Rabies response, One Health and more-than-human considerations in Indigenous communities in northern Australia
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Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Rabies response, One Health and more-than-human considerations in
Indigenous communities in northern Australia
Chris Degelinga,∗, Victoria Brookesb, Tess Leac, Michael Ward
a Research for Social Change, Faculty of Social Science, The University of Wollongong, Australia
Sydney School of Veterinary Science, The University of Sydney, Australia
c Department of Gender and Cultural Studies, Faculty of Arts and Social Sciences, The University of Sydney, Australia
A R T I C L E I N F O
Keywords:
Australia
Rabies control
Health policy
Indigenous health
Biosecurity
Housing
Storyboarding methodologies
A B S T R A C T
Australia is cu
ently canine rabies free; however, the spread of rabies in eastern Indonesia poses an increasing
isk to northern Australia. Domestic dogs are numerous in East Arnhem Land (EAL) and the Northern Peninsula
Area (NPA), usually unrestrained and living in close relationships with humans. The response to any rabies
out
eak on Australian te
itory will focus on dog vaccination, controlling dog movements and depopulation. A
One Health approach to zoonotic disease control should seek to co-promote human and animal health, whilst
also seeking to accommodate the preferences of affected communities. We report on 5 collaborative workshops
and 28 semi-structured interviews conducted between January 2017 and June 2018 with: (i) EAL and NPA
community members; (ii) Indigenous Rangers in EAL and NPA; and (iii) residents of Cairns, the local regional
centre. Storyboard methodologies were used to work with participants and explore what rabies response mea-
sures they thought were justified or unacceptable, why they held these views, and what other steps they believed
needed to be taken. Key findings include that the capacity of the NPA and EAL communities to contribute/adapt
to a biosecurity response is limited by structural disadvantage including poor infrastructure (such as lockable
premises and intact fences) and appropriate information, dominant cultural norms and food security concerns.
Dogs and dingoes can have great cultural and social importance; key interventions might be accommodated
within cultural beliefs and long-standing norms of dog management if sufficient effort is made to adapt inter-
ventions to local contexts and community preferences. Adopting such a ‘strengths-based’ approach mandates
that the communities at greatest risk need help to prepare for and develop strategies to manage a biosecurity
esponse to a rabies incursion. This would include listening to individual and community concerns and attending
to the educational and infrastructural needs for supporting different groups to respond appropriately.
1. Introduction
Canine rabies is a fatal, viral zoonosis most commonly transmitted
via the bite of an infected dog. The global burden of rabies is high: there
are estimated to be more than 50,000 human fatalities each year,
mainly in Asia and Africa (Hampson et al., XXXXXXXXXXAustralia is cu
ently
free of canine rabies, but a zoonotic incursion is a realistic and im-
minent threat. Rabies is endemic in most of the western Indonesian
islands. It has spread eastward along the archipelago – probably
through human activities such as taking sub-clinically infected dogs on
fishing trips and journeys to visit relatives (Tenzin and Ward, 2012).
There are vi
ant sea trade routes between northern Australia and ra-
ies-affected areas and the cultural links between these communities
are strong. The movement of dogs across national borders is restricted
y international regulations, but most experts believe it is only a matte
of time before a rabies-infected dog enters the northern Australian
mainland from Indonesia direct or via the coastal regions of Papua New
Guinea (Hudson et al., 2017; Sparkes et al., XXXXXXXXXXIn the absence of an
effective and rapid response, rabies could conceivably become endemic
to large parts of northern Australia (Johnstone-Robertson et al., 2017).
Risk assessment models indicate that the Cape York Northern
Peninsula Area (NPA) in Queensland and coastal areas of East Arnhem
Land (EAL) in the Northern Te
itory (Fig. 1.) are the most likely lo-
cations for a rabies incursion on the Australian mainland (Dü
and
Ward, XXXXXXXXXXDogs are numerous and free-roaming in Aboriginal and
To
es Strait Islander (Indigenous) communities in both of these areas
(Burleigh et al., XXXXXXXXXXLikewise, people can also be widely distributed.
Many live in larger regional centres, while some live in what are called
https:
doi.org/10.1016/j.socscimed XXXXXXXXXX
Received 28 March 2018; Received in revised form 3 July 2018; Accepted 4 July 2018
∗ Co
esponding author. Research for Social Change, Faculty of Social Science, Building 233, G05D, Innovation Campus, The University of Wollongong, NSW,
2500, Australia.
E-mail address: XXXXXXXXXX (C. Degeling).
