Rabies vaccine is cost-effective given alternative

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

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.