Rabies elimination in India: Pathways from vision to reality

Overview of scientific advances

Over the past two decades, there has been remarkable progress in rabies prevention, diagnosis, and surveillance. Modern cell-culture vaccines, such as purified Vero cell rabies vaccine (PVRV) and purified chick embryo cell vaccine (PCECV), have replaced older nerve tissue vaccines in most countries, including India, offering greater safety and efficacy. Dose-sparing intradermal (ID) vaccination regimens, endorsed by the WHO, have made PEP more affordable and accessible, especially in resource-limited health systems¹. Diagnostic capabilities have advanced with tools like lateral flow assays, real-time RT-PCR, and point-of-care assays, enabling faster, more accurate rabies detection in both humans and animals, and supporting timely public health responses^3-5. Oral rabies vaccines, already proven effective in controlling wildlife rabies in Europe and the Americas, are now being adapted for free-roaming dog populations in Asia and Africa^6,7. Additionally, the recent introduction of monoclonal antibody-based products in India for PEP, offers scalable, cost-effective substitutes for human/equine rabies immunoglobulin, helping to overcome long-standing supply shortages^8,9.

Current challenges

Despite significant progress, several persistent challenges hinder rabies elimination. Rabies control exemplifies the principles of One Health, since human disease is driven by animal reservoirs. However, fragmented coordination between public health, veterinary, environmental and municipal sectors further undermines control efforts.

India harbours one of the world’s largest street dog populations, with estimates up to 62 million¹⁰. With a human population of 145 crores, the dog-to-human ratio is about 1:23, making rabies elimination by 2030 a formidable challenge. The dog population control remains constrained by limited commitment, funding, and scalable sterilisation methods. As dogs are the primary reservoir, controlling rabies in this species is essential to achieve and sustain elimination. Yet, in most regions, vaccination coverage is absent or falls far below the ≥70 per cent threshold needed to interrupt transmission, sustaining viral circulation in dog populations and driving the continued occurrence of preventable human rabies cases.

An elimination programme is only as good as its surveillance system. India’s rabies surveillance remains heavily dependent on clinical diagnosis, with laboratory confirmation limited to a handful of reference laboratories¹¹. Consequently, human and animal rabies cases remain under-reported, especially in rural regions.

Access to PEP is often delayed, with frequent shortages of vaccines and immunoglobulins due to weak forecasting and supply-chain gaps^12,13. Misconceptions, fear of injections, and low awareness of timely treatment further drive preventable deaths. Programmes also remain constrained by short-term funding and limited sustained domestic investment.

Opportunities

With strong global momentum, India has a unique opportunity to accelerate rabies elimination under the ‘Zero by 30’ strategy. The National Rabies Control Programme (NRCP), initiated during the 12th Five-Year Plan (2012–2017), built the operational backbone, while the National Action Plan for Dog-Mediated Rabies Elimination (NAPRE), launched in 2021, provides the One Health policy framework¹⁴. A central decree to make human rabies a notifiable disease, already adopted in several States, will improve reporting and accountability. The National Centre for Disease Control’s ‘Rabies Free Cities’ initiative further drives progress by targeting high-burden urban areas with dog vaccination, rapid bite management, and digital surveillance¹⁵. The Supreme Court’s August 2025 directive also offers a pragmatic framework to balance human safety and stray dog welfare in population management¹⁶.

Encouragingly, a recent national study estimates fewer than 6,000 rabies deaths annually; evidence of substantial decline in the last two decades yet underscoring the need for sustained investment and policy focus^17,18. India has proven success through State-led initiatives: Goa’s sustained dog vaccination, surveillance and public awareness drives have nearly eliminated human rabies deaths, while Sikkim’s community-based vaccination and sterilisation programmes significantly reduced the incidence^19,20. Rabies control efforts can be further strengthened by integration with broader zoonotic disease programmes, immunisation services, and primary health care systems, thereby maximising reach and efficiency. India’s established capacity in the manufacture of rabies vaccines and monoclonal antibodies positions the country not only for national self-reliance but also as a key supplier to other endemic countries, reinforcing regional solidarity under the global elimination agenda. Scale-up opportunities include wider adoption of ID vaccination to improve equity and availability, and expansion of digital surveillance platforms, such as mobile-based bite reporting and geospatial mapping, for better case detection, vaccine tracking, and targeted interventions.

