Designing out rabies: a conceptual urban planning framework for dog-mediated rabies control in informal settlements

The persistence of human rabies transmitted by dogs in informal urban settings poses a significant challenge to global health. Although almost always fatal but completely preventable, the disease disproportionately affects marginalized populations. This suggests that the limitations in rabies elimination are not only biological but also reflect spatial, infrastructural, and governance determinants specific to informal settlements. To develop a conceptual framework integrating urban planning, the One Health approach, and rabies epidemiology to understand why existing biomedical strategies are less effective in informal settings and to identify spatial factors useful for more sustainable elimination strategies. An interdisciplinary conceptual research approach was adopted, synthesizing evidence from rabies epidemiology, One Health governance, and urban planning. The analysis focused on how spatial and infrastructural determinants influence the effectiveness of rabies control interventions at the neighborhood level. Rabies is treated as an urban-structural phenomenon, linking urban spatial configurations to dog ecology, human exposure, and access to prevention. The RABIES-SAFE SETTLEMENT framework integrates these dimensions through a micro-territorial One Health perspective, highlighting the role of urban planning as an upstream factor that can influence the performance of established biomedical interventions. Progress toward rabies elimination is influenced not only by the availability of effective biomedical tools, but also by the material and spatial characteristics of urban settlements. Integrating urban planning considerations into One Health approaches can promote more equitable and sustainable reductions in human rabies transmitted by dogs, especially in informal communities.