11/02/2022 - 

On 6th January 2022, a panel discussion was held to explore the topic of integrated and co-delivery strategies for rabies and peste des petits ruminants (PPR) vaccination. Organised by the PPR GEP Secretariat, the event brought together over 100 participants via Zoom for a dynamic discussion. Speakers showcased a range of examples of community engagement in coordinated disease control initiatives aimed at enhancing impact and cost-effectiveness.

PPR and rabies are two major disease burdens that affect, in particular, the lives of the very poorest people, and that require a collaborative approach for their control. The PPR Global Eradication Programme (PPR GEP) aims to eradicate PPR by 2030, and global rabies elimination efforts aim to achieve zero human deaths from dog-mediated rabies by 2030. They share a date, but can these programmes also share resources, planning, and lessons learnt to accelerate their progress?

Prof Sarah Cleaveland, from the University of Glasgow, started by describing studies which have assessed integrating dog vaccination against rabies with various different health interventions. These include de-worming of children, vaccination of children, vaccination of livestock and de-worming of dogs for zoonotic parasitic diseases. She highlighted positive effects of integrated delivery on cost-saving, community support and increased levels of trust.

Key questions remain, however: what is the operational feasibility of scaling up initiatives, how would resources or funds be managed where these are shared across sectors, and would there be negative perceptions around linking animal and human health interventions?

Next, Dr Ahmed Lugelo, from the Paul G. Allen School for Global Health, Washington State University, explained his experiences of vaccine delivery to remote areas. The development of vaccine storage devices, costing only 14 US Dollars and holding 400 vials of vaccine, has enabled rabies vaccination in hard-to-reach communities. Such storage devices, Dr Lugelo suggested, could also be applied to the PPR GEP to help delivery to remote areas. He also explained how individuals trained as ‘One Health Champions’ had played a key role in sensitizing and engaging with communities.

The discussion then moved to the subject of funding. The moderator Dr Katinka de Balogh from the FAO Investment Centre remarked that that different disease control programmes are often siloed and have separate funding mechanisms. She asked Dr Thumbi Mwangi, from the Paul G. Allen School for Global Health, about options for cross-sectoral funding and sustainability of community-based programmes. Dr Mwangi remarked that prioritising the most important diseases, at country-level and at community-level, and planning of integrated control activities were key. He highlighted certain activities, for example estimating the size of target populations for vaccination (critical for programme costing) and conducting post-vaccination sero-surveillance, which could be implemented jointly for different disease programmes within the same communities.

We then heard experiences from two countries, Liberia and Sierra Leone, where integrated rabies and PPR vaccination campaigns have already occurred. Dr Joseph Anderson, the Chief Veterinary Officer of Liberia, and Dr Mohammed Alpha Bah, the Director of Livestock and Veterinary Services in Sierra Leone, both reported improved community awareness resulting from joint rabies/PPR awareness campaigns. They also highlighted how partnering with the public health sector had enabled access to benefits (including motorcycles for vaccination teams).

Finally, Dr Martin Ilott from EuFMD focused his talk on another form of integrated service delivery: vaccinating the same animal against several diseases. He highlighted the difference between authorised ‘combined vaccines’ and ‘associated use’. Associated use refers to administration of two or more veterinary vaccines holding separate registrations. There remain significant challenges for the development of safety & efficacy data for associated use, which may impede the integration of vaccine schedules for veterinary species.

In conclusion, the discussion demonstrated considerable interest in the topic of coordinated or integrated service delivery, which can span animal and human health to enhance impact and support at community level. Challenges remain, but the benefits are clear.

Improved collaboration between animal health and public health sector workers was seen following the joint rabies/PPR programme according to Liberia’s CVO. Importantly such collaboration can strengthen capacities across the spectrum of endemic AND emerging diseases that threaten our world. As Prof Cleaveland highlights: ‘The very capacities we need in health emergencies are those that can be strengthened in ‘peace-time’ – a trained workforce who know each other and have worked with each other, logistics/infrastructure and, critically, TRUST.

A poll was conducted during the meeting to assess participants views on the benefits of, and barriers to, joint PPR/ rabies vaccination campaigns. The results of the poll can be found HERE