National prioritisation of zoonotic diseases in Rwanda: a One Health modified Delphi consensus study

The Quadripartite One Health Joint Plan of Action and the WHO's Pandemic Agreement emphasise operationalising the One Health (OH) approach to strengthen global preparedness, prevention and response to emerging health threats. In line with these global commitments, Rwanda has developed a national One Health Strategic Plan to enhance multisectoral collaboration across the human, animal and environmental health sectors. However, effective implementation requires substantial investment in integrated surveillance, preparedness and response systems, highlighting the need for an evidence-based prioritisation framework to guide resource mobilisation and strategic allocation. This exercise aimed to prioritise zoonotic diseases of public health importance in Rwanda using criteria including disease burden, outbreak potential, morbidity and mortality, socioeconomic impact, availability of diagnostic tools, transboundary risk and the effectiveness of prevention and control measures.

A modified Delphi approach was employed, consisting of (1) a planning phase to develop prioritisation criteria and survey instruments, (2) two rounds of expert surveys and (3) a consensus-building workshop using Mentimeter for anonymous voting. All the activities were conducted in Kigali, Rwanda. 25 experts representing the Ministries of Health, Agriculture and Environment; national regulatory agencies; the Rwanda Agriculture and Animal Resources Development Board; Rwanda Wildlife Conservation, Gorilla Doctors; the University of Rwanda; the University of Global Health Equity and development partners including Igisekuruza Tree (iGiTREE), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and United States Agency for International Development (USAID) participated. Additional technical support was provided by the Pan-African One Health Institute.

Rabies, zoonotic tuberculosis and toxoplasmosis emerged as the highest-priority zoonotic diseases within their respective categories. Participants identified limited transdisciplinary training opportunities, inadequate sustainable financing mechanisms and insufficient data integration across sectors as key barriers to effective OH implementation.

Strengthening integrated surveillance systems, improving multisectoral data sharing and investing in a competent OH workforce are critical for enhancing preparedness against priority zoonoses. Furthermore, regular prioritisation exercises will ensure that disease rankings remain current and responsive to evolving risks.