Challenging the norm of rabies control in Tamil Nadu

by Hiral Anil Shah & Syed Shahid Abbas

The Global Alliance for Rabies Control (GARC) has set a target for worldwide rabies elimination by 2030. To achieve this there is a need for policy-makers to commit to cost-effective canine rabies control programmes at the population level.

Rabies is an infectious disease, largely transmitted to humans by bites from infected dogs, and can prove fatal without prompt treatment. Mass canine vaccination campaigns are the currently recommended rabies control strategy and have been successful inmany contexts. However, in many low- and middle-income countries, where there is an abundance of stray dogs, mass canine vaccination campaigns are often viewed as too costly or insufficiently effective. Combining canine vaccination with animal birth control (ABC) programmes is an alternative strategy which supports a socially stable but declining dog population. However, there is currently no evidence to show that combined programmes are a cost-effective intervention for rabies control.

Approximately 35% of all human rabies deaths occur in India. In Tamil Nadu state around 4.7 million cases of dog bite injuries and 350 suspected human rabies cases have been reported in the past five years. In order to address the problem of rabies and dog bites, the government currently provides free post-exposure prophylactic vaccination following a dog bite. Additionally, the government and NGOs have conducted localised, city-based, pilot canine vaccination and ABC programmes to reduce canine rabies transmission. However, these efforts are yet to be scaled-up to the district or state level due to policy concerns surrounding feasibility and financial sustainability.

Supported by a Grand Challenge award for developing One Health metrics, we used the programme and epidemiologic data from Tamil Nadu to populate an integrated dynamic transition and economic model. This model was used to assess and compare the costs and human health outcomes, such as death and dog bite burden, of several canine-based interventions including canine vaccination; canine vaccination with sterilisation in all dogs (the currently preferred procedure); and canine vaccination in all dogs with sterilisation in female dogs only. TheAnimal Welfare Board of India recommends a female-orientated ABC programme, as sterilizing predominantly female dogs should be sufficient to control the population.

We found that a relatively moderate strategy that combined mass canine vaccination with female sterilisation could cost-effectively reduce the incidence of human rabies. Sterilising 10% of female dogs, alongside the recommended mass canine vaccination programme, could reduce rabies deaths and dog bite morbidity by over 90% within five years. Likewise, combining canine vaccination with the sterilisation of around a quarter of female dogs annually could prevent 4,000 dog bites per year.

Our results suggest that combining mass vaccination with female dog sterilization has the potential to cost-effectively and dramatically reduce human rabies mortality. However, coordination between different sectors of state government will be fundamental to the intervention’s success.

 

Authors

Hiral Anil Shah is a Health Economics Consultant to the Public Health Foundation of India.
Syed Abbas is a public health researcher affiliated with Health & Nutrition cluster at the Institute of Development Studies, UK and the Public Health Foundation of India.

Acknowledgments

Our study was funded by a grant from the Bill & Melinda Gates Foundation through the Grand Challenges Exploration Initiative. It was conducted in collaboration with researchers from Center for Infectious Disease Modeling and Analysis at Yale and the London School of Hygiene & Tropical Medicine.

Note

This originally appeared on the Global Health, Epidemiology and Genomics blog and is reposted with permission. For more information about GHEG please visit http://gheg-journal.co.uk/.

(Proactive) Foresight

by Gioel Gioacchino

‘Live in the now’ is the mantra of ‘good living’ I have been focusing on in the last few years. As I understand it, living in the now does not prescind being responsible, or planning ahead. Instead, it suggests that ‘surrendering’ to the present moment, exploring all its nuances, its possibilities, can make my experience more vivid. Future possibilities, after all, can only be generated in the now – in a sense the now holds all future knowledge and possibilities.

So while I am seriously focusing on being in the now, I get hired as research officer at IDS to work on foresight – a toolkit of methodologies to explore the systematic understanding of future possibilities. How ironic, I thought, and I launched myself into it. I read and I read, trying to wrap my head around how IDS researchers have been looking into the future of different development issues. I learned about scenario building, and was fascinated by the possibility of using narratives to capture multiple possible realities.

Flexing the foresight muscles

On 15 October, IDS hosted a conference on ‘Foresight and international development’. It was a ‘cosy’ event: 30 ‘experts’ sitting around a table and discussing the whys and hows of foresight.

