Thanks for your work. The post mentions the work done in Goa, India, I would like to highlight the cost-effectiveness of the injectable rabies vaccine reported in the paper on the intervention done. “Elimination of human rabies in Goa”. (I had read this paper once and thought the numbers were impressive. feel free to criticise it)
”The estimated mean cost per death averted and cost per DALY averted from 2013 to 2019 were 14,866 USD and 526 USD, respectively. During this period, the program was estimated to result in 2,249 DALYS averted and 80 deaths averted compared to no intervention. Over a 10-year projection (2013–2023), the intervention was estimated to prevent 121 human rabies deaths and 3427 DALYS at a mean cost of 567 USD per DALY averted.”
Administering injectable vaccines does pose logistical issues; They report mean vaccination coverage in the 2016 campaign as 71.8% in all sighted dogs and 60.1% in roaming dogs. In 2017, intensive methods were applied state-wide, achieving an estimated coverage of 71.7% in all dogs sighted and 53.1% in the roaming population. Would improving operational efficiency in covering the free-roaming population of dogs with the traditional rabies vaccine be considered a good recommendation?
Thanks for your comment and the paper! I’ve come across this paper before but didn’t read it in detail. I have skimmed the paper again just now, so here are a couple of my ad-hoc thoughts:
The cost-effectiveness of the Goa campaigns seems to be a lot better than my modeled program in India. My CEA is very speculative, so it’s nice to see that a retrospective CEA of this intervention yields a relatively good $-per-averted-DALY result. However, I’m not swayed by the number, since it’s still far from GiveWell’s cost-effectiveness bar of 100$ per averted DALYs. It would also be interesting to have a closer look at the assumptions they make in the CEA. From a brief look at the spreadsheet, they seem to equate one rabies death with ~26 YLL. This is a lot lower than my assumed ~45 DALYs per rabies death in my model (I used Founders Pledge’s moral weights and roughly adapted them to the age distribution of rabies victims; also, virtually all of the DALY burden from rabies comes from YLL). This change alone would probably increase (potentially double?) the cost-effectiveness in the paper you linked but I guess it would still not pass GiveWell’s bar.
Regarding the logistical issues you mention, this aligns with what I discovered in my research. As far as I know, free-roaming dogs have a higher rabies incidence than homestead dogs. But free-roaming dogs are hard to vaccinate with traditional (injectable) vaccines, since these dogs can be very shy and hard to catch. That’s where oral vaccines would come in since you can simply throw a vaccination baits in front of a dog without having to come the dog. Which means that oral vaccine could be a good method to close the vaccination gap beween homestead and free-roaming dogs.
I wonder if there might be particularly strong regional effects to this—maybe Goa had quite a large dog population, quite a lot of rabies, or quite dense dog/human populations (affecting rabies, bite, and transmission incidences).
I think there could be room for further research to identify whether there would be better-looking (sub-country) regions—though like Helene_K found, data would be difficult.
Good point! I found that my CEA model was very sensitive to dog rabies incidence. If the incidence were high enough, doing a vaccination campaign could probably become cost-effective. However, the issue is that the effect of a vaccination campaign in a specific region alone would be fleeting if surrounding areas aren’t also included in the campaign (since rabid dogs and other animals likely migrate from un-vaccinated regions to vaccinated regions). I discussed this issue in more details in section 5 in my report. Ultimately, this is what kills this idea in my opinion (when considering whether to start a new charity for it): you’d have to implement this intervention on a very large scale in order to have a lasting effect.
Thanks for your work.
The post mentions the work done in Goa, India, I would like to highlight the cost-effectiveness of the injectable rabies vaccine reported in the paper on the intervention done. “Elimination of human rabies in Goa”. (I had read this paper once and thought the numbers were impressive. feel free to criticise it)
”The estimated mean cost per death averted and cost per DALY averted from 2013 to 2019 were 14,866 USD and 526 USD, respectively. During this period, the program was estimated to result in 2,249 DALYS averted and 80 deaths averted compared to no intervention. Over a 10-year projection (2013–2023), the intervention was estimated to prevent 121 human rabies deaths and 3427 DALYS at a mean cost of 567 USD per DALY averted.”
Administering injectable vaccines does pose logistical issues; They report mean vaccination coverage in the 2016 campaign as 71.8% in all sighted dogs and 60.1% in roaming dogs. In 2017, intensive methods were applied state-wide, achieving an estimated coverage of 71.7% in all dogs sighted and 53.1% in the roaming population. Would improving operational efficiency in covering the free-roaming population of dogs with the traditional rabies vaccine be considered a good recommendation?
Thanks for your comment and the paper! I’ve come across this paper before but didn’t read it in detail. I have skimmed the paper again just now, so here are a couple of my ad-hoc thoughts:
The cost-effectiveness of the Goa campaigns seems to be a lot better than my modeled program in India. My CEA is very speculative, so it’s nice to see that a retrospective CEA of this intervention yields a relatively good $-per-averted-DALY result. However, I’m not swayed by the number, since it’s still far from GiveWell’s cost-effectiveness bar of 100$ per averted DALYs. It would also be interesting to have a closer look at the assumptions they make in the CEA. From a brief look at the spreadsheet, they seem to equate one rabies death with ~26 YLL. This is a lot lower than my assumed ~45 DALYs per rabies death in my model (I used Founders Pledge’s moral weights and roughly adapted them to the age distribution of rabies victims; also, virtually all of the DALY burden from rabies comes from YLL). This change alone would probably increase (potentially double?) the cost-effectiveness in the paper you linked but I guess it would still not pass GiveWell’s bar.
Regarding the logistical issues you mention, this aligns with what I discovered in my research. As far as I know, free-roaming dogs have a higher rabies incidence than homestead dogs. But free-roaming dogs are hard to vaccinate with traditional (injectable) vaccines, since these dogs can be very shy and hard to catch. That’s where oral vaccines would come in since you can simply throw a vaccination baits in front of a dog without having to come the dog. Which means that oral vaccine could be a good method to close the vaccination gap beween homestead and free-roaming dogs.
Hope this addresses some of the points you made!
I wonder if there might be particularly strong regional effects to this—maybe Goa had quite a large dog population, quite a lot of rabies, or quite dense dog/human populations (affecting rabies, bite, and transmission incidences).
I think there could be room for further research to identify whether there would be better-looking (sub-country) regions—though like Helene_K found, data would be difficult.
Good point! I found that my CEA model was very sensitive to dog rabies incidence. If the incidence were high enough, doing a vaccination campaign could probably become cost-effective. However, the issue is that the effect of a vaccination campaign in a specific region alone would be fleeting if surrounding areas aren’t also included in the campaign (since rabid dogs and other animals likely migrate from un-vaccinated regions to vaccinated regions). I discussed this issue in more details in section 5 in my report. Ultimately, this is what kills this idea in my opinion (when considering whether to start a new charity for it): you’d have to implement this intervention on a very large scale in order to have a lasting effect.