India’s march towards Rabies Elimination: One Health Approach

Rabies is endemic in all Indian states and union territories with the exception of Andaman & Nicobar and the Lakshadweep Islands. In India, dog bites account for 96% of Rabies-related mortality and morbidity and it accounts for two-thirds of the Rabies burden in Southeast Asia and one-third of the overall world Rabies burden.

For nation categorization, five different Rabies Elimination stages has been put forward by the World Health Organization:

i. Endemic stage: Confirmed Rabies cases being reported with very less implemented control measures

ii. Control stage: Drastic decrease in Rabies cases due to various Rabies prevention and control interventions

iii. Zero human Rabies Death: No human deaths due to Rabies and cessation of dog and human Rabies transmission

iv. Elimination Stage: Signifies cessation of transmission of Rabies and no more canine Rabies cases.

v. Maintenance Stage: Maintaining Rabies free status e.g., by stopping occurrence of any human Rabies or canine Rabies. According to WHO, every country is in different phase of Rabies Elimination.

A global objective of “Zero human deaths due to dog-mediated Rabies by 2030”, was established in 2015 as a call for action. Various global organizations, namely World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organizations (FAO), & Global Alliance for Rabies Control (GARC) working jointly for achieving the target of “Zero human deaths due to dogmediated Rabies by 2030”.

The Ministry of Health and Family Welfare, Government of India has implemented National Rabies Control Programme (NRCP) for the entire nation as a part of country’s 12th Five Year Plan. The objectives of NRCP to prevent human Rabies deaths mainly by training the manpower, scaling up of Intradermal Rabies Vaccination for Rabies Post Exposure Prophylaxis, awareness generation in the community and strong surveillance mechanism to detect human Rabies cases and cases of animal bites & canine Rabies cases, improving diagnostic facilities for Rabies and intersectoral coordination. With the aim of reaching the goal of elimination of human Rabies deaths by 2030, NRCP is continued with support to the State Governments.

Rabies being a neglected tropical zoonotic disease; the prevention and control mainly depends on multi-sectoral collaboration which involves health, veterinary and wildlife sectors.

One Health approach is the very successful model implemented worldwide for achieving Rabies elimination. One Health is a collaborative, multisectoral approach acting from local to global level to achieve the targets. Only by the consistent and coordinated political will and administrative support by all the stakeholders involved, can the goal of eliminating Rabies be met. By utilising the experience of interested stakeholders from various sectors, the One Health Approach is a widely accepted method and logical approach for addressing complex problems and challenges.

Government of India through Ministry of Health and Family Welfare has launched The National Action Plan for dogmediated Rabies Elimination from India by 2030 (NAPRE) after consultation with key stakeholders, lessons learnt from NRCP activities and adopting the suggestions from global agencies such as WHO, OIE, and GARC and FAO. 

The five major pillars for successful implementation of NAPRE are: 1. Political will and Commitment 2. Sustained funding for logistic 3.Intersectoral coordination 4.Community Participation and 5. Operational Research.

The three guiding principles of The National Action Plan for dog mediated Rabies Elimination in India are 3Ps

Prevention: Promoting and introducing very cost-effective intervention for Rabies elimination such as making Rabies post exposure prophylaxis more accessible and affordable.

Promotion: Creating awareness on Rabies by advocacy, IEC and operational research.

Partnership: Involvement of local community, urban and rural civil society, the government, private sector, and international partners, for the anti-Rabies campaign in a coordinated manner.

The National Action Plan for Rabies Elimination is relying on two Core strategies to achieve Elimination of Dog Mediated Human Rabies from India:

A. Human health component:

Preventing Rabies deaths among humans by timely access to Rabies post-exposure prophylaxis to all animal bite victims and establishing robust Public Health System; including strengthening surveillance mechanism for animal bites and Rabies cases in human.

B. Animal health component:

Administering Anti Rabies Vaccination to at least 70% of dog population in the specified geographical area annually for the three continuous years.

Surveillance is considered as a key element in NAPRE, for problem identification and prompt remedial action. It is assumed that the success of Rabies of elimination strategies relies mainly on robust GIS-enabled surveillance mechanism for capturing data pertaining to activities related to human and animal health components of NAPRE and impact of these strategies on trend of human and animal Rabies deaths. By establishing an excusive portal and GIS-enabled surveillance mechanism, NAPRE can have data sharing mechanism at different levels for tactical reactions to cases of rabies and animal bites in real time.

Thus, NAPRE is a strategic and guidance document based on the One Health approach for all the stakeholders of states / UTs to develop need specific action plan for enabling India to reach the Global target of “Zero human deaths due to dog-mediated Rabies by 2030”