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Two diseases, one health

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RABIES and Ebola virus differ biologically, epidemiologically and in terms of their effects and the challenges they present, but efforts to combat both would benefit from a One Health approach. That much is clear following two global events last week. One was the eighth annual World Rabies Day, on September 28, which again sought to raise awareness of rabies and the means available to prevent it. The other was a Global Health Security Agenda summit meeting in Washington, at which the US President, Barack Obama, drew particular attention to the impact of the Ebola epidemic that continues to unfold in West Africa, and described fighting the disease as ‘a national security policy for the United States’.

Calling for a global response to this and other diseases, President Obama made the point that, while the Ebola epidemic was ‘particularly dangerous’, other diseases had crossed borders and threatened the world before. And, he said, ‘Each time, the world scrambles to coordinate a response. Each time, it's been harder than it should be to share information and to contain the outbreak. As a result, diseases have spread faster and further than they should have – which means lives are lost that could have been saved.

‘With all the knowledge, all the medical talent, all the advanced technologies at our disposal, it is,’ he pointed out, ‘unacceptable if, because of lack of preparedness and planning and global coordination, people are dying when they don't have to.’

Highlighting the need for a new approach, he added, ‘We have to change our mindsets and start thinking about biological threats as the security threats that they are – in addition to being humanitarian threats and economic threats. We have to bring the same level of commitment and focus to these challenges as we do when meeting around more traditional security issues.’

There seems to be a belated consensus that the world's response to the Ebola epidemic has been slow and inadequate and, in that respect, President Obama's call to arms (which preceded reports this week of a case of Ebola in the USA) was welcome. Equally welcome were comments he made about preventing, detecting and responding to outbreaks: ‘We have to prevent outbreaks by reducing risks. We need to detect threats immediately wherever they arise. And we need to respond rapidly and effectively when we see something happening so that we can save lives and avert even larger outbreaks.’ Those principles are not unfamiliar to anyone with an interest in disease control and apply just as much to diseases of animals as to diseases of humans. The problem is they tend to be forgotten between disease emergencies, and are only remembered when a new crisis arises. Meanwhile, in the case of emerging zoonotic diseases like Ebola, early detection of disease threats, and hence the ability to mount a rapid response, at least partly depends on strengthening surveillance for diseases not just in people, but in animals too. The importance of strengthening disease surveillance at the animal-human interface was discussed by Matthew Dixon and colleagues in an article in Veterinary Record's One Health series earlier this year (VR, May 31, 2014, vol 174, pp 546-551).

An editorial on the Ebola outbreak in Nature last week suggested, among other things, that ‘strengthening healthcare systems everywhere will be the best defence against [disease] outbreaks of potential concern’, while also pointing out that ‘the reality is that few poor countries have anything that resembles a working outbreak-response system’.1 The case for strengthening healthcare systems in the poorer countries of the world is undeniable, but, as the World Organisation for Animal Health (OIE) has pointed out on more than one occasion, there is a need to build and strengthen veterinary infrastructures as well.

Among many activities marking World Rabies Day last week, the World Veterinary Association, the World Medical Association and the Global Alliance for Rabies Control issued a joint statement calling for closer collaboration between the medical and veterinary professions, while the OIE launched a new global web portal to bring together information on the disease (see p 315 of this issue). Meanwhile, without seeking to detract from the horrors and potential implications of the Ebola disease epidemic unfolding in West Africa, it is perhaps worth mentioning that, while this is reported to have resulted in more than 3000 deaths so far, rabies kills more than 50,000 people each year, mostly children in Africa and Asia. It is perhaps not for nothing that rabies is classified by the World Health Organization as a neglected tropical disease. In another recent article in Veterinary Record's One Health series, Sarah Cleaveland and colleagues explained how an integrated approach involving the veterinary and medical sectors is needed to control and eliminate rabies, arguing that this could be a ‘test case’ for the One Health approach (VR, August 30, 2014, vol 175, pp 188-193). With rabies, as with Ebola and other zoonotic diseases, mindsets need to change.

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