The time to vaccinate is now, ahead of recovering tourism & ahead of panic
BALI, Indonesia––Tourism to Bali is back, rebounding from a two-year bout with COVID-19, but resurgent canine rabies may menace the Balinese economic recovery.
That can practically be guaranteed if the Bali government repeats past mistakes, trying to kill rabies by killing dogs, instead of vaccinating outbreaks out of any possibility of spreading.
“A two-and-a-half-year-old boy died after being bitten,” Bali Animal Welfare Association founder Janice Girardi emailed to ANIMALS 24-7 on May 20, 2022. “There were no vaccines available for him.”
The child died at the Negara Public Hospital in Jembrana regency.
“Tragic when a child dies & parents could not get vaccines”
“Others have also died this year,” Girardi acknowledged, including a 65-year-old Jembrana man who reportedly refused to seek treatment even after the dog who bit him died three days later, “but it always seems so very tragic when a child dies and the parents knew he had to get vaccinated, but couldn’t get the vaccines.”
Why could the child not get rabies post-exposure vaccine?
If there was no rabies post-exposure vaccine immediately available in Bali, in itself an inexplicable circumstance in view that the island has been battling sporadic canine rabies outbreaks since 2008, why was the vaccine not flown in from elsewhere in Indonesia?
Bali health officials tried to blame their self-evident lack of preparedness on economic disruption associated with COVID-19, which hit Bali especially hard.
Why Americans hoarded toilet paper
Yet if the global COVID-19 pandemic should have taught anyone anything, that lesson should have been about the importance of being prepared, with adequate stocks on hand of whatever might be necessary to get through a crisis.
This, for instance, is why Americans hoarded toilet paper to the point of absurdity in the early days of the pandemic.
Bali, to be sure, has had an exceptionally difficult time with COVID-19. About 80% of the Balinese economy normally depends on tourism, but tourism plummeted from a record 6.28 million visitors in 2019, when the Mount Agung volcano erupted on June 13, to barely more than one million visitors in 2020, the first year of the pandemic, and then to just 51 in 2021, with tourism to all of Indonesia nearly completely closed by federal decree.
Low economic agility
Altogether, about one Bali resident in five contracted a confirmed case of COVID-19. About one in ten lost a job, according to official statistics, which reflect only wage and salaried labor.
Also thrown out of work were tens of thousands of Balinese who were formerly employed in family-owned businesses, worked for tips, or were otherwise part of a thriving “underground economy” which in much of the island might have been bigger than the official economy.
Without tourists to transport, the public transportation sector lacked money to buy gasoline, so most of the Balinese taxi and bus fleet quit running on regular schedules, if at all, and quit serving the less affluent and more remote neighborhoods.
Hospitals, the online newspaper Bali Coconuts explained on May 20, 2022, quit spending money to stock rabies post-exposure vaccine.
The Bali government quit funding the rabies vaccination campaign that had almost eradicated canine rabies before the COVID-19 pandemic began.
Lessons from the Pharaohs
Historically, successful governments from at least the dawn of the ancient Egyptian civilization, more than 7,000 years ago, have stockpiled food, medicine, water, tools, weapons, and building materials, among other necessities, to help their people through disasters.
Historically, wise rulers have known that running up public debt, if necessary, to help their communities recover from disaster is the surest, fastest way to rebuild a taxable economy sufficient to pay off the debt and become prepared for whatever crisis comes next.
Lurching from disaster to disaster
Historically, Bali has not been known for preparation and planning, tending instead to lurch from one disaster to another.
Before COVID-19 hit, there was a nightclub bombing by Islamacist militants that killed 202 people and temporarily crashed tourism in October 2002; a catastrophic H5N1 avian flu outbreak in October 2003, part of a regional outbreak spread by cockfighters that devastated the poultry industry throughout Southeast Asia; the 2008 arrival of rabies; the August 2018 Lombok earthquake, which killed only two people in Bali but disrupted tourism; the September 2018 Palu Sulawesi tsunami, completely bypassing Bali but also disrupting tourism; and the eruption of Mount Agung, sporadically underway from October 2017 to June 2019.
Because Bali is a tourism-dependent island, each disaster tends to have outsized economic aftershocks, resulting not so much from the incidents themselves as from the displays of ineptitude that typically follow.
Time and again Balian authorities have demonstrated themselves to be hell-bent on covering up issues too large to conceal, trying to exhibit control of situations that they cannot control because they do not understand them, and trying to divert the arrival of outside help and resources to the maximum benefit of their own families, friends, and political supporters.
Rabies is pretext for employing goondas
The sporadic rabies outbreaks in Bali, as in much of the developing world, and as in the U.S. until well into the 20th century, have often been used as a pretext for governing parties to put their goondas on the public payroll, ostensibly to kill dogs, but mostly to keep them loyal during election campaigns.
The recurring failure of dog purges, worldwide, to stop rabies in turn tends to become a pretext for keeping the goondas on the payroll to kill more dogs, whereas funding adequate vaccination and keeping stocks of rabies post-exposure vaccine on hand would eliminate this traditional excuse for goonda employment.
Thus it was no surprise that also on May 20, 2022, after explaining that most Bali hospitals have no rabies post-exposure vaccine, Bali Coconuts mentioned that the Jembrana Health Department “also suggested that all wild dogs,” meaning street dogs, “be exterminated or eliminated (killed).”
