Tag Archives: one health

To stop zoonotic diseases, we need to make One Health a reality. Tackling rabies is a good place to start

How rabies control can help build the One Health systems we need.

By Professor Sarah Cleaveland and Professor the Lord Trees*

The coronavirus pandemic has opened the world’s eyes to zoonotic diseases – illnesses that are transmitted from animals to humans (and sometimes vice-versa). Covid-19, Ebola, MERS, avian flu and HIV all originated in animals. Most future pandemics will also start with cross-species “spillover”.

One of the oldest and most frightening zoonotic diseases is rabies. No longer a threat to people in the UK, rabies remains prevalent in over 150 countries, mainly in Africa and Asia, and costs an estimated $8.6 billion a year, mainly in lost productivity and treatment costs.

It’s estimated that around 60,000 people die every year from the disease. Almost half of those killed are children under the age of 15 and by far the main source of infection is a bite from a rabid dog. Once symptoms appear, the disease is almost always fatal.

Despite its gruesome pathology, rabies is an entirely preventable disease. Unlike many other zoonoses, the route to rabies control is clear: it requires effective surveillance and reporting, mass dog vaccination to prevent transmission to humans, speedy vaccination to treat people suspected of exposure to rabies, and public education. Latin America has significantly reduced rabies and Mexico was recently declared canine rabies-free by following this process. However control of the disease in Africa and Asia remains poor due to inadequate monitoring and reporting, few dogs being vaccinated and people in the most vulnerable communities rarely having reliable or affordable access to post-bite vaccinations.

While rabies and COVID-19 are very different diseases, the current pandemic clearly shows that we cannot afford to ignore the interconnections between the health of people and animals. However we lack the systems to respond effectively. We need to bridge the governmental divides and budget lines separating human and animal health, and share knowledge in real time to systematically detect dangerous pathogens and intervene swiftly to control them.

At present, human health systems dwarf the animal health sector, and institutional barriers constrain the ability of the two sectors to act in concert. But we do have a way forward in ‘One Health’, a globally-recognised framework for integrating human, animal and environmental health responses. The challenge is to implement it more widely.

There is no doubt that making One Health a reality is complicated. It adds new dimensions to interactions and processes for detecting, reporting and responding to disease outbreaks. Rather than building completely new systems, we should build on existing knowledge where we can. Rabies provides an excellent platform for One Health implementation, particularly in developing countries where resources are limited. We know a lot about the disease, we have cost-effective interventions for saving lives, and when implemented, the rapid and tangible impacts are clearly recognised by communities, building trust and confidence and reversing cycles of neglect.

At present the gap between human and animal health receives very little political attention or resources, especially in developing countries. Instigating a One Health approach for rabies therefore needs top-level political leadership to create formal ways for human and veterinary systems to link up. With most veterinary budgets focussed on controlling livestock diseases of economic value, governments and external funders need to recognise the value of veterinary interventions in supporting public health and ensure sufficient resources for mass dog vaccinations and surveillance. Community outreach and education programmes need to be in place to encourage people to have their dogs vaccinated and registered and to report incidents to relevant authorities. At the same time, treatment for people suspected of rabies exposure must be made accessible and affordable. But in a few short years, governments would be able to show demonstrable results in rabies reduction, creating new networks, building capabilities, and laying the foundations for tackling other zoonotic diseases.

There are already many measures in place to eliminate dog-mediated rabies and establish One Health in practice. A global strategy has been agreed by the World Health Organization (WHO), Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). Gavi, the global vaccines alliance, plans to add human post-exposure vaccine to its schedule in the next few years, making this costly medicine more widely available to the world’s poorest people. The OIE is working with endemic countries to create National Rabies Control Programmes. Kenya and Tanzania have established One Health and Zoonotic Disease Units, and technical experts from the East African region have been developing a coordinated regional rabies elimination plan. Numerous NGO-led dog vaccination and education projects are run every year and work is underway to create a One Health financial facility to support mass dog vaccination and enable the scaling-up of rabies elimination efforts.

