India’s rabies burden may be lower than long believed but elimination still depends on controlling infection in dogs

A new review of India’s rabies-control strategy argues that the country has made measurable progress under its One Health framework, while warning that persistent gaps in dog vaccination, access to post-exposure care and coordination between human and veterinary services could still prevent elimination by 2030. One of the most striking updates is a revised estimate of around 5,726 human rabies deaths annually, far below the figure of nearly 20,000 deaths that dominated estimates for two decades.

The review examines India’s National Action Plan for Rabies Elimination 2030, or NAPRE 2030, and the practical obstacles that remain between national policy and effective control in the field.

A major revision of India’s rabies burden

India has historically been described as accounting for roughly one-third of global rabies mortality. Earlier estimates, based largely on studies conducted in the early 2000s, suggested close to 20,000 human deaths each year. The review highlights a much lower contemporary estimate. A nationally representative 2022–2023 survey using community-based data and decision-tree modelling estimated approximately 5,726 human rabies deaths per year.

The authors caution, however, against interpreting this as a simple 70% decline. Part of the difference probably reflects genuine improvements, particularly broader access to post-exposure vaccination and expansion of dog vaccination programmes, but part also reflects major differences in epidemiological methods between older and newer studies. Rabies therefore remains a major public-health problem despite the downward revision.

Dogs remain the critical reservoir

The review reinforces a fundamental point: human rabies cannot be eliminated through human post-exposure prophylaxis alone.

Dogs are responsible for more than 99% of human rabies exposures globally, and India’s owned and free-roaming dog population is estimated in recent literature at roughly 62–90 million animals. NAPRE 2030 therefore places mass dog vaccination at the centre of elimination, with a target of maintaining at least 70% vaccination coverage in dog populations.

That threshold remains difficult to achieve consistently. In many areas, rapid turnover in free-roaming dog populations means that immunity can fall below protective levels within months after a single vaccination campaign as puppies are born and unvaccinated animals move into the area.

Free-roaming dogs are not only a veterinary problem

One of the more important One Health aspects of the review is its focus on the urban environment. Open organic waste around markets, slaughterhouses and residential areas provides a stable food source that can support high densities of free-roaming dogs. Rabies control therefore involves more than vaccination and sterilisation: municipal waste management influences the size and persistence of the canine reservoir.

India’s Catch-Neuter-Vaccinate-Release and Animal Birth Control programmes face additional logistical limitations. They require surgical infrastructure, veterinary staff and post-operative facilities that are often beyond the financial capacity of smaller municipalities.

Traditional catching methods also preferentially capture approachable dogs. The review cites field work suggesting that 40–60% of some street-dog populations may remain difficult to capture, leaving a potentially significant unvaccinated reservoir.

Human vaccines exist but access remains uneven

India’s problem is not necessarily national vaccine-production capacity. The review reports annual production on the order of 81.7 million anti-rabies vaccine vials and 17.7 million rabies immunoglobulin vials. The bottleneck is distribution.

Rabies immunoglobulin, essential for severe Category III exposures, is reported to be available in only around 5.9% of primary health centres, falling to approximately 1.8% of urban primary health centres in some national assessments cited by the authors.

Maintaining the necessary 2–8°C cold chain in remote areas also remains difficult because of unreliable electricity, limited refrigeration and irregular distribution.

One Health coordination remains incomplete

NAPRE 2030 was explicitly designed to correct the fragmentation between human medicine, veterinary services, municipalities and wildlife authorities. Its structure combines three pillars: universal access to human post-exposure prophylaxis; sustained dog vaccination and population management; and integrated human-animal surveillance through national, state and district One Health committees.

Implementation, however, remains uneven. The review reports that many district-level One Health committees are still inconsistently established and that electronic reporting between human and veterinary systems remains incomplete.

That matters operationally: a patient presenting with a dog bite can represent an early epidemiological signal. If that information does not rapidly reach veterinary authorities, opportunities for investigation, tracing and ring vaccination may be lost.

New tools could change rabies control

The authors identify several technologies that could overcome some of the current limitations. Oral rabies vaccination could reach free-roaming dogs that cannot easily be caught for injection. Recombinant monoclonal antibodies may progressively offer an alternative to serum-derived rabies immunoglobulin. WHO-recommended shortened intradermal vaccination schedules can reduce both vaccine use and the number of healthcare visits required.

Digital surveillance tools, mobile mapping and spatial monitoring could also help identify clusters of bites and animal cases more rapidly.

The review additionally discusses emerging mRNA and self-amplifying RNA vaccine technologies and the potential use of drones for last-mile delivery of biological products in remote regions, although these remain far less operationally mature than conventional dog vaccination and PEP.

Goa and Sikkim show elimination is operationally possible

Regional programmes in Goa and Sikkim are highlighted as proof that coordinated approaches can work in Indian settings. Their experience supports a model combining sustained mass dog vaccination, surveillance, rapid access to PEP, dog-population management and cooperation between public-health and veterinary authorities. The broader challenge is scaling such models across a country with enormous variation in geography, municipal capacity, dog populations and healthcare access.