Rabies: Economics vs. Public Safety
By Merlin D. Tuttle
If public health warnings were based on actual probability of harm, bats and rabies would rank near the bottom of the list of threats. Due to successful dog and cat vaccination programs, rabies is now the second rarest disease in the United States and Canada, behind polio, accounting for only one or two human cases annually. To put such a rate in perspective, bicycle accidents killed 800, bee stings 95, and dog attacks 20 in the most recent year of reporting for the United States alone.
Unfortunately, frightening stories about bats and rabies are good for a lucrative rabies control business and for media which unwittingly carry, and sometimes even embellish, already exaggerated stories. Thanks to hundreds of our alert members and colleagues, Bat Conservation International (BCI) has been able to document the rapid growth and consequences of such coverage over the past two years.
Last year, BCI joined forces with the U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) to provide balanced advice through publication of a brochure titled Bats and Rabies. The project was headed by Dr. Charles Rupprecht, chief of the Rabies Section, and his expert staff.
We easily agreed on the facts, but when a draft of the proposed brochure was circulated to state health departments, we learned a great deal about the real agendas of those who do most to promote public fear of bats. The Council of State and Territorial Epidemiologists, as well as the National Association of Public Health Veterinarians, gave overwhelmingly positive reviews, and more than 100,000 pre-publication copies were ordered. Nevertheless, several state health departments launched a campaign to have the project terminated or the brochure rewritten. Without providing any documentation for their opposition, they convinced high-level administrators at the CDC to intervene and counter their own experts.
Not surprisingly, opponents predominantly represented states with the largest or least justified bat rabies surveillance and prevention budgets. They strenuously opposed clear emphasis of what is and is not an exposurethe most important issue for medical professionalsand tried to delete helpful advice for homeowners. They also forced deletion of any mention that bats eat mosquitoes and attempted to add a section on vampire bats, even though none live in the United States. The recurring behind-the-scenes theme was that the brochure was too bat-friendly, meaning bad for business, and the mandated revisions certainly aided those wishing to foster fear of bats.
In this same period, we have seen more than the usual share of scare-tactic claims that bats can bite people without the bites being noticed. Although there is a remote possibility of being bitten unknowingly while a person is deep in sleep, if this were anything but the rarest of events, rabies would not be the second rarest disease in America.
Over the last year, New York State provided prime examples of the impact of such speculation and its costs to society. Despite only one reported case of bat-transmitted rabies in that states history, health officials recently declared a Bat Rabies Alert, distributing tens of thousands of warning posters, magnets, and stickers to schools, camps, fairs, and other community sites. At the same time, summer camps and other childrens facilities reported being forced to spend large sums of money for bat-proofing, with the threat of closure if they didnt comply.
The effects of New Yorks bat rabies alert and new policies are best illustrated by the experiences of two childrens camps. The first incident was reported by the Putnam County Reporter-Dispatch on August 11, 1998. Forty-four disabled campers and their counselors were vaccinated, based on health department recommendations, approximately a month after bats flew over them at the Childrens Bible Fellowship Camp. As a result, the camp also was investigated for possible safety violations for failing to protect children from bats.
The second example comes from Camp Dudley, a prestigious boys camp and the oldest camp in America. Although not a single safety problem had occurred because of bats in 114 years of operation, the camp was put through an extremely costly ordeal when an apparently healthy bat simply flew in the vicinity of 53 boys (See excerpts from the camp directors letter, opposite page).
Imagine being a camp doctor or nurse and having to call the parents of 53 children to explain the health departments contention that a possible rabies exposure had occurred because a bat was seen flying near their sons. Dr. Stuart Updike, who found himself in that situation, was astonished at the lack of common sense surrounding the entire issue. Updike, a professor of medicine at the University of Wisconsin Medical School, appealed to both the State of New York and the U.S. Advisory Committee on Immune Practices. His letter of October 15, 1998, read, in part:
To help with risk assessment for human rabies, let us compare risk of rabies to risk of motor vehicle accidents. The U.S. National Safety Council reported the 1996 mileage death rate as 1.76 per 100 million vehicle miles. Since 1960, the CDC-reported annual death rate for rabies is approximately one per 150 million persons in the U.S.A., or one or two deaths per year. Analysis of this data shows the risk of death from driving one mile in a motor vehicle is greater than the per- year risk of death from rabies!
