The last mile to zero: a one health paradigm for ending rabies transmission

Abstract

A bite can mark the beginning of a fatal disease—or the point where prevention and One Health converge. Rabies is an almost invariably fatal yet preventable zoonosis, with most human infections arising from dog-mediated transmission. Despite the availability of highly effective vaccines, post-exposure prophylaxis and proven control tools, rabies continues to persist where prevention systems remain fragmented or unevenly implemented. Gaps in canine vaccination, surveillance, community engagement, healthcare access and intersectoral coordination leave critical breaks in the prevention chain. Sustainable elimination therefore demands a dual-front strategy: suppress transmission at its animal source while ensuring that every exposed person can access timely and effective protection. The One Health paradigm integrates human, animal and environmental health through coordinated action across veterinary, medical, public health, environmental and community sectors. Mass dog vaccination, responsible dog population management, timely case recognition, laboratory-supported surveillance, prompt wound management and equitable access to post-exposure prophylaxis form the core of rabies prevention. Community engagement and risk communication further strengthen responsible animal ownership, timely exposure reporting and vaccination uptake. The global Zero by 30 initiative provides a shared vision to end human deaths from dog-mediated rabies by 2030. Achieving this goal demands sustained investment, resilient surveillance, strengthened veterinary and healthcare systems, equitable access to prevention and care, and coordinated multisectoral action. Rabies is therefore not merely a zoonotic disease but a defining test of One Health—where collective action can transform a preventable threat into an eliminable one and turn the vision of zero preventable rabies deaths into reality.