Rabies: the cruel and expensive disease of India’s most impoverished

Source: The post  “Rabies: the cruel and expensive disease of India’s most impoverished’’ has been created, based on “Rabies: the cruel and expensive disease of India’s most impoverished” published in “The Hindu” on 26th December 2025.

UPSC Syllabus: GS Paper-2-Governance

Context: Rabies is a viral zoonotic disease that primarily affects the central nervous system and is almost invariably fatal once clinical symptoms appear. Despite being completely preventable, rabies continues to cause a large number of deaths in India, reflecting deep gaps in public health systems and social awareness.

Magnitude of Rabies in India

1. Rabies causes approximately 59,000 human deaths globally every year.
2. India accounts for nearly one-third of these deaths, with an estimated 20,000 fatalities annually, the highest in the world.
3. The disease remains endemic in India and disproportionately affects economically weaker and marginalized communities.

Reservoir of Infection and Transmission

1. Dogs are the primary reservoir of the rabies virus in India.
2. The majority of human rabies cases occur due to bites from free-roaming and unvaccinated street dogs.
3. Poor management of the stray dog population allows continuous circulation of the virus.

Dog Population and Bite Burden

1. India has an estimated 80 million free-roaming dogs.
2. Approximately 20 million dog bite incidents are reported every year.
3. These large numbers significantly increase the risk of rabies transmission and make control efforts more challenging.
4. The incubation period of rabies can range from a few days to several months depending on the bite location and severity.
5. Initial symptoms gradually progress to severe neurological manifestations such as hydrophobia, paralysis, fear of light and air, and aggressive behavior.
6. Once symptoms appear, rabies is almost always fatal, with death occurring due to cardio-respiratory failure.

Preventability of Rabies

1. Rabies is entirely preventable if appropriate medical care is provided in a timely manner.
2. Immediate washing of the bite wound with soap and running water for at least 15 minutes significantly reduces the risk of infection.
3. Early medical intervention plays a crucial role in preventing the virus from reaching the brain.
4. Post-Exposure Prophylaxis (PEP): Post-exposure prophylaxis includes the administration of anti-rabies vaccine to all bite victims.

• Rabies immunoglobulin is essential for deep, bleeding, or severe wounds to neutralise the virus at the site of entry.
• A vaccine alone is insufficient in severe cases without the use of immunoglobulin.

Challenges

1. Shortage of Rabies Immunoglobulin: India faces a severe shortage of rabies immunoglobulin across public health facilities.
   • Many government hospitals lack immunoglobulin supplies, forcing patients to travel long distances or seek private care.
   • The shortage leads to incomplete treatment and increases the risk of preventable deaths.
2. Gaps in Healthcare Infrastructure: Many public health facilities do not have trained doctors, adequate vaccine stocks, or immunoglobulin.
   • Rural and remote areas face severe accessibility challenges, delaying treatment. Inadequate referral systems further compromise patient outcomes.
3. Lack of Awareness and Social Factors: Public awareness regarding rabies prevention and treatment remains low, particularly among vulnerable populations.
   • Many people fail to wash wounds properly or delay seeking medical care after animal bites.
   • Some patients resort to unqualified practitioners and traditional remedies, which are ineffective and dangerous.
4. Economic Burden on Households: Rabies treatment imposes a heavy financial burden on poor families.
   • Costs related to vaccines, travel, and hospital visits often push households into debt.
   • Children and daily wage workers are particularly vulnerable to both health and economic consequences.
5. Inequity in Disease Burden: Rabies predominantly affects the poorest sections of society, including rural populations, children, and informal workers.
   • Limited healthcare access and affordability exacerbate inequalities in disease outcomes. The disease thus reflects broader social and health inequities in the country.
6. Legal and Policy Challenges in Dog Control: Policies and court directives exist for managing stray dog populations, but implementation remains weak.
   • Dog sterilisation and vaccination programs face administrative, legal, and logistical obstacles.
   • Lack of coordination between municipal bodies and health authorities hampers effective control.
7. Vaccine Production and Supply Issues: India’s production of anti-rabies vaccines is insufficient to meet national demand.
   • Supply gaps affect the timely availability of vaccines in public health facilities. Dependence on limited suppliers increases vulnerability to shortages.

Way Forward

1. New Medical Interventions: New monoclonal antibody treatments have been developed as alternatives to rabies immunoglobulin. These newer treatments are cheaper and easier to administer. However, they are still under limited availability and are yet to be widely integrated into public healthcare.
2. One Health Approach: Rabies control requires a One Health approach integrating human health, animal health, and environmental management. Coordinated action among health departments, veterinary services, and local governments is essential. Addressing only human treatment without controlling the animal reservoir is insufficient.
3. Strategies for Effective Rabies Control: Mass dog vaccination and sterilization programs should be strengthened nationwide. Post-exposure prophylaxis, including vaccines and immunoglobulin, should be available at all primary healthcare centers.
4. Public awareness: Public awareness campaigns should emphasize wound washing, early treatment, and completion of vaccination schedules. Faster drug approvals and increased public investment in healthcare infrastructure are necessary.

Conclusion: Rabies in India represents a tragic failure to prevent a completely avoidable disease. Eliminating rabies requires sustained political will, strengthened healthcare systems, effective dog population management, and widespread public awareness. With coordinated action, India can significantly reduce rabies deaths and move towards eventual elimination.

Question: Rabies remains a major yet preventable public health challenge in India. Discuss the magnitude of the problem, key challenges in rabies control, and the measures required for its effective prevention and elimination.