Poisoning is no cheaper than vaccination––even if it worked
The two most effective ways to prevent further rabies deaths in Bali would be to fly in adequate stocks of post-exposure vaccine, borrowing the money to buy the vaccine stocks if necessary, if only to prevent rumors about rabies deaths from interfering with the Balinese economic recovery; and to resume the dog vaccination campaign that appeared to be eminently successful until the cost of coping with COVID-19 became an excuse for stopping it.
Bali Coconuts editorially tried to please everyone by recommending “vaccinating dogs and eliminating wild dogs.”
Responded Janice Girardi, who probably has longer experience in successfully combatting rabies through vaccination than anyone else in Bali, “We would argue that if there is enough budget for a large-scale dog elimination operations, and the stocks of strychnine poison required to do it, then this budget would be far better used if channeled into a robust and methodical mass vaccination scheme––the one and only proven and globally recognized method to truly control rabies––which has been successful for Bali in years past.
“There are no feral or wild dogs in Bali”
“It is very concerning that Bali continues to have so many rabies cases,” Girardi continued, “but for this to mean that all outside dogs––or what the authorities refer to as wild dogs–––to be killed would be an absolute tragedy. In reality there are no feral or wild dogs in Bali. There are community dogs, or dogs living on beaches or in forests, but they are still dependent on humans or human scraps for their sustenance.”
[ANIMALS 24-7 observed in 2008 and 2010 that many of the Balinese street dogs appeared to get most of their protein by eating the eggs left by the abundant feral chickens. Where there were dogs, there were chickens, often picking insects out of the feces of dogs and other domestic animals, and where there were chickens, there were dogs, lounging under shady bushes until time to scramble out after a freshly laid but abandoned egg, a scene also often witnessed in Peru and Puerto Rico.]
“In the fight against rabies,” wrote Girardi, outdoor community dogs are not a problem, but unvaccinated dogs are. So we really must all work together toward the goal of getting all of Bali’s dogs vaccinated, and continuing to vaccinate new puppies as they enter the population.
“Get 70% or flunk”
“We have to establish population stability and herd immunity [among dogs] in Bali. It is more important now than ever,” Girardi emphasized.
“Achieving herd immunity requires vaccinating over 70% of all dogs within a population,” Girardi explained.
“This also means not killing vaccinated dogs, not throwing away unwanted puppies and dogs into the streets and beaches, and banning the breeding of dogs [for sale], which introduces more dogs into the population, who also often end up discarded when sick or no longer wanted. All of this contributes to destabilizing the population,” and feeds the clandestine dogfighting and dog meat industries, which Girardi has also worked for decades to stop.
“This recent response by Jembrana’s government to the rise in rabies,” Girardi said, “feels very reminiscent of the early years (2008-2010) when the rabies virus first hit Bali. Hundreds of thousands of dogs were eliminated, which did not solve the problem. Then BAWA vaccinated and vaccinated and vaccinated, and the government vaccinated and vaccinated and vaccinated––and we were very successful, almost completely solving the rabies issue.
“Must learn from past mistakes & successes”
“Unfortunately, [the Balinese government] then went back to killing dogs,” Girardi reminded, “and rabies came back with a vengeance. Once they realized that was the wrong approach, they went back to yearly dog vaccination programs and Bali was truly doing great––until COVID hit. Due to COVID restrictions and a lack of budget, they stopped vaccinating, had a shortage of human and dog vaccines, and now we are back to ground zero.
“We must learn from these past mistakes and also the past successes,” Girardi again emphasized.
“Robust dog vaccination programs worked! Elimination programs did not, and they certainly won’t work now.
“Rabies is the most deadly disease known to mankind,” Girardi finished, “but it is also the most preventable through vaccination. We implore the Central Government of Indonesia to issue an immediate emergency budget to be used for human vaccines and a supply of immunoglobulin for the serious cases that require it in order to save lives.”
ANIMALS 24-7 explained in depth and detail what happened in Bali in 2008-2010 in How not to fight a rabies epidemic published in the peer-reviewed journal Asian Biomedicine, accessible by clicking the title link.
“Bali, an island, should never have been afflicted with canine rabies,” explained the abstract, “but in 2008 a lack of surveillance allowed the import of an unvaccinated rabid dog from Flores, a distant island where canine rabies was similarly introduced in 1997 and has since become endemic.
“The initial rabies outbreak on Bali occurred in a remote village at the end of an isolated peninsula, but five months elapsed before the outbreak was officially recognized. Even then, rabies had yet to escape the peninsula.
“However, Bali officials relied on exterminating dogs as their primary control strategy, did not vaccinate enough dogs on the neck of the peninsula to keep the outbreak confined, prevented nongovernmental organizations and private citizens from vaccinating dogs until approximately a year after the outbreak started; used unreliable indigenous vaccines of only short-term potency, killed vaccinated dogs, and repeatedly disregarded the advice of visiting rabies control experts.
“Two years after the outbreak started, 44,000 people had received post-exposure vaccination after suffering bites from suspected rabid dogs. The number of human rabies deaths had doubled each six months since the first death occurred.”
How not to fight a rabies epidemic included a list, by name, age, and place of death, with various other notes, of all of the first 150 human rabies fatalities occurring from 2008 to 2010.