Stopping Human Diseases Often Starts With Animals
Vaccinating dogs against rabies prevents the disease in people.

As many neglected tropical diseases (NTDs) spread via vectors like ticks or domestic mammals, human-centric prevention programmes alone are inadequate – and adopting more holistic approaches such as the routine vaccination of animals is logical. 

This was the key message conveyed by health and policy experts at a panel discussion, “For a new approach to NTDs based on One Health”, at the Geneva Health Forum on Wednesday. 

‘One Health’ is a perspective that acknowledges the interconnectedness of human health with animals, microorganisms and the wider environment. A solution aiming at more lasting, sustainable health development, it moves beyond treating disease in humans to tackle the root causes of the spread of diseases.

Dirk Engels, former NTD director at the World Health Organization (WHO)  and a member of the Swiss Alliance Against Neglected Tropical Diseases (SANTD), highlighted the potential of One Health approaches to eradicate diseases in animal reservoirs, reduce the population growth of infected animals, and consequently save more human lives.

Rabies, with its high mortality rate of 80% and explicit animal-to-human transmission, is particularly amenable to holistic control methods. As the WHO’s Bernadette Abela-Ridder remarked, rabies control is often restricted to post-exposure prophylaxis in humans, despite the potential of mass vaccination in dogs to curb rabies deaths quickly, cheaply and effectively – as 99% of rabies cases are dog-mediated.

“We know vaccinating dogs prevents rabies,” she said – yet outside the South American continent, where several countries have successfully brought down rabies deaths through mass dog vaccination campaigns, “nobody actually does it”.

“If you want to stop rabies in humans very quickly, you vaccinate the dogs,” she added. “Dogs are part of the patchwork of our society, yet nobody is responsible for them: who will take care of dogs and pay for costs of vaccination?”

Not only would this One Health-inspired strategy address the root cause of the disease, it would also circumvent the hassles of current human prophylaxis, which involves a combined multi-dose treatment administered over two weeks.  

NTDs are a group of 20 preventable and treatable diseases that disproportionately affect marginalized populations in Africa, Latin America, and Asia

Developing ‘bite-sized’ strategies 

For novel strategies against NTDs to persist, countries need to buy into the value of the approach. Indeed, a barrier to embracing One Health is its breadth, noted Abela-Ridder, being a concept that encompasses virtually any component of our environment. This can understandably feel overwhelming for governments. 

However, segmenting such preventive strategies into “bite-sized” pieces will make them far more manageable to implement. In the case of rabies control, for example, this might look like identifying one high-priority target vector, and one single intervention mode – that is, dogs and vaccination. 

This, together with strong and motivated leadership at the national level, is the key for holistic approaches to function as effectively and sustainably as possible. Encouragingly, some countries have already set up dedicated supra-ministerial units for cross-cutting action on One Health. 

For successful provincial, district and community level implementation, the best place to start is building on existing intersectoral collaboration. To achieve this, José María Gutiérrez, a One Health expert at the University of Costa Rica, raised the importance of cooperating with local administrators and parliamentarians on novel NTD prevention. They “have the key” to the intersectoral resources that will cement local programmes, even if the changes start by being “small, but incremental”. 

Galvanising the private sector 

Meanwhile, in another GHF session on One Health, speakers acknowledged that the private sector could play an important role in operationalising this approach.

The speakers stressed that, in a resource-constrained world, every sector intersects with another in a web rather than a linear value chain – and more companies are starting to understand this inter-dependency.

Uta Jungermann of the World Business Council For Sustainable Development said one of the entry points for private sector involvement was in improving health systems: “There’s a question of how to exchange the know-how, innovative capabilities, stakeholder networks, and what unique expertise businesses can bring to the table and identifying health system resilience gaps and then developing strategies to close them,” she said. 

Ilona Kickbusch of the WHO Council on the Economics of Health for All, called for the private sector to be “activated”.

“I think there are good opportunities,” said Kickbusch. “There are so-called CEO roundtables. There are pharmaceutical associations. But they talk among themselves. And then here we talk a bit among ourselves. So this dialogue needs to happen and I know that the World Economic Forum is doing a great job in bringing this together, but we need more, especially for the One Health concept”.

* Additional reporting by Shadi Khan Saif.

Image Credits: Daniel Stewart, Our World in Data.

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