Mission Rabies, a nonprofit organisation, has initiated a campaign in Goa to stop the spread of canine rabies using a three-pronged approach that includes vaccination, education and data gathering.
Seven young men sprinted down paths, darting behind houses and vaulting low walls. Each one carried a long-handled net. From yards, alleys and streets the din of canine outrage filled the air, announcing the invasion of the neighbourhood. Some dogs hid; others retreated a bit before resuming their chorus of barking. The most wary fled long before the catchers got near.
Too bad. Getting caught could be the best thing that ever happened to them. T-shirts emblazoned with a paw print logo are the uniform worn by the dogcatchers who work for Mission Rabies, and the team carries the canine rabies vaccine. Once given a shot, a dog should be safe for at least a year.
Goa is India’s smallest state. Originally colonised by the Portuguese, it’s a popular tourist destination set between the Arabian Sea and the mountain range of the Western Ghats. Although its churches and the importance of Roman Catholicism set it apart from the rest of India, Goa shares with other states the same abundance of street dogs. In town centers, in middle-class neighbourhoods with fenced yards and around palm-thatched huts where women cook over open fires, dogs—black and white, dusty brown, friendly and furtive—are everywhere.
As is rabies. Worldwide, about 59,000 people a year die from rabies, most in Africa and Asia, 99% of them because they were bitten by a rabid dog. About 40% of the victims are children, according to the World Health Organization, which has announced a campaign to reduce human deaths from dog-transmitted rabies across the globe to zero by 2030. The WHO estimates the death toll in India at about 20,000 a year.
Mission Rabies, which is part of Worldwide Veterinary Service and supported partly by Dogs Trust Worldwide, both nonprofits, has targeted Goa as a place to demonstrate the viability of its programme to stop the spread of canine rabies. It spends about $300,000 a year and has vaccinated 100,000 dogs a year since 2017, about 50,000 a year before that. Deaths of people from rabies in Goa fell to zero last year from 15 in 2014, when the campaign started. There are none so far in 2019.
The programme has gained the full support of the state government, which now contributes about $70,000 per year. And its work is widely recognised as effective. Ryan M. Wallace, a veterinarian who heads the rabies epidemiology unit at the Centers for Disease Control and Prevention in Atlanta and who has collaborated with Mission Rabies in Haiti, said its effort in Goa was “one of the most successful programmes in lower/middle income countries that I have seen in a decade.”
Attaining global eradication is the goal of anti-rabies organisations, but most see it as an aspiration, not a likely achievement. Not because the science is difficult, or the practical methods are unproven. Medically, rabies is easy to prevent, in dogs and people. Organisationally, the path to stopping rabies is well understood.
But, like all public health problems, rabies control depends on large and continuing government action. Eradication of canine rabies in a dog population, which is how human deaths drop to zero, requires a long-term commitment. To reach zero human deaths, the 120 countries in which the disease is endemic would need to find the money and act efficiently, now.
Even in India, with a powerful central government, Maneka Gandhi, a member of parliament and widow of Indira Gandhi’s son Sanjay, as well as a former government minister and animal welfare activist, said rabies “is not really a priority issue with the government, unfortunately.”
Goa is an exception that Mission Rabies hopes can lead the way, if not for the globe, then for India, and if not for India, then for other countries. The state government is fully behind the programme of Mission Rabies, which has published data that not only shows it is remarkably effective, at reasonable cost, but also offers lessons on what needs to be done to stage effective anti-rabies campaigns: vaccinating dogs.
(Atul Loke/The New York Times)
Most lethal disease
Case by case, rabies is the most lethal disease known. The virus enters the body at the time of a bite. It then begins to travel up nerves towards the brain. In humans, once it reaches the brain stem, usually after about two weeks, but perhaps months later, it starts to cause excessive salivation, convulsions, impaired movement, sensitivity to light and noise, and sometimes avoidance of water.
Once symptoms appear, it is nearly 100% fatal. But it can be prevented even if a person is infected with the virus. A series of shots, given before symptoms appear, can stop the virus in its tracks.
About 15 patients are known to have survived the disease once symptoms have appeared, according to the WHO, but all of them except one had at least one dose of vaccine before symptoms appeared. And many of them had permanent neurological damage.
In most cases, and in most parts of the world, rabies is a death sentence. The patient is kept isolated and tied to a bed in a dark room. Death is often preceded by seizures, pain and hallucinations.
As if the deadliness of the virus weren’t terrifying enough, rabies is spread by humanity’s oldest animal friend. For 15,000 years or more we have lived with dogs, loved them, buried them alongside us, written poetry and songs to them. And for 4,000 years at least, and probably much longer, some of them have wagged their tails and licked our faces one day only to infect us the next.
Control and eradication
The consensus among rabies experts is that if the level of vaccination in the dog population can be kept at 70% over a period of seven years, the variant of the rabies virus that thrives in dog populations will disappear.
Effective vaccination depends not only on technical tools but also on an understanding of dog-human relations. Who owns or cares for dogs in any given community? And how much control do the humans have over the dog population?
