Impact of One-Health framework on vaccination cost-effectiveness: A case study of rabies in Ethiopia

Abstract

Livestock losses due to rabies and health and the corresponding benefits of controlling the disease are not often considered when the cost-effectiveness of rabies control is evaluated. In this research, assessed the benefits of applying a One Health perspective that includes these losses to the case of canine rabies vaccination in Ethiopia. We constructed a dynamic epidemiological model of rabies transmission. The model was fit to district-specific data on human rabies exposures and canine demography for two districts with distinct agro-ecologies. The epidemiological model was coupled with human and livestock economic outcomes to predict the health and economic impacts under a range of vaccination scenarios. The model indicates that human exposures, human deaths, and rabies-related livestock losses would decrease monotonically with increasing vaccination coverage. In the rural district, all vaccination scenarios were found to be cost-saving compared to the status quo of no vaccination, as more money could be saved by preventing livestock losses than would be required to fund the vaccination campaigns. Vaccination coverages of 70% and 80% were identified as most likely to provide the greatest net health benefits at the WHO cost-effectiveness threshold over a period of 5 years, in urban and rural districts respectively. Shorter time frames led to recommendations for higher coverage in both districts, as did even a minor threat of rabies re-introduction. Exclusion of rabies-related livestock losses reduced the optimal vaccination coverage for the rural district to 50%. This study demonstrated the importance of including all economic consequences of zoonotic disease into control decisions. Analyses that include cattle and other rabies-susceptible livestock are likely better suited to many rural communities in Africa wishing to maximize the benefits of canine vaccination.

Mathematical modelling and phylodynamics for the study of dog rabies dynamics and control: A scoping review

“…In recent years, researchers have been trying to identify external factors impacting the spatial dynamics of RABV spread ( n = 5) [ 63 , 64 , 68 , 69 , 71 ] ( Fig 2D and S1 Table ). Contrary to phylodynamic studies, the modelling category gathers a diverse panel of models with aims that cover the implementation of new mathematical methodologies ( n = 2) [ 42 , 46 ], the characterization of rabies dynamics ( n = 11) [ 26 , 27 , 31 , 32 , 40 , 41 , 44 , 47 – 49 , 51 ], the identification of factors driving the resurgence or maintenance of rabies ( n = 9) [ 16 , 23 , 25 , 33 – 35 , 37 , 38 , 43 ], the assessment of control strategies efficacy ( n = 18) [ 16 , 23 , 24 , 27 – 29 , 31 , 33 – 36 , 42 – 45 , 49 – 51 ], the risk assessment of rabies introduction and the evaluation of outbreak preparedness in rabies-free areas ( n = 3) [ 30 , 36 , 42 ], and cost-effectiveness studies ( n = 2) [ 39 , 48 ] ( Fig 2D and…”

Policy Perspectives of Dog-Mediated Rabies Control in Resource-Limited Countries: The Ethiopian Situation

“…In Ethiopia, Beyene et al ( 8 ) estimated the cost-effectiveness of mass vaccination in representative urban and rural districts while accounting for human health impacts as well as livestock impacts. This particular study simulated over the period of 5 years identified vaccination coverages of 70 and 80% to be the most likely to provide the greatest net health benefits in urban and rural districts, respectively.…”

“…In other words, the cost of the mass vaccination campaign is less than the total financial loss associated with rabies, which includes cattle-related rabies. On the other hand, the active investigation to identify other bite victims also comes at an reasonable additional cost to the program, which was not included in the cost accounting of the study ( 8 ). Similar studies need to consider at least costs of risk-based investigation, although implementation has been difficult for many countries including Ethiopia where funding for dog vaccination is limited.…”

“…For an annual cost-effective canine mass vaccination campaign with a coverage of 70% in urban and 80% in rural, the total investment for Ethiopia is estimated to be 17.5 million USD/year, in the order of 0.2$/dog per year ( 8 ). An investment of 17.5 million USD is a big investment for the Ethiopian government to allocate to rabies control compared to the amount of the budget allocated to the health sector in general.…”

“…These coverages are far lower than the 70% recommended minimum coverage to prevent rabies outbreaks ( 7 ). Although mass vaccination of dogs is a proven and cost-effective means of rabies control, there is a lack of motivation from owners and an inadequate intervention from local governments due to a lack of political will and resources ( 8 ).…”