A one health analysis of the reemergence of dog-mediated human rabies in Peru

The 2023 reemergence of dog-mediated human rabies in Arequipa, Peru, after nearly a decade of absence, represents a critical failure in public health systems. Despite regional progress toward the “Zero by 30” strategy, this human rabies case highlights persistent systemic vulnerabilities. Here we investigate how this preventable death emerged, by integrating epidemiologic, socioecological, and policy data through a One Health lens. Using the Swiss cheese model, we identified multiple defensive layers—policies, outbreak response, system capacity building, and socio-geographical features—that aligned to permit transmission. We identified critical breaches, such as an 80% decrease in surveillance sampling, insufficient management of feral dog populations in urban corridors, and clinical misdiagnosis of the victim. These findings suggest that rabies persists not for lack of tools, but due to fragmented application and institutional amnesia. We propose a redesigned multisectoral framework to transform human rabies from a neglected tragedy into a true “never event”.