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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 48

rotundus. Attempts by the government to establish milk and meat production in the jungles of the Amazon
and Orinoquía opened new ecological niches for some wild species, including bats and carnivorous animals,
resulting in them changing their diets to feed on domestic animals. However, transhumance is the primary
mode of farming in this region, wherein herds are continuously moved to more productive regions. When
this occurs, the bats lose their primary food source, causing them to redirect their feeding again, this time to
local indigenous communities, predominantly children. This is evidenced by the increase in notifications of
exposures (bites) in departments such as Vaupés, Amazonas, Guaviare, Meta, and Caquetá. For example, the
Emberá community (Bajo Baudó, Chocó) suffered an outbreak in 2004 which resulted in 17 fatalities, the
majority of which were in children .
[25]

THE SOCIOPOLITICAL LANDSCAPE OF RABIES IN COLOMBIA
Under a One Health approach, it is crucial to examine all working parts of the human-animal-environment
triad. The three elements are heavily underpinned by sociopolitical context and, thus, so is rabies
transmission, prevention and control. Consequently, understanding the interplay of social, cultural, political
and economic factors is vital for the implementation of context-specific interventions which are evidence-
based, accepted by local communities, and, ultimately, effective.

Conflict, displacement and poverty
For decades, on-and-off fighting has occurred between different political factions in Colombia. The most
recent, an uprising by the Revolutionary Armed Forces of Colombia (FARC) against the government, ended
with a peace agreement in 2016, although pockets of fighting remain, particularly in rural areas of the
country where FARC predominated . In addition to direct implications on the welfare of the Colombian
[26]
people, the economy and local drug trade, the conflict indirectly promotes the spread of rabies among
human and animal populations. Decades of warfare has resulted in 35.7% of the population living below the
[27]
National Poverty Line, the majority of whom live in rural areas . Areas of lower socioeconomic status are
more likely to be inhabited by internally-displaced persons, international refugees and marginalized
populations, including those of Afro-Caribbean and indigenous descent - all of whom are more likely to
have negative health outcomes as a result, including with respect to infectious disease status such as
rabies [28,29] . Poverty has a strong, positive correlation with canine rabies. This is likely, in part, due to the
association between poverty and poorer healthcare and transport infrastructure, which in turn obstructs
rapid diagnosis and treatment in humans and animals . Socioeconomic status, underpinned by warfare,
[30]
also determines a nation’s ability to manufacture/procure and deliver vaccinations; thus, Colombia’s
political instability likely hindered the delivery of presentation vaccinations to animals and post-exposure
prophylaxis to humans . Areas prone to violence, such as the Department of Chocó, also have disrupted
[31]
surveillance, in part due to the shift in public priorities as their health is more immediately threatened by
warfare . The ELN (National Liberation Army) is another armed group that, currently in 2023, is
[30]
hindering not only vaccination campaigns but also surveillance activities and other health interventions in a
large part of the department. Other departments such as Arauca and Caquetá, known as excellent livestock
producers, are experiencing the same situation as Chocó. Arauca, dominated by ELN, and Caquetá and
Meta, are places that have been forgotten by public health priorities as technical assistance and vaccination
campaigns are scarce.

Indigenous populations
Land-grabbing and deforestation have increased in recent years within Colombia, particularly in the Andes-
Amazon regions where wildlife biodiversity is high, including among species of rabies vectors . Habitat
[32]
disturbance positively associated with the presence of rabies in reservoir host and vector species of bats in
[33]
French Guiana - another Latin American country with parallels to Colombia . Consequently, similar
anthropogenic activities in rural regions of Colombia likely promote circulation of rabies among local