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Cediel-Becerra et al. One Health Implement Res 2023;3:42-54 https://dx.doi.org/10.20517/ohir.2023.01 Page 44

domestic dogs of the Native Americans, the importation of many new breeds promoted spill-over events
[5-7]
into canines, commencing their role as the primary reservoir of rabies during this time .
Beginning of the 20th century
In 1917, an important initiative was established in Colombia, commencing research on canine and human
rabies, and human rabies vaccination at the Colombian National Institute of Health. Research, diagnosis
and vaccination campaign efforts were supported through international collaboration with organizations
from Europe (Boehringer Private Laboratory, Germany, and Zooprophylactic Institute in Brescia, Italy) and,
most notably, the United States (Rockefeller Foundation, Kellogg’s Foundation, Ford Foundation, Cornell
University, Illinois University, Nebraska University, University of Texas) . The rapid advancements seen
[8,9]
at the beginning of the rabies prevention program in Colombia were attained as a result of this support and
the unified vision of international academic partners.

Throughout this time period, the field of vaccine production in the country underwent significant changes.
Initial production, established in 1942, was conducted in lamb brains; in 1944, production changed to the
use of calf brains with inactivation via phenol and heat. In 1954, Eduardo Fuenzalida and Raúl Palacios
developed a vaccine in suckling mouse brains. This vaccine was first licensed for use in humans in Chile in
1960, and later adopted by Uruguay for human PEP in 1963, followed by Argentina and Peru in 1964, Brazil
[9]
and Venezuela in 1965, Cuba and Mexico in 1967, and Ecuador and Guatemala in 1969 . However, the
nervous tissue of the mice resulted in serious side effects in some recipients; between 1967 and 1973, there
were 21 cases of neuroparalytic reactions in humans who received the post-exposure rabies vaccination, the
vast majority of whom were infected by dogs . These individuals had received between 4 and 18 doses of
[8]
the vaccine, and 11 of the adverse reactions resulted in fatality. Consequently, the routine number of post-
exposure doses was reduced from 21 to 14, and subsequently again to 7, after which a reduction in the
number of such adverse reactions was observed. Additional complications included the difficulty in
[9]
maintaining the cold chain throughout the vaccine lifecycle .

1955 to 1970
Several institutions were funded to support rabies animal vaccine production. The Colombian Agricultural
Institute (ICA) conducted animal rabies diagnosis and the Colombian Vaccine Production (VECOL)
[10]
supported animal rabies vaccine production . Notably, the first institutional bat rabies campaigns
conducted in La Guajira, northern Colombia, in the 1960s are an excellent example of the utilization of the
4Cs under a One Health approach. Sponsored by the health sector, the Ministry of Health trained
agricultural veterinarians to recognize and control outbreak rabies aiming to reduce onward transmission
and control outbreaks in bovines intended for human consumption as the carcasses were posing a
substantial human health risk . Despite that, at that time, One Health was not yet recognized as a
[11]
framework, the activities of the Colombian government in this decade exemplify coordination for capacity
building for infectious disease control.

Another demonstration of coordinated actions among stakeholders is the integrated effort demonstrated by
the Colombian leadership on canine rabies vaccination campaigns. Successfully reducing dog-transmitted
rabies in humans by 90% in the 1960s, the efforts in Colombia were modelled by the Pan American Health
Organization (PAHO) across Latin America in line with the blueprint for the “Rabies Control and
Prevention Roadmap” . This was achieved by ensuring 70% vaccine coverage in canines, encouraging
[1,9]
laboratory-based surveillance, and enhancing rabies virus diagnosis and genotyping in domestic animals,
including dogs and wildlife. These activities were supported by the continual targeting of health education
campaigns among the most at-risk populations regarding transmission, prevention, and responsible pet
ownership [9,11] .