Research & policy disconnect: the case of rabies research in India.

Sir,

India is home to a significant portion of the global burden of endemic zoonoses and is a global hotspot for emerging infections1. Research studies have demonstrated that India produces the highest number of rabies cases in the world2. Consequently, there is an increasing recognition among policymakers about the need for controlling rabies in India as demonstrated in the repeated disease prioritization exercises in the country34 and the fact that rabies has been considered as a priority zoonosis by the Planning Commission to be tackled in the 12th Five Year Plan5.

Rabies has been successfully eliminated or controlled in many Latin American and Sub-Saharan African countries using proven intervention strategies, such as post-exposure prophylaxis in humans and animal birth control and immunization among dogs6. Studies conducted in India have also identified efficacious human7 and animal8 interventions that can be administered at a population level for rabies control. However, policymakers in India, as in many other countries, remain concerned about presence of sufficient information in order to implement these strategies910. Different reasons are advanced to explain the disconnect that prevents the translation of scientific research outputs into effective policies in rabies and as well as in other health domains. These range from lack of a strong evidence base910 to limited emphasis on knowledge translation activities1112. In our recent article on rabies research from India13, we found that less than ten original research articles on rabies were published annually in India. The Indian research output represents 4.4 per cent of the global research on rabies which is grossly disproportionate to the magnitude of the problem and the size of the research community in India. It was also found that four institutions (two each from human and animal sectors) generated almost half of the total research output in India13. Even though the importance of controlling rabies virus circulation from animal reservoirs is well established1415, it was found that most of the research from India focussed on the rabies virus (58%) or the human (34%) aspects of the disease13. Research articles focussing on animals and research published in animal centric journals comprised less than 9 per cent of total research output13. It was also found that most published research was laboratory based or clinical research while rural areas, accounting for the bulk of rabies cases16 were the focus of only 1 per cent of the total research13.

Despite the fact that India is among the leaders globally on research funding for neglected diseases17, its contribution is still small in relation to the global research output1318. Further, the limited research output that exists in health sector, is not aligned to the public policy needs131819. There is a disconnect between the information needs of the public health planners and the evidence that is generated by the research community.These issues around translation of evidence into informed policies are especially important for research related to rabies and other zoonoses that deals with interface between multiple sectors and species. The diverse nature of incentives driving research in the human and animal health sectors20 makes a compelling reason for a Strategic Research Agenda that can jointly guide the research across different disciplines and sectors for zoonoses prevention and control21. Our findings highlight the importance of moving beyond a purely researcher-driven agenda and suggest the need to promote research that has a vision for rabies control in the near future.