In countries where dogs have become leash-bound pets, like the United States and Western European nations, canine rabies has been eliminated. The result is that there are one to three deaths a year caused by rare contact with bats, dog bites outside the country or bites from other animals, like raccoons. In most of the Americas, North and South, national governments have devoted the money and political will to vaccinate the vast majority of dogs every year, so even in countries where the disease is not eliminated, deaths are rare.
In Africa, where tens of thousands of people die from rabies each year, most dogs, even if they run free, are owned by families, as in the Americas, and vaccination drives can concentrate on the owners, who will bring them to vaccination locations.
India is different. Street dogs and people in India often have a kind of understanding. The dogs aren’t wild, but they aren’t owned either. Free-roaming dogs are often supported by the community, but nobody decides when and where they live, eat or mate.
Rahul Sehgal, India-Asia director for the Humane Society International, who is based in Ahmadabad, said, “In other places people don’t feed dogs.” But, he said, “I haven’t seen a single place in India where dogs are not fed by individuals or community.”
There are about 35 million dogs in India, Sehgal estimated, compared with 90 million dogs in the United States. India is only a third the size of the United States, geographically but three times the size in population, so the number of dogs per suburban acre, or city block, is about the same, and the number of dogs per person far less. But any visitor walking through a neighbourhood in India could be forgiven for thinking that the country has a much denser dog population. The difference is that in India, the dogs are mostly outside; in the United States, they’re mostly indoors.
Rabies campaigns in other countries often involve getting owners to bring dogs to central vaccination points, but that poses problems in India, because of the lack of individual ownership. The answer, according to Mission Rabies, is to send out teams to find and vaccinate street dogs, using various techniques, with about 40% requiring capture by nets.
Beyond Goa
Andy Gibson, a veterinarian from Sussex, England, oversees the Goa project for Mission Rabies and frequently visits India. He joined Mission Rabies not long after he found himself doing an MRI on a cat and wondering whether a life spent caring for the pets of the rich was what he wanted.
Gowri Yale, a veterinarian from Bangalore, who works in Panjiim for Mission Rabies, took a similar turn. She was working with livestock but felt the industry was cruel.
“I’m a vegan now,” she said. “And when I thought about becoming a small animal vet—cats and dogs—I felt I was helping rich people keep fancy pets, so I thought I want to do something with more impact.”
In a small Mission Rabies office in Panjim, the two vets discussed the central importance of data gathering to the project in Goa. “If you don’t measure it, you can’t prove it,” Gibson said. And if you can’t prove it, you can’t get political support.
The Mission Rabies programme has three aspects: vaccination, education and data gathering.
At the heart of the plan is a smartphone app that allows the vaccination teams to track their GPS-monitored progress through a neighbourhood on a map as they move from street to street. Team leaders can easily see each day’s progress. And the accumulated data helps set the next day’s plan and provide information for analysis. The CDC, which advises the Haitian government, used the app there and achieved an increase in dogs vaccinated to 76% from 40%.
Mission Rabies estimates the vaccination cost per dog, including salaries and other costs, at $2.50, far lower than the cost of treating humans, which involves not only a more expensive vaccine but also potential hospital stays. By that accounting, every dog in India could theoretically be vaccinated for under $90 million. India now spends $490 million a year on post-bite treatment, Gibson estimated.
Gibson has heard criticism that Goa’s project is too small a model to be replicated at a large scale.
Applying the Goa project’s methods on a larger scale would require at least one technical piece that is missing—an oral vaccine. Western Europe eradicated rabies in foxes by dropping baits with oral vaccines, beginning in 1990 when rabies was widespread and lasting more than 20 years.
The oral vaccine has also been tested in dogs in Haiti and other countries with success. And Gibson has run tests to show how the oral vaccine can reduce the number of people needed to reach hard-to-vaccinate dogs. Many dogs now caught in nets might approach hand-tossed bait.
The end of street dogs?
While international experts, like Wallace, are insistent that mass vaccination is the way to stop rabies and that Mission Rabies’ work in Goa has been successful, the response to such efforts in India is mixed.
“In India it will never be possible to do it in a disciplined and effective manner because that costs too much and it needs an army with cameras, data gathering, computer recording etc.,” Maneka Gandhi said in an email.
In addition, she said, dogs that are vaccinated but not sterilised “will have 12 puppies in the coming year and then the process starts again.”
Instead she supports population control. “The sterilisation of dogs is a must,” she wrote. “There is no other way.”
The parent organisation of Mission Rabies does include programmes that train vets and sterilise dogs. And population control of dogs, through sterilisation (with vaccination), is the approach preferred by Humane Society International.
But that approach poses its own challenges for the future. In North America and Western Europe, increasing wealth has led to a change in the status of dogs, which has certainly made rabies control by vaccination much easier. As Wallace put it, they move off the streets, “into our yards, then our houses, then our beds.”
In India, a big reduction in street dog populations would mark a significant cultural change, which, Sehgal said, is already beginning. As India becomes more urban and standards of living increase, he said, “Suddenly people are intolerant of dogs.” People travel to other countries, he said, and “they don’t see dogs in the street.” Over time, street dogs may disappear in the cities. “There will be apartments; there will be malls; there will be gated communities that will not tolerate the survival of these dogs.”
© 2019 The New York Times