title: Tribulations of the Last Mile: Sides from a Regional Program.
abstract: In Latin American and Caribbean (LAC) countries, the number of cases of dog-mediated human rabies is at its lowest since the onset of the Regional Program for Rabies Elimination in 1983, a commitment from LAC countries to eliminate dog-mediated rabies coordinated by the Pan American Health Organization. Despite minor setbacks, the decline in the number of human cases has been constant since 1983. While many LAC countries have significantly reduced rabies to a level where it is no longer significant public health concern, elimination has proven elusive and pockets of the disease remain across the region. In the 33-year period since 1983, the region has set and committed to four dates for elimination (1990, 2000, 2012, and 2015). In this paper, we ponder on the multiple causes behind the elusive goal of rabies elimination, such as blanket regional goals oblivious to the large heterogeneity in national rabies capacities. Looking ahead to the elimination of dog-mediated rabies in the region, now established for 2022, we also review the many challenges and questions that the region faces in the last mile of the epidemic. Given the advanced position of the Americas in the race toward elimination, our considerations could provide valuable knowledge to other regions pursuing elimination goals.
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO), Rio de Janeiro, Brazil; School of Veterinary Medicine, University of Surrey, Guildford, UK.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Del Rio Vilas
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Freire de Carvalho
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Marco A N
authors.initials: MA
authors.lastname: Vigilato
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rocha
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Vokaty
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Pompei
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Baldomero
authors.initials: B
authors.lastname: Molina Flores
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Natael
authors.initials: N
authors.lastname: Fenelon
authors.affiliation: Pan American Foot-and-Mouth Disease Center (PANAFTOSA), Pan American Health Organization, Regional Office of the World Health Organization for the Americas (PAHO/WHO) , Rio de Janeiro , Brazil.
authors.forename: Ottorino
authors.initials: O
authors.lastname: Cosivi
keywords: America; canine mediated; elimination; rabies; regional program