FAO's Support Rabies Control in Indonesia_Oct22.pptx

Why rabies is important
Story of rabies in Indonesia
What us ECTAD doing?
SARE exercise
Lessons for rabies control and elimination
Options to enhance rabies control in the future

1. FAO’s Support on Rabies Control in Indonesia Denpasar, 10 October 2022 Rabies Control Team Emergency Center for Transboundary Animal Diseases, FAO Indonesia

2. Why is rabies important? Story of rabies in Indonesia What is ECTAD doing? SARE exercise during ARACON meeting Lessons for rabies control and elimination Options to enhance rabies control in the future Presentation content FAO’s Support on Rabies Control in Indonesia

3. Rabies has a significant impact on lives and livelihoods in developing countries The poor and marginalized communities are most heavily impacted Rabies is 99% fatal, but 100% vaccine preventable 4 of 10 deaths of rabies are in children The economic impact of rabies is enormous at USD 8.6 billion annually, 6% of that is due to livestock losses Rabies is a model disease for One Health approach Why is rabies important? FAO’s Support on Rabies Control in Indonesia

4. First reported rabies case was in horse in Jakarta (1884) First human case was reported in 1894 26 out of 37 provinces in Indonesia are rabies infected rabies Over the last decade, the Indonesian Government together with other stakeholders, has implemented control and elimination activities with the aim of controlling rabies in Indonesia FAO has been involved in rabies control programmes in Indonesia, especially in Bali since 2011 Story of rabies in Indonesia FAO’s Support on Rabies Control in Indonesia Name of island / area Province Year Flores island East Nusa Tenggara 1997 Ambon island Maluku 2003 Seram island Maluku 2003 Halmahera island North Maluku 2005 Morotai island North Maluku 2005 Ketapang district West Kalimantan 2005 Buru island Maluku 2006 Bali island Bali 2008 Bengkalis island Riau 2009 Rupat island Riau 2009 Nias island North Sumatera 2010 Larat island Maluku 2010 Dawera island Maluku 2012 Kisar island Maluku 2012 Ketapang district West Kalimantan 2015 Sumbawa island West Nusa Tenggara 2019

5. How rabies emerged and evolved within a decade after introduction in Bali 2010 2012 2008 2009 2015 2017 FAO’s Support on Rabies Control in Indonesia

6. FAO ECTAD has been supporting the Government of Indonesia to control rabies: Support the development of national rabies elimination guidelines (masterplan and roadmap) Support the implementation of rabies control strategies Mass dog vaccination (MDV) Oral rabies vaccination (ORV) – pilot studies Integrated bite case management (IBCM) Dog population management (DPM) Public awareness What is ECTAD doing? FAO’s Support on Rabies Control in Indonesia

7. Capacity buildings FAO’s Support on Rabies Control in Indonesia Mass dog vaccination Post vaccination survey Data management Sample collection Rapid response

8. R10 R2 R3 R4 R5 R6 R7 R8 R9 MDV implementation Annual MDV across the island has been implemented by local government with the support from central government and FAO since 2011 ( https://rabiesalliance.org/resource/faos-technical-cooperation-project-bali )  Additional strategies to increase coverage: sweeping and emergency vaccinations Pilot vaccination in Gianyar Island-wide Vaccination R1 FAO’s Support on Rabies Control in Indonesia

9. A-Team story On the front-line of eradicating rabies from Bali and remote rural areas are the vaccination teams, known as the “A-Teams” 1 vaccinator, 1 recorder, 4 dog catchers The teams search villages and remote mountainous areas for roaming dogs  ( https ://www.youtube.com/watch?v=_VBxYMXY0nc&t=73s )  FAO’s Support on Rabies Control in Indonesia

10. MDV data management apps development FAO’s Support on Rabies Control in Indonesia

11. ORV pilot studies FAO’s Support on Rabies Control in Indonesia One of the biggest challenges: vaccinating free-roaming dogs To address this challenge the option of using ORV is considered Two studies of ORV on the bait acceptance and oral vaccine immunogenicity were implemented in Karangasem and Buleleng , Bali ( https://kumparan.com/kanalbali/uji-coba-vaksin-oral-rabies-dilakukan-kementan-di-bali-1wzIVFtahjl/full ) 

