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Page 49 Cediel-Becerra et al. One Health Implement Res 2023;3:42-54 https://dx.doi.org/10.20517/ohir.2023.01

wildlife populations - a strong risk factor for infection in livestock, domesticated animals and humans. As
indigenous people make up 60% of the population in the Amazonian region, interventions must be designed
[34]
which are orientated around these target populations .

Due to their close contact with wildlife, indigenous communities require targeted interventions which
respect both their culture and attitudes towards the health-disease interface. This is evidenced through
epidemiological data collected over a 10-year period across Colombia, which showed persons of indigenous
and Afro-Caribbean descent had the highest exposure to human rabies . As such, rabies prevention and
[34]
control activities must be designed and implemented in collaboration with community leaders and
traditional healers to address the One Health principles of sociopolitical and multicultural parity, and
transdisciplinarity between epidemiology and indigenous healing practices [35,4] .

Establishing preventive programmes in these indigenous communities is complicated. In addition to
cultural barriers, including languages and healthcare practices, they live in remote areas which often can
only be accessed via rivers, thus, rapid communication to provide timely care is difficult. There is also no
electricity making it difficult to maintain the cold chain necessary to preserve the bio-activity of biologicals,
particularly with lengthy, short-interval dosing schedules, among other logistical difficulties in the delivery
of post-exposure vaccinations. In response to this, shortened schedules have been introduced, including the
use of double-dosing on days 0 an 7 post-exposure, with an additional application of anti-rabies serum on
day 0 for severe cases. This national post-exposure prophylaxis program, oriented to indigenous and remote
communities, was the work presented by the Colombian winner of the George Baer award at the RITA
Conference in 2018 in Buenos Aires, Argentina together with the Pan American Health Organization (A.
Castro, personal communication, 4th June, 2023).

Although some international authors have assessed the efficacy of bat culling , demonstrating that it has
[36]
minimal effects on rabies seroprevalence when spatially coordinated control is absent, this method is still
used at a national level. Besides culling to control wildlife rabies, alternative methods include the use of
topical rabies vaccines for wild bats and the use of baits to orally vaccinate fox populations where sylvatic
rabies transmission predominates. However, among indigenous populations and the general public,
vaccination may be ill-received as they conflict with values of living harmoniously with nature. As such,
transdisciplinary communication between key national and international stakeholders, including
representatives of indigenous communities, regarding the potential vaccination with recombinant rabies
vaccine for vampire bats should be done to explore their potential as a control strategy for RABV in the
complex socio-ecological context of Colombia. Despite the difficulties surrounding logistics and provisions
of resources, addressing rabies among these regions is critical to promote improved outcomes among these
communities and reduce health inequities under a One Health approach. Whilst this requires continuous
funding, the direct and indirect costs of non-vaccination on morbidity and mortality in livestock,
domesticated pets and humans far exceeds the necessary financial investment. Control of rabies in
Colombia is possible, evidenced by the absence of reported human cases of dog-transmitted rabies in urban
areas for the last 15 years. However, to expand these results to the neglected rural and indigenous
communities requires concerted, non-competitive, collaborative working relations across all sectors
responsible for surveillance in the human and animal health components.

A need for a renewed chapter of rabies program in Colombia
The Quadripartite Organizations - the Food and Agriculture Organization of the United Nations (FAO),
the United Nations Environment Programme (UNEP), the WOAH and the WHO - collaborate to drive the
system transformation across all levels (national, regional, and global) required to mitigate the impact of