India’s Rabies Crisis: Why a Preventable Disease Still Kills Thousands Every Year

India continues to account for nearly a third of the world’s rabies deaths, despite the disease being entirely preventable with timely treatment. The reality inside rabies wards — such as the stark, lightless room at Bengaluru’s Epidemic Diseases Hospital where patients are taken only to die — underscores how failure in public health systems, poverty, and policy gaps combine to make rabies one of the country’s most neglected killers.

What makes rabies uniquely terrifying

Rabies is not just fatal; it is relentlessly cruel. Caused by a neurotropic virus, it travels silently along peripheral nerves to the spinal cord and brain, often weeks or months after a dog bite. Once symptoms appear — hydrophobia, hallucinations, paralysis, and violent agitation — survival is virtually impossible.

Unlike many infections, rabies does not spread through blood, making late treatment futile. The disease’s clinical progression explains why hospitals can only sedate patients and manage distress, not save lives. As doctors attest, every patient wheeled into advanced rabies wards is expected to die.

India’s disproportionate burden

Globally, rabies kills an estimated 59,000 people annually. India alone contributes around 20,000 of these deaths, according to a December 2024 paper in “One Health”. The virus remains endemic, with dogs as the primary reservoir.

The burden falls overwhelmingly on the poor — daily wage workers, rural populations, waste collectors, brick kiln labourers, and children. Nearly 40% of dog-bite victims are under 15 years of age. Free-roaming dogs, estimated at 80 million nationwide, cause around 20 million bites every year, turning rabies into a chronic public health emergency rather than an episodic outbreak.

Why prevention fails despite clear medical protocols

Rabies prevention is well established. Post-exposure prophylaxis (PEP) requires immediate wound washing with soap and water for 15 minutes, followed by anti-rabies vaccination (ARV), rabies immunoglobulin (RIG), and a tetanus shot.

Yet access collapses at every step. Awareness remains low, particularly in rural and peri-urban India. Many victims delay treatment, underestimate minor scratches, or rely on traditional healers. Even when they reach hospitals, vaccines and immunoglobulins are often unavailable.

A January 2025 study in “The Lancet Infectious Diseases” found that over 20% of dog-bite victims received no vaccine at all, while nearly half failed to complete the full course. RIG — essential for bleeding wounds — is scarce and prohibitively expensive, costing ₹5,000–₹20,000 per dose, pushing families toward dangerous alternatives.

The economics behind avoidable deaths

Rabies exposes the deeper fault lines of India’s healthcare financing. High out-of-pocket expenditure means families hesitate even before seeking care. In one documented Assam case, a man bitten by a neighbour’s unvaccinated puppy died despite partial treatment, after delays, refusals at government hospitals, and fragmented private care.

The “One Health” study ranks institutional neglect — refusal to hospitalise, lack of seriousness in treating dog bites, and delayed referrals — as a primary factor leading to death. Even ARV supply remains inadequate: India needs roughly 60 million doses annually but produces only 50 million, exporting a significant share.

Stray dogs, policy dilemmas, and legal interventions

India relies almost exclusively on the Catch–Neuter–Vaccinate–Release (CNVR) strategy to manage free-roaming dogs. However, evidence of its effectiveness at scale remains weak. In November 2025, the Supreme Court of India directed States to remove stray dogs from hospitals, schools, railway stations, and other public spaces, placing them in shelters after sterilisation and vaccination.

Animal rights groups have criticised the order as impractical and cruel, while public health experts argue that unchecked dog populations continue to fuel human deaths. The debate highlights a persistent policy tension between animal welfare and human health, with rabies victims often invisible in the discourse.

What experts say must change

Researchers such as Harish Kumar Tiwari of Indian Institute of Technology Guwahati describe rabies as a disease of vulnerability — shaped by poverty, geography, and weak health systems. Experts stress that solutions must be multi-layered.

This includes guaranteed availability of vaccines and immunoglobulins at public hospitals, compensation for treatment costs, expansion of safe and enclosed dog shelters, and community-level responsibility for vaccinating and neutering local dogs. New monoclonal antibody treatments developed in India offer hope, but regulatory inclusion and scaling remain slow.

Equally critical is awareness: washing wounds immediately, treating even minor bites seriously, and seeking prompt medical care. Until prevention becomes universal and systemic failures are addressed, rabies will remain a grim reminder that in India, death can still come from a disease that medicine already knows how to stop.