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Rabies prevention and control – lessons from Chongqing, China

By: United Against Rabies

20 October 2022

Experts from the United Against Rabies Forum alongside the World Health Organization (WHO), World Organisation for Animal Health (WOAH) and Food and Agriculture Organization (FAO) collaborating institutions met in Paris on 12-16 December 2022 noting the lack of progress towards achieving the globally agreed goal of ending all human deaths from dog-mediated rabies by 2030.

Together they set out the global imperative to scale up political commitment, increase resource allocation, and take urgent action to eliminate human rabies deaths.

The group of experts wish to emphasise that the rabies virus is the deadliest of all zoonotic pathogens, both in terms of disease burden and case fatality rate. Yet human rabies deaths are entirely preventable. Deaths are the direct result of health inequalities in access to vaccines, related services and awareness.
WHO Rabies Modelling Consortium predicted that more than 1 million deaths, nearly half of which are children, will occur in 67 rabies-endemic countries from 2020 to 2035, if nothing changes.

Chongqing is the largest municipality in the world with a population of 32 million people and an estimated dog population of 1.3 million, of which around 200,000 are stray or free-roaming dogs.

Chongqing recorded 907 human rabies deaths between 2000 and 2022, with the peak occurring in 2007 when 175 people died. Despite this high number, only 86 canine rabies cases were confirmed that year by the municipal veterinary laboratory. It was clear to experts that there was a lack of data about dogs and canine rabies, lack of accountability for vaccination, and lack of coordination between public health and veterinary bodies.

To address this problem a Dog Administration Office was created in 2008 to improve surveillance of dog rabies and ensure PEP access. In 2008 the municipal government also introduced a Measure for Dog Administration which set out responsibility at city, county and township level and made canine rabies vaccination compulsory.

By 2011, relatively accurate data were being collected, the number of human rabies deaths declined to 47, but the demand for PEP had soared, costing some $USD 7 million per year, while only $USD 0.1 million was being spent on canine rabies prevention. There was also inconsistent data between counties within the municipality, with some recording 50-60 human rabies victims but no animal cases, and vice versa.

A new strategy was then developed to invest in 32 county-level veterinary laboratories and to improve the disease reporting system, costing around $USD 20 million. With the help of FAO experts and the WOAH reference laboratory in China, a massive technical training campaign was carried out for vets as well as a public awareness campaign for policymakers, dog owners and students.

In 2012, Chongqing’s animal health department proposed an ambitious goal to make rabies a priority zoonosis and achieve 0 human cases by 2020. New regulations, multi-department cooperation and epidemiological investigations were implemented, along with more transparent disease reporting. NGOs, professional associations, and animal hospitals were involved directly in monitoring the dog population, reporting suspicious cases and sample collection. “Rabies Free County” schemes were piloted in 2 counties to test the strategy. Most importantly, national funds were provided for free rabies vaccinations for all dogs, as well as antibody tests to verify the effect of a less expensive attenuated vaccine. In 2017, a free, inactivated rabies vaccine replaced the attenuated vaccine.

The updated strategy resulted in an increase of positive rabies antibody rates to 81%, and zero rabies deaths cases in both humans and animals in 2020. Chongqing shared its experience across the country and participated in developing China’s national control plan.

Unfortunately, in 2021 and 2022 respectively, 2 and 3 human deaths were recorded, and dog rabies cases were also confirmed. Since then, the municipal authority has started to increase legal enforcement, establishing a dog network management system that integrates vaccination information and dog ID. The municipality now aims to achieve zero human deaths from dog-mediated rabies by 2030.

Key lessons from Chongqing:

1. Veterinary authorities need to be able to communicate and advocate effectively with government and political leaders and carry out ongoing training of veterinary professionals to ensure that any rabies related death is seen as public health security incident.

2. Authorities should encourage transparency in reporting any disease outbreak and ensure proactive inter-sectoral communication and collaboration.

3. Health and veterinary experts should remind government leaders and decision makers that rabies control and eradication require a long-term approach; goals should be pragmatic and legal support is essential.

4. If possible, set up a hotline or direct contact to key political actors. In Chongqing residents are able to send suggestions directly to the Mayor’s email channel while other important political fora are the People’s Congress of Chongqing Municipality, and the Political Consultative Conference.