When William Tasiame saw a young boy infected with rabies, he knew the child was going to die.
"He gasped for breath, hiding his face from the light. I knew the symptoms from dogs, they are similar. It is a sad death and it was the worst thing I have seen in my life," Tasiame told Global Citizen.
Tasiame studied veterinary medicine in Cuba, before going back to his home country of Ghana, where he worked as a veterinarian for 12 years. Today, he is doing research for his doctoral thesis on rabies under Christian Drosten at the Charité in Berlin, Germany.
Although rabies had always been an interest in Tasiame’s professional life, it wasn’t until he saw that child suffering from it with his own eyes that he decided he would dedicate his research and all his energy to fighting it.
Once a person begins to show signs of having rabies, it will almost always lead to death. Signs and symptoms include headaches, nausea, vomiting, abdominal pain, diarrhea, fever, or cough. But they also include confusion, difficulty swallowing, hallucinations, and a fear of water, according to the Centers for Disease Control and Prevention (CDC).
Rabies is almost always transmitted by infected animals, mostly dogs or wild animals, such as foxes, bats, and raccoons. The virus travels through the nerves to the spinal cord and brain. It usually takes three to eight weeks between initial contact with the virus and the onset of symptoms.
Children Are Most at Risk
"Rabies is a very brutal disease that mainly affects children — and there is nothing you can do about it. There are no active ingredients or medication to combat it. Once the brain is affected, it's too late," Tabea Binger, laboratory manager of the Kumasi Center for Collaborative Research, a research facility of the Bernhard Nocht Institute for Tropical Medicine in Ghana, told Global Citizen.
Like Tasiame, Binger also wrote her doctoral thesis under Christian Drosten. She focused on viruses that infect bats and that can be transmitted to humans — one of which is the rabies virus.
Having studied the virus so intensively, Binger explained that she has been vaccinated against rabies and that every year, she was tested to ensure that the protection provided by the vaccine was still sufficient.
"Most people do not have this luxury,” she said. “But they actually need this vaccination urgently.”
Rabies is one of the diseases on the World Health Organization’s (WHO) list of NTDs. These diseases are most common in tropical regions, where access to health care or water and sanitation is often poor in global comparison.
There are solutions to some of these diseases readily available, but NTDs are not prioritized globally. And while some pharmaceutical companies have donated treatments and worked to tackle these diseases, there is minimal research and development being conducted on NTDs as there is no market for the drugs.
There is no effective drug against rabies. There is a vaccine, but it requires three doses per person, which can be difficult to deliver in areas with little access to health care.
More than 59,000 people die every year worldwide from this NTD, with 95% of human cases occurring in Africa and Asia, according to the WHO.
"With the polio [vaccine], it is only three drops to swallow. Here in Ghana, polio workers go from door to door to distribute the vaccine to every child under 5 years of age. I have a little daughter who has just had this done," Binger explained. "But, unfortunately, there is no such simple vaccine against rabies for humans."
What makes it all the more tragic is that more than 40% of the rabies cases affect children under 15 — and most of them are caused by a dog bite, Tasiame added.
Diagnosing rabies is also a challenge as there are no efficient or cost-effective rapid tests available. This means that doctors have to find alternative methods to confirm if a child has been bitten and infected by an animal.
"Children often say that they didn't tease the dog so that they don't get into trouble — it just happened that he bit out of the blue. But that makes it difficult for us to find out whether the dog had rabies or not," Tasiame said. "The only thing us vets can do is go to the village and find the dog — then I can know for certain whether it was a sick dog or not."
Vaccines Are the Only Line of Defense
Theoretically, it is possible to administer a post-bite vaccine to prevent death from rabies.
"This does not work very well in Ghana. As a doctor, you have to know that the patient actually has rabies. You have to be able to obtain the vaccine — because it is usually only available in the capital, Accra, but the cases occur far away, in the very north of Ghana, more than 13 hours by car," Binger said.
It is also impossible to vaccinate all children that have received a dog bite as the vaccine is far too expensive.
That is why attempts are being made to instead vaccinate the disease vectors — in Ghana, this generally means dogs.
"The primary solution to rabies is to vaccinate as many dogs as possible," Tasiame said.
The vaccine for dogs costs about $1.75 per vaccination, according to Tasiame, which is significantly cheaper than the one for humans, which he said costs more than $100.
"In Ghana, the method is particularly useful because there are hardly any street dogs here — every dog has an owner. We just have to get hold of the dogs and raise enough money to vaccinate enough dogs," Tasiame said.
The government of Ghana has not done much to address this health crisis, according to Tasiame. The vet says that the last government-initiated vaccination campaign against rabies in Ghana took place in the 1970s.
Protecting Dogs Will Help Protect Humans
Last year, Tasiame launched a vaccination campaign to educate about the disease and vaccinate dogs free of charge.
"The people who are most exposed to rabies infection are poor people. The area where I started the campaign is in the north of Ghana, a poor area. I went there for the first time last year. It feels like driving to the end of the world. The roads are bad, water and electricity supplies, and health care are a problem," Tasiame said. "Last year, we vaccinated 650 dogs, but that is not enough. Statistics show that we have 1.4 million dogs in Ghana."
About 70% of the dogs would have to be vaccinated to provide sufficient protection — and this would need to be done every year.
"This year, we have collected enough money to vaccinate about 1,000 dogs — most of it comes from friends," Tasiame said, adding that him and his team have also launched a small appeal and set up a function that allows people to donate via SMS.
Through word of mouth, Tasiame and his team encourage dog owners to bring their dogs for vaccination on World Rabies Day and the weekend before in Bongo, Zerko, and Belungu, three villages in the north of Ghana. The campaign takes place in a well-known place in each village so that it’s easy for everyone to find.
Tasiame's wish is for the world to see the issue and take action on it.
"Most people who die of rabies live in rural areas — they have no education, no water, no road network," he said. "And they still have to die of a disease that could be prevented with vaccines. That hurts me the most."