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India’s Rabid Epidemic | The Public Health Advocate

India’s Rabid Epidemic

This article was originally published in our Spring 2022 print issue.


PHOTO BY A. BELSARE/S. DESAI

India’s deadly, yet silent, epidemic has gone largely unmentioned by the Indian government, and unnoticed by the rest of the world. Over time, this has allowed for the quiet voices of the victims to be drowned out and eventually forgotten. 

According to the World Health Organization, roughly 36% of the world’s rabies deaths occur in India each year. Most of those occur when children come into contact with infected dogs. This number has only been on the rise. Although India is taking measures to rescue and care for its growing street dog population, hostile interactions between communities and dogs are common and somewhat inevitable. In an exclusive interview, Dr. Aniruddha Belsare, a computational ecologist at Emory University who has extensively participated in veterinary medicine and conservation research in India, introduces rabies as a “disease of poverty”. According to his indepth research and fieldwork, Dr. Belsare states that there could be up to one rabies death every thirty minutes in India. He recognizes that the majority of deaths are from young children in remote villages, lacking access to healthcare.

It is very difficult to estimate the impact of rabies in villages in India, since rabies cases are scarcely documented and almost never reported in rural areas. Not only is there no nationally reliable documentation system, but most rabies patients die at home and never make it to the hospital. Even if patients are brought to ill equipped hospitals, many times, they are asked to return home regardless. Belsare insists that it will take at least a few years for hospitals to revamp their documentation criteria, and this level of improvement will not be possible without enforced governmental participation. The high number of unaccounted rabies cases only further perpetuates government inaction regarding this cause. 

Although the constantly growing stray street dog population has caused widespread infrastructure and public health related damage, this issue has failed to generate much political attention. Belsare explains how rural public-health issues, such as the rabies epidemic, often get left on the back burner, since they have relatively little impact on the more developed, urban parts of India.  

PHOTO BY A. BELSARE/S. DESAI

ABC

More recently, after being endorsed by the WHO, movements such as the government-supported “Animal Birth Control” (known as ABC), working to mass sterilize canines, have gained traction and are receiving international support. Since 1998, this ABC initiative has helped to identify small pockets of stray dogs, sterilize them, and return them to the streets.

While the dogs are held, they are also vaccinated, and treated for any visible maladies. This movement is often praised by animal-rights activists for limiting the number of euthanizations conducted by the government. In response to the results of this initiative, the Indian supreme court has issued a statement that specifies that the country should “strike a balance between compassion to stray dogs and lives of human beings”.

One such nonprofit that regularly conducts ABC missions, called VSPCA, has indicated that they have had much success with their sterilization and vaccination movements, noting that their specified work area, spanning a few cities, has had “zero rabies cases for the third year in a row”. 

PHOTO BY A. BELSARE/S. DESAI

Belsare acknowledges the importance of ABC, but he addresses that conducting this movement by itself is not enough of a solution. In fact, he claims that at a larger scale, ABC is proving to be an inefficient use of time, space, and funds.

Most importantly, the process of ABC is built as such that it always needs an input of constant and consistent funding from the local government. Even if there is a momentary breach, years of the effort will be reversed. 

He then goes on to comment on the uncoordinated nature of the Animal Birth Control Initiative. He alleges that due to the consistent effort, budget, and collaboration needed, “nobody is intending to conduct this movement in the villages”. Not only does this create an unequal distribution of funding, but it deprives the most at-risk regions from seeking access to key resources. “Even locally reducing the population of certain dog populations will not prevent other dog populations from repopulating”, he emphasizes. Throughout his years of conducting rabies-related research, Belsare has proposed a three-pronged approach that he believes will not only be practical for India to implement, but will also be the most effective.

The Approach

The first aspect of his plan is to establish coordinated communication with the local pharmacies of India. He wants to increase access to the rabies vaccine and make it easier for people to obtain the first dose within 24 hours of getting bitten. If the vaccine is not acquired within the first day, the chance of full recovery drastically decreases. After much contemplation he has found a good solution to implement this: develop an app. This app will use location services to indicate to the user the location of the closest rabies vaccine. However, there are still some barriers that need to be overcome for this plan to be successful. 

One of the major components that this will require is that pharmacies must digitally disclose their stock quantity of rabies vaccines. Belsare anticipates that with government support in the form of mandates, this portion of the plan will be manageable, and therefore, possible to put into action. Ultimately, tracking the available stock of urban pharmacies is quite within reach, since many of them already have access to GPS technology. However, it is the rural pharmacies that are desperately needed, and will require more convincing. 

Many times, the problem is that families know the risk and the signs of rabies, but they don’t know how to access treatment. During our interview, Belsare details stories of families renting out cars and aimlessly driving hundreds of miles with the hope of finding an available vaccine before the twenty four hour window closes. He reiterates that “The technology to do this is simple, we are in fact surrounded by it. This solution will not cost anything, and it will save lives”. 

His second priority is to increase rabies outreach starting at the primary school level, especially in rural villages. Since young children between the ages of seven and fourteen make up most of the rabies patients, it is important for them to develop an awareness for the symptoms of this illness. Belsare believes that rabies can be tackled in a way similar to polio. Nonprofit organizations, backed by government support, can take on the responsibility of creating regular educational lesson plans. 

This would allow children to recognize the risks of rabies and learn early prevention methods. Belsare said “There’s no point in only educating parents, if they are not the primary demographic of rabies victims. We need to be smart and learn about who is really impacted.” 

Lastly, Belsare knows that an umbrella solution would not be appropriate in this case. Instead, an adaptive “fluid” plan needs to be developed and implemented. Based on protocols established by the local government, every region needs to create an individualized solution that’s suitable for its population, geography, and stray street dog population. He insists that this solution is to communicate with the people, and allow them to contribute to the creation of the solution. This will help with two things: firstly, the solution will be better, and, secondly, it will also be most likely to be implemented and followed. 

PHOTO BY A. BELSARE/S. DESAI

The federal government, research institutions, general public, and local government need to work in unison to determine the best solution, whether it be mass vaccination campaigns, ABC initiatives, distribution of rabies vaccines, or a combination of both.  

Parting Thoughts

More solutions include encouraging adoption of dogs and discouraging the mass feeding of stray dogs. At least in the high-income urban areas, India is a dog-loving country. However, the current trend includes importing designer breeds from foreign nations, instead of adopting local mix-breeds. Belsare is optimistic because, with time, the local adoption rates are on the increase. 

Belsare left with a parting thought. He brought up how feeding stray dogs was not the answer and was not combatting animal cruelty. Instead feeding street dogs would just allow the population to continue to increase. “These dogs go on to live terrible lives” he claims, “allowing the growth of this population is animal cruelty within itself”. Claiming that this is an “ultimate form of tough love”, he accepts that campaigns to prevent the feeding of stray dogs in India have been largely unsuccessful. 

Knowing that publicly fighting rabies will continue to be an uphill battle, Belsare is still optimistic about finding an Achilles’ heel to the overall situation. By increasing access to the rabies vaccine, providing education to school children, and creating an individualized geographic-based structure to combat rabies, Belsare believes that India can make leaps towards preventing the annual number of rabies deaths a year. If implemented perfectly, his calculations show that this plan should display significant results by the end of the next decade. As long as the government and the public make it a priority to promptly begin to fund an anti-rabies initiative, the solution is well within reach. By raising awareness for this public health issue, the quiet voices of the victims will be heard and they can finally receive the justice that they deserve. 

PHOTO BY A. BELSARE/S. DESAI