Perspective: Rabies and global health trends
‘Operationalizing One Health’, ‘Strengthening health systems’ and ‘Pandemic prevention’. These are all buzz phrases that have been on the tongues of many people in the human, animal, and environmental health communities. If you follow the news, you would have likely heard these phrases from international agencies like the World Health Organization, and at global meetings like the G20 summit. So many people are mentioning these phrases, but what is being done to implement them? How can such massive concepts be implemented so that we truly can improve our health, animal health and environmental health (One Health)? What does it mean to strengthen a health system? How can we prevent pandemics by monitoring and preventing diseases that are already present yet have never caused pandemics before?
Operationalizing One Health
Last year’s World Rabies Day theme was “Rabies: One Health, Zero Deaths” with a focus on the One Health approach to rabies elimination. While we may understand the concept of One Health (in brief, improving animal, human, and environmental health through collaboration), it is not necessarily so clear as to how we can truly put this concept into practice – or how we can ‘operationalize’ One Health. While working together sounds easy, it is not always the case, as many of you will be aware in your day-to-day lives working in teams to get a job or task done. This is made far more challenging when working with people in a different field to you. Thinking about this in a disease perspective, the human health sector has very clear and different priorities to the animal health sector, and while interventions may exist to protect each sector’s target (humans or animals respectively), these are often implemented in a siloed manner – with the human health sector focusing on human disease preventative or control measures and the same for the animal health sector. While this siloed approach is often the case for rabies, the disease goes beyond that, as the control and elimination of the disease in the animals has a direct and measurable impact on human health. In fact, there is irrefutable proof that if we eliminate the disease in animals, there will no longer be any human rabies cases. While being an oversimplified explanation, this is a key means as to why rabies is an excellent example of a disease to ‘Operationalize One Health’ – it is a disease where the One Health concept can be truly put into practice. For example, if the human health sector were to work closely with the animal health sector and invest directly into rabies elimination in animals, we would progress more rapidly towards the goal of dog-mediated rabies elimination (in both humans and animals). Importantly, rabies is also one of the few diseases like this that has truly demonstrated clear and tangible progress in operationalizing One Health. Joint taskforces have been created and joint action plans are being implemented around the world. Furthermore, international collaborations, such as the United Against Rabies Forum are clear evidence that One Health is being operationalized at the international level.
Strengthening health systems
Strengthening health systems by implementing changes in policies and practices in a country's health system has been another major focus of the global community. This call typically asks for the dissolution of ‘siloed’ approaches where stakeholders focus on a particular disease and rather focus on strengthening the overall system to improve health in general. However, it can be equally as effective if a particular disease intervention addresses not only that disease, but strengthens overall health systems as a result of its successes. This is the case with rabies – as rabies elimination progresses and capacities are built in the human, animal and environmental sectors, the effects of the improved capacity developed through rabies helps to create a stronger overall health system that is thus equipped to address other health threats. Rabies capacity building includes the operationalization of One Health – meaning that other zoonotic diseases have the foundations and collaborations in place as a result of the work through rabies. Furthermore, education, professional training, laboratory capacity, disease surveillance and other key elements of rabies elimination are essential skills that can easily be transferred for implementation by other diseases with only minor modifications.
Pandemic prevention means that the world needs to be ready and prepared for the next pandemic. COVID gave the world a ‘wake-up call’ and now the global community is pushing to help prevent pandemics before they even arise. But how can rabies help to do this?
Pandemic prevention is based on strong health systems that are resilient to new and emerging threats that test health systems (in humans and in animals) to their limits. Because rabies helps to strengthen health systems, we can use the improved capacity to prevent the next pandemic. In addition to helping to strengthen health systems, rabies helps us to respond better to disease outbreaks as strategic rabies interventions rely heavily on rapidly identifying rabies cases and responding with a rapid, One Health intervention, including mass vaccination and case detection. If we used these strengths from rabies and applied it to any emerging disease with pandemic potential, it would help to prevent another pandemic like COVID from ever happening again.
Rabies is a disease that is still present around the world and affects every country either directly (where it is endemic) or indirectly (through the threat of the reintroduction of the disease). By driving rabies elimination efforts around the world, we not only address the deadliest disease known to humankind, but also help to prevent and eliminate other diseases, present and future.
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Article contributed by: Terence Scott (GARC)