Foresight is uncomfortable for many academics and practitioners used to ‘evidence based approaches’. Inevitably, the future is elusive, uncertain and unpredictable. As Jim Sumberg put it when wrapping up the event, ‘doing foresight requires a whole set of different muscles that as researchers we don’t usually exercise’.

The conference, which was followed by a foresight workshop organised by Frances Seballos, left me with more question than answers (as it should).

I left the event thinking ‘I am missing something?’. So I tried to ask myself the question: Why foresight?

There is something almost instinctual about looking at the future. But our ‘foresight instinct’ is not a strong enough reason to coordinate expensive projects.

The foresight literature stresses ‘preparedness’: preparing for multiple possible futures builds resilience.

Foresight exercises are by nature reductionist, they will never completely account for the complexity of future possibilities. While preparedness and resilience are reassuring terms, I was not completely convinced.

Our life is exciting precisely because we cannot sit down and plan who we will be in ten years. Yet, following the logic that the future is locked in a now that has not yet matured, we must have some agency in the future. So this is not about preparing and building resilience for a set of non-normative inevitable futures…

So why foresight?

Today, a close friend of mine posted this status update on Facebook: ‘Dreams of the future reveal more about the mind of the dreamer than the future itself.’

This resonated with me. Foresight could help question the ‘dreams’ of imagined future realities.

In the foresight approach that IDS has adopted so far, researchers organise workshops involving stakeholders in a process of collectively coming up with the drivers of change expected to influence the future. Key drivers are converted into spectrums – participants at this stage are asked to reflect on what could be the two extremes to how a driver might evolve over time. By triangulating two spectrums, participants develop narratives of a set of ‘plausible future scenarios’.

This is a fascinating, tricky process. For example, the way a driver is transformed into a spectrum influences the scenarios that might emerge. The analysis of drivers is carried out through a STEEP analysis, which helps participants think about change holistically by focusing on drivers in the Social–Technological– Economic–Environmental–Political.

But the future is full of random and unexpected events – what if the future were to be shaped by a radical shift in our ethical principle? Or by a UFO invasion?

I think there is value in how, collectively, the scenarios stretch our imagination. This said, we are inevitably imposing our own limits in imagining the future.

Desirable futures

The foresight approach that IDS has used so far does not take into account ‘desirable futures’. I personally find this disempowering. We can imagine ourselves as spectators in a world that is unfolding with endless possibilities. And we might as well be. But we are also agents, and in international development we are trying to exercise our agency on the world. Aren’t we?

During the conference, Marie de Lattre-Gasquet – representing CIRAD – shared her experience with, ‘La prospective’, foresight in the French tradition. ‘La prospective’ considers the future to be the result of human agency, which, in turn, is strongly conditioned by human desires, projects, and dreams’ (Godet, 2008). According to the ‘spiritual father’ of ‘la prospective’, Gaston Berger, ‘imagination is the complement of reason, and opens the door to innovation and entirely new perspectives on the world’ (cited in Godet, 2008). Foresight ‘should elicit human values and aspirations’ (ibid).

‘The goal is not to observe the future from the present, but rather to observe the present from the future.’

In the week following the Foresight conference at IDS I was invited to be Master of Ceremonies at the ninth UNESCO Youth Forum in Paris. Guess what methodology they used? Foresight! Imagine 500 young people from all over the world asking themselves how the world would be in 2040. At UNESCO, they were not too concerned with how the future would be – instead, they wanted to challenge participants to imagine the future differently. Participants were asked to unpack the assumptions they were making about the present in order to envision the future. A sort of collective unprogramming.

Isn’t this the foresight we’d like to do at IDS? If not, why?

Let’s experiment!

My hope is that we can continue exploring foresight methods innovatively and intentionally. As Marie explained, in the French school foresight promotes ‘anticipation, appropriation and action’. Anticipation is in line with what IDS has utilised so far. The term appropriation calls for being aware of ‘who is in the room’ and suggests that foresight is a participatory tool and ‘whose foresight’ we are referring to is an important question to keep in mind. Finally action: a call that we owe to keep asking ‘so what?’.

The ‘Foresight in International Development’ conference report will be published in January 2016. It will be shortly followed by an IDS Bulletin entitled ‘Foresight and International Development’. 

Listen to our podcast ‘Using strategic foresight in international development‘ in which participants from the 2015 IDS-hosted conference ‘Foresight and international development’ reflect on how they are using foresight and similar planning approaches in research and policy for development.

Gioel Gioacchino is a PhD student at Institute of Development Studies affiliated with Rural Futures cluster.

