Implementation of rabies

surveillance models
from a One Health perspective
 History of BAWA contribution
& actions in Bali
 In December 2009, BAWA began and funded a pilot program of
house-to-house vaccination in banjars in Gianyar regency.
Within six months (by the end of June 2010) 48,293 dogs were
vaccinated.

 Due to the success of the pilot program in Gianyar, the World

Society for the Protection of Animals (WSPA) provided
operational funding and the Australian government provided
vaccines to BAWA to extend the vaccination program into the
Bangli regency where an additional 22,025 dogs were
vaccinated .

In January 2010, BAWA hosted a three-day rabies seminar at

Udayana university/ medical college, where the government,
veterinarians, and medical doctors were invited to participate for
free. World-leading experts in rabies control, including the
director of zoonoses for the World Health Organization, attended
to share their expertise in human rabies vaccines and canine
vaccination, highlighting the need for canine vaccination over
elimination. 
History of BAWA contribution & actions in Bali
• On the 21st September 2010, a Memorandum of Understanding (MoU) for Humane Eradication of Rabies
in Bali was signed between the Bali Animal Welfare Association (BAWA) and the Governor of Bali, and
subsequently by all regency leaders, including the Mayor of Denpasar, except for Klungkung. This
agreement was to vaccinate over 70% of dogs in Bali and not eliminate dogs outside of the euthanasia
policy. The 1st island wide vaccination program was started in six regencies from October 2010.
• Epidemiologists recommended 3 islandwide programs to eradicate rabies in Bali As part of the
agreement, BAWA hired and trained both local staff and the Bali government and trained 440 members of
staff over six months to ensure the following island wide campaigns could continue.

• Statistics show that this 1st island wide program effectively reduced canine rabies by 86% when
comparing June and July 2011 to June and July 2010.
• As of May 2011, according the MoU, BAWA handed over the program to the provincial government who
funded and operated the next island wide programs in collaboration with the FAO of the UN and
continues to do so. 
Lessons learned on disease containment

• BAWA run Island-wide mass vaccination campaign in 2010

• Discontinuation of culling fundamental for the conduct of the vaccination
campaign as advised by local and international welfare groups
• Dog culling still conducted in response to reported rabies deaths or large dog
populations
• Leads to death of owned & vaccinated dogs.
• No containment of rabies spread.
• Potential dog migration to avoid culls increases spread of infected dogs.
• Rabies transmission is not dependent on population density.
• National Policy in Indonesia
-> No indiscriminate culling!
History of BAWA
-> Selective and targeted euthanasia of suspected rabid dogs should follow contribution & actions in
the National Guidelines. Bali
 History of BAWA contribution & actions in
Bali
Lessons learned on the need to operate in collaboration

• Communication with local stakeholders is key to

overcoming misperceptions
• Data management and feedback of analyzed data are
significant contributors to supporting local
implementation
• Coordination, management, and engagement with all
partners to overcome political sensitivities, differing
cultures, and understandings of rabies and its control
Rabies Pada Anjing di Bali
Kabupaten 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Jumlah

Badung 9 27 34 6 12 2 5 13 14 9 2 133
Buleleng   10 56 7 10 6 23 97 41 23 23 296
Bangli   1 52 12 35 12 23 90 28 9 27 289
Denpasar 1 10 42 5 3 0 2 6 1 0 0 70
Gianyar   13 101 22 10 6 10 40 39 7 22 270
Kelungkung     30 8 4 1 10 22 3 0 11 89
Jembrana     21 22 33 7 22 73 28 14 12 232
Tabanan   8 18 6 1 0 9 54 29 5 2 132
Karangasem   11 56 2 8 8 25 131 24 26 36 327
Bali: 10 80 410 90 116 42 129 526 207 93 135 1.838
Rabies – The importance of One Health

Source. OpenWHO Rabies & One Health.

Effective and One Health
sustainable
The link between
rabies animal health and human health
elimination =
strategy rabies control.

 
Tabel 3.
Gap Analysis pengendalian  
Rabies di Bali
 
 
Program dharma started in 2016 as a multi-  
sectoral partnership between the University of  
Udayana, the Bali Animal Welfare Association
and the Centre for Public Health
Innovation(CPHI) with support from IFAW,  dan pelibatan partisipasi dalam program Pemahaman masyarakat masih rendah tentang penanganan
FOUR PAWS Australia and Green School Bali.
Variabel
Manajemen HPR
Sistem surveilan
Vaksinasi anjing
Cara pemeliharaan anjing
Program Kontrol Populasi
Manajemen Manusia
Penanganan kasus gigitan
Kurangnya edukasi pada masyarakat Masyarakat belum mendapatkan edukasi yang baik.
vaksin
Kerjasama stakeholder yang lemah
Keterangan
 
Belum ada sistem pendataan yang akurat terhadap data jumlah
anjing
Sistem vaksinasi masih tersentral sesuai jadwal sehingga jika
ada anjing yang belum tervaksin harus menunggu jadwal vaksin
berikutnya.
Masyarakat masih banyak yang tidak memberikan makan dan
minum anjingnya secara rutin serta membiarkan lepas mencari
makan berkeliaran. Kesadaran masyarakat dalam memelihara
anjing masih rendah.
Anjing yang dilepas liarkan semakin banyak dan tidak jelas
status vaksinnya. Populasinya tidak terkendali. Sehingga perlu
dilaksanakan program control populasi dengan sterilisasi anjing.
 
Masih kurangnya edukasi pada masyarakat dalam penanganan
kasus gigitan anjing. Semua kasus kematian karena tidak
mendapatkan vaksin anti rabies. Ini menunjukkan bahwa belum
ada sistem pelaporan dan respond pada kasus gigitan.
luka bekas gigitan dan cara memelihara anjing. Terutama di
daerah pedesaan.
Kerjasama dalam melakukan penanganan GHPR perlu
dilakukan koorinasi yang intensif antara puskesmas dan
puskeswan.
 Annoyance
Fear Discord among
Sadness & frustration neighbors
Health risk Inhumane
Problems management
Economic well-being caused by practices
Cycle of Intolerance dogs
Dogs must
fend for
themselves Intolerance
for dogs

People don’t
Ambivalence
take care of
to suffering
dogs
& Cruelty Trauma & Anger
Inhibited
development of
empathy
Cycle of Violence
10
 One Health. The link between animal health and human health = rabies
control.

People take care Dog population

Dog welfare Rabies control
of dogs stability

Healthy
environment

11
 • Identification of dog population
• Baseline mapping through survey
• Monitoring and tracking
• Supporting healthy dog population stability
How NGOs • Vaccination
• Spay neutering
can • General treatment, e.g. parasites
• Integrated bite case management (human and dog bite
contribute to cases)
• Education children on proper wound washing, responsible
human health pet ownership, provoke/unprovoked bite.
• Support and advocate political stakeholders for
sustainability
• Traditional village regulation Peraram
• Administrative village regulation Perdes
Rabies – the importance of One health
Potential support from
animal welfare NGOs

Suseno et al., Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia, 2019.
 Mass dog elimination (killing, poison, cruelty)

What
Dog meat trade

Loosing rabies herd immunity through

puts the
Unstable dog population or irregular vaccination, vaccine quality, cool chain

Not having enough human vaccination (VAR, BAR)

success Not continue public education and awareness

at risk?
Regulations against animal cruelty not being enforced

No access to data between all sectors

Disrupted collaboration and communication between

stakeholders.