The stark image of a ward in Bengaluru where every rabies patient dies underlines a grim reality: rabies remains among the most lethal yet preventable public health crises in India. Despite medical knowledge and available vaccines, the disease continues to claim thousands of lives each year, largely among the poorest and most vulnerable.
A disease that kills once symptoms appear
Rabies is a viral zoonotic disease that becomes almost universally fatal once clinical symptoms develop. Unlike many infections, the virus does not spread through blood; instead, it travels along peripheral nerves to the spinal cord and brain. Victims often experience paralysis, hallucinations, hydrophobia (fear of water and air), and finally cardio-respiratory failure. At this stage, medicine can only sedate and comfort, not cure.
India accounts for nearly one-third of the world’s estimated 59,000 annual rabies deaths, according to research published in the journal One Health. This makes rabies not just a medical issue, but a structural public health failure.
Why the poor bear the heaviest burden
Rabies in India is closely linked to poverty and social marginalisation. People living in areas with large populations of free-roaming dogs face the highest risk. Daily wage workers, waste collectors, brick kiln labourers, rural communities and children are disproportionately affected.
Experts from institutions such as Indian Institute of Technology Guwahati describe rabies as a “disease of the poor”, driven by:
- Low awareness about wound washing and urgency of treatment
- Poor access to government health facilities
- High out-of-pocket health expenditure
- Dependence on unqualified local healers
Post-exposure prophylaxis: known, yet inaccessible
Rabies is preventable if post-exposure prophylaxis (PEP) is administered promptly. This involves:
- Immediate washing of the wound with soap and running water for at least 15 minutes
- Anti-rabies vaccination (ARV)
- Rabies immunoglobulin (RIG) for bleeding wounds
- Tetanus injection
However, multiple gaps persist. Studies published in The Lancet Infectious Diseases show that a significant proportion of dog-bite victims either never receive ARV or fail to complete the full course. RIG, which can be life-saving, is scarce in public hospitals and prohibitively expensive in the private sector, often costing several thousand rupees.
Health system failures and economic constraints
In many cases, delays or neglect at the first point of care prove fatal. Patients are often turned away from government hospitals, forcing families into costly private care. Even when treatment begins, interruptions due to stock-outs of vaccines or immunoglobulin undermine effectiveness.
These failures reflect broader systemic issues: underfunded public health infrastructure, shortage of trained staff, and weak accountability in managing dog-bite cases.
Free-roaming dogs and policy dilemmas
India has an estimated 80 million free-roaming dogs and records around 20 million dog bites annually. Current policy relies mainly on Catch–Neuter–Vaccinate–Release (CNVR) programmes, intended as a humane population control method. However, evidence of their effectiveness in reducing rabies transmission remains limited.
In November 2025, the Supreme Court of India directed States to remove stray dogs from hospitals, educational institutions and other public spaces, placing them in shelters after sterilisation and vaccination. The order has triggered debate between public health advocates and animal rights groups over feasibility, ethics and implementation capacity.
Emerging solutions and the road ahead
Some positive developments are underway. India has recently produced rabies monoclonal antibodies, which are cheaper alternatives to human rabies immunoglobulin. While these are still under pharmacovigilance and not yet part of national guidelines, they offer hope for affordable treatment in the future.
Public health experts emphasise that eliminating rabies requires a multi-pronged approach:
- Ensuring uninterrupted supply of ARV and RIG in public hospitals
- Strengthening dog vaccination and sterilisation with evidence-based planning
- Creating functional shelters for homeless dogs
- Improving community awareness about immediate wound care
- Compensating families for treatment costs to reduce delays
What to note for Prelims?
- Rabies is a neurotropic viral disease with nearly 100% fatality after symptom onset
- Dogs are the main reservoir in India
- Post-exposure prophylaxis includes wound washing, ARV and RIG
- India accounts for about one-third of global rabies deaths
What to note for Mains?
- Rabies as an indicator of health inequity and weak primary healthcare
- Challenges in access, affordability and availability of PEP
- Debate around stray dog management and public health ethics
- Need for One Health approach integrating human, animal and environmental health