Cross-posted from IDS Opinion Blog

The cloud over the mineral sector in Sierra Leone

by Franklin Bendu

Sierra Leone is an interesting case in mineral sector development in a post-conflict country where it is trying to attract investment whilst as the same time facing the challenge of ensuring it gets a fair share of the resource rent generated. The end of the civil conflict in 2002 coincided with the start of high prices of minerals which lasted from 2003 to 2010. Though mineral exports accounted for over 75 percent of merchandise exports, mineral revenue has contributed on average 4.6 of domestic revenue between 2003 and 2014. According to the
United Nations Conference on Trade and Development (UNCTAD), “the potentially most important direct contribution from mineral extraction is the rise in host-country income, much of which takes the form of government revenue” (UNCTAD, 2007). However, developments in the mineral sector over the past year has meant the contribution of the mineral sector has fallen dramatically in 2015. The two iron ore mines are now under new ownership and unlikely to produce in 2015, and the only large scale diamond company has stopped operation because of shortage of working capital.

The change from 2013 to present could not have been more different. Gross Domestic Product (GDP) grew by 21.3 percent in 2013 and is forecast to fall to 6.6 percent in 2015, mainly as a result of developments in the mineral sector. Mining contribution to GDP was 18 percent in 2013 and is forecast to drop to 3.6 percent in 2015.  In 2013, mineral export was US$1.4 billion (91 percent of merchandise exports), but this is forecasted to fall to US$247.9 million in 2015. Mineral revenue as a proportion of domestic revenue was almost 10 percent in 2013 and is forecast to fall to less than 5 percent in 2015. Why has it come to this? The blame cannot be solely placed on the government. First the outbreak of the EVD in 2014 have had an adverse impact on economic activities including the mining sector. However, the main underlying factors are the fall in price of iron ore which has affected the cash flow of the two iron ore companies and the inability to attract capital for further expansion.

Key challenges

One of the main benefits from mineral endowment is the wealth that can be created through taxation. The issue of low tax revenue from the mineral sector is not peculiar to Sierra Leone as many mineral rich countries have been unable to translate mineral wealth to mineral revenue through taxation. To ensure that government as the owner of mineral resources is able to generate a fair share of the resource rent from the extraction of its mineral wealth, three key issues are important: First, the design of effective mineral taxation policies and ensuring its proper implementation. Second, it is important that government get the right type of investors into the mineral sector. Third, there has to be the political will and institutional capacity to monitor the operations of the mineral sector.

There are currently five large scale mining companies in Sierra Leone and each has a mining agreement with government. These different agreements have various fiscal provisions which for all intent and purpose has led to government not getting a fair share of the resource rent generated. A case in point is the Sierra Rutile Agreement which was signed in 2002 but re-negotiated twice in two years. By 2004, the royalty rate had been reduced from 3.5 percent to 0.5 percent. To translate this into revenue, between 2006 and 2014, total rutile exports amounted to US$620 million. Royalty payments from the company has amounted to just over US$3 million. If the royalty rate of 3.5 percent was applied, royalty rate would have been over US$ 22 million.

Mineral extraction is capital intensive and as such it is very important that the right type of investors operate in the sector. However, making sure that this happens depend on the decision relating to the award of production licenses and the due diligence checks undertaken by government on prospective investors. Frequently, government officials make the argument that after the civil conflict, it was difficult to get investors into the mineral sector and as such those that took the risk to invest have to be rewarded through investment incentives and fiscal concessions. The capacity of the mining companies is very important, especially when the price of minerals are falling as they are at the moment. What has happened in Sierra Leone over the years is that the country has been unable to attract established mining companies into the mineral sector. In Guinea, there is Vale mining iron ore, whilst in Liberia three is BHP Billiton and ArcelorMittal in their iron ore sector. These companies because of their size are much more able to cope with falling prices. In Sierra Leone, the two main iron ore mining companies are under new owners as both went into administration in 2014 and 2015. At the moment, production of iron ore is at a standstill the current iron ore price level is not enough to cover their operational cost. No production also means no royalty payment for government. The diamond mining company is also facing severely challenges in attracting capital for its underground kimberlite operations as it had exhausted the open pit reserves. Again no production of diamonds means no revenue for government.

Another key issue is the lack of technical capacity in government institutions responsible for overseeing the operations of the mining companies. The National Revenue Authority has an Extractive Industry Unit but is grossly understaff to undertaken any meaningful forensic audit on the financial statements of mining companies. In all of this, it is imperative that there is the political will to ensure the enabling environment that will not only attract investment into the sector but also ensure the existing legislations are implemented.

