on the elimination of dog-mediated human rabies: the time is now 9 • • • • • Vaccine banks can be an impetus for improved data collection, as the recipient country is required to report on vaccine use and results. This creates better recordkeeping protocols, leading to better understanding of the situation. Vaccine banks ensure the procurement of high-quality vaccines manufactured in line with OIE intergovernmental standards and delivered in a timely manner. Empower local health communities in first aid and PEP. The most affected people who continue to die from rabies are in remote, mostly subsistence communities, with no local access to care. It will take time for rabies to disappear in dogs; in the meantime, providing care to at-risk patients in remote settings is a moral obligation. The intradermal route of administration of vaccine for PEP saves approximately 80% of costs. Pharmaceutical companies are urged to include intradermal route on labels and countries to adopt this alternative cost saving, safe and efficacious route of administration. Most of the deaths from rabies occur in remote areas where very poor victims do not have access to PEP. Delivery of human vaccines to these remote settings is essential where local healthcare workers can be empowered to provide PEP to bite victims. Provision of PEP will be needed as long as transmission of rabies in animals is ongoing. Success factors • Collaboration among the agriculture, animal health and human health sectors and high-level political recognition of the need to address the disease at source through mass dog vaccination are key success factors. In-country rabies • • • • • • • stakeholder consultations can kick-start coordinated rabies control and are an integral part of a step-wise approach towards rabies elimination. Access to safe, efficacious and affordable dog and human rabies vaccines can be improved through better forecasting and planning, optimized procurement practices and support from the private sector. Provision of vaccine can provide a stimulus to start up rabies control and elimination programmes, which in turn demonstrate success and stimulate interest and further investment. Funding strategies should also support capacity and awareness building, planning and initiation of local, national or regional programmes and activities, animal handling and implementation of standard operating procedures for bite management, including encouraging a shift to intradermal vaccine administration. Veterinary, medical and pharmaceutical students are underutilized resources: greater engagement is needed. Rabies elimination is a long-term investment: it is important to engage the next generation of leaders now. Increasing access: availability, affordability, reliable health and supply systems to reach affected people. Timely care for bite patients saves lives. Vaccine manufacturers have a role to play in ensuring quality assurance systems are in place. Involving vaccine manufacturers in projects from the beginning helps to assure quality, quantity and timing of vaccines; appropriate lead times are important. Use alternative funding mechanisms such as the revolving fund used in PAHO countries to enable the procurement of rabies vaccines. 10 Global conference on the elimination of dog-mediated human rabies: the time is now Challenges • Barriers to engaging private sector veterinarians (such as lack of workforce, lack of resources, general apathy, or perceived or real competition from freely donated services from outside volunteers) must be resolved so that private sector veterinarians can be fully involved in rabies control. Public and private veterinarians can act as leaders, facilitators and educators. Session 6 The global campaign for rabies elimination Presenters and their topics included Katie Hampson, UK (The impact of rabies and the benefits of prevention); Eduardo Pacheco de Caldas, Brazil (Local government and municipalities: motivating communities); Bavukile Kunene, Swaziland (Cross-border collaboration: the influence of the champion country); and Deborah Briggs, USA (An effective communication campaign: nine years of World Rabies Day and the End Rabies Now Campaign). The panellists were Ahmed Be-Nazir (National Institute of Preventive Medicine, Bangladesh) and Sivasothy Arumugam (Sri Lanka). The burden of rabies • Annual economic losses resulting from dog-mediated human rabies are estimated to be US$ 8.6 billion. The largest component of the economic burden is due to premature death (55%), direct costs of PEP (20%) and lost income while receiving treatment (15.5%). Costs related to dog vaccination are minimal by comparison. These losses are frequently invisible for policy makers given the high number of underreported or misdiagnosed cases. © OIE Philippines 2014 The sixth session focused on strategies to increase awareness and political will for the elimination of dog-mediated human rabies. The presentations considered the benefits of prevention and transboundary collaboration and highlighted the importance of community engagement and the impact of campaigns such as World Rabies Day. KEY MESSAGES • • The economic burden of rabies impacts public sector budgets, communities and families. The highest risk of rabies occurs in the poorest regions of the world. Success factors • Brazil has achieved a 90% reduction in cases of dog-mediated human rabies over the past decades. Success is attributed to recognition of the disease as a public health concern, improved surveillance processes, mass dog vaccination campaigns, prophylactic Global conference on the elimination of dog-mediated human rabies: the time is now 11 • • Community involvement • World Rabies Day is a partnership initiative led by GARC. Launched in 2007 as a global day of action against rabies, World Rabies Day is commemorated on September 28 and has become a focal point for thousands of rabies prevention events in over 200 countries; participation is included in the action plans of many country and regional rabies elimination strategies. • Participation in annual World Rabies Day activities creates increased awareness and community involvement and demand for both dog rabies vaccination and post-bite treatment. • • The End Rabies Now campaign aims to significantly raise the profile of rabies as a global neglected tropical disease. Objectives include eliminating dog-mediated human rabies by 2030, including rabies control on the agenda of foundations, donor governments and international institutions, and recognizing rabies as an urgent priority leading to political commitment and support for rabies elimination in endemic countries. Sustaining the global movement