Last August, a man in the Chicago suburbs woke to find a rabid bat on his neck. He declined treatment over fear of vaccines and died a few weeks later. He was the first Illinois resident to die of rabies since the 1950’s. Unfortunately, he was not alone.
Five Americans died in 2020 from rabies, an unprecedented toll for a disease that has been well managed for decades. Human cases of rabies are so rare in the US that the CDC publishes a summary of each individual case. Though the disease carries a mortality rate near 100%, almost no one dies from it here if they get treatment. Four of the five victims did not receive the rabies vaccine, two because they were unaware of their exposure.
There have been about 20 deaths from rabies in the US since 2009, half a result of travel to developing countries where rapid treatment was unavailable. To have five in a single year is a landmark.
What does this mean? Maybe nothing, but it does fit into a larger picture. Rabies deaths are a strong measure of public health infrastructure. No one has even contracted rabies in France since 1924. Japan hasn’t had a domestic rabies case since 1957. New York has had one rabies case since 1954, during a broader outbreak of rabies among raccoons in 1993. Though endemic among wild animals and absolutely lethal in humans, rabies can be prevented almost entirely with competent public health initiatives.
Constant monitoring of wild populations, careful efforts to control feral dogs and cats, aggressive pet vaccinations and public awareness campaigns are all necessary to contain rabies. When those efforts are in place, rabies almost entirely disappears. When those efforts cannot be maintained, the disease blooms.
On average, about two people die every week from rabies in Haiti. On the other side of the same island, in the Dominican Republic, they see about seven deaths a year. Rabies deaths are rare in Europe and the developed countries of Asia while Russia suffered seven rabies deaths last year.
Where is the US on public health?
Republicans are seizing on COVID paranoia to wreck the keystone of public health – vaccine requirements. Alabama just banned all new vaccine requirements in schools. Republicans in Florida are pushing a “review” of all pediatric vaccine requirements. Republicans in Montana just banned all vaccine requirements for employment. Four years of Republican looting have destroyed the world’s leading disease control institution, the CDC. 2020 saw a record number of rural hospital closings. And insurance executives are pointing to some worrying statistics from last year, suggesting that “excess deaths” ranged more than 40% higher than published figures among working-age people. We are not well.
Like tuberculosis, pellagra and hookworm, rabies is a barometer of political health, a disease of politics. Our political sickness is spreading.