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Swedberg et al. One Health Implement Res 2023;3:77-96 https://dx.doi.org/10.20517/ohir.2023.02 Page 81

Protocols in the province generally followed WHO guidance, specifying that equine rabies immunoglobulin
(ERIG) be administered primarily to Category III bites on their first presentation. For ERIG, one vial (5 mL
EQUIRAB) per patient was provided for free and any additional vials were required to be purchased by the
patient. Typically, any contact/bite patient that presented to an ABTC received PEP regardless of their risk
of rabies (i.e., including Category I non-exposure events from healthy vaccinated animals). In rare
occurrences of PEP stockouts, ABTC nurses used a more risk-based approach to make PEP decisions,
saving the free government-supplied PEP for more severe Category II and III events. However, during
stockouts, PEP was still available for any person to buy from private health facilities.

Each municipality has a Municipal Agriculture Office (MAO) responsible for managing crops, fisheries,
livestock, and, to a lesser extent, domestic animals, such as dogs. MAOs report directly to the mayor’s office.
However, for animal health activities at the provincial level, MAOs are often supervised by the Provincial
Agriculture Office and the Provincial Veterinary Office (Pro-Vet), which reports to the Bureau of Animal
Industry - all of which fall under the jurisdiction of the Department of Agriculture. Most MAOs have
animal health staff assigned to livestock, but few or no veterinarians. Veterinary capacity is concentrated
near Calapan, where the government employs city vets and there are around five private practices. While
these vets could increase the capacity of government-led initiatives, they are currently not mandated to
conduct rabies control measures.

The Anti-rabies Act of 2007 enacted responsible pet ownership ordinances, specifying that all dogs be
registered, regularly immunized against rabies, not allowed to roam freely, and that bite events be reported
within 24 h, with medical expenses shouldered by the animal’s owner. Enforcement of these ordinances and
initiation of anti-rabies activities, such as mass dog vaccination (MDV), should be carried out by the MAO
if sufficient funds have been allocated via their budget plan. However, many MAOs have insufficient
capacity (i.e., trained vaccinators) for MDV and often require additional logistical support and funding
from the Pro-Vet. Dog registration, costing owners 20 Philippines pesos (~$0.40 USD), and MDV, offered
free to owners, are typically conducted annually from March (Rabies Awareness Month) to June.

Given the decentralized government structure, achieved vaccination coverage heavily relies on the budget
allocated by the local government, resulting in notable variation between municipalities. This variability also
extends to the MDV strategy, such as house-to-house vs. central point, and the protocols employed,
including dog age/health restrictions. While some municipalities allocated zero funds for MDV, others
allocated upwards of 100,000 Philippines pesos (~$2,000 USD) per year. Due to the COVID-19 pandemic,
almost all MDV campaigns were canceled in 2020 and 2021, leading to much lower vaccination coverage.
Moreover, the dog population and proportion of roaming dogs were thought to have increased during
lockdowns due to more people purchasing pets and reduced animal sterilization.

Data collection
Government surveillance, health, and population data
Human population data from the 2020 government census were utilized to estimate the dog population
[18]
and denominators for bite patient and rabies exposure incidence in Oriental Mindoro Province. To evaluate
surveillance performance, laboratory diagnostic data for animal samples tested for rabies were obtained
from RADDL, including both direct fluorescent antibody tests (DFA) and lateral flow devices (LFD). Brain
samples were collected by either trained MAO or RADDL staff, adhering to safety and quality protocols
(e.g., use of personal protective equipment and transportation in cold boxes). In cases where RADDL was
unable to complete DFA diagnostic testing (e.g., due to lack of a working fluorescent microscope or a
broken storage freezer), LFD testing was conducted at RADDL, and then samples were sent to the Research