The risk-benefit evaluation should also include cost of post exposure prophylaxis (PEP), and the time, anguish and resources needed to explain to parents the Public Health Department recommendation for PEP, which includes that PEP itself is not without risk. At the state level, for Public Health officials who have power to close unsafe camps, to explain that they are only offering a guideline, and it is the youngsters parents and personal physician who must make the decision, is not helpful.
New Yorks much-publicized bat rabies alert, combined with its policies that result in vaccination from mere proximity to bats, have resulted in a doubling of the number of New Yorkers seeking vaccination, despite the fact that the recorded incidence of rabid animals has remained stable. An article in the August 22, 1998, issue of the Onondaga Post-Standard cited experts as now believing that bats may easily transmit rabies through the skin without evidence of a bite or open cut. (See How is Rabies Transmitted? on page 8).
By March 16, 1999, such claims caught the attention of the New York Times, focusing national fear on a rare problem that has not changed in decades. The article implied that even when awake, people may fail to detect being bitten by a bat. This point is strongly disputed by leading bat experts, who have lifetimes of experience handling bats. Two months later, these misconceptions were expanded when the May 1999 issue of Child magazine reported that people can contract rabies from bats without even having contact.
Interestingly, states that have so-called passive rabies prevention programs in which they simply inform people of animal bite risks and vaccinate pets and exposed humans, suffer no more human rabies mortality than do states with active programs supported by large budgets for surveillance and prevention. As Dr. Updike pointed out, it is extremely unlikely that stricter guidelines involving bats and rabies could reduce this consistently rare problem. The letter to the New York Department of Health from state wildlife biologist Alan Hicks (left) illustrates some of the irrationality of current approaches. As leading bat rabies researcher Dr. Denny Constantine once noted: The public health problems posed by bats are relatively insignificant compared to the public health problems usually initiated by those who publicize bats as problematic.
Citizens of regions where the public is being misinformed would be well advised to suggest media investigation of how funds could be better allocated toward areas of greater risk. Keep in mind that the vast majority of public health professionals are not participating in scare tactics and, in fact, many are cooperating with bat conservationists. All of us who care about responsible health precautions and the conservation of bats deeply appreciate the efforts of these professionals and of the CDC Rabies Section to find reasonable means of protecting against this horrible disease.
Merlin D. Tuttle is Founder and Executive Director of BCI. He has studied bats for more than 35 years.
See following page for questions and answers about bats and rabies.
Additional information about rabies is available on the BCI web site at http://www. batcon.org/discover/rabies.html. For a copy of the CDC brochure about rabies or the Are Bats Dangerous? brochure for children, send your name, address, and the name of the brochure you want via e-mail to email@example.com or by mail to: Brochure Request, BCI, P.O. Box 162603, Austin, TX 78716
(Camp Dudley Letter)
|. . . The New York state policy on bat rabies was a costly experience for our camp in 1998. . . . This past summer, 53 boys were sleeping in cabins where a bat was seen flying. Despite no evidence of contact with the bat, no evidence the bat was rabid, and no known case of any human becoming rabid from a bat flying near him, 52 of the boys received a series of rabies shots. (One boys parents refused.)
The cost of rabies shots is between $1,000 and $3,000 per person. The cost to the state for 52 boys to receive the shots was therefore between $52,000 and $156,000. The states cost to test the 23 bats [which the state health department ordered us to trap] must also have been substantial. . . . Our camp spent $27,638 to comply with the states bat rabies policies and procedures. Our expenses included 730 man hours bat-proofing and re-bat-proofing 38 cabins, and over 96 hours calling parents of boys who were sleeping in a cabin when a bat flew in and could not be caught.
While these costs were significant, the most significant cost was not economic. The 52 boys who received inoculations each lost between two and three hours out of their camp day on five separate occasions. That is between 520 and 780 hours of camping activities to which the boys were entitled. . . .
(New York Department of Environmental Conservation Letter)
|. . . Nearly 160,000 people die each year in New York State from causes other than rabies. To put it in even broader terms, in the time it takes a single case to occur that might be addressed by your new policy, roughly 6 million people will have died of other causes.