Community engagement, through schools, local governance bodies, and animal welfare organisations remains essential to increase awareness about rabies, improve timely bite reporting and PEP, and to mobilise support for mass dog vaccination drives. At a regional level, cross-border coordination across South Asia is essential to manage rabies risks in transboundary dog and wildlife populations. Looking ahead, policy innovation around universal rabies pre-exposure prophylaxis, particularly for children and other high-risk groups in endemic areas could complement PEP and accelerate progress toward elimination²¹.

Pathways towards rabies elimination

To move from aspiration to reality, policymakers and health professionals must act on evidence-based strategies.

• (i)

  Universal access to timely PEP is critical, ensuring every bite victim receives free and immediate post-exposure immunisation, supported by decentralised stockpiles, trained staff, and streamlined referral pathways. Adoption of WHO-recommended ID, abbreviated PEP regimens could further enhance compliance, vaccine equity and cost-effectiveness in India^1,12.

• (ii)

  Mass dog vaccination must achieve and sustain ≥70 per cent coverage to interrupt transmission. Decades of evidence confirm this strategy is feasible and highly cost-effective. Oral rabies vaccination should be explored as a complementary tool to accelerate scale-up in India^22,23.

• (iii)

  One Health coordination should be institutionalised, with well-defined roles, shared budgets, and accountability across health, veterinary, and local government systems.

• (iv)

  Sustainable financing mechanisms are needed, including dedicated government budget lines, to reduce dependence on donor-driven or short-term projects.

• (v)

  Strengthening laboratory capacity is vital to expand diagnostics for human and animal samples, enhance surveillance, and integrate results into national databases for rapid action^4,11.

• (vi)

  Public awareness requires sustained, culturally tailored campaigns for high-risk groups, schoolchildren, community leaders, and pet owners, emphasising wound washing, timely PEP, and responsible dog ownership. Even modest gains in awareness significantly boost PEP uptake.

• (vii)

  Operational research should guide adaptive rabies control, prioritising thermostable dose-sparing vaccines, dog ecology and population dynamics, oral vaccination of free-roaming dogs and scalable population control, and viral genomic surveillance to track transmission, assess vaccine efficacy, and refine strategies.

• (viii)

  Dignity in death through palliative care is a moral and ethical imperative for those with confirmed rabies, ensuring compassionate symptom relief, psychosocial support, and reduction of stigma for patients and families, reinforcing that rabies elimination is not only a scientific goal but also a humanitarian one.

• (ix)

  Treatment for rabies warrants attention, despite its universal fatality after symptom onset. Investment in experimental therapies and critical care innovations is essential to pursue future breakthroughs for this devastating disease.

From commitment to action

The elimination of polio in 2011 demonstrated India’s ability to mobilise massive vaccination campaigns and politically showcase the feasibility of disease elimination in South-East Asia²⁴. Rabies now presents a similar challenge; one not limited by science, but by political will, sustained financing, and coordinated action.

The evidence is unequivocal: dog vaccination interrupts transmission, timely PEP prevents deaths, and integrated surveillance enables targeted interventions. Countries in Latin America and parts of Asia that consistently implemented these measures have achieved dramatic reductions in human rabies^1,25. For India and other high-burden countries, the ‘Zero by 30’ target is attainable, but only if policy commitments translate into uninterrupted, scaled, and sustained implementation. Each unvaccinated dog, every missed PEP, and each unreported case represents a missed opportunity that delays elimination.

India now stands at a decisive crossroads. The tools are available; the urgency is undeniable. Achieving India’s commitment to ‘Zero by 30’ will require strong political leadership, reliable and sustained domestic funding, accountability across sectors, and integration of rabies control into national and State health priorities. Success in rabies elimination will not only be a significant public health milestone but a flagship global model of One Health in action.

Rabies elimination in India is not a distant dream; it is a choice. A choice to prioritise prevention over neglect, and to transform knowledge into action. The cost of inaction will be paid in human lives. The time to act is now.