Impact on the economy

The challenges facing the iron ore and diamond sub-sectors have already impacted on government, employees and local businesses in the country. Due to their inactivity, royalty payments from the mineral sector will reduce substantially in 2015. Local employees have been made redundant with its attendant consequences on their families. Local businesses are also owed tens of millions of dollars in outstanding obligation from these companies. In Sierra Leone, local businesses access loans from commercial banks at very high interest rates. As such, failure by these mining companies to make timely payments to these businesses imposes additional repayment cost to the banks and affects their credit history.

The way forward

Some issues worth considering going forward include: First, government should recognise that mineral endowment is finite and hence the need to establish the enabling environment to attract the right type of investors; second, taxation instruments are the main vehicle for generating revenue for government and as such it is important for the provisions in the mineral agreements to be in line with existing legislations governing the sector; third, the political will to ensure laws are implemented; and fourth, the need to invest in institutional capacity.

Franklin Bendu is a PhD researcher at IDS working on governance and taxation in Sierra Leone. 

Ebola and the changing environment in Sierra Leone

by Franklin Bendu

Sierra Leone is a country endowed with mineral resources but the amount of revenue that has been generated from the sector has been quite low. My research focuses on mining taxation, specifically in trying to understand why revenue from the mineral sector has been very low. In 2013 when I left Sierra Leone, iron ore production had resumed in 2011, there was a smooth general election in 2012 and growth prospects looked good over the medium term. The outbreak of the Ebola Viral Disease (EVD) in Sierra Leone, Guinea and Liberia in April of 2014 changed the economic landscape of these countries.

In Sierra Leone, economic growth rates, exports of minerals and revenue projections have been revised downwards. By the time I arrived for my fieldwork in June, 2015, the EVD had claimed the lives of over 4,000 people in the country. The outbreak also exposed the decaying health system of the country given that, at time of the outbreak, the country had only one testing centre that was operated by an international non-governmental organization.

Even though I had been following developments about the EVD, I was not prepared for the changes that this disease had brought on the day-to-day lives of people in the country. In Sierra Leone, despite the high level of poverty, people walk around with a smile and social interaction is very much a national pastime. The outbreak of the EVD has brought about a lot of change in the way people interact.

Fieldwork challenges

Arriving in Freetown, I was confronted with the challenge of how to go about my fieldwork in the most effective and safe way. How could I move within the city whilst at the same time limiting physical contact? Which offices should I visit to get information?

As a researcher, moving around to get information is crucial, but the EVD made doing so extremely challenging. Moving around Freetown is never easy because of the limited number of alternative routes and high population density. Now, to reduce body contact, the number of passengers allowed in a taxi was reduced from four to three. Travelling became even more time consuming.

The EVD also affected work pattern as people spent less time in their offices, returning home earlier than the normal. In fact, some of my interviews had to be conducted at the homes of officials as that was the only way I would get them to allocate time for me.

In all Freetown offices, the presence of a bucket of chlorine, hand wash sanitizers and security guards with thermometers became part of the set-up. People were required to wash their hands and have their temperature checked before entering. I was not told what temperature level would be a cause for alarm but my readings were, fortunately, always between 34˚C and 37˚C.

Also within offices, I noticed that the formal dress code had changed as workers adopted long-sleeved clothing as a means of limiting body interaction. Formal greetings were now achieved by placing the right hand to the heart or by touching elbows (that is, if you are wearing a long sleeve shirt). This replaced the former firm hand shake and embrace.

Ebola-related measures

Other changes since the EVD outbreak included a national hotline to report suspected cases of Ebola or the death of an individual. The government became responsible for burying the dead at designated burial sites, whether the death was Ebola-related or not. In addition, with the help of the international community, new testing sites were established in Freetown.

These measures have dramatically helped to reduce the number of new cases since the start of the year. However, a few challenges remain, especially in rural areas. These include:

• People failing to report symptoms of the disease early enough;
• The inability to restrict the movement of people, especially where Ebola has been reported;
• Accessibility to testing facilities; and
• The continuation of traditional burial rites.

Economic consequences

Even though the EVD is a health issue, it has brought with it adverse economic consequences. Commercial activities, especially informal-sector activities, have been severely affected. Businesses now close down at 6pm and all commercial activities are banned on Sundays. There have been redundancies for some private-sector employees and informal-sector activities have been hit the hardest.

