{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:20:28Z","timestamp":1792106428448,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T00:00:00Z","timestamp":1489968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["602825\u20102"],"award-info":[{"award-number":["602825\u20102"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Rabies is an essentially 100% fatal, zoonotic disease, caused by Lyssaviruses. Currently, the disease is vaccine\u2010preventable with pre\u2010 and post\u2010exposure prophylaxis (Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">PEP<\/jats:styled-content>). Still, rabies virus is estimated to cause up to 60,000 human deaths annually, of which the vast majority occurs in rural Asia and Africa, due to the inaccessibility of prophylaxis and non\u2010existence of treatment. Despite these unmet clinical needs, rabies control mainly focuses on the sylvatic reservoir and drug innovation receives relatively little attention compared to other neglected tropical diseases (<jats:styled-content style=\"fixed-case\">NTD<\/jats:styled-content>s). As such, the lag of innovation in human rabies prophylaxis and treatment cannot be explained by limited return on investment alone. Strategies countering rabies\u2010specific innovation barriers are important for the acceleration of innovation in human rabies prophylaxis and treatment. Barriers throughout society, science, business development and market domains were identified through literature review and 23 semi\u2010structured interviews with key opinion leaders worldwide. A subsequent root cause analysis revealed causal relations between innovation barriers and a limited set of root causes. Finally, prioritization by experts indicated their relative importance. Root causes, which are fundamental to barriers, were aggregated into four types: market and commercial, stakeholder collaboration, public health and awareness, and disease trajectory. These were found in all domains of the innovation process and thus are relevant for all stakeholders. This study identifies barriers that were not previously described in this specific context, for example the competition for funding between medical and veterinary approaches. The results stress the existence of barriers beyond the limited return on investment and thereby explain why innovation in human rabies medication is lagging behind <jats:styled-content style=\"fixed-case\">NTD<\/jats:styled-content>s with a lower burden of disease. A re\u2010orientation on the full spectrum of barriers that hinder innovation in rabies prophylaxis and treatment is necessary to meet unmet societal and medical needs.<\/jats:p>","DOI":"10.1111\/zph.12352","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T09:22:51Z","timestamp":1490001771000},"page":"599-611","source":"Crossref","is-referenced-by-count":18,"title":["Barriers to innovation in human rabies prophylaxis and treatment: A causal analysis of insights from key opinion leaders and literature"],"prefix":"10.1111","volume":"64","author":[{"given":"L. H. M.","family":"van de Burgwal","sequence":"first","affiliation":[{"name":"Athena Institute VU University  Amsterdam The Netherlands"},{"name":"Artemis One Health  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M. G.","family":"Neevel","sequence":"additional","affiliation":[{"name":"Athena Institute VU University  Amsterdam The Netherlands"},{"name":"Viroclinics Biosciences  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. A. C. M.","family":"Pittens","sequence":"additional","affiliation":[{"name":"Athena Institute VU University  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. D. M. E.","family":"Osterhaus","sequence":"additional","affiliation":[{"name":"Artemis One Health  Utrecht The Netherlands"},{"name":"Viroclinics Biosciences  Rotterdam The Netherlands"},{"name":"University of Veterinary Medicine  Hannover (RIZ) Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. E.","family":"Rupprecht","sequence":"additional","affiliation":[{"name":"The Wistar Institute  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Claassen","sequence":"additional","affiliation":[{"name":"Athena Institute VU University  Amsterdam The Netherlands"},{"name":"Artemis One Health  Utrecht The Netherlands"},{"name":"Viroclinics Biosciences  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002721"},{"key":"e_1_2_7_3_1","first-page":"281","article-title":"Economics of human and canine rabies elimination: Guidelines for programme orientation","volume":"68","author":"Bogel K.","year":"1990","journal-title":"Bulletin of the World Health Organization"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000839"},{"key":"e_1_2_7_5_1","unstructured":"2002 W. 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