Tribulations of the Last Mile: Sides from a Regional Program

Abstract

In Latin American and Caribbean (LAC) countries, the number of cases of dog-mediated human rabies is at its lowest since the onset of the Regional Program for Rabies Elimination in 1983, a commitment from LAC countries to eliminate dog-mediated rabies coordinated by the Pan American Health Organization. Despite minor setbacks, the decline in the number of human cases has been constant since 1983. While many LAC countries have significantly reduced rabies to a level where it is no longer significant public health concern, elimination has proven elusive and pockets of the disease remain across the region. In the 33-year period since 1983, the region has set and committed to four dates for elimination (1990, 2000, 2012, and 2015). In this paper, we ponder on the multiple causes behind the elusive goal of rabies elimination, such as blanket regional goals oblivious to the large heterogeneity in national rabies capacities. Looking ahead to the elimination of dog-mediated rabies in the region, now established for 2022, we also review the many challenges and questions that the region faces in the last mile of the epidemic. Given the advanced position of the Americas in the race toward elimination, our considerations could provide valuable knowledge to other regions pursuing elimination goals.

Rabies in the Caribbean: A Situational Analysis and Historic Review

“…This can in turn be used as evidence to leverage political commitment and initiate policy development for disease prevention and control. Furthermore, in an attempt to evaluate the sensitivity of surveillance mechanisms to identify human rabies cases, systemic evaluations of surveillance outcomes, for example, and reviews of medical records for acute encephalitis, can be conducted [ 27 ]. In localities where there is separation of responsibilities for animal and human rabies surveillance, inter-sectoral coordination is essential to avoid inefficiencies.…”

“…Bolivia, Brazil, Peru, Honduras, Guatemala, Haiti, Dominican Republic, and Cuba) [ 23 , 25 ]. As such, the action plan and expected elimination date have been updated several times, with the latest revision running up until 2022 [ 27 ]. The aforementioned regional program was launched at the first Meeting of National Rabies Program Directors in the Americas (REDIPRA), which is coordinated by PAHO and supported by numerous non-governmental organizations and public-private partnerships [ 28 ].…”

“…The aforementioned regional program was launched at the first Meeting of National Rabies Program Directors in the Americas (REDIPRA), which is coordinated by PAHO and supported by numerous non-governmental organizations and public-private partnerships [ 28 ]. REDIPRA usually meets biennially to advocate for and review existing control strategies, compare program achievements against objectives, and update the regional action plan accordingly [ 27 , 28 ]. These meetings have been instrumental in the success of the regional program, aligning the countries towards a common goal and facilitating practical amendments to their national rabies control programs through shared experiences [ 29 ].…”

“…Laboratory-based surveillance activities in Latin America and the Caribbean are supported by PAHO/WHO Research Centers in North America [ 32 ]. However, it has been recognized that there has been limited systematic evaluations of rabies surveillance carried out within the region [ 27 , 33 ].…”

The Formation of the Eastern Africa Rabies Network: A Sub-Regional Approach to Rabies Elimination

“…The PARACON epidemiological bulletin, a web-based surveillance database, is a useful tool for the collection, collation, analysis, and dissemination of rabies surveillance data [ 17 ]. To encourage the use of the bulletin, sub-regional country-specific data were collected from meeting participants, and collated data were summarized on a single viewable page.…”