towards rabies elimination requires formal and informal communication and information-sharing, networking and collaboration among peers, sectors and countries. © Mission Rabies • measures directed at people at risk, education campaigns, community involvement and sustained investment. There have been no recorded deaths from human rabies in Swaziland since 2012. Success is attributed to free annual dog vaccination campaigns by mobile teams countrywide, animal bite reporting, outbreak declaration protocols, annual spay/neuter clinics and provision of PEP to dog bite victims. South Africa and Swaziland continuously engage in cross-border collaboration meetings where issues such as rabies control are discussed. The two countries have a Movement Permit for Dogs and Cats that requires proof of rabies vaccination. Ongoing vigilance once dog rabies has been eliminated is important as there could be residual problems with wildlife rabies or reoccurrence of dog rabies. S i 7 Session Aiming for success The roundtable discussion during the seventh session considered the elimination of dog-mediated human rabies from donors’ perspectives. With the key success factors understood and ready for implementation (such as political will, engagement, communication, technical tools, motivation), what else must be done to make a compelling, sound case? In this context, the objectives of the session were: 12 Global conference on the elimination of dog-mediated human rabies: the time is now • • • to better understand donors’ motivations to invest in rabies elimination; to identify gaps and opportunities for investment in human rabies elimination; and to determine the performance measures required to demonstrate progress and success. • • Representatives of donor groups participating in the discussion included Andrea Ellis (Canada), Pedro Rosado (European Commission), Anne-Marie Sevcsik (UBS Optimus Foundation), Judith Kallenberg (Gavi, the Vaccine Alliance) and Molly Mort (Bill & Melinda Gates Foundation). • • The collaboration of the three major international organizations (WHO, OIE, FAO) demonstrates commitment and cross-sectoral collaboration. Intersectoral collaboration within countries and regions also sends an important message to donors. Country-to-country technical assistance and exchange (e.g. twinning projects to build capacity) is important. Action plans must be doable; ensure they demonstrate how to bring together stakeholders and communities. Ensure robust surveillance systems are in place to determine if the measures implemented are working and to monitor any reoccurrence of disease. Countries cannot depend on donors for the long term: there must be a transition of ownership plan and sustainable activities and resources as part of the rabies control action plan and strategy. KEY MESSAGES • Demonstrate success and return on investment • Rabies elimination is feasible and has been demonstrated. Successful proof of concept projects have provided an evidence base; this is important because success makes investment attractive to donors. • Donors want to see the social impact of their investment: make a compelling case for lives saved. • Emphasize the cost effectiveness of rabies prevention and elimination versus the cost of doing nothing. Look beyond vaccines and beyond rabies • Donors should also be considered as sources for support beyond vaccines and vaccine delivery: capacity development for education, transfer of knowledge and information, diagnostics, surveillance and reporting are all areas where donors can be involved. Demonstrate a sound strategy, collaboration across sectors and sustainability • Donors want to see that there is country commitment and mobilization to rabies elimination; rabies must be a country priority and a recognized public health issue, supported by a comprehensive plan. • Approaches that leverage opportunities and maximize investment are attractive to donors. Look to build onto other initiatives to maximize the impact of investments. For example, other platforms or projects could be used to deliver rabies control services and programmes or, conversely, there may be opportunities for rabies elimination efforts to help other projects. Global conference on the elimination of dog-mediated human rabies: the time is now 13 There is no one donor or one solution to dog-mediated human rabies: it requires collective approaches, coordination and motivation. © OIE Philippines 2014 • In accordance with the consensus of the Global Conference (Geneva, 10–11 December 2015), this framework provides a coordinated approach and vision for the global elimination of dogmediated human rabies. It is intended to harmonize actions and provide adaptable, achievable guidance for country and regional strategies. Strategic vision: zero human deaths from dog-mediated rabies by 2030 in participating countries. THE FIVE PILLARS OF RABIES ELIMINATION (STOP-R) Session 8 Building a global strategic framework The eighth (open forum) session looked to further discuss issues and identify actions needed to achieve effective rabies elimination in the context of a global strategic framework. Following the conference, the input was used to finalize the Global Framework for elimination of dog-mediated human rabies, the content of which is provided below. The graphic version is available at the end of this document and on the OIE rabies portal.5 Pillar 1: Socio-cultural Rabies control involves a wide range of stakeholders including the general public. The socio-cultural context influences rabies perceptions and dog-keeping practices of at-risk populations. Understanding the context guides approaches to motivate behavioural change and plan feasible delivery of services. Includes activities for: • Awareness: build awareness of dogmediated rabies as a preventable global public health problem including through participation in initiatives such as World Rabies Day and the EndRabiesNow campaign; GLOBAL FRAMEWORK FOR THE ELIMINATION OF DOG-MEDIATED HUMAN RABIES • Dog-mediated human rabies kills tens of thousands of people every year worldwide. Freedom from dog-mediated human rabies is a global public good and is feasible with currently available tools. Responsible dog ownership: promote responsible dog ownership and dog population management practices, including dog vaccination, in accordance with OIE standards; • Bite prevention and treatment: develop and implement educational programmes on bite prevention and first aid for both children and adults; 5 15 http://www.oie.int/rabies 14 Global conference on the elimination of dog-mediated human rabies: the time is now • • Post-exposure prophylaxis: increase awareness