The cost of living has gone up as the prices of basic commodities have increased with no proportionate increase in income.  It is now expensive to import goods into Freetown (due to the increase in insurance cost) and this is translated into price increases for basic goods as the country relies on the importation of most consumer goods.

Some private-sector employers have made staff redundant or requested that they stay at home without salary until there is a turnaround in business. It was difficult to see colleagues who were employed before the outbreak of the EVD, but who have now been unemployed for several months.

The fieldwork gave me the opportunity to interact with the various stakeholders in the mineral sector and a thorough insight into how politics, corruption and the civil conflict have affected the development of the sector. As I left Freetown, I looked forward to the 42-day countdown and the eventual declaration of an Ebola-free country.

Franklin Bendu is a PhD researcher at IDS working on governance and taxation in Sierra Leone. 

‘I Googled IDS…’

by Violet Barasa

I Googled IDS. It was a sunny Friday evening after work, when Nairobi gets really hot, just before the sun loses its grip on the city. A friend at work had been talking about the Institute of Development Studies in the UK during coffee break, telling a group of disconnected, and bored natural scientists about his recent trip there to attend a short course on monitoring and evaluation.

It was not the first time I had been interested in IDS. I had worked with theInternational Livestock Research Institute (ILRI) as a research assistant for just over a year and come to know a diverse range of people. Some of the most impressive ones had told me they had obtained their degrees and diplomas from IDS, or they frequently used IDS references in their publications. This had got me curious. The Institute seemed to be widely known and favourably regarded across the social-bioscience divide for its research quality and standing. And no credible development talk finished without a mention of it.

I checked out the website and saw that scholarships from the ZELS-funded projects in the Livestock Livelihoods and Health (LLH) programme could be the opportunity to realise my dream. I had spent almost two years working in Tanzania in the livestock development and livelihoods sector and was interested in pursuing research on social dynamics of zoonotic diseases, including gender relations among Tanzania’s small-holder livestock farmers.

I registered an account to apply for a scholarship – and looked at my work calendar. I had tons of things to do. Ahead there were things I was going to have to cancel and a weekend that would be spent behind closed doors coming up with a working concept paper. Friends would have to be called in at a moment’s notice to give reviews and provide input into the proposal.

Fast forward and there I was in the remotest of villages in the north of Tanzania, where work had sent me to supervise enumerators collecting data on child nutrition. I received an email.

Well, I could see an email icon on my battery-starved laptop but I couldn’t open it because my internet dongle had only a single megabyte of data left.

So I carried on with work in Tanzania, while enjoying her bewitching beauty. A part of me will forever belong to this gigantic East African nation, albeit I am a native of neighboring Kenya, loyalty-wise.

I was finally able to open and read the email three days later when I got to a hotel with internet in Arusha, a city in northern Tanzania, where in fact the LLH fieldwork was to take place. Dr Linda Waldman, my soon-to-be supervisor at IDS, had written a congratulatory message saying that my application had been accepted. You know how your hairs stand on end and you get a rush of goose pumps and tears of joy …  it was a marvellous feeling.

But there was a caveat to this excitement.

If you are from Kenya, like me, you have to pay hefty visa fees and an additional lump-sum for the UK health surcharge to come into the UK – £150 a year for the four-year duration of the PhD, and another £322 for the visa. That is around 170,000 Kenya shillings. The average monthly wage for Kenyan professionals is less than half that.  I panicked at the thought of not being able to afford these monies and perhaps forfeiting my chance to start my PhD.

Linda put these fears to rest. She outlined the situation in a letter to IDS and I got the funds wired through. I still maintain that it is an absurd joke that UK Embassies in the developing world have to charge so much for visas.

However, I arrived at IDS on Monday, September 28. It was as I had expected: beautiful, classy and grand. And my first meeting with Linda was an emotional one. She was kind and understanding, and very African, in fact. She asked me if I was ‘’warm enough’’ (although the sun was out and bright outside), and offered me help to settle in.

I am ready for this. I am at the bridge, I must cross it. Come rain, come sunshine. I will let you know how it goes. I promise …

Cross-posted from IDS Blog

*Violet’s proposed PhD title is ‘A gendered assessment of vulnerability to brucellosis in cattle, goat and sheep small-holder farmers in northern Tanzania’. You can follow her PhD journey via twitter (@vibarasaafrica), Facebook (Violet Barasa), and LinkedIn (Violet Barasa).

