The financial challenge of keeping a large region rabies-free--the EU example.

Following the implementation of oral rabies vaccination of foxes (ORV) in Western Europe, a continuous decrease in rabies incidence was reported, and eventually rabies was eliminated. Once fox rabies is eliminated in a given area, re-infection from neighbouring infected countries is a permanent threat. As a result, countries need to maintain a vaccination belt along common borders until rabies is also eliminated in sufficiently large border regions of neighbouring infected countries. In a theoretical approach EU member states were taken as a prime example, assuming that they were rabies-free but that neighbouring countries were still infected. Using GIS, a 50 km deep vaccination belt beyond the front of the rabies endemic zone was installed in countries bordering those regions. The annual cost for the prevention of re-infection of the EU territory was calculated considering current EU recommendations (vaccination twice per year, aerial and complementary hand distribution, bait density of 30 baits per km2). Minimum and maximum prices for commercial available oral rabies vaccine baits, aircraft and rabies surveillance were considered for the calculation of costs. The total vaccination area which needed to be established was about 251,000 km2. Using mainly fixed-wing aircraft, the annual cost for ORV including rabies surveillance varied between a minimum of 10 and a maximum of 16M Euro, depending on the cost of vaccine bait. If helicopters were used exclusively, the maximum cost increased to about 32M Euro. Depending on the length of the border to infected regions, countries will have to pay up to 25% of the total cost. Countries which need to install a vaccination belt will never have a rabies-free status because of the likely occurrence of rabies cases in border zones.