and understanding of postexposure prophylaxis (PEP) imperatives and options including intradermal administration; Includes activities for: • Vaccination: ensure safe, efficacious and accessible dog and human vaccines and immunoglobulins, and promote and implement mass dog vaccination as the most cost-effective intervention to achieve dog-mediated human rabies elimination; • Surveillance: support improved surveillance, sampling, reporting and data-sharing; • Technical support: provide guidance and technical support for the development and tailoring of regional and national plans, including promoting the use of existing tools; • Proof of concept: support proof-ofconcept programmes, and then scale up through leveraging of success. Community engagement: encourage community involvement and engagement in activities to eliminate dog-mediated rabies. Pillar 2: Technical Effective animal health and public health systems are required to eliminate dogmediated human rabies. These systems must be strengthened and resourced appropriately, and gaps identified and filled. • • Logistics: collect data on needs forecasts to inform the vaccine procurement system and to create and sustain the logistics and infrastructure required for effective delivery and implementation of mass dog vaccination programmes and PEP administration; Diagnostics: ensure capacity and capability for rapid and accurate rabies diagnosis through accessible, well equipped laboratories and trained personnel; Pillar 3: Organization The One Health approach of close collaboration is applied. Leadership, partnership and coordination for rabies elimination activities arise from the human health and animal health sectors and other stakeholders. Includes activities for: • One Health: promote the One Health approach and intersectoral coordination through national and regional networks; • Good governance: establish good governance, including clear roles, chain of command, measurable outcomes and timelines; • Harmonization: align work plans and activities with national and regional priorities and approaches fostering synergies among sectors; • Coordination: coordinate and combine human resources, logistics and infrastructure of other programmes and initiatives, as 16 appropriate and feasible; Global conference on the elimination of dog-mediated human rabies: the time is now 15 Indicators and performance: identify targets and their indicators to support performance measurement, including surveillance and validation data, to identify areas requiring attention or extra support; • Monitoring and evaluation: support monitoring and evaluation of national plans to ensure timely and costeffective delivery. Pillar 4: Political Success depends on political will and support for elimination of dog-mediated human rabies. Political will results from recognition of rabies elimination as a national, regional and global public good. Includes activities for: • Political support: political support is essential and most relevant during and following country instability (political upheaval, natural disasters, etc.); • • • International support: encourage countries to request a resolution on dog-mediated human rabies elimination through the World Health Assembly (WHO) and the General Assembly of Delegates (OIE); • “ Rabies does not recognize country borders Pillar 5: Resources Rabies elimination activities frequently span several years and therefore require sustained, long-term support. Includes activities for: • Case for investment: promote the case for investment in dog-mediated human rabies elimination to persuade countries, policy-makers and donors of the feasibility, merit and value of investing in rabies elimination strategies; • Business plans: prepare business plans based on the Global Framework for Dog-mediated Human Rabies Elimination; • Investment: encourage different forms of investment and partnerships (private and public investment) to leverage resources and engagement. Legal frameworks: establish and enforce appropriate legal frameworks for rabies notification and elimination; Demonstrating impacts: demonstrate the compelling case for mass dog vaccination programmes and their impact on protecting and saving human lives; Regional engagement: support active national and regional engagement and cooperation to commit to a rabies elimination programme and promote the exchange of lessons learnt and experiences to leverage resources and engagement. 17 16 Global conference on the elimination of dog-mediated human rabies: the time is now “ • • Long-term political and social commitment REFERENCES AND ADDITIONAL INFORMATION Conference Report on the outcomes of a meeting on human and dog rabies vaccines and immunoglobulins (Geneva, 12–13 October 2015). • http://apps.who.int/iris/ bitstream/10665/199176/1/WHO_HTM_ NTD_NZD_2015.11_eng.pdf; ƒ 2 ƒ 3 ƒ 4 ƒ 5 • Community engagement • Sustainable vaccination of 70% of the at-risk dog population • Proof of concept: start small, scale up. • Sufficient resources, logistics and infrastructure • Promote vaccine banks and other strategies for acquisition of rabies immunologicals to ensure sufficient supply of quality-assured rabies vaccines and human immunoglobulin • Reach remote, rural and at-risk populations 1 ƒ Abstracts and presentations from Conference above are available on the OIE website. • http://www.oie.int/eng/RABIES2015/ index.html PAHO Action Plan. • http://www.paho.org/panaftosa/index. php?option=com_docman&task=doc_ download&gid=378&Itemid=311 The Stepwise approach towards rabies elimination and the Blueprint for rabies prevention and control. • www.rabiesblueprint.com Global Strategic Framework • http://www.oie.int/rabies • Conduct performance measurement at all levels • Maintain trained and motivated implementation personnel 18 “ “ CRITICAL SUCCESS FACTORS Rabies is 99.9% 0% fatal but 100% preventable Global conference on the elimination of dog-mediated human rabies: the time is now 17 18 SOCIO-CULTURAL both children and adults Post-exposure prophylaxis: increase awareness and understanding of postexposure prophylaxis (PEP) imperatives and options including intradermal administration Community engagement: encourage community involvement and engagement in activities to eliminate dog-mediated rabies TECHNICAL Includes activities for: • Vaccination: and accessible dog and human vaccines and immunoglobulins, and promote and implement mass dog vaccination as the most cost-effective intervention to achieve dog-mediated human rabies elimination • Logistics: collect data on needs forecasts to inform the vaccine procurement system and to create and sustain the logistics and infrastucture required for effective