Rabies as a Public Health Concern in India—A Historical Perspective

Abstract

India bears the highest burden of global dog-mediated human rabies deaths. Despite this, rabies is not notifiable in India and continues to be underprioritised in public health discussions. This review examines the historical treatment of rabies in British India, a disease which has received relatively less attention in the literature on Indian medical history. Human and animal rabies was widespread in British India, and treatment of bite victims imposed a major financial burden on the colonial Government of India. It subsequently became a driver of Pasteurism in India and globally and a key component of British colonial scientific enterprise. Efforts to combat rabies led to the establishment of a wide network of research institutes in India and important breakthroughs in development of rabies vaccines. As a result of these efforts, rabies no longer posed a significant threat to the British, and it declined in administrative and public health priorities in India towards the end of colonial rule—a decline that has yet to be reversed in modern-day India. The review also highlights features of the administrative, scientific and societal approaches to dealing with this disease in British India that persist to this day.

Rabies control in South Asia requires a One Health approach

“…About 35% of all human deaths from rabies occur in India which also accounts 60% of rabies deaths in Asia [ 8 , 23 ]. Some 95% of rabies cases are dog mediated.…”

“…Some 95% of rabies cases are dog mediated. It is estimated that there are about 60 million stray/free-ranging dogs in the country and more than one million people receive PEP each year [ 8 , 13 , 23 ]. Despite these figures, there is no coordinated and structured surveillance system for rabies which is not included in the list of regular surveillance diseases under the Integrated Disease Surveillance Project of the Indian Ministry of Health and Family Welfare [ 24 ].…”

“…Animal Birth Control, rabies control in animals, and vaccination of stray dogs were to be the responsibility of the Animal Welfare Board of India [ 25 ]. The National Rabies Control Programme of the Twelfth 5-year plan (2012–2017), administered by the National Centre for Disease Control and the Animal Welfare Board, aimed to halve human deaths by 2017 but there is no evidence that this target was achieved [ 23 ]. Control of human rabies is included in the National Rural Health Mission for which around 6.13 million US dollars was allocated in 2018 but then reduced to around 3.51 million US dollars in 2019 and 2020 [ 23 ].…”

Eliminating dog-mediated rabies: challenges and strategies

“…Based on the production levels in 2015, Wallace et al (2017aWallace et al ( , 2017b) calculated that US $3.9 billion was required to vaccinate 70% dogs in all countries where the disease is endemic. It is unrealistic to expect a commitment of such funds for canine mass-vaccination when in countries, such as India, the disease is not notifiable and is certainly not priority for control (Radhakrishnan et al 2020). Further, there are barriers to the success of such immunisation campaigns, especially in countries where most of FRD are inaccessible for parenteral vaccination (Gibson et al 2020).…”

One Health and Neglected Tropical Diseases—Multisectoral Solutions to Endemic Challenges

“…In some contexts, ethical considerations may also be involved. For example, in their review of rabies as a historical public health concern in India, Radhakrishnan and colleagues [ 4 ] note conflicting perspectives on the importance of animal welfare with respect to management of feral dogs, a major source of human rabies in the country. Finally, the work presented in Boyce et al [ 5 ] demonstrates how a lack of holistic understanding about transmission pathways can complicate control or prevention of a disease.…”