You appear to be following the one death is one too many philosophy, but in truth, society cannot function, and does not function, under such a policy. We not only accept, but demand, highway speed limits that kill; we fly in planes that crash; we release people from prisons that have proven their willingness to kill; and our homes are full of pets that could, and do on rare occasions, kill family or neighbors.
As indicated above, bat rabies exposure without a known bite is such a rare event that few people could even name a cause of death that occurs as infrequently. (Hanta virus comes to mind.) This type of rabies exposure is so rare that no cause of death has occurred less frequently in the State of New York.
Why then, is our Department of Health spending 1 million dollars a year today, and perhaps many millions in the near future, to prevent a cause of death that has occurred only once in 35 years (in essence 35 million dollars per fatality)? Does the Department of Health budget include 3.9 billion per year for tuberculosis, 800 million for influenza, 1.3 trillion dollars for cancer? It would have to if these diseases were to get proportional funding. How many deaths is this rabies policy causing because the additional money you are spending is not being spent to address some greater health risk?
If you were to apply the same bat standards to familiar aspects of peoples lives, they would laugh. Tell them they should not ride in vehicles (60,000 people die in New York in vehicle accidents for every bat-related death), or go near water (6,000 drownings per bat-related death), and they would wonder why you were not spending your time doing something productive.
Instead of capitalizing on public ignorance, the Department of Health should focus its efforts to make absolutely certain that people clearly understand the risks (or lack of risks) involved.
How you can Help
If you see a damaging article about bats and rabies in a periodical or on TV,
please inform BCI, then share the information in this article with the editors or producers.|
Ask your local health department for information about bats and rabies. If their material appears to be inaccurate or misrepresentative of actual dangers, share this article with them and direct them to Bat Conservation International, (512) 327-9721, for assistance.
If your local or state health department insists on needless scare tactics about bats and rabies, despite diplomatic objections, contact the appropriate legislators or other individuals who determine funding for public health issues.
The Bats and Rabies brochure began as a successful joint effort between BCI and the Centers for Disease Control and Prevention, but was severely revised due to powerful intervention from a few states whose health department budgets appear to benefit from public fear of bats. It remains, however, a step in the right direction.
Thousands of these fear-inducing refrigerator magnets (above) and posters (right), as well as stickers and brochures with a similar message, recently have been distributed to schools and other facilities by the New York Department of Health, at the expense of far more dangerous public health concerns.
BCI encourages education about the potential risks of being bitten by a sick bat, but groundless bat rabies alerts do more harm than good, leading to widespread intolerance and killing of bats, as well as to extreme anxiety and financial costs to people.
Left: People terrified by false alarms about bats and rabies are vulnerable to many kinds of exploitation. This excerpt from a nationally run ad by a New York company
is similar to ads common in the 1960s and 70s, the period of Americas greatest bat losses. If misinformation is not promptly countered, there will again be a proliferation of such ads and associated losses.
Right: In Austin, Texas, BCI and the city
and county health departments collaborate in educating children to safely enjoy neighborhood bats without fear, as illustrated by this jointly published brochure.
Below: Excerpts from a letter to the New York State Department of Health from Dr. Wheaton Griffin, director of Camp Dudley, one of the nations premier camps.
Right: The little brown bat (Myotis lucifugus
) is one of North Americas most abundant, beneficial, and widespread speciesthe one most often found in peoples neighborhoods and bat houses. Although this species has an outstanding record of safe coexistence with people, it is the one most often eradicated in large numbers due to false alarms regarding rabies.
Below: Excerpts from a letter to the New York State Department of Health from Alan Hicks, a wildlife biologist with the New York State Department of Environmental Conservation, Division of Fish, Wildlife, and Marine Resources. Views reflected in the letter are Hicks own and do not necessarily represent the views of his department.
For nearly 20 years, Austin, Texas, has shared its downtown area with 1.5 million bats, and no one has contracted a disease as a result. Hundreds of local fans and visitors from around the world gather each evening, from March through October, to watch the bats emerge from their roosts under the Congress Avenue bridge. If bats were even remotely as dangerous as we are led to believe by those who profit from public fear, Austin would have been compelled to declare a state of emergency long ago.