The Covid-19 pandemic has focussed global attention on the need to build One Health systems and rabies control offers a practical way forward. It will take more money and political engagement, especially from national governments, but in the face of a pathogen like coronavirus, we need to make One Health a reality, and there is little time to lose.

*Professor Sarah Cleaveland OBE, MRCVS FMedSci FRSE FRS is Professor of Comparative Epidemiology, University of Glasgow.

Professor the Lord Alexander “Sandy” Trees MRCVS, FMedSci, HonFRSE is a Crossbench Member of the House of Lords, Emeritus Professor of Veterinary Parasitology and former Dean of the Faculty of Veterinary Science, University of Liverpool

Healthy, Wealthy Rural Communities

The Rural Economy Research Group (RERG) met for the fifth time in the House of Lords on the 28th October 2015. The annual meeting was attended by a broad range of peers, ministers, scientists, academics and vets and featured fascinating presentations on the future of rural businesses, the challenges facing the UK water industry and the importance of rural landscapes for human health. The meeting was kindly sponsored by the Royal Agricultural University, the University of Liverpool and the University of Nottingham and Chaired by Professor the Lord Trees of the Ross.

The theme of the meeting was “Healthy, Wealthy Rural Communities” and this broad title brought together a diverse group of speakers. Professor Paul Wilson (Professor of Agricultural Economics at the University of Nottingham) started the meeting with an overview of the UK agricultural sector using data from the Farm Business Survey that has been collecting data on farm businesses since 1936. In the UK there are currently 290,000 registered farmers with a total income of £5.4 billion. He discussed how the future might look for farmers if subsidies were removed and showed the variability in levels of reliance on subsidies across farming sectors from high reliance in cereal farmers and lowland grazing through to lower reliance in the pig and poultry sectors. He ended the talk by looking at the future of the dairy industry and asked the question “Will dairy farmers ever be happy again?”. The short answer is that some will and some won’t. There is huge variation in the profitability of dairy businesses with the top 10% making a profit of £80 per cow and the bottom 20% loosing £50 per cow. It was interesting to note that the top 10 most profitable dairy producers use relatively fewer concentrates and have lower yield per cow than some less profitable farms emphasising the importance of good farm practices to reduce cost per litre of milk and ensure that dairy businesses remain profitable.

The second talk came from Dr Robert Ward, Director of Science at the British Geological Survey. He started by describing how the resilience of water supply varies across the UK with South East England most at risk from drought. He explained how public water supplies are resilient to short-term droughts but private supplies are much more vulnerable. There are 100,000 private water supplies to rural communities suggesting that these communities are particularly at risk from the effects of drought. He described how the last 4 years have seen unprecedented fluctuations in water levels with both historical lows in 2012 and highs in 2014 and with climate models predicting drier summers and wetter winters the future challenges to the water industry remain uncertain. He ended his talk by discussing the problem of nitrate pollution in water supplies and the 3D modelling work that is being carried out to minimise the risk of aquifer pollution as a consequence of shale gas and oil extraction.

The final talk came from Dr Rebecca Lovell and Dr Ben Wheeler from the University of Exeter who discussed evidence for the positive effects of the natural environment on human health. In general those living in rural areas are reported to have better health and longer life expectancy and there is increasing recognition of the value of greenspaces in reducing stress and stimulating physical activity. Coastal areas of the UK receive 1.4 billion visits per year for the purposes of walking dogs alone and it has been estimated that these visits bring £19 billion to these areas. The value of rural landscapes extends far beyond agricultural income and the growing appreciation of the role of these landscapes for public services to human health and the environment is likely to play an increasing role in decision-making of farmers, land manager and policy makers.

Discussion of the future of Rural Economies over dinner in the Attlee Room at the house of Lords
Discussion of the future of rural economies over dinner in the Attlee Room at the House of Lords

The meeting ended with a dinner in the Attlee Room at the House of Lords and a lively and thought-provoking discussion of many of the points raised. It was clear to see how the future of rural economies is important not just for farmers but for all of us and inspiring to see such a broad range of people brought together to discuss the challenges that we face.  By working together we can help to ensure that rural economies remain sustainable and safeguard the natural environment that is essential to our future health and well-being.