Social Science & Medicine XXXXXXXXXX–67
Available online 05 July 2018
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outstations or homelands, comprising smaller settlements where In-
digenous people might permanently or periodically reside, to be close
as possible to the sites for which they hold primary custodial respon-
sibility. As well as being used for hunting and as physical and spiritual
protectors, many dogs live in close relationship with community
members. Dogs can have immense importance to different Indigenous
people, because they are totems or are central to Dreaming stories
(Constable et al., 2010; Rose, XXXXXXXXXXLike most Australian canines, these
dogs are not vaccinated against rabies because the disease is cu
ently
exotic to the continent. Unlike other regions of the world where rabies
is endemic, domestic dogs in regional and remote northern Australia
also live in contact− and are sometimes contiguous−with feral dog
and wild dingo populations (Dwyer and Minnegal, XXXXXXXXXXA rabies
out
eak in either the domestic, feral or wild dog populations in
northern Australia could have devastating, long-term impacts on both
human and animal health. Therefore, a timely and effective response to
a rabies incursion is important to increase the probability of control and
prevent human deaths. However, controlling the risks in affected areas
would require a re-orientation of how individuals and communities live
with and among domestic and wild dog populations. Interventions that
Fig. 1. Map of the study region (far left). Inset 1 (centre map) is East Arnhem Land (EAL), and inset 2 (far right map) is the Northern Peninsular Area (NPA).
Textbox 1
Measures included in the 2011 AUSVETPLAN for canine rabies.
Stage 1
• Communicate with residents in the declared area, encourage them to report dog bites and unusual animal behaviour, and provide them with
strategies to minimise rabies risks
• Establish a restricted area (RA) around the out
eak to stop domestic animals being moved out of the area. The RA could be as small as
individual premises or as large as the home range of wild or feral animals.
• Conduct a rapid census of all the dogs in the RA
• Seize, quarantine and destroy any dogs displaying signs consistent with a rabies infection
• Trace and quarantine any dogs who have been in contact with these animals
• Promote and perform euthanasia on old and sick dogs voluntarily su
endered by their owners and seek permission to destroy any unowned
or stray dogs in the community
Stage 2
• Once the canine vaccines and appropriately trained personnel are available a larger ‘control area’ (CA) would be declared around the RA (to
act as a buffer between it and non-infected areas)
• Stop all dog movements (including free-roaming, hunting, car travel, etc.) in the CA and insist that all owned dogs are kept at home (within
a secure fenced area or on a chain)
• All dogs still ‘at large’ within the CA would be considered stray or unowned and impounded until claimed and/or destroyed
• Using the dog census, teams of trained responders would rapidly vaccinate all dogs in the RA and CA at their owner's home by going door-to-
doo
Stage 3
• Monitor dingoes and wild dogs in and around the RA for signs of rabies
• If rabies is found in wild animal population then the RA and CA would be enlarged to contain them and provide a buffer zone for non-
infected areas
• Oral vaccines would be deployed throughout the RA to try and eliminate the disease by decreasing the number of susceptible hosts.
• A trap-vaccinate-release program might be initiated in the RA or on the boundary between it and the CA if oral vaccination is proving to be
ineffective.
• Limited and cautious use of culling of a specific animal population (only as a last resort) after careful consideration of the circumstances
• 3 weeks after the mass vaccination program is completed and if there are no further rabies cases, owners of vaccinated dogs in the CA are
likely to be allowed to move their dogs between secure premises after applying for a receiving a permit
• Any dogs moved from the CA to the RA will not be permitted to return to the CA until restrictions are lifted
C. Degeling et al. Social Science & Medicine XXXXXXXXXX–67
61
involve dogs in Indigenous communities can be contentious and highly
politicized. In the past, the approach taken by authorities to perceived
public health and social problems associated with dog overpopulation
has involved the a
itrary culling of dogs found in the community, most
often without consent (Musha
ash, 2017; Rose, XXXXXXXXXXThis history has
eroded trust, such that there might be suspicion and a lack of
oad
support for public health measures in the event of a rabies out
eak.
1.1. Policy background: AUSVETPLAN
Australian biosecurity agencies have a range of disease prepared-
ness plans, including one to address a rabies incursion (Animal Health
Australia, XXXXXXXXXXThe AUSVETPLAN for rabies outlines the key control
measures and coordination requirements to ensure the rapid contain-
ment and eradication of the disease from Australian te
itory. The most
likely scenario is that a fishing boat or yacht will
ing a dog with a sub-
clinical rabies infection illegally through the northern quarantine zone.
If this dog then escaped into the bush or was purchased or given to
someone as a gift, then the large number of free-roaming dogs in and
around the local communities and outstations provide a suitable host
population for rabies transmission. Because rabies can have a long in-
cubation period, it is possible that the disease would spread undetected
through the dog population for many months and the first indication of
an incursion might be a human case (Dü
and Ward, 2015; Sparkes
et al., 2016b). Because rabies is a category 1 notifiable disease, when an
incursion is detected, disease control measures would be implemented
within a ‘declared area’ in accordance with the Biosecurity Act (2012)
and relevant legislation.
Experiences of controlling rabies in other countries indicates that
the response would be undertaken in stages (Textbox 1), consistent with
the cu
ent epidemiological characteristics of the out
eak (Putra et al.,
2013; Tenzin and Ward, XXXXXXXXXXThe key objectives of stages 1 and 2 are
to stop dog movements