| Articles |
Rabies:
Economics vs Public Safety
By Merlin D.
Tuttle
How the fear of rabies can be used to inflate
public health budgets at great cost to people and
bats . . .
 If
public health warnings were based on actual
probability of harm, bats and rabies would rank
near the bottom of the list of threats. Due to
successful dog and cat vaccination programs,
rabies is now the second rarest disease in the
United States and Canada, behind polio,
accounting for only one or two human cases
annually. To put such a rate in perspective,
bicycle accidents killed 800, bee stings 95, and
dog attacks 20 in the most recent year of
reporting for the United States alone.
Unfortunately, frightening stories about bats and
rabies are good for a lucrative rabies control
business and for media which unwittingly carry,
and sometimes even embellish, already exaggerated
stories. Thanks to hundreds of our alert members
and colleagues, Bat Conservation International
(BCI) has been able to document the rapid growth
and consequences of such coverage over the past
two years.
Last year, BCI joined forces with the U.S.
Department of Health and Human Services Centers
for Disease Control and Prevention (CDC) to
provide balanced advice through publication of a
brochure titled “Bats and Rabies.” The
project was headed by Dr. Charles Rupprecht,
chief of the Rabies Section, and his expert
staff.
We easily agreed on the facts, but when a draft
of the proposed brochure was circulated to state
health departments, we learned a great deal about
the real agendas of those who do most to promote
public fear of bats. The Council of State and
Territorial Epidemiologists, as well as the
National Association of Public Health
Veterinarians, gave overwhelmingly positive
reviews, and more than 100,000 pre-publication
copies were ordered. Nevertheless, several state
health departments launched a campaign to have
the project terminated or the brochure rewritten.
Without providing any documentation for their
opposition, they convinced high-level
administrators at the CDC to intervene and
counter their own experts.
Not surprisingly, opponents predominantly
represented states with the largest or least
justified bat rabies surveillance and prevention
budgets. They strenuously opposed clear emphasis
of what is and is not an exposure—the most
important issue for medical professionals—and
tried to delete helpful advice for homeowners.
They also forced deletion of any mention that
bats eat mosquitoes and attempted to add a
section on vampire bats, even though none live in
the United States. The recurring
behind-the-scenes theme was that the brochure was
“too bat-friendly,” meaning bad for
business, and the mandated revisions certainly
aided those wishing to foster fear of bats.
In this same period, we have seen more than the
usual share of scare-tactic claims that bats can
bite people without the bites being noticed.
Although there is a remote possibility of being
bitten unknowingly while a person is deep in
sleep, if this were anything but the rarest of
events, rabies would not be the second rarest
disease in America.
Over the last year, New York State provided prime
examples of the impact of such speculation and
its costs to society. Despite only one reported
case of bat-transmitted rabies in that state’s
history, health officials recently declared a
“Bat Rabies Alert,” distributing tens
of thousands of warning posters, magnets, and
stickers to schools, camps, fairs, and other
community sites. At the same time, summer camps
and other children’s facilities reported
being forced to spend large sums of money for
bat-proofing, with the threat of closure if they
didn’t comply.
The effects of New York’s bat rabies alert
and new policies are best illustrated by the
experiences of two children’s camps. The
first incident was reported by the Putnam County
Reporter-Dispatch on August 11, 1998. Forty-four
disabled campers and their counselors were
vaccinated, based on health department
recommendations, approximately a month after bats
flew over them at the Children’s Bible
Fellowship Camp. As a result, the camp also was
investigated for possible safety violations for
failing to protect children from bats.
The second example comes from Camp Dudley, a
prestigious boys’ camp and the oldest camp
in America. Although not a single safety problem
had occurred because of bats in 114 years of
operation, the camp was put through an extremely
costly ordeal when an apparently healthy bat
simply flew in the vicinity of 53 boys.
Imagine being a camp doctor or nurse and having
to call the parents of 53 children to explain the
health department’s contention that a
possible rabies exposure had occurred because a
bat was seen flying near their sons. Dr. Stuart
Updike, who found himself in that situation, was
astonished at the lack of common sense
surrounding the entire issue. Updike, a professor
of medicine at the University of Wisconsin
Medical School, appealed to both the State of New
York and the U.S. Advisory Committee on Immune
Practices. His letter of October 15, 1998, read,
in part:
To help with risk assessment for human rabies,
let us compare risk of rabies to risk of motor
vehicle accidents. The U.S. National Safety
Council reported the 1996 mileage death rate as
1.76 per 100 million vehicle miles. Since 1960,
the CDC-reported annual death rate for rabies is
approximately one per 150 million persons in the
U.S.A., or one or two deaths per year. Analysis
of this data shows the risk of death from driving
one mile in a motor vehicle is greater than the
per- year risk of death from rabies!
The risk-benefit evaluation should also include
cost of post exposure prophylaxis (PEP), and the
time, anguish and resources needed to explain to
parents the Public Health Department
recommendation for PEP, which includes that PEP
itself is not without risk. At the state level,
for Public Health officials who have power to
close “unsafe” camps, to explain that
they are only offering a “guideline,”
and it is the youngster’s parents and
personal physician who must make the decision, is
not helpful.
Despite only one reported case of bat-transmitted
rabies in New York history, state health
officials recently declared a "Bat Rabies
Alert."
New York’s much-publicized bat rabies alert,
combined with its policies that result in
vaccination from mere proximity to bats, have
resulted in a doubling of the number of New
Yorkers seeking vaccination, despite the fact
that the recorded incidence of rabid animals has
remained stable. An article in the August 22,
1998, issue of the Onondaga Post-Standard cited
“experts” as now believing that bats
may easily transmit rabies through the skin
without evidence of a bite or open cut. By March
16, 1999, such claims caught the attention of the
New York Times, focusing national fear on a rare
problem that has not changed in decades. The
article implied that even when awake, people may
fail to detect being bitten by a bat. This point
is strongly disputed by leading bat experts, who
have lifetimes of experience handling bats. Two
months later, these misconceptions were expanded
when the May 1999 issue of Child magazine
reported that people can contract rabies from
bats without even having contact.
Interestingly, states that have so-called “passive”
rabies prevention programs in which they simply
inform people of animal bite risks and vaccinate
pets and exposed humans, suffer no more human
rabies mortality than do states with “active”
programs supported by large budgets for
surveillance and prevention. As Dr. Updike
pointed out, it is extremely unlikely that
stricter guidelines involving bats and rabies
could reduce this consistently rare problem. The
letter to the New York Department of Health from
state wildlife biologist Alan Hicks (left)
illustrates some of the irrationality of current
approaches. As leading bat rabies researcher Dr.
Denny Constantine once noted: “The public
health problems posed by bats are relatively
insignificant compared to the public health
problems usually initiated by those who publicize
bats as problematic.”
Citizens of regions where the public is being
misinformed would be well advised to suggest
media investigation of how funds could be better
allocated toward areas of greater risk. Keep in
mind that the vast majority of public health
professionals are not participating in scare
tactics and, in fact, many are cooperating with
bat conservationists. All of us who care about
responsible health precautions and the
conservation of bats deeply appreciate the
efforts of these professionals and of the CDC
Rabies Section to find reasonable means of
protecting against this horrible disease. |
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