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Govt barking mad if it holds back cash to defeat rabies
The COVID-19 pandemic and political expediency have dashed Sri Lanka’s hopes of reaching its robust goal of “zero rabies by 2020”.
The programme to eliminate dog-mediated rabies, which started in 2013, has once again stalled due to poor government funding this year, health ministry officials said.
The Public Health Veterinary Services (PHVS) said the cash-strapped Treasury has released only Rs. 65 million for the programme this year. For a smooth-running programme the health ministry needs a minimum of Rs. 200 million annually.
“Sri Lanka has around three million dogs, of which 30 per cent roam free. Failure to vaccinate dogs and neuter females on time will result in an increased population and more rabid dog bites,” PHVS Director Dr. L.D. Kithsiri warned.
This year alone, around 300,000 rabid bites have been reported, causing 26 human deaths. About 95 per cent of the bites are by dogs, the rest by other animals such as jackals, cats and squirrels.
From 1975, it has been a frustrating journey for the PHVS in its fight to contain rabid bites that stood at 1.6 million and 350 human deaths that year.
Sri Lanka has around three million dogs, of which 30 per cent roam free
In 2013, the health ministry set itself the herculean task of having no more than three deaths in a single year over a five-year period by 2020, but this target remains out of reach.
Dr. Kithsiri said Sri Lanka had almost got there, with only five rabies deaths reported in the first half of 2016. The change of government in 2015 interrupted this momentum, with the new government transferring the rabies eradication programme to the Ministry of Animal Production and Health (MAPH) in 2017.
The new ministry took time to study, organise and resume the programme, and the resultant pause in progress rendered futile the health ministry’s work up to that point.
The government has bought another five years, until 2025, from the World Health Organisation (WHO), which has set 2030 as its target to eliminate rabies from the face of the world.
COVID-19 this year put paid to the work that had to be done this year to achieve the 2025 target, restricting movement and making it difficult to conduct sterilisation and vaccination campaigns across the country
In previous years. around 1.5 million dogs were vaccinated annually but this year only 700,000 dogs were vaccinated. The government gave only half the money needed to run the programme.
Many deaths have been avoided in recent years because post-exposure prophylaxis (PEP) treatment is available in major base hospitals around the country. The PEP dose, which has human rabies immune globulin and rabies vaccine, costs the health ministry up to Rs. 40,000 for each patient.
The head of the Rabies Treatment Unit at the National Hospital, Dr. Amila Gunasekera, said despite the lockdown in Colombo and its suburbs there had been no decrease in rabies bites reported to the hospital.
“We work 24/7 and patients keep coming round the clock,” he said. “There has been no change in the numbers.”
He described what happens when anyone bitten by a rabid animal comes to hospital.
“The hospital has to start treatment immediately irrespective of whether the dog was vaccinated or not as there are no records of vaccination for roaming dogs.
“Patients who delay seeking treatment, sometimes for up to five or six months, often develop complications, even leading to death.”
Dr. Gunasekera said dog owners often do not vaccinate their dogs and, even if they do, generally fail to keep records.
Fragmented information-sharing is hampering clinicians in follow-up treatments and health surveillance.
In 2016, under WHO guidance, the health ministry developed an electronic platform for rabies surveillance in four districts: over nine months, information on patients and outcomes of PEP treatment were recorded and shared by six clinics, four laboratories and area Public Health Inspectors (PHI).
The programme sent out automated messages as alerts to patients, reminding them about vaccination and the date of their next appointment. All bites in the districts were reported to relevant PHIs of the area. At the end of the period, analysis showed the technology useful in improving public health surveillance, and experts recommended the process to the health ministry.
The ministry is sub-contracting the dog component of rabies to private veterinary practice. One practice that has signed a contract with the ministry, Vets for Future, criticised the paucity of funding to the ministry to pay for the programme.
Vets for Future Director Dr. Chamith Nanayakara said it had not been possible this year to deliver the expected 1.3 million annual vaccinations due to funding shortages and the pandemic.
“We are frantically fighting against time to cover at least 50 per cent of our vaccination caseload,” he said
Ideally, 200,000 female dog sterilisations annually can bring down the population, but there should be follow-up programmes every year.
Due to lack of funds, the health ministry can only engage in follow-up programes once every three years, by which time unsterilised female pups breed and increase dog numbers
Vets for Future is working on a pilot project in Ratnapura covering around 5,000 animals and says this work, which began in 2008, is yielding good results. “The mission is to disprove the belief that sterilisation and vaccination are ineffective in controlling rabies,” Dr. Chamith said.
He is talking to the government about a plan to register pets, which would make owners legally responsible for their pets, which are sometimes thrown out of homes when they develop rashes or other diseases, or are not sterilised, or left untreated by vets when they become ill
The Director of Global Vet, which is under contract to control rabies in north and north-central Sri Lanka, Dr. Parakrama Gunatilake, also emphasised that sterilisation has to be maintained for good results.
Global Vet is working in the Matara and Kandy districts and has sterilised 335 dogs in Matara and 725 in Kandy. The vets will soon move to the Nuwara Eliya district.
Animal welfare organisations are supporting the task of controlling the dog population and vaccinations. One successful model is in Sigiriya, carried out by Adopt a Dog. Justice to Animals, another organisation, has joined hands with the Moratuwa Municipal Council to sterilise cats.