Abstract
Rabies is a feared global disease, largely due to the extreme case-fatality rate, which approaches 100% once a patient becomes ill [4]. The true burden of disease remains undefined, but rabies causes tens of thousands of human deaths annually and is responsible for major economic losses, including dog vaccination costs in excess of US$130 million, and US$512 million in livestock deaths in rabies-endemic countries. After exposure, rabies virus causes an acute, progressive fatal encephalitis, which is prevented with timely post-exposure prophylaxis (PEP). Pre-immunisation in populations at risk, using modern, safe and efficacious cell culture vaccines, also prevents rabies. Where the disease burden is greatest, vaccines are not always readily available, and they can be prohibitively expensive.
Rabies cases in vaccinated individuals are becoming increasingly recognised [6]. The challenge of ineffective vaccines is complex and multifactorial but could be part of an apparent growing global trend for counterfeit vaccines [2]. The World Health Organization (WHO) defines counterfeit medicines, including vaccines, as products containing either incorrect, little or no active ingredient, which are marketed and sold as authentic medicines. Such products are illegal if the contents have been altered deliberately and the authorisation forged. The increasing availability and administration of counterfeit rabies vaccines, especially for PEP, may result in otherwise preventable deaths.
In 2015, the WHO, the World Organisation for Animal Health, and the Food and Agriculture Organization of the United Nations, in partnership with the Global Alliance for Rabies Control, proposed the global goal of zero human deaths as a result of dog-mediated rabies, by 2030. This goal is supported by a strategic plan, aiming to save lives, reduce costs, and enable clear communications on the validation of canine rabies elimination in endemic countries.