Rabies is one of the ancient and dreaded diseases known to India for centuries. It still claims its firm anchorage on India. Rabies is a re-known zoonotic disease present in developing countries of Asia and Africa. One person dies of rabies every ten minutes in the world. India holds the highest record of deaths due to rabies. World Health Organization (WHO) reports that there are 20,000 annual dog-mediated rabies deaths in India. 85-90% of the victims are children aged 15 years or below.

Lack of awareness and unfamiliarity among children on how to behave with dogs makes them an easy target. It wouldn’t be incorrect to say, that we Indians learned to live and tolerate the deadly virus for centuries. The question comes down to why is it still uncontrollable? Why there is no cure?

At present, there are a lot of hustles about the stray dog population and its negative impact on society. Four decades back rabies prevalence was as high as today although the reporting of the disease was scanty. One such incident occurred in 1981, in Andhra Pradesh. A 30-year-old gentleman who worked as a railway engineer adopted a puppy from the streets. He took care of the puppy. One day while playing, he got a mild scratch on his hand which barely bled. Due to a lack of awareness or negligence, the post-exposure anti-rabies vaccine was not taken.

Three months later he felt lethargic and weak. He consulted a doctor and explained his symptoms. The moment doctor offered him a glass of water he mimicked a rabid dog with a protruding tongue. The doctor had to call out his name loud to bring him to consciousness. Once he realized the gravity of his condition, he cried out loud and regretted his negligence. Soon he was locked in an isolation cell in Andhra Pradesh.

He had violent episodes in the isolation cell and passed away in two days. This was one of the unreported cases. Unfortunately, this young man was my grandmother’s brother. All are well aware that rabies is one of the fatal diseases, yet the urgency of the situation is felt only when it befalls a dear one. A simple post-exposure vaccine can save lives but people are often reluctant to go to a hospital and get it done.

India’s current population is 1.38 billion. The current free-roaming dog population in India is 30 million, which exceeds the population of Australia. Dog-mediated rabies is a huge crisis in India because of the massive population and people belonging to various socio-economic strata. The existence of the wealthiest to the destitute makes the mitigation process more complex.

Indian rural and urban areas are overflowing with free-roaming dogs, scavenging for food and water. The fight for their bread and butter is much more challenging than one can imagine. They roam in packs, fighting for territory and resources. Most of the free-roaming dogs are aggressive and unfriendly, unlike pet dogs. The existence of such a stray population has negatively impacted society in many ways. The antagonistic and predatory behavior of dogs stirs up anxiety and apprehension among the public. Many case reports are filed to the local authorities stating their concern to walk on the road fearlessly.

In states like Kerala and Uttar Pradesh, there are 1,00,000 dog bite incidents reported in the past one year. The rising stray dog population adds more magnitude to public health issues. The other menaces of the rising stray dog population are, the disease spread among dogs, dogs to other livestock animals, and dogs to humans. Rabies can be easily transmitted to any warm-blooded animal from bites/scratches from the infected dog. Once bitten by an infected dog, post-exposure vaccinations are mandatory to prevent the virus from infecting the nervous system.

Due to the surge of stray dog bite cases, people lost compassion for orphan pups and dogs on the streets. Mass culling programs were organized to eliminate the dog population on the streets. This program gained wide public support, though animal activists revolted against it. The public and involved political parties believed that wiping out all the free-roaming dogs at once can prevent rabies. The trend of informing the municipality when a dog is spotted became a common sight. Both aggressive and docile dogs were brutally choked and killed, their tails were sliced and taken as proof.

There was a time where trucks were loaded with dog corpses and were taken for incineration. The animal health professionals and a minority of the public were perplexed by these reforms. Questioning and weighing the cruelty against animals and the public health benefits from it. The outcome of the mass culling program was not satisfactory. Brutality was much more than the benefits from it. Wiping out a massive population of stray dogs did not end or prevent rabies. It had very little effect on the dog transmitted rabies in India. However, mass culling did reduce the number of unwanted animals that are not properly cared for or protected from various diseases.

