Global health

‘Not just a dog bite’: why India is

struggling to keep rabies at bay
The government is being urged to dispel myths and ensure
drugs are available – and take responsibility for the millions of
stray dogs

Estimates put India’s stray dog population at between 30 to 40 million. Photograph: Sajjad
Hussain/AFP/Getty

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Amrit Dhillon in New Delhi

B
Wed 14 Oct 2020 07.15 BST

y the time the patient, a young man, reached Dr Ramesh Masthi

at a Bengaluru hospital, it was too late to save him. After being
bitten by a pack of stray dogs as he went out to buy some milk,
his family had applied a paste of green chillis, then lime juice
and finally, when the wound looked gruesome, turmeric.

“He came about a week after he was bitten. The wound was serious, and
we couldn’t save him. There is so much ignorance about dog bites and
myths. A rabies shot in time would have saved him,” Masthi says.

It is this unnecessary loss of human life to rabies that led India’s first
Rabies Awareness Summit in early October, organised by the Integrated
Health and Wellbeing Council in Delhi and attended by Masthi, to demand
the eradication of the disease by 2030.

The only way to achieve this, experts say, is for the Indian government to
make rabies a “notifiable” disease like polio or tuberculosis, significantly
changing its status. Essentially, it means the government would pay
proper attention to it, measuring the incidence rate, monitoring progress,
and allocating resources and funds. Health clinics across the country, for
example, would have to keep adequate supplies of the rabies shot, as
opposed to the current situation, with clinics in remote areas often
running out of supplies or lacking trained staff to administer a complete
course of shots.

A government programme would need to include a campaign to improve

public awareness as well as the crucial matter of vaccinating and
sterilising stray dogs.

Experts say a government programme is needed to vaccinate and sterilise stray dogs.
Photograph: RS Iyer/AP

“Eradicating rabies will take a sustained programme like the one we have
for polio, so that measures can be monitored and evaluated. It requires
vaccination and sterilisation of dogs, but the political will for all this is
largely missing,” says Maneka Gandhi, minister of women and child
development and animal welfare activist.

The World Health Organization’s target of ending human rabies deaths

globally by 2030 will not be achieved unless India succeeds (it accounts
for 36% of cases).

Eradicating Over the years, India’s stray dog population

has grown. It is estimated to be between 35–40
rabies requires
million. Visit any city, town, or village and
vaccination and
packs of dogs, usually friendly but sometimes
sterilisation of dogs,
feral, are unavoidable. Going for an evening
but the political will
walk often entails running the gauntlet of a
for all this is largely pack.
missing
Maneka Gandhi The animals are usually fed by dog lovers but
no one is responsible for vaccinating them.
Even if they are vaccinated, but not sterilised,
a dog can have several puppies in a year, and the whole cycle begins again.

“When I take my beagle for a walk, I carry a big stick and have to be
aggressive to keep the street dogs away. It ruins my enjoyment
completely. They are fed by dog lovers but no one takes responsibility for
them,” says Avantika Gupta, who lives in New Friends Colony in Delhi.

Pet owners take their dog for vaccination ... dog bites are the cause of almost all rabies cases
in India. Photograph: Noah Seelam/AFP/Getty

India has around 20,000 rabies deaths a year. Worldwide, over 59,000
people die every year from rabies, around 40% of them aged under 15.

Dog bites, as opposed to bites from monkeys or bats, cause almost all the
cases of rabies in India. Many poor Indians are unaware that it is vital to
treat a dog bite immediately. Even if they are aware of this, they often get
one or two rabies shots and fail to return for the remainder.

Eliminating rabies requires vaccinating and sterilising the stray dog

population. This is not easy. Catching stray dogs – hardy, streetwise
animals, not lumbering, overweight labradors – to vaccinate them is a
challenge.

The dogs see the dog catchers coming a mile off, setting off a chase which
may or may not result in a dog being caught, immobilised and given a
shot. Most municipal authorities, already struggling with huge issues of
pollution, waste treatment, and homelessness, tend to treat dog
vaccination as a low priority.

Dr M K Sudarshan, founder of the Association for Prevention and Control

of Rabies in India, believes human rabies is neglected because “it is a
disease of the poor”.

Making it a notifiable disease is the only way for it to be taken seriously

rather than left as an issue for animal lovers, or those bitten by dogs, to
worry about, he says.

“Once it becomes a notifiable disease, for which a law has to be passed,

reporting cases will become mandatory. Any doctor or hospital that fails to
report cases will be penalised. Making it notifiable will raise its profile
hugely,” he says.

This, he cautions, will take time. The government would have to come
under pressure from the public, who are currently not well-informed, he
says.

Changing the disease’s official status is the key to eradicating rabies. “Only
then will people stop treating it as ‘just a dog bite’,” he says.

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