delivery and implementation of mass dog vaccination programmes and PEP administration • Diagnostics: ensure capacity and capability for rapid and accurate rabies diagnosis through accessible, well equipped laboratories and trained personnel • Surveillance: support improved surveillance, sampling, reporting, and data-sharing • Technical support: provide guidance and technical support for the development and tailoring of regional and national plans, including promoting the use of existing tools • Proof of concept: support proof-ofconcept programmes, and then scale up through leveraging of success Effective animal health and public health systems are required to eliminate dogmediated human rabies. These systems must be strengthened and resourced 2 ORGANIZATION Includes activities for: • One Health: promote the One Health approach and intersectoral coordination through national and regional networks • Good governance: establish good governance, including clear roles, chain of command, measurable outcomes and timelines • Harmonization: align work plans and activities with national and regional priorities and approaches fostering synergies among sectors • Coordination : coordinate and combine human resources, logistics and infrastructure of other programmes and initiatives, as appropriate and feasible • Indicators and performance: identify targets and their indicators to support performance measurement, including surveillance and validation data, to identify areas requiring attention or extra support • Monitoring and evaluation: support monitoring and evaluation of national plans to ensure timely and cost effective delivery The One Health approach of close collaboration is applied. Leadership, partnership and coordination for rabies elimination activities arise from the human health and animal health sectors and other stakeholders. 3 POLITICAL • • Demonstrating impacts: demonstrate the compelling case for mass dog vaccination programmes and their impact on protecting and saving human lives Regional engagement: support active national and regional engagement and cooperation to commit to a rabies elimination programme and promote the exchanage of lessons learnt and experiences to leverage resources and engagement RESOURCES Includes activities for: • Case for investment: promote the case for investment in dog-mediated human rabies elimination to persuade countries, policy makers and donors of the feasibility, merit and value of investing in rabies elimination strategies • Business plans: prepare business plans based on the Global Framework for Dog-mediated Human Rabies Elimination • Investment: encourage different forms of investment and partnerships (private and public investment) to leverage resources and engagement Rabies elimination activities frequently span several years and therefore require sustained, long-term support. 5 and human immunoglobulin eReach remote, rural and at-risk populations eConduct performance measurement at all levels eMaintain trained and motivated implementation personnel eLong-term political and social commitment eCommunity engagement eSustainable vaccination of 70% of the at-risk dog population eProof of concept: start small, scale up e ePromote vaccine banks and other strategies for acquisition of rabies immunologicals to ensure CRITICAL SUCCESS FACTORS Includes activities for: • Political support: politcal support is essential and most relevant during and following country instability (political upheaval, natural disasters, etc.) • International support: encourage countries to request a resolution on dog-mediated human rabies elmination through the World Health Assembly (WHO) and the General Assembly of Delegates (OIE) • Legal frameworks: establish and enforce appropriate legal frameworks for Success depends on political will and support for elimination of dog-mediated human rabies. Political will results from recognition of rabies elimination as a national, regional and global public good. 4 Global conference on the elimination ofrabies dog-mediated human rabies: inthe time is now STRATEGIC VISION: zero human deaths from dog-mediated by 2030 participating countries • • Includes activities for: • Awareness: build awareness of dogmediated rabies as a preventable global public health problem including through participation in initiatives such as World Rabies Day and the EndRabiesNow campaign • Responsible dog ownership: promote responsible dog ownership and dog population management practices, including dog vaccination, in accordance with OIE standards • Bite prevention and treatment: develop and implement education programmes keeping practices of at-risk populations. Understanding the context guides approaches to motivate behavioural change and plan feasible delivery of services. Rabies control involves a wide range of stakeholders including the general public. The socio-cultural context 1 In accordance with the consensus of the Global Conference (Geneva, 10-11 December 2015), this framework provides a coordinated approach and vision for the global elimination of dog-mediated human rabies. It is intended to harmonize actions and provide adaptable, achievable guidance for country and regional strategies. The fi ve pillars of rabies elimination (STOP-R) Dog-mediated human rabies kills tens of thousands of people every year worldwide. Freedom from dog-mediated human rabies is a global public good and is feasible with currently available tools. GLOBAL FRAMEWORK FOR THE ELIMINATION OF DOG-MEDIATED HUMAN RABIES Appendix: Participant List Chynara AALIEVA Lead expert State Inspectorate on veterinary and phytosanitary safety Kyrgyzstan GUSTI NGURAH BAGUS Manager Bali Animal Welfare Association Indonesia Yaser AL-ERYANI General Director Animal Health and Vet Quarantine Ministry of Agriculture and Irrigation Yemen James I. BALAMI Cordinator-zoonotic NTDs NTD programme, Department of Public Health Federal Ministry of Health Nigeria Karim AMIRI Deputy for Zoonoses control Program Department of Sanitary and animal diseases control management Iran Ibrahim BANGANA Directeur Général des Services Vétérinaires Ministère de l’Elevage Niger Farid AMRAOUI Chef de la Division de la Santé Animale Office National de Sécurité Sanitaire des Produits Alimentaires Morocco Daouda BANGOURA Conseiller du Ministre Elevage Ministère de l’Elevage et des Productions Animales Guinea Marc ARTOIS Professeur Groupe de travail de l’OIE sur la Faune Sauvage France Sivasothy ARUMUGAM Director Department of Animal Production and Health Ministry of Livestock and Rural Community Development Sri Lanka Rauna Ndinelao ATHINGO Representative for Dr. Maseke Chief Veterinary Officer Directorate of