Honourable ministers, colleagues at OIE and FAO, members of the Global Alliance for Rabies Control, experts in the veterinary and public health sciences, ladies and gentlemen,
Rabies belongs in the history books. This event will help put it there.
In a world of multiple existing and emerging threats to health, it is in our collective best interest to eliminate this disease. Rabies is a 100% preventable disease that still kills tens of thousands of people every year.
If not detected and managed quickly, the disease is almost invariably fatal. Death is horrific and agonizingly painful.
Most human rabies deaths occur in poor rural communities of Asia and Africa. Eliminating rabies is a pro-poor contribution to sustainable development that leaves no one behind.
As rabies kills nearly all of its victims quickly, the disease has lower visibility than most other infectious diseases. This low visibility helps explain the failure of many countries to invest in rabies control despite the existence of highly effective interventions. This is what we need to change.
As this conference will show, we now have the evidence, the experience, the arguments, the technical tools, the incentives, and some innovative funding mechanisms and partnerships to put the world on course to eliminate human rabies deaths by 2030.
We know the priority: eliminate rabies at source. Human infection is incidental to the epidemiology of rabies. Worldwide, dogs are by far the most important species in maintaining the cycle of infection. Well over 95% of human rabies cases result from the bite of a rabid dog.
Vaccinating at least 70% of the dog population breaks the cycle of transmission in dogs. This target threshold applies to dog populations across a wide range of settings in Asia and Africa regardless of dog density or ownership patterns.
When canine rabies goes down, so do human deaths. Mass vaccination is far more effective, and far more humane, than rounding up stray dogs and destroying them.
We know the other intervention needed to eliminate human rabies deaths. Post-exposure prophylaxis with vaccine and rabies immunoglobulin saves lives when accessible and promptly administered before the onset of symptoms. GAVI data show that post-exposure prophylaxis is highly cost-effective in terms of illness averted and lives saved.
As a third prong of the elimination strategy, we need to make these medical products more widely available and affordable, right down to the poor rural communities that bear the heaviest rabies burden. To do this, I cannot overstress the importance of moving health systems towards universal health coverage.
However, post-exposure prophylaxis alone will never eliminate rabies. Moreover, for a disease that mainly affects the rural poor, the costs are prohibitive. One dose costs between $40-$50, roughly equivalent to 40 days of wages. We need to make this treatment more affordable.
Without investment to control rabies at its source, the costs of preventing human deaths will be perpetually, and increasingly, high. Worldwide, $1.7 billion is currently spent on direct post-bite treatment, with a further $1.5 billion incurred through indirect patient costs.
Working together, OIE, FAO, WHO, industry, science, and civil society can use these resources more wisely.
However, controlling rabies at source is by far the more sustainable, and affordable option.
Ladies and gentlemen,
I want to thank the experts from multiple disciplines, under the Global Alliance for Rabies Control, who issued a web-based blueprint for the elimination of canine rabies.
Elimination has powerful technical interventions, and the incentives to use them. The situation is highly encouraging. WHO prequalification procedures ensure that human vaccines meet quality standards and are safe and efficacious.
Dog vaccines are safe, efficacious, and affordable. Current procurement mechanisms used by OIE and WHO for dog vaccine banks work well. To date, collaboration between WHO and the OIE vaccine bank has delivered more than 15 million doses of canine rabies vaccines to scale up efforts.
Over a five-year period, WHO coordinated four proof-of-concept projects to develop an evidence-based strategy for eliminating canine rabies and demonstrate the feasibility of doing so.
I wish to thank the Bill and Melinda Gates Foundation for supporting projects conducted in the Philippines, South Africa, and the United Republic of Tanzania. The fourth project took place in Bangladesh.
The projects, which had many innovations, proved that rabies can be eliminated, even in remote areas with little infrastructure and no previous experience in dog rabies control. They provided the evidence that rabies can be stopped.
As I conclude, let me honour the presence of Dr Henry Wilde, a renowned rabies expert and long-serving member of WHO expert panels and committees. His work has been instrumental in advancing the science of human and animal rabies, especially in improving prophylactic vaccination. This work has saved countless lives in endemic, low-resource settings around the world.
I also want to pay tribute to Bernard Vallat as this is his last month as Director-General of OIE. Under his leadership, the collaboration among OIE, FAO, and WHO has moved forward.
Thank you.