Towards Canine Rabies Elimination in Cebu, Philippines: Assessment of Health Economic Data

SummaryRabies is endemic in the Philippines. In 2010, with support from the Bill andMelinda Gates Foundation, a canine rabies elimination project was initiated inthe Philippine Archipelago of Visayan. We conducted an analysis of dog vaccina-tion and human PEP costs for dog bite patients in a highly urbanized area and alow-income rural municipality in Cebu Province, Philippines, from 2010 to 2012.Our findings indicated that eliminating rabies in dogs through mass vaccinationis more cost-effective than treating rabies exposures in humans. The average costs(in USD) per human life saved through PEP were $1620.28 in Cebu City and$1498 in Carmen. Costs per dog vaccinated ranged from $1.18 to $5.79 in CebuCity and $2.15 to $3.38 in Carmen. Mass dog vaccination campaigns conductedin each village were more cost-effective than fixed-site campaigns. The costs ofdog vaccination can be reduced further through bulk vaccine purchase by thenational government or large donor agency, for example the BMGF. As commu-nities achieve canine rabies elimination, more judicious use of PEP will result insignificant public savings. The study affirms the willingness of local governmentsto invest and reassure donors of their cooperation and resource contribution tosustain disease elimination efforts.IntroductionRabies is a neglected zoonotic disease that continues to be asignificant cause of human and animal deaths in manyparts of the world (Anderson and Shwiff, 2013). For manycountries in Asia, Africa and Latin America, canine rabies isendemic and the majority of human rabies exposure resultsfrom dog bites to children (Government of the Philippines,2010, n.d.). Reliable data indicating the actual incidence ofhuman rabies exposure are scarce or non-existent in manycountries, leading to the widespread belief that the globalnumber of human deaths is significantly underreported(Knobel et al., 2005; Miranda and Meslin, 2006; WHO,2013). As a result, rabies impacts are often consideredinsignificant by policymakers, which ultimately results ininadequate political pressure to implement disease controlmeasures.Rabies has a case fatality rate of almost 100% but is com-pletely preventable with timely intervention of post-expo-sure prophylaxis (PEP). Prevention of rabies in humans iscomplicated by the fact that it is often the case that thosemost commonly exposed to canine rabies (e.g. children andthe poor) also lack the resources necessary to treat or pre-vent exposure. As the relationship between humans anddogs is a main epidemiological driver, the elimination ofrabies in dog populations through vaccination campaignsis necessary to prevent human rabies exposure. As a firststep towards examining the feasibility of the global elimina-