12. IBCM was first established in Bali in 2011 Which then, was re-introduced in 2016 following the surge in cases in 2015 ( https://www.fao.org/indonesia/news/detail-events/fr/c/431438/ )  IBCM is a One Health protocol to enhance networking among different sectors (animal-wildlife health and public health) in managing and responding to bite cases IBCM Implementation FAO’s Support on Rabies Control in Indonesia

13. FAO’s Support on Rabies Control in Indonesia IBCM improved : Response to bite cases Coordination and communication between sectors Sample submission to animal health laboratories Human case management (efficiency in the use of rabies post-exposure prophylaxis/PEP) Surveillance activities

14. FAO’s Support on Rabies Control in Indonesia 2016-19: development of IBCM for three sectors – wildlife implemented in four pilots IBCM is used as a model for One Health control measures for other zoonoses: anthrax, leptospirosis, avian influenza, and EIDs

15. Increase economic efficiency through the expansion of intervention programmes across sectors Economic efficiency can be seen from the results of the evaluation of cross-sectoral cooperation implementation in North Sulawesi province​ The program generates a benefit-cost ratio (BCR) between  6.56 and 14.35 , which means that for every dollar invested, the program can generate benefits worth USD 6.56-14.35. ​ IBCM’s added value 10   FAO’s Support on Rabies Control in Indonesia

16. SIZE is a national health surveillance information system linked information systems from three different sectors (public health, animal health and wildlife/environment ) SIZE aims to support early detection, reporting, and response through coordination, communication and collaboration from field  level to policy decision-makers SIZE on rabies has been piloted in 4 provinces and plan to expand to other provinces  SIZE will be expanded for other priority zoonosis diseases  SIZE development Animal Health Public Health Wildlife Health FAO’s Support on Rabies Control in Indonesia

17. DPM pilot in Bali FAO’s Support on Rabies Control in Indonesia DPM program was piloted in Gianyar , Bali ( https://www.fao.org/indonesia/news/detail-events/zh/c/426486/ )  DPM was piloted focusing on community empowerment as a cadre to educate communities and backed up by traditional law enforcement It promotes responsible dog ownership, increases public awareness of rabies risk to the community as well as increases dog vaccination coverage In recent years, the Government have involved community as zoonoses cadres to support zoonoses response and control, particularly rabies

18. Target: Elementary school Communities Culture and religion group FAO’s Support on Rabies Control in Indonesia Public awareness

19. Community involvement through Dana D esa FAO’s Support on Rabies Control in Indonesia The development of practical guidelines for the prevention and control of zoonoses and EIDs through optimizing the function of Puskeswan with the support of village funds This guide can be used by Puskeswan throughout Indonesia for prevention and control of zoonoses and EIDs, as well as for the development rural economy through livestock and animal health The use of Dana Desa Rabies vaccines procurement Dog vaccination activities Leptospirosis surveillance activities Community capacity building

20. Lessons for rabies control and elimination FAO’s Support on Rabies Control in Indonesia Control strategies Lessons learned + Annual MDV campaign   + High quality vaccines   + Sweeping vaccination   + Emergency vaccination   + IBCM protocol + DPM + Rabies public awareness Not fast enough or wide enough https://pubmed.ncbi.nlm.nih.gov/31564729/  

21. Recommendations FAO’s Support on Rabies Control in Indonesia Comprehensive island-wide MDV campaigns should be conducted annually with high quality vaccines in all villages  on as short time as possible and aim to achieve high coverage (minimum 70%) Supplementary vaccinations should target puppies born after campaigns and unvaccinated dogs missed during campaigns-involving all sectors including veterinary surgeons/practitioners Emergency response vaccinations should be  implemented rapidly and cover sufficient radius of risk areas Targeted surveillance through IBCM , coupled with increased public awareness, is a sensitive and efficient way to increase case detection DPM strategy implemented to encourage responsible dog ownership, with a focus on vaccinating dogs, particularly puppies , to maintain high levels of vaccination coverage Creating awareness for children and students is effective to send messages to their parents and their communities.

22. Options to enhance rabies control in future FAO’s Support on Rabies Control in Indonesia The usage of other funding resources to strengthen rabies control program in Bali: Dana Desa,  Biaya Tak Terduga (BTT), Dana Siap Pakai (DSP) Increased puppy vaccination (involving private practitioners and IVMA) Oral rabies vaccination for roaming dogs/ hard to catch dogs Increased community involvement  Expand the DPM and responsible dog ownership to the whole of Indonesia Children Declaration for Indonesia to be Free of Rabies by 2030, at World Rabies Day, 2019

23. Thank you!