Challenges and potential opportunities for improving One Health surveillance in low-resource settings: Insights from rabies surveillance in Malawi.

The growing threat of zoonotic diseases has driven an increased interest in “One Health”, a framework that demands a more holistic approach to understanding, preventing and controlling the emergence and spread of health risks at the human-animal-environment interface. This approach requires systems that capture data across human, animal, and environmental health sectors. However, in resource-limited settings, critical actors, namely public health departments, veterinary services, and environmental monitoring agencies, are often underfunded and lack robust surveillance systems. Additionally, the absence of historical collaboration between these sectors often results in limited or nonexistent data sharing, further hindering effective disease monitoring and response. During a study on the epidemiology of human rabies and accessibility of post-exposure prophylaxis (PEP) in Southern Malawi, we observed significant disparities in data management infrastructure between human and animal health sectors. Furthermore, there were significant challenges in data capturing, management, and sharing. These issues remain in practice largely because of the absence of digital and standardized data management systems, especially in the animal health sector, compounded by insufficient recognition of the importance of surveillance and its low prioritization in health strategies. This gap hinders the accurate reporting of diseases, disrupts resource allocation for prevention and control, and prevents countries from contributing to global disease records, thereby limiting international efforts to track and mitigate emerging infectious disease threats. To address these challenges, future efforts should consider standardizing record capture, improving data storage practices, leveraging existing technical capacities, promoting wide-scale use of electronic records, and developing intersectoral and interoperable information management systems.