Paper short abstract:

In Nepal, Rabies persists and lives are lost yearly despite control efforts. Policy gaps are rooted in socio-cultural nuances, bureaucratic intricacies, and underestimation of cases. Urgent scrutiny is needed for informed policies, reducing fatalities.

Paper long abstract:

Disease burdens disproportionately affect the developing, resource-limited, and marginalized regions of the world, not solely due to a lack of resources or technology, but often stemming from the challenges in implementing health policies and programs. Rabies serves as a poignant illustration. Although an effective vaccine has existed for 138 years, the disease still exacts a heavy toll on human and animal lives in developing countries. In Nepal, the persistent threat of Rabies continues to claim numerous lives each year, despite decades of control efforts. The disconnect between grassroots realities and policy formulation arises from insufficient comprehension of disease dynamics influenced by socio-demographic, cultural, and economic factors. Internal bureaucratic complexities within government health institutions, coupled with personal interests and political considerations, shape the design and execution of disease control programs. The ongoing fatalities are exacerbated by a lack of understanding of bite victims' treatment-seeking behaviour, challenges in accessing and affording post-exposure prophylaxis for different population groups, and societal attitudes toward free-roaming dog populations, influenced by superstitions and local beliefs. This knowledge gap not only leads to the underestimation of annual bite and rabies cases but also results in a lower prioritization of the disease. Moreover, critical scrutiny is warranted in assessing the government's vaccine supply, the rationale behind various rabies control initiatives, and the implementation of surveillance systems. Bridging these gaps in understanding and prioritization is essential to inform evidence-based policies, ultimately reducing the human and animal toll inflicted by Rabies.