Due to the ineffectiveness of the program, it leads to the birth of a new program, named mass sterilization or animal birth control program. It involved: capturing the dogs from the streets, castration/spaying, vaccination, and post-operative care were given until the dog is fit for release. To avoid territorial issues, dogs were released to the exact location of capture. There are dedicated teams of surgeons working for animal birth control programs. Birth control programs envisioned to control the stray dog population, however, sterilized dogs can still bite and transmit rabies.

The main challenge is that the number of sterilized and vaccinated dogs should always exceed the reproducing rate of the current free-roaming dog population. Only then the program can be called effective. In reality, in many states, the pace at which sterilization procedure takes place is slower than the current reproducing rate of the stray dog population. Other limitations of the program include the requirement of huge infrastructure and funds to execute the procedures. Population control and simultaneous vaccination are mandatory to control rabies.

Although the reduction of stray dog population plays an important role in rabies mitigation, vaccination is an integral part of the prevention process. The ‘mission rabies’ campaign was launched in 2013, an initiative by World Veterinary Service (WVS). They were successful to vaccinate 7,65,882 dogs in India and educated 3 million children in India and South Africa. Mission Rabies is one of the dedicated charity programs focusing on the prevention and elimination of rabies by 2030.

Recent initiatives to eliminate rabies are jointly put forth by World Health Organization (WHO), World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO), and Global Alliance for Rabies Control (GARC). The global response is initiated in all the affected countries. This strategic plan envisions to end rabies by 2030. They focus on mass vaccination, creating awareness among the public, and provision of financial aid to improve the quality of life. Dog-mediated rabies is a multifactorial concern.

Humans and animals are equally affected by it. After the onset of the symptoms, it is 100% fatal. Dogs have their fair share of creating public nuisance: road accidents, aggressive behavior, scavenging garbage dumps and chasing children. Aggressive behavior is demonstrated not only by rabid dogs but also by other stray dogs. Aggression and predatory behavior are some of the basic animal instincts.

Mass culling is certainly not the answer to end rabies. Unlike other developed countries, there are no pet documentation and licenses required to own a pet in India. This is one of the reasons why there is no accuracy in the estimated pet population. To mitigate the rabies crisis, all the sectors should join their forces together: animal health professionals, public health professionals, political parties, health organizations, and children.

India should focus on a multipronged strategy for the elimination of dog-mediated rabies. An initiative to collect pet census can be beneficial in the long run. The Pet-dog census will help to estimate the pet-dog population in India. Most of the stray dogs were once owned by someone. Abandonment of pet dogs on the road when they are sick increases the overall free-roaming dog population.

Pet-ownership laws should be formulated to avoid such mishappenings. Free-roaming dogs can be identified and numbered with the cooperation of the people living in the same streets. According to the place and division, mapping of the free-roaming dogs can be done. This can give a clear idea of the dog population, in turn, help in capturing and vaccination strategies.

The mission rabies campaign is one of the finest programs fit for the cause. Animal birth control activities as well as mass vaccination can be implemented for rabies free tomorrow. A strategic plan can be formulated if there are dedicated teams of surgeons and veterinary nurses who can work without boundaries. Another dedicated team is required to create awareness among the public. School children should be educated on how to behave with animals, the importance of vaccination, symptoms of rabies, first aid for dog bites, and prevention of rabies.

Many people in rural areas die of rabies because they cannot afford treatment or cannot find a functioning health center in their area. In such cases, useful information regarding the prevention and first aid for dog bite wounds can save lives. The health ministry continues to give free post-bite vaccination in government hospitals. This has helped the public to access the treatment as soon as possible. Post-bite vaccination for humans can save their lives, but if a dog is vaccinated against rabies it can prevent the disease on a much bigger scale.

An integrated approach involving animal health workers, public health workers, political parties, and children can help to achieve the goal sooner. Political leaders can influence and create awareness among the public. Veterinarians can educate the pet owners regarding the need for vaccination for animals.

Doctors can educate people about the risks and fatality of diseases once infected. Children are the future, educating them can help to achieve long term results. A true one health approach is required to end dog-mediated rabies by 2030. There is a dire need to accelerate the fragmented and uncoordinated mitigation strategies to see the dawn of a rabies-free tomorrow.

“Let us join our hands and work together to eliminate dog-mediated rabies by 2030”