From data to action: addressing geographic inequalities in rabies burden through targeted policies

He Lu¹En Tan^2*

• ¹Shanghai Jiao Tong University, Shanghai, China
• ²First Hospital of Lanzhou University, Lanzhou, China

Objective: Rabies remains a preventable yet fatal zoonotic disease, disproportionately affecting low-and middle-income settings. Despite global progress in prevention and control, the extent of geographic, socioeconomic, and age-related disparities in rabies burden has not been fully quantified. Methods: Using data from the Global Burden of Disease (GBD) Study 2021, we evaluated global, regional, national, and sociodemographic index (SDI. Income, education, and fertility are integrated to form a single SDI value, it categorizes countries or regions into quintiles, reflecting their level of socio-demographic development)-specific patterns in rabies burden, focusing on age-standardized rate (ASR), including age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life-year rates (ASDR). Temporal trends were quantified using the average annual percentage change (AAPC). Health inequalities were examined with the slope index of inequality (SII) and concentration index (CCI), while frontier analysis was conducted to estimate potential gains relative to socioeconomic development. Results: In 2021, the global ASIR of rabies was 0.129 per 100,000 population [95% uncertainty interval (UI): 0.076, 0.182 per 100,000 population], the ASMR was 0.128 per 100,000 population (95% UI: 0.075, 0.181 per 100,000 population). All global ASR declined from 1990 to 2021, yet the absolute burden remained concentrated in low-SDI countries. Marked inequalities persisted, with ASIR, ASMR, and ASDR highest in low-SDI regions and lowest in high-SDI regions, whereas South Asia carried the greatest absolute number of deaths and disability-adjusted life-year (DALYs) cases, and Eastern Sub-Saharan Africa recorded the highest ASR. At the country level, Nepal showed the highest ASR, while India contributed the largest case numbers. Health inequality analysis demonstrated that the absolute gap in ASDR between the highest-and lowest-SDI countries narrowed substantially from 1990 to 2021, but relative inequalities remained stable. Frontier analysis revealed wide room for improvement even in some poor resource, and rich settings. Conclusion: Global rabies elimination requires comprehensive efforts to reduce disparities both between and within countries, primarily through expanding access to post-exposure prophylaxis, increasing dog vaccination, and addressing socio-economic disparities.