Philippines: Collaboration is critical in navigating the rabies minefield
The country has recently gained the World Organisation for Animal Health (OIE) endorsement for its official control programme for dog-mediated rabies. This milestone will contribute to save many lives across regions and populations improving the health of humans and animals alike.
A few years ago, Sarah was watching her mom Susan, a 48-year-old food vendor, cook traditional banana fritters in their home in rural Philippines. This idyllic scene was broken up when a stray dog appeared as if from nowhere, running up and slashing Sarah across her face with a furious bite. Trying not to panic, Susan grabbed her distraught daughter and rushed to wash the wound with running water and soap. Moments later two other people – an ice cream vendor and a tricycle driver – were bitten by the same dog, which was later found to be rabid. Susan called the authorities to report the attack. All three victims were advised to pursue post-exposure prophylaxis right away at the Naga City Hospital. Two barangay tanod (police officers) were able to catch the dog and take it to the closest Veterinary Office. After being isolated and placed under observation, the animal was euthanised as symptoms worsened. He eventually tested positive for rabies.
It is not unusual for such events to unfold in the Philippines. A striking 82% of rabies cases are the result of bites from free-roaming dogs, which underlines the stray-dog conundrum that the country is trying to manage. Rabies continues to pose a daunting challenge to its population: over one million Filipinos are bitten by dogs every year, nearly half of whom are children below five years of age.
Unowned free roaming dogs play an important role in the transmission of the disease. Some dogs also act as guardians to their owner’s homes, meaning they spend most of their time outdoors, exposed to other animals and nature. Although ordinances have been released against this practice, guard dogs are still a common sight in remote areas. There, the lack of access to medical treatment brings added hardship to those who fall victim of dog bites.
Despite the government spending 500 million pesos (around €8.5 million) every year for the vaccination of humans against rabies, 200-300 Filipinos still die every year. The last decade, however, has witnessed a more positive trend: the annual incidence rate of rabies exposure has decreased from 285 in 2007 to below 222 in 2020. In addition, because of an enhanced awareness of rabies, the protocol of seeking medical care when a dog bite occurs – rather than a ‘tandok’ (traditional healer) – has increased within the population, thereby saving lives.
Road to the endorsed control programme: the value of collaborative efforts
Back in 2007, the enactment of the ‘anti-rabies law’ provided a clear legal framework for rabies prevention and control, outlining key responsibilities for each concerned national authority agency and department.
The Philippines reached a new milestone when its official control programme for dog-mediated rabies was endorsed during the 88th General Session of the World Organisation for Animal Health (OIE) in May 2021. Together with Namibia, the Philippines are the first OIE Members to be granted such recognition. This achievement was welcomed as an important step forward in the global fight against rabies. Additionally, this recognition by the OIE means that the Philippines has a strong argument to advocate for scaled-up assistance from its government to progressively curb and stop the spread of the disease. It also guarantees a wider access to capacity-building activities and expertise, and stronger coordination at the regional level.
At the international level, the Organisation has been a steady supporter of the Philippines efforts to eradicate dog-mediated rabies. In 2013, the Bureau of Animal Industry (BAI) received 500,000 doses of rabies vaccines for dogs through the Organisation’s Rabies Vaccine Bank and thanks to European Union funding. The Rabies Vaccine Bank provides OIE Members with high-quality dog vaccines in a timely manner, and at a pre-established low, fixed price to support their national rabies elimination strategies. Additional rabies vaccines were then delivered to the Philippines in 2014 (320,000) and 2015 (300,000) thanks, this time, to Australian funding. Indeed, to further support rabies vaccination campaigns in the Philippines and other countries in Southeast Asia, the World Organisation for Animal Health partnered with the BAI and Australia to establish the ‘Stop Transboundary Animal Diseases and Zoonoses’ (STANDZ) Rabies project.
The initiative was designed to develop a better understanding of the role of each involved party in handling dog bites and rabies cases. It proved key to building the country’s capacity to improve its Rabies control programme. Through STANDZ, the OIE assisted in developing the Operation Plan for Rabies Elimination in Dogs (Oplan RED), which later led to the application of the Philippines for the Organisation’s endorsement of its national rabies plan. The World Organisation for Animal Health and the World Health Organization succeeded to support continuously the Philippines in the following years by supporting the numerous deliveries that were organised in the country from 2015 to 2020 (18 deliveries for a total of 15,7 million doses of rabies vaccines).
“The OIE supported us with the implementation of dog vaccination campaigns and helped us to refine multisectoral collaboration in the Philippines,” says Dr Daphne Jorca, veterinarian at the Department of Agriculture’s BAI. The impact of having rabies programmes in place, she says, is the result of increased commitment of both policymakers and implementers, from veterinarians and veterinary paraprofessionals to the broader public health sector. Knowing that freedom from rabies is a public good that can be accomplished with the currently available tools has encouraged government agencies to make the needed investments to eliminate the disease.
While a future without rabies could be on the horizon for the Philippines, there remains some hurdles to overcome. More funds and human resources to implement activities and support rabies affected families are needed. At the same time, changes in leadership within the government and involved organisations create other challenges: policymakers and organisational leaders must be sensitised on the rabies situation every three to six years, in order to secure the necessary budget to pursue the various projects and activities.
Nonetheless, Dr Jorca is confident that finding a nationwide solution against dog-mediated rabies will allow the Philippines to reap benefits elsewhere. “We are looking at eliminating the disease. Once we eliminate rabies, the government can redirect funds to other neglected tropical diseases or human health concerns,” she explains.
Besides the motivated focus of the government to stop rabies, community-level awareness has been fundamental to the success of rabies control efforts in the Philippines. Rabies Awareness Month is held annually in March, including an expansive information campaign around rabies prevention and control, along with free mass dog vaccination campaigns across the country. In addition to educating people on seeking the proper medical care when bitten by a dog, school-based interventions have shown potential for encouraging behavioural change, specifically for responsible dog ownership. In 2019, rabies education was integrated in the curriculum. The programme was put on hold due to the COVID-19 pandemic but is set to start again in the near future.
None of the gradual outcomes with rabies would have been possible without the joint efforts of different national players: Department of Agriculture, Department of Health, Department of Interior and Local Government, Department of Education, the Local Government Units, non-government organisations, international organizations, academia, Philippine Veterinary Medical Association as well as the provincial, city and municipal veterinarians league of the Philippines. Their shared goal to achieve freedom from dog-mediated rabies throughout the country has demonstrated a true One Health commitment to this issue, each body making their own contribution and working together.
Future success in rabies elimination remains to be a collaborative effort. Continued government action, international support through the OIE, WHO and donors, in hand with public awareness and education will be key in the years ahead. Dr Jorca is vocal about the need to eliminate human rabies, something that cannot be done by one agency or one sector. “Everybody has a role to play to put an end to rabies,” she argues, “As we say in the Philippines, Ang pagsugpo sa Rabies ay sama-sama, hindi kanya-kanya: rabies elimination is not a segregated approach but a collective one.”