Repeated Anthrax Outbreaks, Poverty, and the Failure of "One Health"

Anthrax outbreaks in livestock, which spread to humans, occurred due to failure to implement the "one health" approach.

The following article was translated using both Microsoft Azure Open AI and Google Translation AI. The original article can be found in Wabah Berulang Antraks, Kemiskinan, dan Kegagalan ”One Health”

KOMPAS/FERGANATA INDRA RIATMOKO

A house built adjacent to a livestock pen in Kayoman Hamlet, Serut Village, Gedangsari, Gunungkidul, Special Region of Yogyakarta, on Friday (15/3/2024). Local residents were carrying on with their daily activities despite the fact that the area has been designated as a red zone for Anthrax.

The repeated anthrax outbreaks in the Special Region of Yogyakarta show the failure of implementing one health in Indonesia. Diseases in animals which then spread to humans, leading to fatalities, also indicate the existence of acute socio-cultural problems and poverty.

The anthrax case in the Special Region of Yogyakarta (DIY) this time was initially detected from the discovery of three animals that died close together in Kayoman Hamlet, Gunungkidul, on March 7 2024. The dead animals consisted of one cow. and two goats belonging to one of the residents.

The data from the DIY Health Department, as previously reported by Kompas.id, reports at least 45 anthrax suspect cases, with 26 in Sleman and 19 in Gunungkidul. Among those suspects, one person has died.

On February 20, the resident experienced stomach pain without a history of acid reflux, diarrhea, and a rash appeared on the right elbow. After being treated at the hospital on February 22, the person passed away on February 25.

The re-emergence of anthrax in livestock, followed by its transmission to humans and resulting in fatalities in DIY, seems to repeat the tragedy that occurred in Gunungkidul in May-June 2023.

See also: Everyday life of residents in the Anthrax Red Zone runs normally

Failure of "one health"

"Early detection and prevention of anthrax still remains a major issue for us, which indicates the lack of coordination between ministries and institutions, as well as local governments," said Tri Satya Putri Naipospos, an animal health expert from the Center for Indonesian Veterinary Analytical Studies.

According to Tri, anthrax is actually an ancient disease that, according to the World Health Organization (WHO), often appears sporadically in animals around the world. Anthrax cases are mainly reported in poor countries in sub-Saharan Africa and Asia, but also in wealthy countries such as Europe, America, and Australia.

Although a global reduction in the number of anthrax outbreaks in livestock and human cases has been reported, anthrax continues to exist in most farming communities, especially those in tropical climates and poor socio-economic conditions. "Like rabies, the spread of this disease in society is also a mirror of poverty," he said.

Public health expert from Griffith University, Dicky Budiman, said that eradicating anthrax is not easy. This is because the bacteria Bacillus anthracis, which causes anthrax, can form spores in the soil that can last hundreds of years. Apart from that, this bacteria can also infect various animal species, including livestock and wild mammals. "This makes it difficult to control the spread of anthrax in nature," he said.

According to Dicky, the effort to clean contaminated land from anthrax spores is not easy. As an example, when one building in the United States was contaminated with anthrax spores due to a mail delivery in a terrorist attack in 2001, it took about 320 million US dollars to clean it up. "If these spores spread in an area, the cost will surely be very high," he said.

However, this does not mean that anthrax outbreaks cannot be prevented. According to Dicky, the outbreak of anthrax in livestock, which then spread to humans, was mainly due to a lack of public awareness, in addition to the failure to implement the one health approach.

One health is an approach that involves animal, environmental and human health. "There are three factors for this recurring outbreak, namely an endemic environment due to contamination with anthrax spores, inappropriate livestock practices, including consumption of livestock carcasses that died due to disease, and a lack of monitoring and control systems by the authorities," said Dicky.

The repeated occurrence of anthrax cases in Gunungkidul Regency, such as in 2019 and 2020, indicates that the area is endemic for this infectious disease. "Since we already know that Gunungkidul is endemic for anthrax, the transmission to humans should be preventable," said Tri.

Livestock vaccination

Once a region becomes endemic to anthrax, the disease can reemerge at any time. Some studies conducted abroad have mapped the pattern of spore emergence based on specific environmental conditions. For example, a study by Oetione et al. (2021) in Kenya, Africa, showed that the distribution of anthrax is influenced by climate change.

According to Tri, the study on the seasonal pattern of anthrax is not yet well understood. However, the rainy season is considered vulnerable to the transmission of this disease as anthrax spores in the soil can be carried by water and then consumed by livestock.

"To prevent an outbreak of anthrax in livestock, the only way is through regular vaccination of livestock in endemic areas, which could be done every year depending on the potency of the vaccine. It can't be like now, where the vaccine is only brought in after a case has occurred, that is already too late," he said.

According to Tri, vaccination of livestock has been proven to reduce the risk of anthrax outbreaks in livestock. “This in itself will reduce the risk of anthrax transmission to humans. "That's the principle of one health, if the animals are healthy, the humans are also healthy," he said.

Tri added that the vaccination of livestock in Indonesia is currently inadequate. "However, the anthrax vaccine is relatively inexpensive. The government-owned factory in Surabaya has already produced it. Although I cannot speak to its quality, we can still rely on it," he said.

However, according to Tri, regions that have been proven to be endemic for anthrax still do not receive adequate vaccination for their livestock. "Who wants to vaccinate their livestock? Local governments on average do not allocate budgets for animal health. This is similar to what happens with rabies, ultimately resulting in the cycle of outbreaks and transmission to humans continuing," he said.

In anticipation of future circumstances, Tri urges the government and local governments to carry out anthrax vaccinations in endemic areas. In addition to DIY, there are eleven other anthrax-endemic areas in Indonesia that are already known, namely West Sumatra, Jambi, DKI Jakarta, West Java, Central Java, West Nusa Tenggara, East Nusa Tenggara, South Sulawesi, North Sulawesi, Central Sulawesi, and Papua.

According to Tri, contact with dead animals due to anthrax is the most common route of infection of this disease for humans. Therefore, as soon as an animal in an endemic area dies, the community should be vigilant by burying it properly and not consuming it.

Also read: Recurring Anthrax Cases in DIY, Government Needs to Massive Prevention

"However, what is happening in Yogyakarta is also a socio-cultural problem. People consume livestock that have died from anthrax. "So, the one health approach also requires good and trusted communication with the community," he said.

Without efforts to address the issue with a consciousness of animal health, environment, and human welfare as a single system, anthrax outbreaks that claim lives could continue to occur in Indonesia.