India’s race to eliminate dog-mediated rabies by 2030: experts stress the need for a ‘One Health’ approach

A recent study in The Lancet estimated that India had around 5,726 human rabies deaths each year, despite an overall reduction in deaths over recent decades, partly due to lapses in vaccine adherence

India has made significant strides in reducing human rabies deaths over the past two decades. However, achieving the goal of eliminating dog-mediated rabies by 2030 will require accelerated efforts and a focused, ‘One Health’ approach, experts say.

The One Health strategy highlights integrating human and animal health measures to address rabies at its roots. Key steps identified include strengthening both human and animal surveillance systems, ensuring timely and complete administration of post-exposure prophylaxis (PEP) for those exposed to the virus, and scaling up dog vaccination efforts across the country. While rabies cases have declined, experts warn that without these integrated actions, India may struggle to meet the 2030 target. 

A recent study published in The Lancet highlights the public health challenge of rabies in India. Using a nationwide, community-based cross-sectional survey, researchers gathered data from 3.37 lakh individuals residing in 78,807 households across 60 districts in 15 states. The survey results estimated that India experiences approximately 9.1 million animal bites annually, with 76.8% attributed to dogs. The annual dog-bite incidence was calculated at 5.6 per 1,000 people.

Significant gaps in post-bite care were noted, as 20.5% of dog-bite victims received no anti-rabies vaccination (ARV), and among those who did receive ARV, nearly half of the 1,253 people who started the vaccination course did not complete it. This lapse in vaccination adherence poses severe health risks, as the study estimates around 5,726 human rabies deaths each year, despite an overall reduction in deaths over recent decades.

“To make rabies a disease of the past in India, it is essential to prioritise prevention, awareness, and vaccination efforts,” says Ranga Reddy Burri, president of the Infection Control Academy of India. “Although human rabies deaths have declined, achieving the goal of eliminating dog-mediated cases by 2030 requires accelerated action. A robust One Health approach, combining human-animal surveillance, timely post-exposure prophylaxis, and extensive dog vaccination is vital. With the increase in pet ownership, responsible pet care and vaccination are also critical to this mission,” Dr. Burri adds.

Government initiatives

In answer to a question in the Lok Sabha on July 30, 2024 on the stray dog menace in the country, Minister of Fisheries, Animal Husbandry and Dairying Rajiv Ranjan Singh said that in 2023, India reported a total of 30.43 lakh dog bite cases, with 286 fatalities linked to these incidents. This data was gathered under the Integrated Disease Surveillance Programme by the Ministry of Health and Family Welfare.  “According to the National Centre for Disease Control, 46,54,398 anti-rabies vaccinations were administered to individuals who sustained dog bites throughout the year,” the Minister said.

The Minister also said that the government had introduced a rabies helpline (15400) in five States, with plans to expand it nationally. Additionally, the Rabies-Free Cities Initiative was launched to create rabies-free zones in Tier 1 and Tier 2 cities, with a structured rabies prevention and action plan.

Shailaja Tetali, dean of research at the Indian Institute of Public Health (IIPH) Hyderabad, however noted that while the National Rabies Control Programme (NRCP) has successfully reduced rabies cases, addressing dog bites requires a comprehensive One Health approach. “To tackle dog bites effectively, we need coordinated efforts across surveillance, resources, training, collaboration, and public awareness,” she explains.

She highlighted the need for enhanced surveillance of dog bites across both public and private facilities, especially in remote areas. “Every case should be recorded, as data is critical to tackle the issue in underserved regions,” she said. Dr. Tetali also stressed on stockpiling anti-rabies vaccines (ARV) to avoid shortages, and filling gaps in veterinary resources to support humane dog population control.

Specialised training for para-veterinary staff is essential, as many are often shifted into animal care without preparation. Collaboration among animal welfare boards, municipalities, NGOs, and resident associations is also necessary for effective dog population management. Dr. Tetali added that public awareness is also vital. “People need to respect animals’ space and understand the importance of post-exposure prophylaxis (PEP) after contact with potentially rabies-carrying animal’s,” she advised, noting that these measures can reduce rabies and dog bite incidents significantly.

Awareness remains low

According to information in India’s National Action Plan for Dog-Mediated Rabies Elimination (NAPRE) booklet, in India, rabies is transmitted commonly by dogs and cats (~97%), followed by wild animals (2%) such as mongoose, foxes, jackals, and wild dogs, and occasionally by horses, donkeys, monkeys, cows, goats, sheep, and pigs. Rodents, rats and bandicoots, squirrels, rabbits, birds, and bats are generally not known to transmit rabies. The presence of unvaccinated free-roaming dogs (FRD) or street dogs, amidst human settlements is a major contributor to the high incidence of rabies in India, which is endemic. Apart from humans, rabies also causes significant mortality among livestock animals such as bovine, cattle and small animals. 

Kiran Madhala, professor of critical care medicine at Gandhi Medical College, Secunderabad, highlighted key findings from the multicentric rabies survey conducted by World Health Organization (WHO) in collaboration with the Association for Prevention and Control of Rabies in India (APCRI) in 2017 and 2018. “According to the study, almost 40% of participants had never even heard of rabies, which is alarming for a country aiming to control this disease,” Dr. Kiran said.

He explained that even among those who knew of rabies, one in four was unaware of its fatal nature. “While nearly everyone recognised bites as a means of transmission, only about half considered scratches, and only a third saw saliva contact as potential sources of infection.”

Dr. Kiran said the perceived risk varies by animal type. “Three-quarters of respondents viewed dogs as a rabies source, yet only about 20% associated the risk with cats or monkeys.” Surprisingly, wild animals like mongooses or bats were rarely considered sources, with only 5-10% mentioning them, whereas some mistakenly believed rodents, birds, and even snakes were rabies risks, he added.

Court rulings

The Supreme Court of India has issued several rulings and guidelines related to dog bites, addressing public safety, the responsibilities of dog owners, and animal welfare. In the All Kerala Stray Dogs Eradication Group v. State of Kerala & Ors. (2015) case, the Supreme Court dealt with rising concerns over stray dog attacks in Kerala, where the public expressed alarm at increasing incidents. The petitioners advocated for the eradication of stray dogs to protect public safety. However, the Supreme Court underscored a balanced approach, reiterating the need to handle stray dog populations in a humane and lawful manner. The Court directed the state to implement the Animal Birth Control (ABC) programme, which involves sterilising and vaccinating stray dogs as a sustainable solution to population control. Rejecting any immediate, drastic measures such as culling, the Court underscored the importance of protecting animal rights while ensuring public safety. 

Published - November 19, 2024 07:00 am IST