Veterinary services Namibia Orhan AYLAN Specialist Veterinarian Rabies Expert General Directorate of Food and Control, Animal Health and Quarantine Department Turkey Fatou Ndiaye BADIANE Coordonatrice Programme National d’Eradication du Ver de Guinée (PNEVG), rage, chargée du S/E MTN Point Focal de la Lutte contre la Rage Ministère de la Santé et de l’Action Sociale Senegal Komla Batasse BATAWUI Directeur de l’Elevage Ministère de l’agriculture, de l’Elevage et de l’Hydraulique Togo Ahmed BE-NAZIR Professor Department of Microbiology National Institute of Preventive and Social Medicine (NIPSOM) Ministry of Health and Family Welfare (MHFW) Bangladesh Thinlay BHUTIA Programme Coordinator Department of Animal Husbandry and Veterinary Services Government of Sikkim Sikkim Anti-Rabies & Animal Health Program (SARAH) India Marcellin BIARMANN Direction des Services Vétérinaires Ministère de l’Elevage Madagascar Zainudin BIN ABDUL WAHAB Head Disease Control Division Zoonotic Infectious Disease Sector Malaysia Lucille BLUMBERG Deputy-Director of National Institute for Communicable Diseases Head of Division of Public Health Surveillance and Response South Africa Bolor BOLD University of Basel, MoH Mongolia Switzerland Isabelle BOLON Institute of Global Health University of Geneva Switzerland Etienne BONBON Président de la Commission du Code Terrestre de l’OIE Union européenne France Andrea BRITTON Director Vets Beyond Borders Australia Rene CARLSON President World Veterinary Association USA Bernardo CASSAMÁ Directeur Générale de l’Elevage Direction Générale de l’Elevage Guinea-Bissau Tu CHANG CHUN Head of OIE Reference Laboratory for Rabies Changchun Veterianry Research Institute (CVRI), Chinese Academy of Agricultral Sciences (CAAS) China (People’s Rep. Of ) Siang Thai CHEW Deputy Chief Executive Officer Agri-Food & Veterinary Authority Singapore Wenya Charmaine CHNG Veterinarian Agri-Food & Veterinary Authority Singapore Tze Hoong CHUA Group Director Agri-Food and Veterinary Authority Singapore Global conference on the elimination of dog-mediated human rabies: the time is now 19 Chynara AALIEVA Lead expert State Inspectorate on veterinary and phytosanitary safety Kyrgyzstan Yaser AL-ERYANI General Director Animal Health and Vet Quarantine Ministry of Agriculture and Irrigation Yemen Karim AMIRI Deputy for Zoonoses control Program Department of Sanitary and animal diseases control management Iran Farid AMRAOUI Chef de la Division de la Santé Animale Office National de Sécurité Sanitaire des Produits Alimentaires Morocco Marc ARTOIS Professeur Groupe de travail de l’OIE sur la Faune Sauvage France Sivasothy ARUMUGAM Director Department of Animal Production and Health Ministry of Livestock and Rural Community Development Sri Lanka Rauna Ndinelao ATHINGO Representative for Dr. Maseke Chief Veterinary Officer Directorate of Veterinary services Namibia Orhan AYLAN Specialist Veterinarian Rabies Expert General Directorate of Food and Control, Animal Health and Quarantine Department Turkey Fatou Ndiaye BADIANE Coordonatrice Programme National d’Eradication du Ver de Guinée (PNEVG), rage, chargée du S/E MTN Point Focal de la Lutte contre la Rage Ministère de la Santé et de l’Action Sociale Senegal 20 GUSTI NGURAH BAGUS Manager Bali Animal Welfare Association Indonesia James I. BALAMI Cordinator-zoonotic NTDs NTD programme, Department of Public Health Federal Ministry of Health Nigeria Ibrahim BANGANA Directeur Général des Services Vétérinaires Ministère de l’Elevage Niger Daouda BANGOURA Conseiller du Ministre Elevage Ministère de l’Elevage et des Productions Animales Guinea Komla Batasse BATAWUI Directeur de l’Elevage Ministère de l’agriculture, de l’Elevage et de l’Hydraulique Togo Ahmed BE-NAZIR Professor Department of Microbiology National Institute of Preventive and Social Medicine (NIPSOM) Ministry of Health and Family Welfare (MHFW) Bangladesh Thinlay BHUTIA Programme Coordinator Department of Animal Husbandry and Veterinary Services Government of Sikkim Sikkim Anti-Rabies & Animal Health Program (SARAH) India Marcellin BIARMANN Direction des Services Vétérinaires Ministère de l’Elevage Madagascar Zainudin BIN ABDUL WAHAB Head Disease Control Division Zoonotic Infectious Disease Sector Malaysia Lucille BLUMBERG Deputy-Director of National Institute for Communicable Diseases Head of Division of Public Health Surveillance and Response South Africa Bolor BOLD University of Basel, MoH Mongolia Switzerland Isabelle BOLON Institute of Global Health University of Geneva Switzerland Etienne BONBON Président de la Commission du Code Terrestre de l’OIE Union européenne France Andrea BRITTON Director Vets Beyond Borders Australia Rene CARLSON President World Veterinary Association USA Bernardo CASSAMÁ Directeur Générale de l’Elevage Direction Générale de l’Elevage Guinea-Bissau Tu CHANG CHUN Head of OIE Reference Laboratory for Rabies Changchun Veterianry Research Institute (CVRI), Chinese Academy of Agricultral Sciences (CAAS) China (People’s Rep. Of ) Siang Thai CHEW Deputy Chief Executive Officer Agri-Food & Veterinary Authority Singapore Wenya Charmaine CHNG Veterinarian Agri-Food & Veterinary Authority Singapore Tze Hoong CHUA Group Director Agri-Food and Veterinary Authority Singapore Diarra CISSE ÉPOUSE AMAN Directeur des Services Vétérinaires Ministère des Ressources Animales et Halieutiques Cote D’ivoire 20 Global conference on the elimination of dog-mediated human rabies: the time is now Sarah CLEAVELAND Professor, Comparative Epidemiology University of Glasgow UK Rubina CRESENCIO Chief Veterinary Officer Director, Bureau of Animal Industry Philippines Duc Anh DANG Director National Institute of Hygiene and Epidemiology Viet Nam Michael DAY Professor of Veterinary Pathology University of Bristol UK Paola DE BENEDICTIS Veterinarian permanent staff Istituto Zooprofilattico Sperimentale delle Venezie Italy Nancy DE BRIYNE FVE Belgium Eduardo Pacheco DE CALDAS Head Coordinator of the National Program for Control and Prevention of Rabies, Coordinator of the Technical Surveillance in Zoonosis Ministry of Health Brazil Rafael Ruiz DE CASTANEDA Institute of Global Health University of Geneva Switzerland Ganga DE SILVA Director Operations Blue Paw Trust Sri Lanka Raffy A. DERAY Program Manager Department of Health National Center for Disease Prevention and Control Philippines Gaston DJONWE Directeur des Services vétérinaires Ministère de l’Elevage, des Pêches et des Industries Animales Cameroon Edgar DOMBOLO Chief Veterinary Officer in Luanda Province Instituto dos Serviços de Veterinária MINAGRI Angola Salome DÜRR Academic researcher Vetsuisse Faculty University of Bern Veterinary Public Health