Rabies: ALL FOR 1, ONE HEALTH FOR ALL
One health triad includes healthy people, healthy environment, healthy animals. If initialised in planned way it will make health care smoother and protect the lives of both people and animals while preserving the environment too.
One health is recognised as an effective way to tackle health issues and to address potential risk at the human -animal -environment interface.
One Health can have the following benefits:
- Decrease potential threats at the human-animal-environment interface to control diseases that spread between animals and humans
- Control anti-microbial resistance (AMR)
- Ensure food safety
- Prevent environment-related health threats to humans and animals
- Protect biodiversity
It was 1st used in 2003-2004. It was associated with the emergence of severe acute respiratory disease (SARS) in early 2003 and subsequently avian influenza H5N1. The outbreak of SARS, the first severe and readily transmissible novel disease to emerge in the 21st century, led to the realisation that :
(a) A previously unknown pathogen could emerge from a wildlife source at any time and in any place and, without warning, threaten the health, well-being, and economies of all societies;
(b) There was a clear need for countries to have the capability and capacity to maintain an effective alert and response system to detect and quickly react to outbreaks of international concern, and to share information about such outbreaks rapidly and transparently; and
(c) Responding to large multi-country outbreaks or pandemics requires global cooperation and global participation using the basic principles enshrined in One Health.
The One Health Commission was chartered in Washington D.C in 2009 and Roger Mahr was the founding CEO. Its mission was to connect individuals and create relationships across human, animal and environmental health sectors as well as to educate the public about the issues with the aim to improve global health
Manhattan principles was developed by Wildlife conservation Society also focuses on links between humans, animals and the environment and highlights on how these links are pivotal in understanding disease dynamics and the importance of interdisciplinary approach for prevention, education, investment and policy development. Inclusion of wildlife health is an essential component of global disease prevention, surveillance, control and mitigation
Rudolf Virchow acknowledged the similarities between human and animal medicine and coined the term “zoonosis” for animal acquired infections.
Important zoonoses are also related to food production chain. Globalization of food supply has substantially increased the risk for outbreaks and spread of food borne pathogens and antibiotic resistance genes.
It is collaborative, multisectoral and transdisciplinary approach commencing at regional, national and international level to achieve optimal health outcomes, risk assessment, develop strategies for response and control.
History is evident that over the past three decades majority of novel emergent zoonotic infectious diseases arises from animals and the major determinant of its emergence is the imbalance in ecosystem and land use, surge of agriculture, urbanisation and international travel and trade.
The global pandemic of COVID 19, caused by a zoonotic virus SARS-CoV-2 clearly depicts that there is a need of hour to strengthen the One Health approach for addressing new diseases threats that affect both people and human. Other diseases requiring One health Collaboration are Ebola and Zika Virus.
Also, the core strategies put forward by the National Framework for One Health, 2021 by FAO can guide towards overcoming the systemic barriers to implement the One Health approach.
The strategy element involves:
- Improving the capacity for public health actions in major stakeholders’ human health, animal health and environment management
- Understanding and responding to the drivers that threaten health; optimising the effectiveness of public health systems in achieving these goals within each sector
- Implementing strong, continuous and mutually beneficial coordination and collaboration between all stakeholders through multi-disciplinary and multi-institutional joint planning and implementation
The Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE) and the World Health Organization (WHO), under their tripartite agreement and in collaboration with the United Nations Children’s Fund (UNICEF) and the World Bank, have developed a joint strategic framework to implement the One Health approach.
In India many institutions have also extended their helping hand to support the one health activities:
Indian council of Medical Research (ICMR) and Indian Council of Agricultural (ICAR) -for joint research to control disease outbreaks and at individual level between human and animal health researchers and health practitioners
The Integrated Disease Surveillance Project – for disease outbreak detection and rapid response functions and information flow of certain diseases
A multi-disciplinary Road Map to Combat Zoonoses (2008) was laid to create an integrated mechanism for surveillance, detection and treatment of zoonoses. It identified several strategies for research and actions, but an integrated surveillance, involving human, domestic and wildlife for long-term monitoring on a large scale have failed to materialise
The National Mission on Biodiversity and Human Well-being built on a framework that integrates biodiversity, ecosystem services, climate change, agriculture, health, bio-economy and capacity-building in the realm of biodiversity science has one mission component that explicitly links biodiversity to human health through the One Health approach.
A dedicated centre under ICMR has been set up by Government of India to contain zoonotic diseases — the Centre for One Health at Nagpur, and also constituted a ‘National Expert Group on One Health’ to promote multi-sectoral, transdisciplinary, collaboration and co-operation to adopt and implement a One Health.
