The potential coordination benefits in disease control - evidence from rabies elimination efforts in Africa

Abstract

Abstract Background Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. Methods In this paper, we conduct a detailed benefit-cost analysis to demonstrate that the low deployment of dog vaccination campaigns is the result of systematic coordination failure between key stakeholders, resulting in a suboptimal policy equilibrium. Combining the most recent cost and effectiveness data with a mathematical model of rabies transmission, we compute the benefits and costs of multiple strategies for 48 countries in mainland Africa. Findings Lack of or incomplete human post-exposure prophylaxis (PEP) and not vaccinating dogs is currently the dominant practice for all countries in Africa. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 – 11.4 billion). Uncoordinated dog mass vaccination between countries and incomplete human PEP have lower welfare gains and don’t lead to the elimination of dog rabies. Nevertheless, for many countries, even with the possibility of reintroduction of rabies from other countries, mass dog vaccination is the dominant strategy in the game-theoretic sense. Interpretation Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies. African inter-governmental platforms like the African Union Inter-African Bureau for Animal Resources (AU-IBAR) and regional platforms like the Economic Community of West African States (ECOWAS) are best placed to achieve such coordination.