Ra­bies vac­cine is cost-ef­fec­tive given al­ter­na­tive

... we should be in­vest­ing in pet vac­ci­na­tions ... en­forc­ing strict quar­an­tines on an­i­mals cross­ing na­tional bor­ders.

China Daily (USA) - - VIEWS -

Avirus that in­fects your brain, makes you want to bite things, and which is al­most al­ways fa­tal af­ter symp­toms ap­pear prob­a­bly sounds like some­thing from a zom­bie movie. But this has been the modus operandi of ra­bies since at least 2300 BC, when it was de­scribed in the Eshuma Code of Baby­lon. The word’s San­skrit et­y­mol­ogy – rab­has, mean­ing “to do vi­o­lence” – dates back even fur­ther, to 3000 BC.

In prin­ci­ple, no hu­man in this day and age should die from ra­bies, and yet, ac­cord­ing to a 2015 study, ca­nine ra­bies kills 59,000 peo­ple each year. That’s 160 peo­ple every day, and the ac­tual num­ber is higher as cases go un­re­ported. Most of these deaths oc­cur in Asia and Africa, with In­dia alone ac­count­ing for onethird of the world’s to­tal mor­tal­ity from ra­bies.

That to­tal is not as high as the death toll from tu­ber­cu­lo­sis, HIV/ AIDS, and malaria; but, un­like those dis­eases, every mam­mal ap­pears to be sus­cep­ti­ble to ra­bies. Dogs, the pre­dom­i­nant host in most re­gions, can be­come in­fected from any ra­bid wild an­i­mal, and then in­fect hu­mans. Dogs show­ing symp­toms may bite a hu­man, but they can also trans­mit the virus sim­ply by lick­ing if their saliva comes into con­tact with a scratch, da­m­aged skin, or mu­cous mem­brane.

For­tu­nately, un­like most vac­cine-pre­ventable dis­eases, ra­bies al­lows for post-ex­po­sure in­oc­u­la­tion.

French sci­en­tist Louis Pas­teur for­mu­lated the first ra­bies vac­cine in 1885, by in­ject­ing the virus into rab­bits, wait­ing for it to kill them, and then dry­ing the in­fected nerve tis­sues to weaken the virus to the point that it could be safely ad­min­is­tered. Then he suc­cess­fully tested it on a 9-year-old boy who had been bit­ten by a ra­bid dog. In to­day’s world, Pas­teur would be thrown in jail for prac­tic­ing as an un­li­censed physi­cian and not fol­low­ing proper clin­i­cal­prac­tice stan­dards; but we can all be thank­ful for his dis­cov­ery.

To­day, ra­bies vac­cines are grown in a lab us­ing cell cul­tures. The virus is then ren­dered in­ac­tive, pu­ri­fied, and ad­min­is­tered by in­jec­tion into the arm. The WorldHealth Or­ga­ni­za­tion rec­om­mends pre-ex­po­sure vac­ci­na­tions for any­one at risk of en­coun­ter­ing ra­bies. This ap­plies to ev­ery­one in ra­bies-en­demic coun­tries; un­for­tu­nately, not ev­ery­one in these coun­tries gets vac­ci­nated.

The ra­bies vac­cine is on the WHOList of Essen­tialMedicines, and has an av­er­age whole­sale price of $11 per dose in the de­vel- op­ing world, and as much as $250 per dose in theUnited States. Of course, be­cause the al­ter­na­tive to post-ex­po­sure vac­ci­na­tion is death, the treat­ment is ex­tremely cost-ef­fec­tive how­ever one looks at it.

Smallpox, which is be­lieved to have emerged even be­fore ra­bies, has now been erad­i­cated, and pro­grams are cur­rently un­der way to put an end to po­lio, and other in­fec­tious ail­ments. So why is ra­bies still preva­lent?

One rea­son is that the virus is al­most al­ways trans­mit­ted by an­i­mals, rather than by other hu­mans. To ad­dress this, we should be in­vest­ing in pet vac­ci­na­tions, re­duc­ing stray-an­i­mal pop­u­la­tions, and en­forc­ing strict quar­an­tines on an­i­mals cross­ing na­tional bor­ders.

