Strategic investment in One Health approaches offers the most cost-effective path to achieving the global "Zero by 30" rabies elimination goal
Imagine a disease with nearly 100% fatality rate once symptoms appear, yet is 100% preventable with proper interventions. This is the paradox of rabies, an ancient scourge that continues to claim approximately 59,000 lives annually despite the availability of effective tools to stop it 6 . The tragedy hits hardest in vulnerable communities where limited resources force heartbreaking choices between competing health priorities.
Annual deaths from rabies globally
Human cases from dog bites
The year 2030 marks a bold global target: the elimination of dog-mediated human rabies deaths. Achieving this ambitious goal requires more than just medical knowledge—it demands strategic economic thinking about how to get the biggest impact from every dollar spent. This is where the innovative One Health approach revolutionizes the battle, bridging human medicine, veterinary science, and economics to create efficient, cost-effective solutions that save both human and animal lives.
The One Health approach recognizes that human, animal, and environmental health are inextricably linked. This is particularly true for rabies, where over 99% of human cases originate from dog bites 6 . Traditionally, rabies control has been fragmented—human health agencies focus on treating bite victims while veterinary services may vaccinate dogs, often with limited coordination.
Indiscriminate PEP administration can strain healthcare budgets, and eventually redirect focus from essential mass dog vaccination campaigns 5 .
This siloed approach leads to inefficient resource allocation. One Health breaks down these barriers, creating coordinated strategies that deliver better health outcomes at lower costs by addressing the disease at its source.
| Aspect | Traditional Approach | One Health Approach |
|---|---|---|
| Primary Focus | Treating human exposures | Preventing transmission at source |
| Cost Driver | Expensive PEP regimens | Dog vaccination campaigns |
| Coordination | Limited between sectors | Integrated human-animal health teams |
| Surveillance | Separate systems | Shared data and response |
| Economic Impact | High recurring costs | Higher initial investment, lower long-term costs |
The economic wisdom of One Health strategies shines through in various studies. A systematic review of cost-effective interventions found that optimal rabies control programs should incorporate "mass dog vaccination and integrated bite case management in combination with efficient use of post-exposure prophylaxis" 1 . This coordinated approach delivers more comprehensive protection at a lower overall cost to communities.
Research has identified several particularly efficient interventions when implemented through a One Health lens:
The cornerstone of sustainable rabies control, with studies showing that 70% vaccination coverage in dogs can effectively interrupt transmission 6 . This represents the most cost-effective long-term solution by addressing the disease reservoir.
This strategy combines risk assessment of biting animals with appropriate PEP guidance. By investigating bite incidents and assessing the rabies risk, health workers can ensure PEP is given when truly needed while avoiding unnecessary treatments 5 .
Switching to a 1-week intradermal rabies vaccine regimen in humans reduces the cost and increases the accessibility of both pre- and post-exposure prophylaxis 1 .
Rather than indiscriminate administration, risk-based PEP allocation guided by animal investigation ensures limited supplies reach those at genuine risk .
Haiti provides an ideal setting to test innovative rabies control strategies. As the poorest country in the Western Hemisphere, with limited healthcare resources and an estimated dog population of over one million, Haiti faces significant rabies challenges . In 2013, the CDC collaborated with the Haitian government to launch the Haiti Animal Rabies Surveillance Program (HARSP), an Integrated Bite Case Management system that would become a crucial case study in cost-effective rabies control.
This program emerged from a stark reality: despite the availability of PEP, dog bite victims often didn't receive proper treatment due to cost, limited access, or lack of awareness about rabies risk. Meanwhile, resources were being wasted on low-risk exposures while genuine emergencies were missed. The HARSP program aimed to create a more efficient, targeted approach through coordinated human and animal health interventions.
Launched in 2013 as a collaboration between CDC and Haitian government
The Haiti IBCM program operated through a carefully designed process that brought together human health and veterinary sectors:
The process began when dog bite victims presented at health clinics or when community members reported bites to local authorities.
Trained field officers would investigate each reported bite, locating and assessing the biting animal using standardized risk evaluation criteria.
Officers recorded clinical signs, vaccination status, and behavior of the biting dog, classifying animals as "confirmed," "probable," "suspected," or "negative" rabies risks.