Systems thinking for rabies control: What does it mean for rabies research

A government office in Tamil Nadu

An atypical zoonosis

Rabies, in many ways, is an atypical zoonosis. It continues to feature as a priority disease by multiple national as well as international agencies. There is substantial research evidence regarding its burden, transmission dynamics as well as intervention efficacy.

In addition, rabies is one of the few diseases for which well-structured and scientifically sound templates for developing national control programmes have been created. However, despite all this effort the disconnect between rabies research and policy remains real.

Continued neglect

Rabies continues to be classified as a neglected disease by the WHO. The global estimates of rabies incidence have remained constant in the last ten years hovering around 50,000 human cases. Why is it that despite the availability of highly efficacious intervention strategies and sustained research and advocacy, decision makers in Africa and Asia continue to be hesitant of mounting national rabies control programmes?

Rabies research output, categorized by type of research http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001748

Research-Policy disconnect

Given the lack of movement in policy discussions despite the sheer amount of rabies research (relative to other ‘neglected’ diseases),  I suggest that those of us working on rabies research and advocacy use the occasion of the World Rabies Day to sit back and reflect upon the reasons we have not been able to convey our insights to decision makers in large parts of the world.

How is it that the researchers and decision makers appear to be talking across each other? Might this be because we are asking the wrong questions? Key messages around rabies control in the recent past have pushed for setting rabies elimination as a goal that is best achieved through canine vaccination. The popular scientific consensus, best encapsulated by WHO is that national mass dog vaccination campaigns are the most cost-effective strategy for preventing rabies.

Statements such as these make several generalisations and, if we are to make any headway, these need to be critically examined.

Framing the problem: Need for a rethink

Rabies elimination is a worthy goal indeed. But given its limited traction, it is worth asking if this target reflects the priorities only of the rabies community or is shared by national governments and affected population groups as well.

While rabies remains a sensitive disease to report, public health officers are often more exercised by dog bite numbers than rabies incidence alone. It is therefore quite likely that interventions advocating for dog bite reduction will find more policy traction than those focussing on rabies elimination alone.

Obviously, if the attention moves from prevention of rabies alone to dog bites control as well, then we will have to start talking about Animal Birth Control programmes that are even more expensive than the canine vaccination programmes (both of which have to be funded in addition to the human vaccination programmes).

Choosing interventions: Making decisions

Another example of the research policy disconnect plaguing rabies discussions relates to the economic evaluations conducted around the disease. Resource allocation is often a zero-sum game for policy makers. Asking them to fund resource-intensive canine vaccination for rabies control might mean taking away funds from a competing social (and political) priority.

Therefore, in order to convince decision makers to go for a particular intervention it will be important to go beyond examining allocative efficiencies using incremental cost effectiveness analysis. We will instead need to develop standards for choosing comparator strategies and study time horizon so that the Incremental Cost Effectiveness Ratio (ICER) values can start to be compared across studies.

Developing standardised composition of intervention packages and incorporating insights from decision analysis will all be required to develop more policy-responsive research around rabies control. Given the recent calls to use rabies as a test case for one health approach, even more important perhaps, is to develop analytic techniques that facilitate analysis and presentation of the costs and benefits of rabies control strategies across multiple sectors and species.

The big picture: Putting values, functions and sectors together

Based upon the above ideas, a group of us thought to ourselves, what would happen when we put together costs and benefits of rabies interventions across human, canine and livestock populations in one matrix? Will such an analysis aid decision making if researchers and decision makers from all these sectors sit together in one room? We got a preview of the exciting possibilities of an integrative approach to research and policy at a recently-concluded meeting in Delhi.

Supported by a Grand Challenge award for bringing animal and human health sectors together, and working with partners across RCZI, PHFI, LSHTM & Yale, we have tried to combine disease transmission and economic evaluation models with decision analytic techniques to present a series of cost and impact results from the perspectives of different sectors drawn from a single integrative database.

We started out our exercise by mapping existing information needs of key rabies stakeholders in India in early 2015. We presented our approach and preliminary findings of a generalized cost effectiveness of rabies control in Tamil Nadu at a stakeholder meeting organized on 7-8 September 2015 in Delhi. The meeting participants consisted of researchers as well as policy makers from animal and human health sectors. Participants included officers from WHO, AWBI, GALVmed, NIVEDI, FIAPO as well as the Departments of Public Health and Animal Husbandry from Government of Tamil Nadu.

