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Mexico’s feat against rabies through cross-sectoral collaboration is possible in other countries

<p><span style="background-color:transparent;text-align:inherit;text-transform:inherit;white-space:inherit;word-spacing:normal;caret-color:auto;">As part of the global strategy to achieve zero
human deaths from rabies by 2030, the World Health Organization (WHO)
and its main partners are encouraging countries to accelerate
cross-sectoral collaboration through the One Health approach.</span></p><div id="content"><div id="primary"><p>Both WHO and the World Organisation for Animal Health (OIE) have jointly developed procedures to enable recognition of countries in which progress has been made against rabies through One Health and those that are on the verge of eliminating the
disease as a public health problem.</p><div><p>&ldquo;<em>There
are many countries that have stepped up rabies control programmes in
dogs and we want to increase the recognition of such efforts,</em>&rdquo; said Dr Gregorio Torres, Head of the OIE Science Department. &ldquo;<em>With our updated international standards on rabies<sup>1</sup>, countries&rsquo; veterinary services can seek endorsement from OIE</em><em> of&nbsp;
<a href="https://www.who.int/docs/default-source/ntds/rabies/oie-endorsement-rabies-control-programmes.pdf?sfvrsn=752e7ce6_2">their national dog-rabies control programme</a><sup>2</sup>,
and declare<sup>3</sup> freedom from dog-mediated rabies or freedom from rabies.</em>&rdquo;</p><div></div></div><p>In 2018, WHO established a validation procedure for countries reaching zero human deaths from dog-mediated rabies.<sup>4</sup> The procedure involves several steps, including close collaboration between the Ministry of Health of the WHO Member
State and the WHO Country and Regional Office as well as WHO headquarters, in the preparation, submission and review of the dossier.</p><div><p>&ldquo;<em>The
WHO procedure involves review of evidence by an international expert
group, followed by an official announcement of the country&rsquo;s
achievement,</em>&rdquo; explained Dr Bernadette-Abela Ridder, WHO rabies focal point. &ldquo;<em>Both WHO or OIE procedures assist countries in gaining recognition of the progress made by their rabies programmes.</em>&rdquo; </p><div></div></div><h2>Mexico&rsquo;s success can be emulated by other countries</h2><p>To date, Mexico is the first and only country to be validated by WHO for eliminating rabies as a public health problem.<sup>5</sup></p><ul><li>The process started when the Mexican Ministry of Health compiled a dossier demonstrating evidence of elimination as a public health problem in accordance with the WHO validation requirements for rabies (See chart). The dossier was submitted to
the Pan American Health Organization (PAHO) and the WHO Country Office in Mexico. It was reviewed also by PAHO’s Department of Communicable Diseases and Environmental Health, which hosts the regional veterinary public health unit (PANAFTOSA)
responsible for the rabies elimination programme in the Region of the Americas. There followed a field visit by an international group of independent experts to review and assess the evidence submitted and national rabies elimination efforts.
The experts concluded that Mexico had met the requirements for validation of elimination of rabies as a public health problem, and the Director-General of WHO officially endorsed the decision.<img src="https://www.who.int/images/default-source/departments/ntd-library/rabies/example-progress-towards-rabies-elimination.jpg?sfvrsn=35f5e145_4" style="background-color:initial;color:#333333;font-size:inherit;font-family:inherit;text-align:inherit;text-transform:inherit;white-space:inherit;word-spacing:normal;caret-color:auto;" alt="Example-progress-towards-rabies-elimination" sf-size="97904" /><a href="https://www.who.int/docs/default-source/ntds/rabies/example-progress-towards-rabies-elimination.pdf?sfvrsn=1aad0a2f_2" style="font-size:inherit;font-family:inherit;text-align:inherit;text-transform:inherit;white-space:inherit;word-spacing:normal;">Example Progress towards elimination (See enlarged chart)</a></li></ul><div><p>&ldquo;<em>This achievement is not just an effort of a national agency or the Government,</em>&rdquo; said Dr Hugo Lopez-Gatell Ramirez, Deputy Director, Mexican Ministry of Public Health. &ldquo;<em>It
required a vision and full commitment from all states in Mexico and the
determination of the nation in getting rid of this problem.</em>&rdquo; </p><div></div></div><p>The core elements of the process for validation of elimination of rabies as a public health problem and OIE declarations of rabies-freedom include that: </p><ul><li>rabies is notifiable,</li><li>state of the art surveillance is in operation,</li><li>2 years of absence of rabies cases (human and/or animal), </li><li>prevention of importation of rabies-infected animals is in place, and,</li><li>presence of an effective national rabies control strategy.
</li></ul><p>To avoid duplication of efforts, WHO and OIE agreed to mutually recognize supporting evidence that a country submits for either procedure and organization. For example:</p><ul><li>An OIE endorsement of a national rabies control programme will be considered, if a country submits a request for WHO validation on rabies elimination. </li><li>A WHO validation for elimination of rabies as a public health problem can support a self-declaration to OIE for dog-mediated rabies freedom.</li><li>Finally, if a country has successfully self-declared freedom from dog-mediated rabies to OIE, it will be considered also to have validated elimination of dog-mediated rabies as a public health problem by WHO.
</li></ul><p>Combined with technical guidance from international organizations, these procedures strengthen the capacity of countries to implement rabies elimination programmes.

</p><p>Sustained political will and community engagement are among the measures necessary to reach the goal of "Zero by 30" and, eventually, freedom from dog-mediated rabies.</p><p>——————————<br /><sup>1</sup><a href="https://www.oie.int/index.php?id=169&amp;L=0&amp;htmfile=chapitre_rabies.htm">Infection with rabies virus. In: Terrestrial Animal Health Code (Chapter 8.14). Paris: World Organisation for Animal Health</a>.<br /><sup>2</sup><a href="https://www.oie.int/animal-health-in-the-world/official-disease-status/official-recognition-policy-and-procedures/">Official
recognition of disease status. In: Official recognition policy and
procedures. Paris: World Organisation for Animal Health</a>.<br /><sup>3</sup><a href="https://www.oie.int/animal-health-in-the-world/self-declared-disease-status/">Self-declaration. In: Self‐declared disease status. Paris: World Organisation for Animal Health</a>.<br /><sup>4</sup><a href="https://www.who.int/publications/i/item/WHO-TRS-1012">Reaching zero human deaths from rabies. In: WHO Expert Consultation on Rabies</a> (Chapter 12 and Annex 14). Geneva: World Health Organization (WHO Technical Report Series, No. 1012.<br /><sup>5</sup><a href="https://www.paho.org/en/news/21-12-2019-mexico-free-human-rabies-transmitted-dogs">Mexico is free from human rabies transmitted by dogs</a>.
Washington (DC): Pan American Health Organization; 2019.&nbsp;</p></div></div><div></div>