This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.This year marks the 15th anniversary of my sister’s death from rabies. In 2010, my sister Ivy bought a home in Sumter, South Carolina, and eagerly began rehabilitating it. Soon, she noticed bats finding their way into her enclosed back porch and main living areas.Aware that bats can carry rabies, she called the local Animal Control office in 2011 to express her concerns. Instead of health advice, she received a warning: She was told bats are protected, and killing them could land her in jail. No one advised her to seek a medical assessment or contact the health department to protect herself and her son.Months later, Ivy developed flu-like symptoms. What followed was a harrowing journey of confusion and misdiagnoses before a neurologist finally ordered a rabies test. By the time we had an answer, it was too late. Rabies is 100% preventable before symptoms appear, but there is little that can be done once a patient becomes symptomatic.Ivy Durant, sister of Tonji Durant.I recently retired as an epidemiologist for the Centers for Disease Control and Prevention, having spent my career in domestic and global health. Yet, sitting in that intensive care unit, my professional background could not save my sister. Her death illuminated critical systemic gaps in how we communicate public health risks at the local level.Seven out of every 10 deaths from rabies in people are linked to bats, and rabid bats can be found in every state except Hawaii. A public health survey conducted in Sumter County after Ivy’s death found 3.5% of respondents had bats either living in their home or entering the home. And while respondents generally knew that bats can transmit rabies, they had limited knowledge of the risks or how to protect themselves.The mistakes surrounding Ivy’s death were born of institutional silos and poor communication:Disconnected agencies: Animal Control and the local health department were located across the street from one another at the time, yet they did not collaborate on communicating community risks. Information gaps: The local health department lacked the resources it needed to provide citizens with practical information regarding the fatal risks of bats in sleeping quarters or how to address bats if they’re there. Today there are more resources available online, but they remain challenging to navigate and apply locally. Recent cuts to the CDC also likely limit capacity for expertise, testing, and engagement, which are especially important for complex conditions like rabies. Diagnostic delays: Because human rabies cases are incredibly rare, the disease was not on the hospital’s radar, delaying crucial decisions regarding her comfort and care. My mother feels our family was robbed, and she is right. Ivy did not have to die. To prevent this from happening to another family, we must fundamentally shift our public health approach.Break down government silos: Agencies must communicate. If Animal Control is aware of bat activity or other exposure risks, it must work closely with public health officials so citizens are immediately informed of health risks, not just legal liabilities.Engage trusted community leaders: We need to return to grassroots strategies. We must engage community-based organizations and trusted local voices to communicate risks and empower residents.Apply global lessons domestically: Having worked in global health, I know the immense value of the community-building strategies we use overseas. We must rebuild local partnerships, applying the lessons we’ve learned globally to our domestic programs. Whether for maternal health, HIV, malaria, vaccine-preventable diseases, or One Health initiatives that recognize the connections between human and animal health, community-based strategies are at the heart of successful prevention programs. Prioritize proactive engagement: Ivy’s laboratory and medication bills (excluding her clinical care) for just her final two weeks of life were roughly a quarter of a million dollars in 2011. Today, that’s approximately a half-million dollars. We must invest in a system based on coordinated prevention and not wait until a crisis hits.One life lost to a fully preventable disease is one life too many. In the last year and a half, we’ve seen significant cuts to public health funding and infrastructure. Without protecting public health investments, declining engagement and resources are inevitable, and we run the risk of repeating past public health mistakes. Tonji Durant is a retired CDC scientist. She now advocates for stronger health systems and coordinated public health communication to prevent tragedies like her sister Ivy’s death. Tonji is a member of the Southern Alliance for Public Health Leadership, whose work focuses on empowering public health professionals across the South.
