1. Neither the WHO bulletin nor The Guardian appeared to reference a methodology for estimates global or India-specific rabies deaths each year. A quick search on academic journals found this article (
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003709) which estimates 59,000 cases but with a pretty wide confidence interval from 25,000 to 159,000 deaths annually; and 20,000 with a confidence interval from 7,000 to 55,000 for India-based rabies deaths. The paper explains the methodology for these estimates as: "The model uses the product of bite incidence, the probabilities of (i) a biting animal being rabid, RP, (ii) a bite victim receiving PEP, PP, and (iii) in the absence of PEP, developing rabies, DP, to extrapolate human rabies deaths and DALYs.". This extrapolation seems less robust than death certificates or registration of cases in hospitals etc., given the multiple input estimations. The researchers show the uncertainty in the variables used for calculating deaths, highlighting uncertainty in (a) bite incidence and (b) PP (probability of a bite victim receiving PEP).
2. Again, couldn't see a methodology referenced in the WHO or the Guardian, but in the same article as above (Hampson et al., 2015) it estimates dog populations by "reported dog population estimates or projected from dog: human ratios using human population data" from UN datasets and surveys. Given this dog population estimate is used as the input into the number of deaths (along with vaccination coverage and population surveillance etc.) it seems that there could be some correlation between the population size and estimates of deaths
3. Rabies prioritization will probably depend on
- (1) problem characteristics - a stronger evidence base on the health and economic impact of rabies will encourage agenda-setting (as well as public or donor support). In particular in comparison to other health challenges.
- (2) feasibility of intervention - reactive shots exist as well as animal vaccination, but these can be expensive. I think Gavi recently (~2018 or 2019) approved financial support for Rabies PEP vaccination for humans post-exposure, which may increase the feasibility of intervention (but perhaps not for India given India is no longer Gavi-eligible). Further global donor subsidy could increase feasibility of intervention and prioritization. This could help operational support (likely costly given many rural deaths and limited time to reach a hospital) as well as procurement costs; and
- (3) politics - even the MoH, and certainly the broader govt., may be swayed by political priorities or those that make political sense. Here successful intervention probably requires vaccination - and with increasing vaccine hesitancy in many areas promoting further vaccine availability and usage may not be the best move politically.
Feedback welcome
