Rabies control in India: a need to close the gap between research and policy

Perspectives Rabies – a viral zoonosis– is recognized as a priority disease for global and national level control measures. 1–3 Key interventions for rabies control include vaccination for high-risk individuals, surveillance of human cases, post-exposure prophylaxis following animal bites, vaccination and/or culling of the canine population and other animal reservoirs. Despite the known effectiveness of these interventions, 4 many national policy-makers across Africa and Asia hesitate to introduce them. 5,6 We argue that this hesitation may be caused by advocacy for technical solutions that do not account for local requirements of policy-makers and implementers. There has been a considerable amount of research on rabies in India, but key questions remain unaddressed. 6 For example, while policy-makers need evidence for social, political and economic outcomes of control programmes, most rabies research is done in the basic sciences. 6 We aim to illustrate the research–policy disconnect in rabies control and describe how this disconnect contributes to the lack of effective rabies-control policies in India. Over the past decade, intradermal administration of rabies vaccine for post-exposure prophylaxis has heralded a major change in rabies-control measures. The World Health Organization recommends this route when vaccines are in short supply, citing the 60–80% reduction in direct costs and vaccine consumption, compared with standard intramuscular injection. 4,7 While intra-dermal administration makes efficient use of limited vaccine supplies, the costs saved by using this strategy at a programme level have not been fully ascertained. We conducted a cost analysis of rabies-control programmes in India and showed that the choice of vaccination route contributed the least to government cost‒savings compared to other drivers of programme costs, such as procurement costs and wastage rates of different vaccine formulations and the incidence of dog bites. 8 Thus, cost-savings from a centralized procurement and supply-chain management system might be outweighed by the costs of uniform adoption of intradermal vaccination in an Indian setting. Through discussion with the programme managers , we found that they favoured the intradermal route in urban hospitals and the intramuscular route in peripheral health facilities. Peripheral facilities, which have fewer patients than urban hospitals, treat one to two dog bites per week, hence, the multi-dose vaccine vi-als are discarded after use in one patient. Therefore, the intradermal use policy does not always lead to vaccine savings but could increase the transaction costs of the vaccination due to the increased need for training and supervision of vaccinators. Canine …