In the case of dog rabies, basically all is known about the biology of rabies to effectively implement elimination [3]. To wit, highly efficacious vaccines are available for dogs. Dog rabies has been eliminated in large parts of the industrialized countries in Europe and North America. In the last decades, a concerted effort of South and Central American countries has strongly reduced dog rabies close to elimination [4]. Dog rabies persists and has even re-emerged in Asia and Africa where still more than 60′000 people die annually from this preventable disease. The largest part of the burden is borne by India and South East Asian countries followed by China (Figure 1) [5]. Using dog-human transmission models, it has been shown that dog mass vaccination leads to rabies elimination and is more cost-effective than exclusive implementation of human post exposure prophylaxis [6]. The basic reproductive ratio of dog rabies is less than 2, making it an ideal candidate for worldwide elimination [7], a goal that is pursued by the partners for rabies prevention http://www.rabiesalliance.org.
However, why is there no or insufficiently effective action to control and eliminate dog rabies? Yin’s paper, based on a systematic analysis of published literature and official documents shows that there is considerable overrepresentation of laboratory investigations or pathogen-associated and basic epidemiology research. On the other hand, information on effective control activities and policies are nearly absent. There is a lack of awareness in the general population about rabies and how to handle exposure to rabies suspected dog bites. Albeit some progress, there is still a lack of standardization of post exposure treatment in China, making it the worlds largest market for human rabies vaccination with no effect on interrupting transmission. Such practices benefit large drug companies but not the poor dwellers, who have to spend the equivalent of several months income on the cost of post exposure prophylaxis. Surveillance in dogs and in humans reports a fraction of the suspected numbers of cases and there is still a lack of communication between the public health and veterinary sector on the subject. Why is it not attractive to do research on effective control and elimination? Rolling out large-scale campaigns against dog rabies is as complex as systems biology at the subcellular level. Reaching sufficient coverage to interrupt virus transmission requires an in-depth understanding of delivery, availability, accessibility, affordability, adequacy, acceptability and many other effectiveness factors [8–10]. The article by Yin and co-workers shows an appalling situation of research still focussing on the biology of rabies rather than on the community-effectiveness of interventions. This observation is not unique for rabies, but in the case of rabies it appears almost cynical. There is a huge potential for research into the determinants of how dog rabies can be effectively eliminated. For a broad range of zoonoses and neglected tropical diseases, scientists seem to prefer sophisticated molecular analyses over investigating in effective interventions in communities. Why are research funding agencies much less interested into research aiming at effectiveness determinants rather than the biology of pathogens?