We analysed the costs and impacts of different combinations of rabies interventions across human, canine and livestock sectors across a 20-year time horizon. From our analysis, it seems that rabies transmission can be controlled relatively quickly with moderate coverage of canine vaccination. A modified ABC-AR strategy consisting of female-only sterilisation also yielded promising results.

Political economy of rabies

While the precise findings from our study will make for a separate post, even the approach of conducting and presenting our findings received interesting reactions from the group. The complexity of political economy of rabies was highlighted when we polled for the preferred outcome indicators among different sector-specific groups. Dog bite emerged as an equally significant indicator of interest as rabies transmission across most sectors. As mentioned above, this has important implications for rethinking existing rabies control strategies.

Another key finding was that the participants valued different time horizons for the study. The program managers, in particular, were interested in shorter time horizons that could demonstrate quick returns for their investments. The state program officers, in particular, were excited by the possibility of demonstrating benefits of interventions across multiple sectors as it would be helpful to them in making a case for increased budgetary allocation.

While there was some scepticism from the group with regards to sourcing the data from different contexts and for the reductionist nature of mathematical models, there was widespread interest in the utility of such an approach for decision-making in rabies.

Conclusion

It is heartening that the tagline for World Rabies Day emphasises on doing so ‘together’. As I have mentioned elsewhere, the rabies community needs to recognize the complexity of rabies landscape where stakeholders might have different expectations from a rabies control strategy. Instead of chasing silver bullet solutions emerging out of simplistic assumptions of rabies control, we need to engage with the diverse constituency of rabies more closely and co-develop solutions with broader appeal.

Syed Abbas is a PhD candidate at IDS, working within the Health and Nutrition research cluster at IDS. Crossposted from his blog

What can we learn from the Greek crisis?

by Matteo Caravani

While Professor Ian Scoones rightly pointed out in his article that there are many lessons that Europe could learn from African countries, the argument of this article is that we should learn something from the Greek financial crisis as well. This crisis has to be an opportunity to move the process of European political and economic integration – that came to halt in 2006 with France’s referendum on the European constitution – forward. We have to decide what we want to do with this Union and this decision can no longer be delayed: we either take a step forward or a step back! If the current state of affairs stays as it is, sooner or later other European countries, especially from the Mediterranean, could suffer a similar fate to Greece’s.

Since May 2010 when the Troika (EC, ECB and IMF) took over the Greek political economy, making the debt and fiscal reforms sustainable for the resources of the country should have been the most sensible goal not only for Greece but also for the collective interest of the European Union.  Instead, over the past five years the recipe for Greece has always been spending cuts and tax rises, rather than finding a long term solution. This is  made clear by looking at the fact that – despite Greece following the Troika’s recipes for the past five years and cutting its Government spending more than any other country in Europe – GDP has reduced and unemployment rate has increased. In sum, five years of neoliberal ideology caused a fall in GDP of 20.7%, between 2010 and 2014, with an estimated loss of 62 billion euros, and an  increase of the unemployment rate from 12.5% in 2010 to 27.3% in 2014 (WB, 2015).

These results have not been caused by austerity measures only – a term that everyone hates nowadays –  but are also the outcome of structural adjustments inspired by neoliberal ideology, as was found in many African countries during the 80s and 90s. In 2012, for example, the Troika imposed on Greece as a condition to receive loans, economic structural reforms, such as the reduction by 22% of the minimum wages for those aged 25 years and 32% for youth under the age of 25, a policy aimed at making Greece’s products more competitive. As should have been foreseeable by then, the result of this policy has been a reduction in aggregate demand, significant disemployment effects (Yannelis, 2014) and an overall worse economic recession.

Who is going to pay for the “horrors” of the economic policies imposed by Troika to Greece from 2010 to 2015 today? That is, besides the Greeks citizens? Theoretically, the Troika should have taken decisions in the interest of the Eurozone, by making the debt and fiscal reforms more sustainable for Greece. The actual result, willing or unwilling, has been that European private banks – especially German and French banks – have much less credit exposure over Greece compared to the situation before the first bail out of 2010. In other words, the Greeks junk bonds were passed from the private banks to the central banks and other institutions in a sort of socialization of losses as also Jeffrey Sachs recently pointed out: “the focus was on bailing out German and French banks.” Overall, the private banking system was saved while Greece in 2015 is in a worse economic condition than five years ago.