This year, the theme, “Rabies: All for 1, One Health for All highlights on collaboration, equality, and the strengthening of health systems through the One Health approach.
In line with the Animal Bite Treatment Center and Public Health Unit’s commitment to support the global efforts of the Department of Health (DOH), World Health Organization (WHO), and the Global Alliance for Rabies Control (GARC) to eliminate rabies deaths by 2030, we are dedicated to commemorating World Rabies Day on September 28 every year.
World Rabies Day 2022 themed social media toolkit are also developed to generate social media messages with the relevant hashtags and messages to promote rabies elimination and World Rabies Day.
The mission of World Rabies Day is to raise awareness about the impact of human and animal rabies, how easy it is to prevent it, and how to eliminate the main sources.
The rabies virus is transmitted in the saliva through bites, licking of open wounds or licking of mucous membranes, such as the mouth, by infected animals
There is no definite cure for rabies and once the symptoms are manifested, death is inevitable. If there is suspected exposure to a rabid animal, washing of bite wounds with soap and water for 15 mins followed by a course of post-exposure immunisation injections should be administered.
Rabies prevention starts with the animal owner. It is critical that all pets are regularly vaccinated
As a zoonotic disease, rabies can be eliminated through the collaborative efforts of different sectors including human and animal government agencies, human and animal health professionals, educators, scientists, community groups, and the private sector, among others.
Planning is a key means to ensure that different stakeholders can contribute and work collaboratively in an effective and efficient manner, preventing the duplication of efforts and facilitating a truly One Health approach to rabies elimination. Through effective planning, key challenge areas can be identified and addressed, while areas of strength can be used for advocacy and to support other programs.
Effective planning will also ensure that stakeholders align their programs with the Global Strategic Plan and international guidelines and recommendations.
Stepwise Approach towards Rabies Elimination (SARE)
The Stepwise Approach towards Rabies Elimination (SARE) has been developed as an One Health, practical planning, monitoring and evaluation tool to guide, develop and refine rabies control programs. To do this, the Microsoft Excel-based SARE relies on a two-step process:
- Users from all sectors involved in rabies elimination assess their own rabies control and elimination programs’ strengths and weaknesses
- The SARE then assists the user with the development of a customized rabies workplan.
The Blueprint and Stepwise Approach towards Rabies Elimination
The Blueprint for Canine Rabies Prevention and Control is an online resource developed by global rabies experts to enable ministries and other interested parties to help themselves through the process of designing, implementing and evaluating a large-scale rabies control programme.
The Blueprint provides:
- Detailed, practical guidance on rabies control
- Single online point of access to all relevant international resources
- Modules on canine rabies, fox rabies and surveillance
- User-friendly, Frequently Asked Questions format
GDREP – A planning tool for mass dog vaccination
The US CDC has constructed a user-friendly tool, the Global Dog Rabies Elimination Pathway (GDREP) tool, to help public health officials plan the resources needed to achieve rabies elimination by 2030 through mass vaccination of dogs. The tool was based on the WHO recommendation of vaccinating 70% of the dog population for several years to eliminate dog rabies.
Way Forward:
It is essential that resources be made available to support research in the OH arena, and particularly in developing a better understanding of the human–animal-ecosystems interfaces including wildlife disease surveillance.
The majority of emerging diseases arise from wildlife but the vast majority of funds are spent on understanding and controlling them in humans.
There is an immediate need to invest in the frameworks, policies and processes required to better identify, articulate and manage risks posted to trade, human health and biodiversity by diseases with wildlife as part of their ecology.
Globally accepted frameworks and standards for research, education and accepted core competencies are required along with the need for an identified career path. However, there is little interest in any form of ‘global governance’:
One Health is a concept or approach not an association or society. Identifying a body that can lead relationship development between major disciplines and foster a true trans-disciplinary approach, develop global guidelines and strategies, and ensure sustainable funding is needed, probably in an advisory capacity.
The recent establishments of groups doing this at the regional level in developing countries (e.g. SACID) do seem to be achieving success in operationalizing OH at the national level and a similar approach could be emulated at the international level.
In its most recent guise, OH is still just an approach for detecting and managing global health at the animal–human-environment interfaces, albeit relatively recent, and requires nurturing and further development to realize its full potential . However, there is no doubt that there is increasing global support for the usefulness and value of the OH approach for the detection and response to diseases at the animal–human-ecosystems interfaces in a transparent, collaborative, and multi-disciplinary way, and that this approach will become an essential component to future global health, and to the provision of safe food and water for an increasingly hungry world.
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