Recent studies conducted by the Food and Agriculture Organization of the United Nations (FAO) through its Emergency Centre for Transboundary Animal Diseases (ECTAD), together with the Australia-Indonesia Health Security Partnership (AIHSP), Ceva Sante Animale – a global animal health company, and the Indonesian Ministry of Agriculture, have revealed the effectiveness of implementing oral rabies vaccination in Bali, Indonesia. The studies have become a critical finding in rabies prevention and elimination for the country.

Rabies has a long history since the first case in dogs was reported in 1890 on Java Island. Over the decades, rabies spread from Java to other regions in Indonesia, such as Sumatera (1911), Sulawesi (1956), Kalimantan (1976), Flores (1997), Bali (2008) and Sumbawa (2019). The Indonesian government set mass dog vaccination (MDV) as its primary rabies control strategy, with a minimum vaccination coverage of 70 percent.

However, several challenges were encountered during the implementation, including vaccine distribution to remote areas, socio-cultural perspectives and lack of adequate resources. “The large number of hard-to-handle free-roaming dogs also pose a big challenge for rabies elimination as they cannot be easily captured and handled for vaccination,” said Pebi Purwo Suseno, the Senior Veterinary Officer at the Ministry of Agriculture in Indonesia and the focal point for World Organization for Animal Health (WOAH). “We therefore looked for other intervention strategy by utilizing oral rabies vaccination to reach free-roaming dogs,” added Pebi further.

Using specific food-baits and an internationally recognized oral vaccine for dogs to fight the deadly disease

Two pilot areas in Bali, Karangasem and Buleleng districts, were chosen to provide in-depth insights into the acceptance of various bait types, the effectiveness and people contact-risks of oral vaccine and the estimated success of oral rabies vaccination under different geographic and demographic circumstances.

By conducting bait trials, the study identified the high effectiveness of the locally made Bali cattle intestine bait and industrially produced egg bait in releasing the vaccine into oral cavity compared to machine-made fishmeal-based bait. Under field conditions in Indonesia, the immunogenicity study revealed no significant quantitative difference in the level of antibodies between orally and parenterally vaccinated dogs. It underlined the advantages of oral rabies vaccination compared with the traditional method of capture-vaccinate-release (CVR), which was used for several years to reduce human contact risk and safeguard people’s health without compromising vaccination coverage. Studies also recommended that oral rabies vaccination can be used to replace the parenteral vaccination method using nets by targeting free-roaming dogs.

To eliminate and beyond

Rabies is an unfairly long-neglected disease that needs collective action from various stakeholders to eliminate the disease. Going forward, field trials to evaluate the cost-effectiveness of ORV in an Indonesian setting are needed and will be included in the next action plan.

These studies also paved the way for the widespread adoption of oral rabies vaccination as a cost-effective and efficient approach to reaching free-roaming dogs. “By embracing oral rabies vaccination alongside other rabies control measures, Indonesia moves further to achieve its eventual goal of eliminating dog-mediated human rabies deaths by 2030,” said Rajendra Aryal, FAO Representative for Indonesia and Timor Leste. “FAO is committed to support the government towards eliminating rabies and protecting lives and livelihoods of the people,” added Aryal.

FAO has been working closely with the Indonesian Government to reduce the impact of threats arising from animals, including rabies, by developing healthy, resilient and sustainable animal health systems using One Health approach. By facilitating capacity building activities and providing technical support to the government, FAO has substantially contributed to optimizing rabies vaccination strategies, raising public awareness of rabies prevention and control, and protecting lives and livelihoods of people in Indonesia, thanks to generous funding from the United States Agency for International Development (USAID).