After more than 50 years, rabies has reappeared in Taiwan. The reappearance has created panic and the public is paying close attention to further developments about whether enough vaccination doses are available.
This is a warning to the public health system that, regardless of how good a disease prevention system is, neglect of zoonotic diseases — diseases that are communicable from animals to humans — can have severe consequences. Our disease prevention systems have long been biased toward humans and neglected the monitoring and prevention of animal diseases.
Taiwan’s proudest public health moments were the eradication of malaria and rabies from the island. However, a look at nearby countries, from China to Southeast Asia, reveals the presence of both. Now that rabies has returned to Taiwan, there are concerns that malaria could return too.
In addition to rabies and malaria, there are many other zoonotic diseases, such as the H7N9 avian influenza in China, the H6N1 here in Taiwan and the new coronavirus strain that has appeared in the Middle East. These occurrences are repeatedly highlighting the increasing importance of work to prevent zoonotic diseases.
The recently established Ministry of Health and Welfare and the Centers for Disease Control (CDC) should strengthen the following aspects of Taiwan’s public health and disease prevention systems:
First, set up a long-term, interdepartmental epidemic investigation task force. When dealing with zoonotic diseases, epidemic prevention specialists and veterinarians should study epidemics together and take an active approach to actively communicate their progress and findings to the media and the public in order to avoid a situation where the media increase public fear and distrust in the government though the media might insist they are trying to help.
Second, establish a system to integrate the monitoring of human and animal epidemics. In the past, disease surveillance has been carried out separately. The CDC has been in charge of surveillance of human disease, while the Council of Agriculture has handled the surveillance of animal disease. Information must flow smoothly between these institutions or else epidemic monitoring and control could fail to spot an epidemic “time bomb.”
The ministry, in addition to pushing the council to become more transparent in its information handling, should set up a reporting system that unites animal and human epidemic info. When announcing human epidemics, the ministry would then also be able to announce animal epidemics that are being monitored. This is the appropriate response to the threat posed by zoonotic diseases.
Third, invest resources in education and in establishing a reporting system. Correct information and understanding of infectious diseases are necessary for a rational response from the public when dealing with outbreaks of infections disease. The public should also be taught how to report and react when they encounter dead animals.
During the West Nile virus outbreak in the US in 1999, it was thanks to a well designed public reporting system that such large numbers of dead birds could be found so quickly.
Using such a system of public reports in connection with Google Maps could help the ministry and the CDC discover epidemics at an early stage. The same approach could be used to handle avian flu, rabies and malaria.