Every year rabies kills nearly 59,000 people worldwide, predominantly affecting vulnerable rural regions and children. In Eritrea, this zoonotic disease is endemic with periodic peaks of transmission which pose a serious risk to local communities’ livelihood, human and animal health. As 99% percent of human cases of rabies are transmitted by dog bites, the Ministry of Agriculture of Eritrea requested the OIE’s support for a mass vaccination campaign for dogs in 2018. The OIE-supplied 150,000 rabies vaccines which were financed through the generous contributions of the European Union. The vaccines filled a €18,000 budget gap in Eritrea’s rabies programming, and propelled Eritrea’s national Veterinary Services to reach 147,800 dogs with rabies vaccines; increasing vaccination coverage to between 80 and 100% in all targeted regions.
Eritrea has had substantial rabies outbreaks in five of its six regions: Maekel, Debub, Anseba, Gash Barka and Northern Red Sea zone. Since 1992, the Ministry of Agriculture has held annual vaccination campaigns in order to eliminate dog-mediated rabies. Due to insufficient funding, the Ministry could only afford 20,000 vaccine doses annually –a fraction of the number needed to adequately cover dog populations and curb transmission rates.
This is where the support of the OIE Vaccine Bank is critical. The OIE has worldwide experience in the management of vaccine banks and the delivery of vaccines which are both of high quality, and directly in line with the OIE International Standards. Since the creation of the banks, they have provided over 25 million rabies vaccine doses for dogs, and over 76.6 million Peste des Petits Ruminants (PPR) vaccine doses for sheep and goats around the world. Vaccine banks create an economies of scale effect, making each vaccine dose cheaper. It is a win-win for both the OIE, and the country involved: countries can more effectively coordinate animal disease control and vaccination programmes, and the OIE can ensure animal health and welfare is improved worldwide.
Figure 1: Map of Eritrea showing the six administrative regions © Veterinary Services, Ministry of Agriculture of Eritrea, 2020
The fight against rabies requires strong intersectoral collaboration and a One Health approach which includes human health, animal health and the environment sectors. That is why the OIE does not work alone on the elimination of rabies. The United Against Rabies Forum, an international partnership led by the OIE, the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), promotes multisectoral collaboration to end human deaths from dog-mediated rabies by 2030. Currently, 80% of rabies deaths occur in rural areas where access to health education campaigns and post-bite prophylaxis is limited or non-existent. Africa and Asia are the continents with the highest risk of human mortality, with more than 95% of the world’s fatal cases.
Before the support of the OIE, only 45% of dogs within Eritrea were vaccinated. Dr Yonas Woldu Tesfagaber, Director of Animal and Plant Health at Eritrea’s Ministry of Agriculture, reflected that having enough rabies vaccine doses was only half the battle. In 2020, he notes that “the main challenge was the novel Covid-19 [virus]. Even though the government took agriculture as an essential activity, the curfew declared from dusk to dawn affected the vaccine uptake, especially in the veterinary clinics located in the major cities.” In addition to Covid-19 concerns, vaccine uptake was challenged by other more traditional obstacles, such as a lack of transportation vehicles, inadequate surveillance and reporting of rabies cases, difficulties in implementing dog population management activities, and poor public awareness of rabies.
To further overcome obstacles to vaccination in the community, Veterinary Services staff developed a comprehensive plan in collaboration with local governments and village elders. They organised a public awareness campaign across TV, radio and print media to ensure that their target audiences for rabies vaccinations, such as dog owners, livestock herders, and schools, were informed about the disease before the vaccination campaign started.
The coordination of the awareness campaign and the following mass vaccination campaign was a success. Dr Yonas Woldu Tesfagaber relates that the sensitisation had a “positive impact and ensured smooth implementation of the programme across the entire country”. Moreover, he highlighted that “the full community’s participation in planning, vaccination program, monitoring and other services resulted in high coverage of vaccination and reduced incidence of rabies cases.”
Figure 2: World Rabies Day Campaign Banner used in Eritrea. © Veterinary Services, Ministry of Agriculture of Eritrea, 2020
The rabies vaccination campaign in rural communities creatively joined forces with livestock vaccination campaigns and used the opportunity to also vaccinate dogs. Dr Yonas Woldu Tesfagaber explained, “Livestock herders usually bring their shepherd dogs with livestock for vaccination, and therefore, we took advantage of this to mass vaccinate the dogs and reduce costs to the veterinary services and time for the livestock and dog owners.” The livestock disease, Peste des Petits Ruminants (PPR), is highly contagious among sheep and goats, and can infect up to 90 percent of an animal herd. PPR kills approximately 30 to 70% of infected animals. While the virus does not affect humans, PPR influences financial and food insecurity, causing 1.5 to 2 billion USD in economic losses globally per year. The disease particularly affects the 65% of Eritreans who earn their livelihood by raising sheep and goat and depend on them for personal consumption as well.
In Gash Barka, a region known as Eritrea’s breadbasket, rabies vaccine coverage since the OIE’s vaccine bank deliveries has nearly tripled from 35% to 90%. In all regions of the country, coverage has more than doubled, while in Maekel and the Southern Red Sea zone, coverage has reached 100%. These high coverage rates promise to promote the safety and security of animals and the people across Eritrea.
Figure 3: Dogs being vaccinated against rabies while Sheep and Goats are vaccinated for PPR and SGP in Gash Barka. © Veterinary Services, Ministry of Agriculture of Eritrea, 2020
The elimination of dog-mediated rabies by 2030 is an ambitious goal —in which mass vaccination campaigns will continue to be critical. Disease models and real-world experience show that sustained vaccination coverage of 70% of dog populations is sufficient to prevent the transmission of rabies between dogs, and from dogs to humans. Elimination makes economic sense, too – nearly 10% of the financial resources currently used to provide emergency treatment for bite victims would likely enable the entire world’s national Veterinary Services to eradicate rabies in dogs.
In Eritrea, the road to eradication does not seem as long now. In 2021, a new delivery of rabies vaccines from the OIE Vaccine Bank, this time supported by Germany, will further target rabies in dogs. A heightened vaccination coverage rate aside, the OIE’s support has been successful in convincing policy-makers that investing in veterinary public health has wide-ranging benefits. The government now plans to continue working with the OIE vaccine bank, and aspires to achieve the eradication of rabies and PPR. Dr. Yonas Woldu Tesfagaber is confident that they are on the right track: “We have managed to cover more than 75% of our dogs population and we are dedicated to achieving eradication by 2030.”