Tracking the Path of India toward Rabies Elimination

Dear Editor, Rabies is a neglected viral tropical disease and is completely preventable by vaccination. It is a fatal and significant social disease. It primarily spreads to humans through the bite of infected dogs. In over 150 nations around the world, rabies kills 59,000 people per year, with 95% of cases occurring in Africa and Asia. India bears the highest burden of global dog-mediated human rabies deaths, affecting all the states and union territories except the Andaman Nicobar and Lakshadweep islands.[1] According to Integrated Disease Surveillance Project report, the number of animal bites has raised from 42 lakhs in 2012 to 72 lakhs in 2020.[2] In 2015, the World Health Organization (WHO), United Nations Food and Agricultural Organization, World Organization for Animal Health (WOAH), and Global Alliance for Rabies Control organizations joined together and set a goal to achieve zero human deaths due to dog-mediated rabies by 2030.[1] As a ray of hope for the management of the rabies situation in India starting in 1998, the Association for the Prevention and Control of Rabies in India was founded. In partnership with the WHO, it conducts the National Multi-centric Indian Rabies Survey in addition to annual conferences, workshops, seminars, and training programs regarding rabies control activities.[3] The Government of India implemented the National Rabies Control Program in the 12th 5-year plan and made Rabies disease “Notifiable” for all government and private health facilities as mandatory from September 20, 2021, onward.[4] To accelerate the dog-mediated elimination of rabies by 2030, the Government of India launched the “National Action Plan for Dog-Mediated Rabies Elimination.” It is a multifaceted approach based on “One Health.” The idea of “One Health” acknowledges the strong connection between human health and the health of plants, animals, and their shared environment. In this approach, various sectors collaborate such as animal husbandry, public works department, and health and welfare department and share information at the local, regional, national, and international levels with the aim of achieving the elimination of rabies.[4] The Sikkim Anti-Rabies and Animal Health program was the first state-wise rabies program in India and demonstrates a successful “One Health” model of dog-mediated rabies elimination in 2006.[5] In Goa, local government, nongovernmental organizations, and academic partners collaborated on this strategy to eliminate human rabies at the state level in India where, each dog was immunized and alerted offline in the app, and their global positioning system (GPS) location was also received in the website. The dogs were accessed using a combination of door-to-door and capture-vaccinate-release techniques. As a part of this program, school children also received health education about rabies, how to prevent dog bites, and what to do if bitten. They also monitored the dog population for the rabies virus.[6] In spite of the success stories in few states, states such as Kerala have been witnessing raise in rabies cases due to the disruption of anti-rabies activities due to the COVID-19 pandemic. Hence, Kerala ministry announced an action plan to make Kerala free of rabies deaths by 2025 by incorporating “One Health.”[7] Elimination of rabies is very challenging in India, where dogs exhibit a variety of ecological behaviors, including roaming freely and residing in isolated areas. Moreover, many animal bite cases are underreported. Current dog rabies immunization programs primarily use injectable vaccines. The process of vaccinating dogs to prevent rabies in low-income nations can be challenging because many canines have never been to a veterinarian and may not be accustomed to close contact with people.[8] Apart from the preventive and control measures taken by the Government of India, other measures such as proper waste management and restraint of dogs in public places mentioned in Table 1, can be adopted effectively. The WHO also recommends giving dogs an oral vaccine, which is a recent technique that is gaining favor as a secure and reliable substitute for injection. It is quicker, simpler, and more practical to get the dogs to “eat” rabies vaccine bait instead of trapping them in nets and administering rabies shots. Furthermore, it saves money because more dogs can receive vaccinations daily.[9]Table 1: Preventive measures for rabies elimination[ 1 , 4 , 6 , 8 , 9 ]Rabies vaccination offers 95% protection after three doses; however, achieving universal coverage is challenging. In India, several obstacles hinder rabies control, including inadequate vaccine supply, irregular availability of anti-rabies serum, and difficulties in maintaining the cold chain, especially in rural areas. In addition, lack of awareness, poor healthcare infrastructure, and financial constraints further limit accessibility. High prevalence of stray dogs and insufficient animal vaccination programs contribute to continued transmission. Strengthening vaccine supply chains, improving logistics, expanding awareness campaigns, and enhancing surveillance are crucial to achieving rabies elimination in India.[10,11] To conclude, the adoption of “One Health” to eliminate rabies has proven effective in many countries, as well as in few states in India. Thus, robust and persistent implementation of the “One Health” approach with appropriate inter-sectoral coordination will help India to become rabies-free in the future and to attain the elimination status by 2030, which needs sustained integrated effort from all the stakeholders. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.