In de­vel­oped coun­tries, pre­vent­ing ra­bies largely re­quires con­trol­ling and im­mu­niz­ing wildlife pop­u­la­tions, which has proved ef­fec­tive in Switzer­land and Ger­many. In Latin Amer­i­can coun­tries where bat ra­bies is a threat, bovine vac­cines have been used, as have an­ti­co­ag­u­lants, to kill bats that feed off the blood of the treated cat­tle.

Ul­ti­mately, the world’s poor­est re­gions still bear most of the ra­bies bur­den. Dogs are not widely vac­ci­nated, as they are in de­vel­oped coun­tries; and even when they are, their pop­u­la­tions turn over very rapidly. Within a year of a large-scale vac­ci­na­tion ef­fort, a new­pop­u­la­tion of un­vac­ci­nated dogs will be roam­ing the streets and in­creas­ing the chances of an out­break.

Mean­while, de­vel­op­ing coun­tries’ health­care sys­tems are al­ready grap­pling with tu­ber­cu­lo­sis, HIV/AIDS, and malaria; and post-ex­po­sure pro­phy­laxis sup­plies are lim­ited. Bar­ring real progress on these chal­lenges, one of the world’s old­est known viruses will con­tinue to af­flict hu­mans and an­i­mals alike. The au­thor is a re­gional med­i­cal ex­pert at Sanofi Pas­teur. Project Syn­di­cate

Road signs are rusty, homes are aban­doned, and schools are closed. The is­lands’ des­tinies are left to a hand­ful of re­main­ing res­i­dents, mostly el­derly, who have no strength and vi­sion to re­vi­tal­ize their mori­bund home­towns them­selves.

Un­til the Se­touchi Tri­en­nale was launched in 2010, fewJa­panese would have had much oc­ca­sion to visit these is­lands, never mind for­eign­ers.

It was pri­vate pa­trons that came up with the idea of rein­vig­o­rat­ing the is­lands through art as op­posed to in­dus­try.

The Tri­en­nale, which runs in spring, sum­mer and au­tumn, has ex­panded the venues from seven is­lands in 2010 to 12 is­lands and two ports now. This year, the event has brought 177 groups of artists from 25 coun­tries and re­gions to the or­di­nar­ily sleepy re­gion.

Tak­ing in­spi­ra­tion from the his­tory and land­scapes of these venues, the artists have cre­ated art­works of var­i­ous sizes and medi­ums that stand in the rice fields, around the ports, and in the woods. Artists use lo­cal ma­te­ri­als and cre­ate art that comes to­gether with the en­vi­ron­ment.

It is a ground break­ing en­deavor. One of the projects takes aban­doned old houses and other build­ings in Naoshima and trans­forms them into per­ma­nent site­spe­cific art ex­hi­bi­tion spa­ces.

In Naoshima alone, visi­tors can ex­plore the ChichuMu­seum, Be­nesse ArtHouse, Lee UfanMu­seum and the ArtHouse Project as well as numer­ous in­stal­la­tions around the is­land, many out­doors.

Much of the art­work re­main stand­ing af­ter the fes­ti­val, jus­ti­fy­ing a visit to the area at any time of the year.

Is­lan­ders have joined the art fes­ti­val, giv­ing the artists a help­ing hand and ma­te­rial.

Mu­se­ums and art in­stal­la­tions at­tract tourists who bring busi­ness to the lo­cal cafes, restau­rants and ac­com­mo­da­tion. Magic has gath­ered on those islets.

In 2010, the 200 or so in­hab­i­tants of the small is­land of Ogi­jima faced a grim fu­ture and feared that their cul­tural sanc­tu­ary would die out. Af­ter the 2013 Tri­en­nale, peo­ple with fam­ily roots, ar­ti­sans, or oth­ers who just wanted to live a quiet is­land life started mov­ing to the is­land.

Ogi­jima’s pop­u­la­tion has been grow­ing, and its school re­opened in 2014. The kin­der­garten will re­open soon.

The or­ga­niz­ers of the Se­touchi Tri­en­nale want to bring vi­tal­ity back to those is­lands where na­ture and the life­styles of the peo­ple have co­a­lesced to­gether. This year’s event was ti­tled “Restora­tion of the Sea”. More than a mil­lion visi­tors are ex­pected to turn up.

The sus­tain­able fu­ture of the is­lands re­mains un­sure as the Tri­en­nale may not bring enough res­i­dents. But the art is mak­ing peo­ple happy.

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