Moving from Rabies Research to Rabies Control: Lessons from India

Abbas SS (2012) Moving from Rabies Research to Rabies Control: Lessons from India. PLoS Negl Trop Dis 6(8): e1748. doi:10.1371/journal.pntd.0001748 Moving from Rabies Research to Rabies Control: Lessons from India Manish Kakkar 0 Vidya Venkataramanan 0 Sampath Krishnan 0 Ritu Singh Chauhan 0 Syed Shahid Abbas 0 on behalf of Roadmap to Combat Zoonoses in India (RCZI) initiative 0 Charles E. Rupprecht, Centers for Disease Control and Prevention, United States of America 0 1 Public Health Foundation of India , New Delhi , India , 2 Office of World Health Organization Representative to India , New Delhi , India Background: Despite the availability of effective interventions and public recognition of the severity of the problem, rabies continues to suffer neglect by programme planners in India and other low and middle income countries. We investigate whether this state of 'policy impasse' is due to, at least in part, the research community not catering to the information needs of the policy makers. Methods & Findings: Our objective was to review the research output on rabies from India and examine its alignment with national policy priorities. A systematic literature review of all rabies research articles published from India between 2001 and 2011 was conducted. The distribution of conducted research was compared to the findings of an earlier research prioritization exercise. It was found that a total of 93 research articles were published from India since 2001, out of which 61% consisted of laboratory based studies focussing on rabies virus. Animals were the least studied group, comprising only 8% of the research output. One third of the articles were published in three journals focussing on vaccines and infectious disease epidemiology and the top 4 institutions (2 each from the animal and human health sectors) collectively produced 49% of the national research output. Biomedical research related to development of new interventions dominated the total output as opposed to the identified priority domains of socio-politic-economic research, basic epidemiological research and research to improve existing interventions. Conclusion: The paper highlights the gaps between rabies research and policy needs, and makes the case for developing a strategic research agenda that focusses on rabies control as an expected outcome. - South Asian countries contribute to more than half of the global burden of rabies [1,2]. However, in spite of the long-standing nature of the problem, and despite the presence of effective intervention strategies [3] for rabies control, rabies continues to pose a major public health challenge to program planners in the region and elsewhere. Most South Asian countries still retain ad hoc approaches and have not been able to develop sustainable, population-level rabies control strategies, such as routine availability of post exposure prophylaxis in humans, dog immunization and dog population control [46]. As demonstrated in Africa, doubts persist among some experts as well as policy makers in low resource settings regarding the technical and operational challenges of rabies control [7]. Concerns related to burden and distribution of rabies as well as cost effectiveness and practicality of the interventions persist among opinion makers even in the face of proven intervention strategies across multiple settings [7]. We propose that this state of policy impasse is contributed by the fact, at least in part, that the research community has not catered to the information needs of the policy makers. This phenomenon is not exclusive to rabies. In fact, research to implementation gap has been reported in many other health domains [8] where the mismatch between the outputs from researchers and policy makers information needs have been described as a key barrier to bridging this gap [9]. India is a major contributor to the global rabies burden, being responsible for 17,00020,000 of the 55,00070,000 deaths that modelling approaches have suggested to occur globally each year [1,2]. In addition, the country has strong institutional capacity for research in medical, veterinary medicine and laboratory sciences. An earlier research prioritization exercise systematically identified priority research options required for prevention and control of zoonoses in India over the next five years (201015) and incorporated the perspectives of a diverse group of stakeholders [10]. Rabies was also specifically identified as a priority zoonosis for India. The exercise found that the identified priority research options highlighted the importance of actionable policy-relevant research for the prevention and control of zoonoses in India. The priorities cut across diseases, disciplines, and sectors and focussed more on policy relevant research than research for development of newer biomedical interventions. Rabies is among the most widely spread zoonoses (diseases that are naturally transmitted between vertebrate animals and humans) in humans in most Asian, African and Latin American countries. Even though researchers have demonstrated effectiveness of strategies to control rabies at the population level, such as post exposure prophylaxis in humans and animal birth control and immunization among dogs, are well known, policy makers in most countries are hesitant to implement these strategies. This paper examines the disconnect that prevents the translation of scientific research outputs into effective policies. We contrasted the type of research papers published on rabies from India in the last eleven years with a previously identified set of priority research options. We found that most published research articles related to biomedical research focussing on development of new interventions. This was in contrast to policy and systems-related research and research to improve the performance of existing interventions that were identified as priority research options for India earlier. The findings of our study highlight the importance of moving beyond a purely researcher-driven agenda and suggest the need to promote research that has a vision of rabies control in the near future. In this paper, we build upon the findings of the earlier study to systematically review the rabies research output from India and examine its alignment with policy priorities of the country. This review is intended to serve as a case study highlighting the research policy gap related to rabies in low and middle income countries (LMICs). Search Strategy, Screening and Inclusion The study was designed as a review of rabies-related research published from Indian institutions from 2001 to 2011 as indexed in the PubMed database. PubMed was selected for the search as it is among the most accessible, standardized and extensive sources of life sciences literature in India, covering research publications in veterinary sciences, public health and molecular biology. The search was restricted to Indian institutions publis (...truncated)