Based on the assessment, biting dogs were either euthanized for laboratory testing, quarantined for observation, or cleared. Meanwhile, bite victims received personalized PEP recommendations based on the specific risk level of their exposure.
All information flowed into a shared surveillance system that tracked both human exposures and animal rabies cases, creating a comprehensive picture of rabies dynamics.
This methodology transformed rabies control from a reactive to a proactive system, preventing unnecessary PEP expenditures while ensuring those at genuine risk received life-saving treatment.
| Strategy | Average Cost per Death Averted (USD) | Cost per Life-Year Gained (USD) | Key Strengths |
|---|---|---|---|
| No Bite Case Management | $7,797 | $158 | Baseline approach |
| Non-Risk Based PEP | $15,244 | $308 | Universal access, but inefficient |
| New IBCM Program | $7,528 | $152 | Balanced efficiency and effectiveness |
| Established IBCM Program | - | $118 | Optimal long-term solution |
The outcomes demonstrated compelling advantages for the Integrated Bite Case Management approach. Compared to traditional methods, IBCM achieved better health outcomes at lower cost, reducing the average expense per death averted by several hundred dollars . The analysis revealed that "better health and cost-effectiveness outcomes are achieved with the continued implementation of an IBCM program ($118 per life-year saved) compared with a newly established IBCM program ($152 per life-year saved)" .
Beyond the numbers, the program yielded crucial operational insights. Active community engagement proved vital for effective surveillance, while the integration of human and animal health data created unprecedented visibility into rabies transmission patterns. The system also demonstrated adaptive efficiency, improving its cost-effectiveness as the program matured and operational processes were refined.
| Tool | Function | Application in Rabies Control |
|---|---|---|
| RT-qPCR Kits | Detection of rabies viral RNA | Rapid diagnosis in suspected animal cases; more accessible than traditional methods |
| Fluorescent Antibody Test (FAT) Reagents | Gold standard for rabies detection in tissue samples | Confirmatory testing in laboratory settings |
| Rabies Viral Antigens | Target for diagnostic assays and vaccine development | Quality control of vaccines and diagnostic tests |
| Virus Neutralizing Antibody Assays | Measurement of protective immune response | Assessment of vaccine efficacy in humans and animals |
| Monoclonal Antibodies | Specific detection and typing of rabies viruses | Detailed characterization of circulating virus strains |
| Cell Culture Systems | Virus propagation and vaccine production | Manufacturing of human and animal vaccines |
These tools form the foundation of effective rabies surveillance and control. For instance, molecular diagnostics like PCR kits allow for rapid confirmation of suspected cases, enabling timely public health responses 4 . Meanwhile, antibody detection methods are crucial for monitoring vaccine effectiveness in both human and animal populations, ensuring that vaccination campaigns provide adequate protection.
The toolkit continues to evolve, with research efforts focusing on developing more affordable and stable reagents suitable for low-resource settings. Innovations such as lyophilized (free-dried) test components that don't require continuous cold chain storage are particularly valuable for rabies control in remote areas where the disease burden is often highest.
The global goal of eliminating dog-mediated human rabies by 2030 represents one of the most ambitious public health targets of our time. While significant challenges remain, the economic evidence for One Health strategies provides genuine cause for optimism. As research continues to refine our understanding of cost-effective interventions, the path forward becomes increasingly clear.
Ongoing investment in coordinated approaches with capacity building in low-income countries
Single-dose pre-exposure vaccines and novel oral dog vaccination approaches
Breaking down silos between human and animal health sectors
The lesson from economic analyses is unequivocal: collaboration across human and animal health sectors isn't just scientifically sound—it's financially smart. By breaking down traditional silos and embracing integrated approaches, we can transform the fight against rabies from a perpetual financial drain into a manageable investment with measurable returns in lives saved.
As we look toward the 2030 deadline, the combination of strategic resource allocation, continued innovation, and strengthened cross-sector collaboration offers our best hope for making rabies the latest success story in the history of disease elimination. The tools are available, the strategies are proven—now comes the challenge of implementation at scale, ensuring that no community is left behind in our final push against this preventable tragedy.
Comparison of cost per life-year gained across different intervention strategies in Haiti.