Rabies has been a scourge for centuries. Despite the fact that this disease is fully preventable, the exemplary efforts that led to the elimination of dog rabies (e.g., in Western Europe, the United States, and Japan) have failed to be replicated across Asia and Africa. Significantly, the continued lack of impetus toward its control and elimination has resulted in the official recognition of rabies as a neglected tropical disease (1). The low priority status of rabies in the global community has resulted in a lack of interest from relevant stakeholders and national governments, despite the important socioeconomic and public health impact of the disease (2). Without a unified governmental and global effort toward rabies control, human lives will continue to be needlessly lost.

Many rabies endemic countries are afflicted by economic and political instability, resulting in a plethora of challenges. These circumstances make it even more difficult to assign sufficient resources toward rabies surveillance and intervention, especially when a host of other diseases competes for attention. Diseases are often prioritized according to those that are most visible or perceived to be emerging threats. Failure to command attention leads to a lack of resources required to implement an effective intervention strategy. A cycle of neglect is thus established, depriving the disease from the attention that it deserves (3). The absence of accurate data is considered as a foundational challenge in the prioritization of the fight against rabies (2, 4).

By providing decision makers, countries and regions with robust estimates as to both the burden of the disease (2) and the associated costs (5), a stronger case for rabies prioritization and intervention may be built. Therefore, an important next step would be for regional networks and the global community to improve data collection, quality, and analysis, among others, to inform the disease prioritization cycle.

There is an inordinate disconnect between the data that are officially reported by governments and that of the estimates provided by predictive models (2). Furthermore, a plethora of data from grassroots levels (e.g., health-care facilities) is also available but is seldom reported and aggregated to the national level. It can be argued that these models provide the most useful and well-considered estimates for the burden of rabies to date, specifically in Africa and Asia where rabies reports, in those instances where reporting does occur, often appear to be haphazard or discrepant (6). Within Africa, for example, underreporting the actual numbers of human deaths can be as much as 100-fold, resulting in the misperception of the burden of rabies in individual countries and on the continent as a whole (7).

While a lack of reported data is problematic, poor-quality data can result in a conscious decision to mistakenly not address a disease. Poor-quality data can present a false picture of the situation, resulting in a false sense of security among governments and decision makers. Thus, improving data reporting should be a process that starts at the lowest governmental levels and aggregates up to the national level. The ultimate goal of each country and stakeholder involved in rabies control and elimination should be to drive accurate data collection, reporting, and analysis in order to ensure that the reported data reflect the true burden of rabies in their country.

Many countries in Africa have functional surveillance systems, yet the data that are reported at a national level or to international organizations such as the World Health Organization (WHO) and World Organization for Animal Health (OIE) do not correlate with that from the community or district level (6, 8–11) as it is sourced from various sectors and databases within the country.

Cumbersome, complex, and time-consuming reporting systems contribute in large to poor data collection and reporting. A recent study showed that only 10/19 surveyed African countries reported human rabies data using an electronic database, but 18/19 countries still used paper-based reporting at some stage(s) within their reporting system (12). Rabies data reports are often late, or submission rates are low. A stand-alone rabies surveillance system was reported in 4/16 countries, meaning that reported data for the remaining 12 countries would likely be presented to an integrated disease surveillance system for multiple diseases within each ministry (12). As a result of the complex structuring of existing types of reporting systems, as well as the lack of any feedback mechanisms, those data misreported or unreported are not pursued, clarified, or questioned (9). These factors all contribute to a lack of confidence in rabies surveillance systems in Africa; only 3/19 countries deemed their rabies surveillance system adequate, despite its status as a notifiable disease in all 19 surveyed countries (12).

Apart from the obvious drawbacks associated with cumbersome reporting systems, the roles played by data managers should also be considered. Individuals responsible for reporting data are tasked with various other responsibilities. These include reporting morbidity and mortality statistics to international organizations and responsibility for reporting data for all of the notifiable diseases to various sectors, stakeholders and decision makers within a country. Additionally, there should be capacity for analysis and interpretation of raw data in order for it to be used for case follow-up, outbreak responses, targeted intervention campaigns, and the identification of disease incidence hotspots. Thus, data managers are often overburdened with a plethora of tasks and commitments, resulting in some health data being poorly reported. In this light, it would be most beneficial for data reporting as a whole if reporting systems could be made as simple and efficient as possible.

Formerly, two main international epidemiological reporting bulletins for rabies existed, namely the WHO Rabnet (13)—reporting on public health data—and the OIE World Animal Health Information System (WAHIS) (14)—reporting on veterinary health data. The Rabnet system closed in 2011 due to a lack of reported data (8). The WAHIS is a well-established global animal disease reporting system that reproduces the data that countries submit to OIE, but it is also limited by the underreporting issues inherent to the national reporting systems (7). A further disconnect exists in many places between human and animal health, with little or no cross-sectoral exchange occurring (8). Thus, the need for regional, One Health-oriented reporting networks has become evident (15). The creation of rabies-specific regional bulletins has been exceptionally successful in the Pan-American Health Organization region (SIEPI database) (16) and in Europe (WHO Rabies Bulletin Europe) (17). These bulletins have enabled countries to improve surveillance for targeted intervention and control measures, while also increasing advocacy and awareness about the disease situation. In Africa, no rabies-specific database existed, and only informal reporting occurred within regional networks (6, 12). Also, with the lack of a regional bulletin, data quality from the African region has remained poor or non-existent, emphasizing the need for such a tool.

The lack of awareness and knowledge about the true burden and impact of rabies within countries in mainland Africa remain the primary barrier to the control and elimination of this disease. With poor rabies surveillance throughout Africa, there remains little political will and motivation to prioritize rabies among other notifiable diseases, resulting in its continued neglect. Improved surveillance is likely to lead to increased interest and more targeted and sustainable control strategies.

Pan-African Rabies Control Network has committed to provide countries with an effective, simple, and free-to-use bulletin for rabies that aims to address the issues of poor reporting and data quality in Africa as a whole. With the successes of other regional rabies reporting bulletins, as well as the addition of the PARACON bulletin for Africa, the next step would be to extend these regional databases into a global collective. With the unification of national data reporting systems and the reduced need for redundant reporting and the use of streamlined and automated data management systems, the expansion of regional bulletins into a global rabies-specific disease database is practicable. As a result, reporting burdens will be relieved and with improved data, decision makers and stakeholders can be convinced that rabies elimination is feasible within their country. With these tools and the support from the international community, the recent global declaration for the elimination of canine-mediated human rabies by 2030 (30) seems a realistic target for countries to aspire toward.

All of the authors contributed equally to the conception, development and drafting of the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.