Institute Switzerland Vali GARAYEV Head Advisor, PhD Biological Science The State Veterinary Control Service of the Ministry of Agriculture Azerbaijan Kenneth GBEDDY Deputy Chief Veterinary Officer Veterinary Services Directorate Ghana Aftab GOHAR Coordinator Indus Hospital ER Pakistan Assi Laurent EBAKOUE First Secretary Permanent Mission of the Republic of Côte d’Ivoire to the United Nations Office and other international organizations in Geneva Côte d’Ivoire Mohamed GUEYA Directeur des Services Vétérinaires Ministère de l’Elevage Mauritania Andrea ELLIS Representing the Canadian OIE Delegate Canadian Food Inspection Agency Canada Amila GUNESEKERA Medical officer in charge Rabies treatment unit National hospital of Sri Lanka Sri Lanka Kamal ELSHEIKH Chief Veterinary Officer & OIE Delegate Ministry of Livestock Sudan VERONICA GUTIERREZ CEDILLO Chief Departamento de rabia en el reservatorio Centro nacional de programas preventivos y control de enfermedades Mexico Egejuru EZE Chief Veterinary Officer Federal ministry of agriculture and rural development Nigeria Hind EZZINE Chef du Service des Maladies Epidémiques Direction de l’Epidémiologie et de la Lutte contre les Maladies Ministère de la Santé Morocco Sampath GADE Deputy Civil Surgeon Institute of Preventive Medicine India Luke Gamble CEO Mission Rabies / Worldwide Veterinary Service UK Katie HAMPSON University of Glasgow UK Essam HASSAN Veterinary in zoonotic departement GOVS Egypt José Antonio HERNÁNDEZ RABELO Director Instituto Medicina Veterinaria Provincia Habana Cuba Elias IBRAHIM Animal resources Director Chief Veterinary Officer Ministry of Agriculture Lebanon Aqil JEENAH International Veterinary Students’ Association South Africa Xolani Roland DLAMINI Chief Veterinary Officer Ministry of Agriculture/Department of Veterinary and Livestock Services Swaziland Global conference on the elimination of dog-mediated human rabies: the time is now 21 21 Kassim Gharib JUMA Principal Secretary Ministry of Livestock & Fisheries Tanzania Winyi Kaboyo Assistant Commissioner Veterinary Public Health Ministry of Health Uganda Corlevin Marby KALALO Government Liaison Bali Animal Welfare Association Indonesia Judith KALLENBERG Head of Policy Policy & Performance GAVI Alliance Switzerland Nicholas KAUTA Director Animal Resources Ministry of Agriculture, Animal Industry and Fisheries Uganda Nadia KHELEF Senior Global Affairs Advisor to the DG, Institut Pasteur France Sim KHENG Deputy Director Department of Communicable Disease Control Ministry of Health Cambodia Abraham Haile KIDANE Associate Researcher, Team Leader Zoonotic Diseases and One Health Ethiopian Public Health Institute (EPHI) Ethiopia Moritz KLEMM Veterinary Officer European Commission, DG SANTE Belgium Lea KNOPF Veterinary Epidemiologist Independant epidemiologist and consultant Switzerland Halimatou KONE EPS TRAORE Directrice Nationale Direction Nationale des services Vétérinaires Mali Johann KOTZE State Veterinarian Nkomazi South Africa 22 Byll Orou KPEROU GADO Directeur de l’Elevage Ministère de l’Agriculture, de l’Elevage et de la Pêche Benin Ramesh MADHAVAN KUMAR Joint Director Animal Husbandry Department Government of Kerala India Bavukile Siphosethu KUNENE Veterinary officer Department of veterinary field services Ministry of Agriculture Swaziland Guinde Djeguedei MAHAMAT Directeur des Services Vétérinaires Ministère de l’Elevage et de l’Hydraulique Chad Dusan LALOSEVIC Director Pasteur Institute Serbia Serbia François LE GALL Banque mondiale USA Kevin LE ROUX Veterinary Services Environmental Affairs KZN Department of Agriculture & Rural Development South Africa Heechul LEE Veterinary Officer Ministry of Agriculture, Food and Rural Affairs Korea (Rep. Of ) Yu LI CDC USA Hung-Jen LIAO Second Secretary Chinese Taipei Switzerland Joann LINDENMAYER Senior Manager of Disaster Operations and Director, Haiti Program Department of Companion Animals and Engagement Humane Society International USA Mbargou LO Directeur des Services vétérinaires Ministère de l’Elevage et des Productions animales Senegal Emelinda LOPEZ Veterinarian IV Bureau of Animal Industry Philippines H B M Golam MAHMUD Principal Director Department of Livestock Services Bangladesh Mpho MAJA Director of Animal Health Department of Agriculture, Forestry and Fisheries South Africa MAKMUN MAKMUN Head of Risk Analysis of Exotic Disease, Biosecurity Sub-directorate Directorate of Animal Health Directorate General of Livestock and Animal Health, Ministry of Agricultura of Indonesia Indonesia Rebecca MANCY Research Fellow University of Glasgow UK Ana Elcira MARTINEZ RAMIREZ Encargada Programa de Prevencion y Control de la Encefalopatia Espongiforme Bovina Direccion General de Ganaderia Dominican (Rep.) Anas MAR’UF Deputy Director Programme and Information Secretariat Directorate General DC & EH Ministry of Health Indonesia Amos MATETA Control Animalm Health Technician Allerton Veterinary laboratory South Africa Min Thein MAW Deputy Director Livestock Breeding and Veterinary Department Myanmar Shichun MA Division Director Zoonotic Disease Control China Animal Disease Control China 22 Global conference on the elimination of dog-mediated human rabies: the time is now Geoffrey MCHAU Rabies contact person Ministry of Health and Social Welfare Tanzania Steven MCIVOR Acting CEO World Animal Protection UK Kamarudin MD ISA Deputy Director General of DVS (Veterinary Health) Ministry Of Agriculture and Agro-Based Industry Malaysia Artur MELIKYAN Chief specialist of Veterinary Inspection State Service for Food Safety of the Ministry of Agriculture of the Republic of Armenia Armenia Max François MILLIEN Directeur des services vétérinaires Ministre de l’Agriculture Haiti Botlhe Michael MODISANE Chief Director: Animal Production and Health Department of Agriculture, Forestry & Fisheries South Africa Sarah MOESCHLER Institut de virologie et d’immunologie Switzerland Marosi Augustine MOLOMO Director of Livestock Services Ministry of Agriculture and Security Lesotho Susan MOORE Director, KSVDL Rabies Laboratory Assistant Professor Kansas State University USA Tiémoko MORIKO Counsellor Permanent Mission of the Republic of Côte d’Ivoire to the United Nations Office and other international organizations in Geneva Côte d’Ivoire Molly MORT Bill & Melinda Gates Foundation USA Emmanuel A. MPOLYA Lecturer Department of Global Health and Bio-Medical Sciences Nelson Mandela African Institution of Science and Technology Tanzania Beryl Mutonono-Watkiss Deputy Director of International Programmes World Animal Protection Gabriel Martin Esono NDONG MICHA Director General de Ganaderia Ministerio de Agricultura y Bosques Equatorial Guinea Kisa Juma