Multiple agencies deliver a set of services

While the inadequacy of a national initiative to control rabies is much spoken of, it is in the same breath that the efforts of Tamil Nadu in this area have been applauded. In this Southern State, multiple agencies (governmental and non governmental) work independently, and sometimes in co-ordination, to deliver a set of services that aim at controlling rabies.

The two-pronged strategy targets animal side (preventive) and human side interventions (post exposure). The former is handled primarily by the local civic bodies, ably supported in this case by a number of non-governmental organisations, and funded by the Animal Welfare Board of India. This essentially involves catching the dogs on the street, immunising them against rabies, and sterilising them.

On the human side, the Directorate of Public Health takes the key position in providing vaccines to those who have suffered bites, though passively.

Anti-rabies vaccines are available at the primary health centres and would be administered free of cost to all those who come seeking treatment. Initiatives have been taken however to prominently display information about the availability of the vaccine, through the office of the Commissioner of Municipal Administration. Streamlined vaccines procurement is done by the Tamil Nadu Medical Services Corporation.

According to officials at the Directorate of Public Health, the state has recorded about 24 deaths in the current year. Last year it was about 42 deaths. A total of 4,63,418 cases of dog bite were recorded last year. Each of the 42 health unit districts sees about 3-5 cases daily on an average, according to statistics available.

Deaths occur primarily because of lack of follow up, officials added. Post exposure, a patient gets the relatively painless intra-dermal vaccine ON 3rd day, 7th day, and 21st day.

“In many instances, the patients do not come back to complete the course. Inevitably, death follows a truncated treatment course,” an official explains.

In a recent Public Health Foundation of India paper, Rabies control initiative in Tamil Nadu, India: a test case for the ‘One Health’ approach, Syed Shahid Abbas et al argue that the rabies control initiative in Tamil Nadu is the first comprehensive such effort in India, with universal coverage and interventions that target both the animal and human populations.

They credit the success of the programme, in large measure to effective intersectoral co-ordination mechanisms at the state and district level and tout it as a replicable model for India.

The paper also noted two major limitations of the rabies initiative in Tamil Nadu — the absence of animal interventions in rural areas; and the weakness of the surveillance system in capturing all dog-bite cases in rural and urban areas.”

Ilona Otter, Clinical Director, International Training Center, Worldwide Veterinary Service, The Nilgiris, says a systematic effort to eradicate rabies by vaccinating dogs has not yet been put in place. It is also not a problem just with dogs without owners.

“Two thirds of the population in India live in villages/rural areas and in these areas, owned dogs are often allowed to roam free for most of the day.”

Interactions with them showed that owners are not aware of rabies vaccination for their pets, but willing to participate when the benefits were pointed out to them. Tamil Nadu too has far to go before it achieves eradication. The path ahead, however, is a robust measure of dog vaccination, combined with systematic animal birth control efforts, and administering a full-course, post exposure vaccination for humans.