The Chinese government established a government-led, multisectoral-coordinated, “whole-society participation” mechanism under the concept of One Health in order to combat rabies. This approach entailed the following: 1) prioritizing elimination of dog rabies, including dog population control, registration, vaccination, quarantine, and movement management as dog vaccination remains the most cost-effective way to prevent human rabies; 2) ensuring the availability, accessibility, and quality of PEP services to establish a second line of defense against rabies, while providing pre-exposure immunizations to high-risk groups, such as veterinarians and laboratory staff; 3) integrating human and animal health surveillance systems and implementing a containment strategy based on a One Health approach, once any human or dog cases are reported; and 4) promoting the welfare of dogs through advocacy, risk communication, and social mobilization.
The strategies and measures for rabies control are detailed as follows:
Active advocacy for the elimination of dog-mediated human rabies by 2030 as recommended by World Health Organization (WHO), a goal that has been highly prioritized by the Chinese government. The National Health and Family Planning Commission (NHFPC) [(currently National Health Commission (NHC)], Ministry of Public Security (MoPS), Ministry of Agriculture (MOA) [(currently Ministry of Agriculture and Rural Affairs (MARA)], and State Food and Drug Administration (SFDA) jointly issued the Current Status of Rabies Control in China in September 2009 (4). This document further defines the responsibilities of multiple sectors, establishing a multisectoral rabies prevention and control strategy, promoting close cooperation between various sectors, and actively carrying out prevention and control programs. It also defines major responsibilities for local governments, such as establishing grassroots organizations and strengthening dog management in rural areas.
Formulation and implementation of rabies prevention and control programs in China. The General Office of the State Council issued the National Medium and Long-Term Animal Epidemic Prevention Planning (2012–2020) on May 25, 2012 (5), which listed rabies as a zoonosis with priority in prevention and control and set a goal of achieving the control standard by 2020. To implement the national plan, relevant departments have implemented their own prevention and control programs.
• The MOA has strengthened the prevention and control programs for animal rabies. The MOA issued and implemented the National Animal Rabies Prevention and Control Plan (2017–2020) (NYF  No. 18) to strengthen rabies surveillance and response as well as dog immunization on June 2, 2017 (6). The MOA conducted large-scale dog immunization campaigns based on the “red collar” project. The MOA strengthened the core role of veterinarians and their sectors in rabies prevention and control and implemented compulsory rabies immunization regulations countrywide. The MOA further strengthened the countrywide dog surveillance and immunization system, especially in rural areas, to ensure the effective implementation of dog immunization measures in both rural and urban areas. As a result, the dog immunization rate has improved dramatically and the incidence of rabies in dogs has decreased, both of which led to the minimization of large-scale dog culling.
• Since 2005, the NHFPC has continued to implement the Central Government Transfer Payment National Rabies Surveillance Program in order to effectively conduct rabies surveillance, strengthen the epidemiological investigation of human rabies cases, and to improve multisectoral cooperation such as the sharing of surveillance information and promoting rabies responses. The NHFPC issued the Rabies Post-Exposure Prophylaxis Regulation in 2006 (7) and Technical Guidelines for Human Rabies Prevention and Control in 2016 (8) to standardize rabies PEP. Specifications for the Treatment Clinic Setting of Rabies Post-exposure Prophylaxis (T/CADERM 3010–2019) (9) were issued by Chinese Medical Rescue Association to strengthen the disposal clinic management of rabies PEP. Public health sectors have continuously strengthened training and conducted widespread professional rabies PEP training for grassroots outpatient doctors in various forms, including annual rabies meetings, online training, and standardized training courses for outpatient doctors at local injury clinics, and rabies awareness programs through official accounts and doctor groups on WeChat. Furthermore, the NHFPC promoted the incorporation of rabies vaccination and immunization into medical insurance in PLADs with high incidence of rabies to improve the accessibility and affordability of PEP services.
• The MoPS has continued to improve the registration and management of urban dogs.
• The SFDA has continued to strengthen the supervision of the quality and circulation of the human rabies vaccines and rabies immunoglobulins in order to supply high quality human rabies vaccines, and the supply of animal rabies vaccines is now sufficient to ensure the needs of prevention and control programs.
Strengthening rabies surveillance and utilizing integrated surveillance information. Based on case reports and post-exposure monitoring, surveillance of situations in which one dog bites multiple people has been emphasized in recent years. China CDC holds rabies laboratory testing training workshops every year to strengthen the construction of laboratory networks. Laboratory testing showed that the virus positive rate of one dog biting multiple people exceeded 80%. The strengthening of epidemiological investigation, with the aim at achieving a case investigation rate of 100% as well as increasing investigation and responses, has been conducted.
Implementing surveillance, containment, and epidemic point and source elimination strategies. Rabies is a reemerging disease or imported infectious disease in most areas, and emergency response strategies should be implemented. All localities are supposed to strengthen joint prevention and control mechanisms and closely monitor and strengthen information sharing. Once a human or animal epidemic or “One dog biting multiple people” scenario emerges, a report must be submitted promptly to initiate the emergency response. Under the guidance of the government and multiple sectors including agricultural, health, and public security, among others, should cooperate closely, strengthen the implementation of various prevention and control measures in epidemic areas, and ensure the elimination of hidden dangers of epidemic spread in accordance with Technical Specification for Prevention and Control of Rabies. This includes the identification of epidemic areas and threatened areas, the culling of infected animals and other animals bitten by infected animals, the isolation of stray dogs, an emergency rabies immunization of all dogs and cats and restriction of their movement, and risk communication with the public.
Promoting the introduction of national laws and regulations related to rabies prevention and control as well as managing dogs according to law. Before 2021, there were no national, unified dog management regulations; moreover, local dog management regulations were only instituted in some regions. The Animal Epidemic Prevention Law of the People’s Republic of China was revised and implemented on May 1, 2021 (10). It defined the main responsibilities of local governments in dog management and stipulated that dog owners should register and vaccinate dogs against rabies. When walking their dogs out of their houses, dog owners should ensure that their dogs have tags and adhere to necessary measures, such as tying dog leashes in accordance with the related regulations to prevent the dog from hurting people and spreading rabies.
Wide publicity, mass mobilization, active advocacy for civilized dog breeding and consolidation of the popular support. Mass media can actively facilitate the publicity of rabies prevention and control knowledge, which would enhance the public understanding of public health. Some non-governmental organizations can participate in the publicity and shelter of stray dogs.