NGEIYWA Chief Veterinary Officer & Director of Veterinary Services Ministry of Agriculture, Livestock & Fisheries; State Depart of Livestock Kenya Thi Huong NGUYEN Zoonosis focal point General Department of Preventative Medicine Ministry of Health Viet Nam Thu Thuy Nguyen Department of Animal Health Viet Nam Yonela S. NKUBUNGU Deputy Director Department of Rural Development & Agriculture Reform Maluti College of Education South Africa Honoré N’LEMBA MABELA Directeur Chef des Services Vétérinaires Ministère de l’Agriculture, Pêche et Elevage Congo (Dem. Rep. Of The) Deogratias NSANGANIYUMWAMI Directeur de la Santé Animale Ministère de l’Agriculture et de l’Elevage Burundi Spiridon NTOUNTOUNAKIS Director Ministry of Rural Development Greece Andrey OGANESYAN FGI « Federal Center for Animal Health » Russia Eric OSORO Medical Epidemiologist Zoonotic Disease Unit Ministry of Health Kenya Lassina OUATTARA Directeur Général Services Vétérinaires Ministère des Ressources Animales Burkina Faso Mangesh A. PATIL Assistant Director National Centre for Disease Control India Kinley PENJOR Faculty of Nursing & Public Health Khesar Gyalpo University of Medical Sciences Ministry of Health Bhutan Keith PERRETT Manager Epidemiology Section Veterinary Services KZN Department of Agriculture & Rural Development South Africa Prapas PINYOCHEEP Director Department of Livestock Development Thailand Budimir PLAVSIC Head of Animal Health Department Ministry for Agriculture and Envornmental protection Veterinary Directorate Serbia Jorge Alejandro PORTALEZVAZQUEZ First Secretary to the Permanent Mission of Cuba in Geneva Irina Vladimirovna POPOVA Chief specialist Department of epidemiological surveillance Federal Service for Supervision of Consumer Rights Protection and Human Welfare Russia Global conference on the elimination of dog-mediated human rabies: the time is now 23 23 Keshav Prasad PREMY Director General Department of Livestock Services Nepal Tashi SAMDUP Director General Department of Livestock Bhutan Bolortuya PUREVSUREN OIE delegate to Mongolia Department of Veterinary and Animal Breeding Mongolia Víctor Hugo SANCHO VARGAS Coordinador del Programa Nacional de Rabia SENASA Costa Rica Beatriz QUIAMBAO Medical Officer V Research Institute for Tropical Medicine Philippines Jennifer SAURINA Deputy Head of Multilateral Relations Sector Federal Food Safety and Veterinary Office FSVO Switzerland Ali Qurban Chief Veterinary Officer Pakistan Ministry of National Food Security and Research Pakistan José Antonio Hernández RABELO Ministerio de Salud Pública Cuba Sergio RECUENCO CABRERA Director-General Centro Nacional de Salud Pública (CNSP) Peru Jack F. REECE Veterinary Surgeon Help in Suffering Maharani Farm India Ann-Marie SEVSCIK Program Director UBS Optimus Foundation Switzerland Abul Khair Mohammad SHAMSUZZAMAN Director Disease control and Line Communicable Disease Control (CDC) Directorate General of Health Services (DGHS) Bangladesh Emmanuelle ROBARDET European Union Reference Laboratories for rabies and wildlife France Sharmin SHARIF Programme Manager BRAC Uganda Country Office Uganda Pedro ROSADO-MARTIN EC, DG SANTE Belgium Cristian SIPOSEAN National Focal Point on Wildlife at OIE - Head of Monitoring and Notification Service National Sanitary and Food Safety Authority Romania Romania Charles RUPPRECHT Director Center for Conservation Medicine & Ecosystem Health Wistar Institute USA Claud SABETA Research Team Manager and OIE Expert for Rabies Agricultural Research CouncilOnderstepoort Veterinary Institute South Africa 24 Karin SCHWABENBAUER Chief Veterinary Officer Bundesministerium für Ernährung und Landwirtschaft Germany R. Vensya SITOHANG Dirctor Vector Borne Diseases Control Ministry of Health Indonesia Jeong Hwa SO Veterinary Officer Animal and Quarantine Agency Korea (Rep. Of ) Jean Jacques SOULA Senior Livestock Officer Ministry of Foreign Affairs and International Development France SOZANSKI Gabriella Alliance for Health Promotion Switzerland R Craig STEPHEN Professor & Executive Director Canadian Wildlife Health Cooperative Canada Daniel STEWART Primary Animal Health Care Coordinator South Africa Mohamad SUBUH Director-General Communicable Diseases Control and Emvironmental Health Ministry of Health Indonesia Pebi SUSENO Senior veterinary officer Directorate of Animal Health Indonesia Shaharul Akmar TALIB State Director Department of Veterinary Services Malaysia Léon TATI Conseiller à l’Elevage du Ministre en charge de l’élevage Ministère de l’Agriculture et de l’Elevage Congo (Rep. Of The) Abdallah TRAORÉ Laboratoire Central Vétérinaire Mali Alexandra TROYANO-GROUX Chargée d’étude, Bureau de la santé animale DGAL, Ministère de l’agriculture, de l’agro-alimentaire et de la forêt France Samat TYULEGENOV Director General National Reference Center for Veterinary medicine Kazakhstan Unesu Hildah USHEWOKUNZEOBATOLU Principal Director Department of Livestock and Veterinary Services Zimbabwe 24 Global conference on the elimination of dog-mediated human rabies: the time is now Sherali VAZIROV Chief State Veterinary Inspection Service Tajikistan Nenad VRANJES Pasteur Institute of Novi Sad Serbia Alexander WANDELER Scientist Emeritus (retired) Animal Diseases Research Institute Canada Xijun WANG Assistant professor Harbin Veterinary Research Institute, CAAS China (People’s Rep. Of ) Osbil Olando WATSON Chief Veterinary Officer Veterinary Services Division Jamaica Henry WILDE Professor Department of Medicine Neurovirology Division, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Thailand Htun Htun WIN Research Officer Livestock Breeding and Veterinary Dept. Myanmar Yonas WOLDU TESFAGABER Chief Veterinary Officer & OIE Delegate Ministry of Agriculture Eritrea DongHo YUN Livestock health control association Korea (Rep. Of ) Daniel ZASPEL Chair of the Board Tierärzte ohne Grenzen e.V. Germany Jakob ZINSSTAG Deputy Head Epidemiology and Public Health Swiss Tropical and Public Health Institute Switzerland Malek ZRELLI Directeur général Direction générale des services vétérinaires Tunisia WHO Collaborating Centres Jesse D. BLANTON WHO Collaborating Centre for Reference and Research on Rabies Rabies Program, Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention (CDC) USA Hervé BOURHY Centre collaborateur de l’OMS de Référence et de Recherche pour la Rage Unité de la Rage Institut Pasteur France Mala CHHABRA WHO Collaborating Centre for Joint Director, Rabies Epidemiology Division of Zoonosis National Centre for Disease Control India Florence CLIQUET WHO Collaborating Centre on Research and Management on Zoonoses Control Head of Lyssavirus Unit Laboratoire de la Rage et de la Faune Sauvage de