A research agenda to reinforce rabies control: A qualitative and quantitative prioritization

Background: Despite the existence of safe and effective vaccines, rabies disease still causes an estimated 59,000 human deaths a year in the endemic areas in Asia and Africa. These numbers reflect severe drawbacks regarding the implementation of PrEP and PEP in endemic settings, such as lack of political will and low priority given to rabies. Since these contextual factors have proven to be persistent, there is an urgency to improve current strategies or develop novel approaches in order to control rabies disease in the future. Methods/Findings: This study aimed to identify and systematically prioritize the research needs, through interviews and questionnaires with key-opinion-leaders (KOLs). A total of 46 research needs were identified and prioritized. The top research needs are considered very high priority based on both importance for rabies control and need for improvement. KOLs agree that animal rabies control remains most important for rabies control, while research on human host, agent (rabies virus) and the environment should be prioritized in terms of need for improvement. A wide variety in perceptions is observed between and within the disciplines of virology, public health and veterinary health and between KOLs with more versus those with less experience in the field. Conclusion/Significance: The results of this study give well-defined, prioritized issues that stress the drawbacks that are experienced by KOLs in daily practice. The most important research domains are: 1) cheap and scalable production system for RIG 2) efficacy of dog mass vaccination programs and 3) cheap human vaccines. Addressing these research needs should exist next to and may reinforce current awareness and mass vaccination campaigns. The differences in perspectives between actors revealed in this study are informative for effective execution of the One Health research agenda. Author summary: Rabies is a 100% vaccine-preventable disease but invariably fatal once symptoms occur. Annually, tens of thousands of people die after being infected with rabies virus, predominantly through bites or scratches of infected dogs. The stable mortality rates highlight the limitations of current disease specific interventions, including prophylaxes, awareness campaigns and mass vaccination of dogs. Consequently, research is needed to develop improved and novel strategies that circumvent the barriers faced in implementation in endemic settings. Interest for rabies, however, is limited and to effectively allocate budgets the field would benefit from a more focused research agenda. This study prioritized research topics based on the importance for rabies control and the need for improvement. According to experts, research should focus on 1) cheap and scalable production systems for RIG; 2) efficacy of dog mass vaccination programs and; 3) development of a cheap human vaccine. By elucidating differences in perceptions of stakeholders between disciplines and between those with more versus those with less experience in the field, this study also provides practical insights to inform stakeholders concerned with the implementation of interdisciplinary collaboration in the field of rabies. The prioritization of rabies-specific research needs is a vital step in accelerating innovation necessary to decrease the burden of disease.