The point here is not to try and establish what would have or could have happened if the loan conditions and reforms set by the Troika had been different. The point is that since the first bail out in 2010, Greece lost its economic sovereignty, becoming a sort of “protectorate” remotely micromanaged from Brussels and Washington. In fact, the height of Greece’s economic decline (2010-2015) happened at a time when the country was, in fact, not fully in control of its political economy: this pushes the question of accountability beyond the historical demerits and negligence of Greece because of the direct political and economic involvement of other actors (i.e. Troika etc…) who cannot eschew the question of responsibility.

The “responsibility” argument that has been voiced repeatedly in the course of the Greek crisis as if to remind the world that the economic recession in the country has been completely self-inflicted because of poor political leadership. The truth is that the “responsibility” for the present Greek disaster is shared among the Eurozone countries represented by the Troika and the damaging economic policies it imposed on Greece over the past five years. In reflection of this state of affairs, the Greek debt relief should be reduced to what it was the day before the first bail out in 2010 – that is, 307 billion euros (IMF, 2010) against the current 314 billion euros (EUROSTAT, 2015)  – with the addition of the GDP loss of 56 billion euros (WB, 2015). In other words, a total of 63 billion euros – that is, the difference between 2015 and 2010 debt and GDP – should be used as proxy for the economic damages that resulted from the Troika policies for Greece. In fact, 63 billion euros should be returned to Greece! All the Eurozone countries should take their own responsibilities in the name of the socialization of losses – a dictate that has been adopted by the Troika in previous occasions, as for the saving of the private bank system with public money. Creditors have been saved from bankruptcy, let’s save debtors too!

This is more than an economic proposal: it is a call for accountability  measures that fairly redistribute responsibilities for the Greek crisis across the different stakeholders. This proposal would eventually just reduce the debt of 20% without solving the more structural problems of the Europe and Greek economy in particular, but it would be a fresh start for the Eurozone that will improve the relationship among the member states; a base for a more solid political union and a recognition that there is need for change in the institutional architecture of the Eurozone.

Once this is done we can sit and discuss whether the current mechanisms are able to help countries that are facing economic recessions. In 2008, for instance, the United States lifted its economy after a terrible recession through policies of deficit spending, of typically neo-Keynesian inspiration. On the contrary, in the Eurozone the current economic ideas and roles – basically a cocktail of Friedman and Maastricht parameters – do not allow countries to realize neo-Keynesian economic policies. As Alan Blinder wrote on The Wall Street Journal last week, countries have three fundamental weapons to fight economic recessions: stimulation of the fiscal system, stimulation of the monetary system and depreciation of their currencies. Being in the Eurozone means losing the last two instruments, while brutally limiting the first one. As a result, the Greek problem may never be solved given the actual roles of the Eurozone. Is this the overarching problem? Are we transforming the European dream into a nightmare due to the monetary roles made by a group of “Chicago boys” nostalgics? If the current system does not allow countries experiencing financial crisis to overcome their situation, why are we judging and inflicting so much pain on Greece?

The Greek crisis proved once again the extent to which Europe is still divided, with many countries protecting their own interests, and without a collective vision and overarching goal for the future. Currently, the European Union is a political hybrid but if we want to overcome the Greek crisis – which could just be the first of many – we need to move forwards the process of European political and economic integration, ultimately towards a federal Europe with fiscal transfers between country members, as in the United States.

Any crisis should be an opportunity to change the institutions and its roles, especially when these no longer serve the best interests of European citizens. As we all know, economics is not a science in the same way that geometry and mathematics are. Once again we need to repeat this to a particular group of economists more notable for mathematical skills than for local knowledge who believe in deregulation, privatization and balanced budgets as the standard solution to economic recessions. Over the past five years, the implementation of packages of neoliberal economic policies in Greece caused more harm than good. It’s time to change ideas and roles. Let’s all learn from Greece!

Matteo Caravani is a PhD researcher at IDS, within the Resource Politics cluster. He is a development economist graduated at the faculty of economics of Rome la Sapienza with a thesis on “Sub-Saharan African Oil Exporting Countries: Uganda’s Case Study.” Then he worked for the World Food Programme in Uganda as Programme Officer in charge of all safety nets and resilience programmes in Karamoja. This experience inspired his PhD research question: “What are causes and drivers of socioeconomic differentiation in the village of Lojom (in Karamoja north-eastern region of Uganda)?”. Overall, his research interests include livelihoods, food security, agrarian change, migration, resilience and social protection mechanisms in Sub-Saharan Africa.