Welburn Susan C, Coleman Paul G, Zinsstag Jakob
Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh , Edinburgh , UK.
Faculty of Infectious and Tropical Diseases, Department of Disease Control, School of Hygiene & Tropical Medicine, London, UK; H2O Venture Partners, Oxford, UK.
Front Vet Sci. 2017 Mar 9;4:32. doi: 10.3389/fvets.2017.00032. eCollection 2017.
The neglected zoonotic diseases (NZDs) have been all but eradicated in wealthier countries but remain major causes of ill-health and mortality in over 80 countries across Africa, Asia, and Latin America. The nature of neglect for the NZDs has been ascribed, in part, to underreporting resulting in an underestimation of their global burden that, together with a lack of advocacy, downgrades their relevance to policy-makers and funding agencies. While this may be the case for many NZDs, for rabies this is not the case. The global burden estimates for rabies (931,600 DALYs) more than justify prioritizing rabies control building on the strong advocacy platforms, functioning at local, regional, and global levels (including the Global Alliance for Rabies Control), and commitments from WHO, OIE, and FAO. Simple effective tools for rabies control exist together with blueprints for operationalizing control, yet, despite elimination targets being set, no global affirmative action has been taken. Rabies control demands activities both in the short term and over a long period of time to achieve the desired cumulative gains. Despite the availability of effective vaccines and messaging tools, rabies will not be sustainably controlled in the near future without long-term financial commitment, particularly as disease incidence decreases and other health priorities take hold. While rabies control is usually perceived as a public good, public private partnerships could prove equally effective in addressing endemic rabies through harnessing social investment and demonstrating the cost-effectiveness of control. It is acknowledged that greater attention to navigating local realities in planning and implementation is essential to ensuring that rabies, and other neglected diseases, are controlled sustainably. In the shadows of resource and institutional limitations in the veterinary sector in low- and middle-income countries, sufficient funding is required so that top-down interventions for rabies can more explicitly engage with local project organization capacity and affected communities in the long term. Development Impact Bonds have the potential to secure the financing required to deliver effective rabies control.
在较富裕的国家，被忽视的人畜共患疾病几乎已被根除，但在非洲、亚洲和拉丁美洲的80多个国家，这些疾病仍是健康不佳和死亡的主要原因。对这些被忽视的人畜共患疾病的忽视，部分原因是报告不足，导致对其全球负担估计偏低，再加上缺乏宣传，降低了它们对政策制定者和资助机构的相关性。虽然许多被忽视的人畜共患疾病可能确实如此，但狂犬病并非如此。狂犬病的全球负担估计（931,600伤残调整生命年）足以证明，基于在地方、区域和全球层面发挥作用的强大宣传平台（包括全球狂犬病控制联盟）以及世界卫生组织、世界动物卫生组织和联合国粮食及农业组织的承诺，优先控制狂犬病是合理的。存在简单有效的狂犬病控制工具以及实施控制的蓝图，然而，尽管设定了消除目标，但尚未采取全球积极行动。狂犬病控制需要短期和长期的活动，以实现预期的累积成果。尽管有有效的疫苗和宣传工具，但如果没有长期的资金投入，狂犬病在不久的将来将无法得到可持续控制，特别是随着疾病发病率下降和其他卫生优先事项占据主导地位。虽然狂犬病控制通常被视为一种公共利益，但公私伙伴关系在通过利用社会投资和证明控制的成本效益来应对地方性狂犬病方面可能同样有效。人们认识到，在规划和实施过程中更加关注应对当地实际情况，对于确保狂犬病和其他被忽视疾病得到可持续控制至关重要。在低收入和中等收入国家兽医部门资源和机构有限的情况下，需要足够的资金，以便狂犬病的自上而下干预能够在长期内更明确地与当地项目组织能力和受影响社区进行互动。发展影响债券有潜力确保提供有效狂犬病控制所需的资金。