Nancy Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (ANSES) France Hildegund C.J. ERTL WHO Collaborating Centre for Reference and Research on Rabies Professor Ertl Laboratory, Immunology Program Wistar Institute USA Christine FEHLNER-GARDINER WHO Collaborating Centre for Control and Epidemiology of Rabies in Carnivores Head, Centre of Expertise for Rabies Ottawa Laboratory Fallowfield (OLF) Canadian Food Inspection Agency Canada Anthony R. FOOKS WHO Collaborating Centre for the Characterization of Rabies and Rabies-related Viruses Department of Virology Animal and Plant Health Agency (APHA) UK Conrad FREULING WHO Collaborating Centre for Rabies Surveillance & Research Institute for Molecular Biology Friedrich-Loeffler-Institut Federal Research Institute for Animal Health Germany Alireza GHOLAMI WHO Collaborating Centre for Reference and Research on Rabies Pasteur Institute of Iran Iran Reeta S. MANI WHO Collaborating Centre for Reference and Research in Rabies Associate Professor, Department of Neurovirology National Institute of Mental Health and Neurosciences (NIMHANS) India Thomas METTENLEITER President, WHO Collaborating Centre for Rabies Surveillance & Research Friedrich-Loeffler-Institut Germany Thomas MÜLLER WHO Collaborating Centre for Rabies Surveillance & Research Head of OIE-RL and WHO CC Institute for Molecular Biology Friedrich-Loeffler-Institut Federal Research Institute for Animal Health Germany Observers Andrea ARANCIBIA Dep Dir Brand Leader Rabies Range&Immuno Sanofi Pasteur France Jose DE JESUS Business Manager CZ Veterinaria.com Spain Jennifer DENT President BIO Ventures for Global Health USA Global conference on the elimination of dog-mediated human rabies: the time is now 25 25 Isabelle DIEUZY-LABAYE Director Strategic Alliances ZOETIS France Carel DU MARCHIE SARVAAS Executive Director HealthforAnimals Belgium Ana María ESPINOZA SILVA Gerente Asuntos Regulatorios Biogenesis Bago S.A. Argentina Louis F. FRIES CEO Novavax, Inc. USA Bhagwat GUNALE Sr Manager Clinical Research Serum Institute of India Ltd. India Kim HARDIE Communications Director Health for Animals Belgium Wouter HUIZINGA Senior Director Key Account Management IDT Biologika GmbH Liechtenstein Suzanne JARVIS Managing Editor BMJ Publishing Group UK Andreas KASTENBAUER Managing Director IDT Biologika GmbH Germany Alasdair Iain MacGregor KING Director Intergovernmental Veterinary Health MSD Animal Health The Netherlands Joanne MAKI Director Veterinary Public Health Merial, Inc. USA Cinzia MARANO Senior Manager GlaxoSmithKline Biologicals Belgium 26 Wilfred MARISSEN Senior Manager Janssen Vaccines Lyn MORGAN Senior Director Vaccine Advocacy and Public Affairs Sanofi Pasteur France Zeev NOGA Veterinary Policy Officer World Veterinary Association Belgium FOOD AND ACRICULTURE ORGANIZATION OF THE UNITED NATIONS (FAO) Nick NWANKPA Director AU-PANVAC Ethiopia Mohammed BENGOUMI FAO Sub regional office for North Africa Italy Valentina PICOT Scientific Adviser Fondation Merieux France Eric BRUM Country Team Leader Bangladesh Sophie RANDOUX Global Director of Feline and Rabies Vaccines MERIAL France Carolin L SCHUMACHER Head Merial Public Affairs & Corporate Social Responsibility France Joris VANDEPUTTE Président Trivarop Belgium Qun WANG Changchun Changsheng Life Sciences Ltd. China FACILITATOR Daniel NORMANDEAU President of ConversArt Consulting Canada RAPPORTEUR Derek ELLIS ConversArt Canada Susan PERRY ConversArt Canada Katinka DE BALOGH Senior Officer-Veterinary Public Health Italy Baukje Gerritsje ANDELA Intern Italy Berhe TEKOLA Director of Animal Production and Health Division Italy GLOBAL ALLIANCE FOR RABIES CONTROL (GARC) Louis Hendrik NEL Professor and Executive Director South Africa Deepashree BALARAM Campaigns Director UK Deborah BRIGGS Chair of the Board of Directors USA Kim DOYLE Chief Operating Officer Switzerland Spring GOMBE-GÖTZ Policy Advisor Germany Sarah JAYME Country Representative Philippines Louise TAYLOR PRP coordinator USA 26 Global conference on the elimination of dog-mediated human rabies: the time is now WORLD ORGANIZATION FOR ANIMAL HEALTH (OIE) Bernard VALLAT Director General France Ronello ABILA Sub-Regional Representative Thailand Luis Osvaldo BARCOS Representante Regional OIE Americas Argentina Tamara BENICASA France Catherine BERTRAND-FERRANDIS Head of the OIE Communication Unit France Gideon BRUCKNER President OIE Scientific Commission for Animal Diseases South Africa Daniel CHAISEMARTIN Head of Administration, Logistics and Publications Department France Ingrid CONTRERAS ARIAS Trilingual conference coordinator France Stephane DE LA ROCQUE Chargé de mission Switzerland Alain DEHOVE Coordinator of the OIE World Animal Health and Welfare Fund France Monique ELOIT Deputy Director General France Brian Ross EVANS Deputy Director General France Yael FARHI Chargée de mission France Mary Joy GORDONCILLO Science and One Health Coordinator Thailand Hirofumi KUGITA Regional Representative Japan Nadège LEBOUCQ OIE sub-regional representative in Brussels Belgium Aashima AUPLISH Intern Anne-France CARRICHON Neglected Zoonotic Diseases Moetapele LETSHWENYO OIE Sub-Regional Rep for Southern Africa Botswana Ritu Singh CHAUHAN WHO Country Office India Kazimieras LUKAUSKAS OIE Regional Representative Russia Jocelyn MEROT Programme officer Tunisia Aleksandra MITEVA Technical Assistant at OIE RREE Bulgaria Djahne MONTABORD Conseiller technique Kazakhstan Yooni OH Regional Project Coordinator Japan Xavier PACHOLEK Regional Representation for the Middle East Lebanon Mereke TAITUBAYEV Head of sub-regional office Kazakhstan Gregorio TORRES Chargé de mission France Karim TOUNKARA Deputy Regional Representative for OIE Africa Mali Alix WENG Head of the Budget and Financial Unit France WHO SECRETARIAT Margaret CHAN Director-General Ottorino COSIVI AMRO/AFT Brazil Denis DAUMERIE Control of Neglected Tropical Diseases Anna DEAN TB Monitoring and Evaluation Maria Nerissa DOMINGUEZ WHO Country Office Philippines Anna FAHRION Neglected Zoonotic Diseases Elkhan GASIMOV EURO Denmark Gyanendra GONGAL SEARO India Joanne HARRIES Intern Sandrine HUBERT Volunteer Maho IMANISHI WHO Country Office Viet Nam Ivana KNEZEVIC Technologies Standards and Norms Anne-Marie LABOUCHE Volunteer Stephen MARTIN Control of Epidemic Diseases Mario MASANA WHO Country Office Bolivia Kazuaki MIYAGISHIMA Director Food Safety, Zoonoses and Foodborne Diseases Dirk ENGELS Director Control of Neglected Tropical Diseases Naoko OBARA Neglected Zoonotic Diseases Bernadette ABELA-RIDDER Team leader Neglected Zoonotic Diseases Marco VIGILATO AMRO/AFT Peru Global conference on the elimination of dog-mediated human rabies: the time is now 27 27