Quantifying the interconnectedness between poverty, health access, and rabies mortality

The global 2030 goal set by the World Organization for Animal Health (WOAH), the World Health Organization (WHO), and the Food and Agriculture Organization (FAO), to eliminate dog-mediated human rabies deaths, has undeniably been a catalyst for many countries to re-assess existing dog rabies control programmes. Additionally, the 2030 agenda for Sustainable Development includes a blueprint for global targets which will benefit both people and secure the health of the planet. Rabies is acknowledged as a disease of poverty, but the connections between economic development and rabies control and elimination are poorly quantified yet, critical evidence for planning and prioritisation. We have developed multiple generalised linear models, to model the relationship between health care access, poverty, and death rate as a result of rabies, with separate indicators that can be used at country-level; total Gross Domestic Product (GDP), and current health expenditure as a percentage of the total gross domestic product (% GDP) as an indicator of economic growth; and a metric of poverty assessing the extent and intensity of deprivation experienced at the individual level (Multidimensional Poverty Index, MPI). Notably there was no detectable relationship between GDP or current health expenditure (% GDP) and death rate from rabies. However, MPI showed statistically significant relationships with per capita rabies deaths and the probability of receiving lifesaving post exposure prophylaxis. We highlight that those most at risk of not being treated, and dying due to rabies, live in communities experiencing health care inequalities, readily measured through poverty indicators. These data demonstrate that economic growth alone, may not be enough to meet the 2030 goal. Indeed, other strategies such as targeting vulnerable populations and responsible pet ownership are also needed in addition to economic investment.Author summary: The 2030 agenda for Sustainable Development, details global targets to ensure improvements to health and well-being globally. SDG states that to meet SDG 1 and 3, poverty everywhere must end, and universal health coverage and access to quality health care must be achieved. Rabies is acknowledged as a disease of poverty, and therefore ending poverty, and improving health and economic deprivation, could in theory result in a reduction of rabies, providing it also results in universal health coverage. We investigated whether rabies incidence is an inevitable consequence of poverty or whether measures of development other than economics, are stronger predictors of countries that have successfully controlled the disease. We highlight that those most at risk of not being treated, and dying due to rabies, live in communities experiencing health care inequalities, readily measured through poverty indicators. We found that economic growth alone, may not be enough to support the global 2030 goal of zero human death due to dog rabies. Indeed, other strategies such as targeting vulnerable populations, responsible pet ownership are also needed in addition to economic investment.