Canine vaccination by Mission Rabies workers in Goa. Photo: Mission Rabies
- Goa has had no human rabies cases for the last four years, according to a study conducted by a rabies elimination campaign in the state.
- ‘Mission Rabies’ began in 2013 and teamed up with the Goan government in 2015, and vaccinated dogs in the state against rabies until 2019.
- Many rabies deaths also go unreported or are misdiagnosed as cerebral malaria. So Mission Rabies also conducted awareness programmes in schools and community groups.
- The team estimated that “the estimated mean cost per death averted” and the “cost per [disability-adjusted life year] averted” in 2013-2019 were Rs 11 lakh and Rs 41,100 respectively.
- The health of free-ranging dogs is neglected because they aren’t food animals on one hand and are excluded from efforts to mitigate human rabies cases on the other.
Millions of free roaming dogs are hard to reach, rendering the elimination of rabies a challenging enterprise. But according to a new study, Goa has eliminated human rabies.
Rabies is a viral zoonotic disease that jumps from animals, mainly dogs, to humans. It leads to death in both animals and humans once the clinical symptoms start appearing. The most effective strategy to prevent rabies has been to eliminate the disease in animals, through vaccination.
In 2015, the Government of Goa established a formal collaboration with an NGO named Mission Rabies, based in Dorset in the UK. “Originally, when we launched Mission Rabies, we selected 12 different locations across India and vaccinated 5,000 dogs in each one,” Luke Gamble, a member of Mission Rabies, told The Wire Science. “The model was to prove it could be done anywhere in India and was not state dependent.”
The results of their efforts were published on May 19, 2022.
Killing dogs to get rid of rabies doesn’t work because there are too many dogs and because killing them is considered inhumane. Indeed, killing some dogs also creates a vacuum that allows more stray dogs to move into the area. The better approach is to create ‘herd immunity’ by vaccinating as many dogs as possible.
“One of the challenges in rabies elimination is primarily persuading states to invest in canine vaccination programmes,” Gamble, who is also one of the authors of the study, said. To eliminate the circulating virus, the state needs to provide sufficient vaccination coverage, which is a costly affair. The goal is to vaccinate 70% of all dogs in an area, and repeat the vaccination every year together with awareness programmes.
According to the WHO, “India is endemic for rabies” and “accounts for 36% of the world’s deaths”. And according to Gamble, the team picked Goa because “it is a tourist hub”, and whose state government was thus “the most receptive to the idea”. The team also tried to pitch the project in Ranchi, only for the Jharkhand government to not invest for the final stage.
But with Goa’s success, other states are also interested in the programme, Gamble said.
Mission Rabies originally began in 2013, and entered into a memorandum of understanding with the Goan government in 2015. It received the rabies vaccine Nobivac free of charge from the state.
The team employed “mobile dog vaccination teams” across the state. This effort had two parts: some teams went door-to-door offering to vaccinate pet dogs while another used nets to capture and vaccinate free-ranging dogs. The mission also used a smartphone app to deploy teams according to requirement “at the sub-village scale”.
The details of every dog that was vaccinated against rabies – including its location – were recorded on the app. This was to help administrators coordinate their efforts for revaccination next year, which is important because the virus shouldn’t be allowed to recirculate. They also set up and publicised a 24/7 “rabies hotline” among the people and government offices to report “suspect rabies cases”.
The people of Mission Rabies also refined their methods from 2013 to 2017, by which time they had vaccinated 97,277 dogs of an estimated total of 137,353 dogs. By 2019, they had administered 426,119 rabies vaccine doses in all.
After receiving a dose, each dog was marked with non-toxic paint on the head for identification. Based on these markings, the team undertook 3,188 dog-sight surveys to validate their coverage, and recorded 280,859 dogs.
The collected data indicated that “the mean vaccination coverage in the 2016 campaign was 71.8% among all sighted dogs and 60.1% among roaming dogs”. Similarly, “In 2017, intensive methods were applied state-wide, achieving an estimated coverage of 71.7% in all dogs sighted and 53.1% in the roaming population.”
These are significant numbers, considering some 30-60% of rabies cases and deaths reported in India occur among those younger than 15 years. According to the paper itself, “the estimated mean cost per death averted” and the “cost per DALY averted” between 2013 and 2019 were Rs 11.61 lakh and Rs 41,100 respectively. ‘DALY’ stands for ‘disability-adjusted life years’: it stands for the number of years affected by poor health, disability or lost due to an early death.
“During this period, the program was estimated to result in a total of 2,249 DALYs averted, and 80 deaths averted as compared to no intervention. Over a 10-year projection (2013-2023), the intervention was estimated to prevent 121 human rabies deaths and 3427 DALYS at a mean cost of [Rs 44,311] per DALY averted.”
“It requires a dedicated team, good strategic planning, commitment and will of the government to invest,” Gamble said. “Many people have said it is impossible to achieve zero rabies deaths in Goa. As we enter the fourth year of no human deaths, it is fantastic to show how wrong they were.”
In India, many rabies deaths also go unreported or are misdiagnosed as cerebral malaria. To remedy this, Mission Rabies has been conducting awareness programmes in schools and among community groups, paralleling their canine vaccination efforts.
According to the WHO data, some 18,000-20,000 Indians die of rabies every year. “India is a priority country for rabies elimination as India has the highest burden of human rabies in Asia,” Gyanendra Gongal, of the WHO regional office for Southeast Asia, New Delhi, which collaborated on the study, said. “The situation will improve with state-level mass dog vaccination.”
According to Gongal, dogs are responsible for 90% of all rabies transmission and consequent human deaths in the country. He also said that the health of free-ranging dogs is neglected because they lie in a blindspot. On the one hand, they aren’t food animals, and food animals’ diseases receive more attention because of the economic consequences. On the other, the human health sector is focused on human rabies, efforts against which tend to ignore eliminating rabies at the source.
“The third problem is,” Gongal added, “the growing stray dog population in urban settings … get ample food and shelter. Rabies often affects poor and marginalised populations, and its elimination requires the involvement of non-health sectors.”
For all these reasons, he concluded, “rabies gets neglected in public health policy decisions.”