Why every third global rabies death is of an Indian

The recent Supreme Court directive mandating the removal of stray dogs from the NCR region has sparked mixed reactions. Dog lovers emphasise the protective role these animals play, as well as the companionship and stress relief they provide. At the same time dog-mediated fatal diseases, rabies or hydrophobia, kills an estimated 20,000 people every year. India thus faces a unique public health challenge stemming from its large free-roaming dog population and the consequent high burden of rabies.

A three‑pronged approach is essential to address the stray dog menace and prevent deaths from rabies. This approach includes dog population management, responsible dog ownership and access to timely treatment to dog-bite victims. Awareness and active engagement of communities are essential to obtain desired results in this approach, which calls upon multi-sectoral joint actions.

Sectors which are directly engaged in dog population management and rabies are local civic bodies, animal husbandry departments and health facilities. Working together for a common objective by these sectors is globally recognised as 'One Health' and recommended by the World Health Organization to address issues around diseases like rabies.

India is estimated to have over 60 million dogs, of which nearly 35-40 million are free‑roaming. The dynamics of the dog population are shaped by cultural, religious and socio‑economic factors. Many households and communities feed stray dogs as part of cultural traditions, leading to high pup survival rates. Poor waste management, uncollected garbage and open markets provide abundant food sources, supporting unchecked growth of stray populations. Despite long‑standing Animal Birth Control (ABC) programmes, sterilisation coverage remains extremely limited, rarely exceeding 10-15 per cent of the dog population in most cities. Uncontrolled dog populations contribute not only to rabies but also to other issues such as dog bites, zoonotic diseases and traffic accidents.

Of all these hazards, rabies remains the most significant public health issue in India. It is one of the oldest known zoonotic diseases, caused by a neurotropic virus, and is invariably fatal once the painful clinical symptom of hydrophobia (a fear of drinking water) appears. Despite being preventable through vaccination and effective animal management, every third death in the world due to rabies is that of an Indian. Most victims are poor and from rural populations. Over 40 per cent are children below 15 years of age. More than 97 per cent of human rabies cases in India follow dog bites. The human rabies burden is therefore both a public health and a social justice issue, disproportionately affecting marginalised communities.

Effective dog population management is essential for sustainable rabies control. Fertility in dogs can be reduced and their population stabilised through extensive Animal Birth Control (ABC) and sterilisation activities. The Animal Birth Control (Dogs) Rules, notified under the Prevention of Cruelty to Animals Act (2001, revised 2023), mandate humane capture, sterilisation, vaccination and release of dogs back into their territories. A sterilisation rate of at least 70 per cent is required to stabilise populations, but most programmes fail to achieve and sustain this threshold because of limited infrastructure, shortage of trained veterinarians and financial constraints. There is an urgent need to scale up this coverage across the country.

Rabies control requires mass dog vaccination covering at least 70-80 per cent of the dog population annually to break transmission cycles. Door-to-door vaccination, use of mobile clinics, and innovative oral rabies vaccines for difficult-to-catch dogs are important strategies.

Using this approach and through joint efforts of health and veterinary sectors, Sri Lanka could significantly reduce mortality due to rabies in humans. We can learn from this experience and replicate it in India through existing infrastructure.

While giving food to stray dogs and loving them is commendable behaviour, one must understand that urban pet dog populations contribute indirectly to the stray problem when abandoned. Public education campaigns must emphasise neutering, registration and vaccination as part of responsible dog ownership.

Dogs require food, water and shelter to live and a mate to breed. Denying these survival essentials to dogs shall reduce their numbers. Reducing food availability through improved solid waste management and community participation can limit dog population growth. Western Europe could eliminate rabies decades ago because of sanitation and hygiene measures through strong civic actions.

To achieve these results, community dog feeders, animal welfare groups, and local leaders must be engaged to create trust and cooperation in ABC and vaccination campaigns. All smart cities should take these initiatives, which can be complemented by activities under the Swachh Bharat mission.

India has launched several activities to reduce incidence of rabies and dog bites. India is committed to eliminating dog-mediated human rabies by 2030 through its National Action for Dog Mediated Rabies Elimination. This national programme emphasises and supports mass dog vaccination and ABC, strengthening human rabies prophylaxis access and improving inter-sectoral coordination through a One Health approach, under which local civic bodies, health facilities and veterinary sectors are expected to work together and obtain community engagement by raising awareness. These actions will not only stabilise the dog population and have greater affectionate human-dog interaction, but also eliminate preventable deaths and misery due to dog bites.

India’s cherished goal of rabies elimination by 2030 entirely rests upon a multifaceted One Health approach. It is achievable but requires collaboration, communication, cooperation and enhanced capacity across all sectors through the allocation of adequate resources; establishing high-volume sterilisation centres via public-private partnerships; achieving over 70 per cent vaccination coverage using innovative methods such as oral vaccines; ensuring an uninterrupted supply of vaccines in rural health centres for dog-bite victims; enhancing the capacity of veterinarians, para-vets and health workers in rabies prevention and dog handling; replicating successful practices from other countries (Sri Lanka, Europe, etc); and transforming dog care through population management into a community-driven movement.

With political commitment, community engagement and sustained investment, India can certainly stabilise the dog population and eliminate dog-mediated human rabies by 2030. Rabies control is not only a public health imperative but also a matter of social equity and humane animal management, demanding a united effort across health, veterinary and municipal sectors under the One Health framework.

(The writer is a former Director, Communicable Diseases, WHO, South-East Asia region)