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Feature South Asia public health

Why did rabies control fail in India?

BMJ 2022; 378 doi: (Published 28 September 2022) Cite this as: BMJ 2022;378:o2284
  1. Kamala Thiagarajan, freelance journalist
  1. Madurai, Tamil Nadu
  1. kamala.thiagarajan{at}

A group of high profile rabies deaths shocked the Indian public in the summer of 2022. Despite the disease being a common concern, treatment is fairly routine. So why did it fail? Kamala Thiagarajan reports

In the summer of 2022 it was not covid, or monkeypox, but rabies on the minds of the Indian public.

It started on 30 May when a student, Sreelakshmi, was bitten by a stray dog while walking to college. As with the usual care, she received a first dose of rabies vaccine at Thrissur Medical College, a government run hospital. Her next two doses were given at the Palakkad District Hospital, and a final one at the Valluvanad, a private healthcare facility. Unlike many who suffer dog bites in India, her treatment was swift. Yet just over three weeks later, Sreelakshmi was admitted to a private hospital with a fever and died two days after being diagnosed with rabies.

On 13 August, a 12 year old girl, Abhirami, was mauled by a stray dog while going to buy milk. She died on 2 September, despite receiving three of four doses of the antirabies vaccine.

These are among the five recent deaths that have shaken public confidence in the rabies vaccine and sparked debate on India’s rabies control measures and the quality and efficacy of the rabies vaccine.

Kerala’s health minister, Veenu George, has written directly to Mansukh Mandaviya, India’s health minister, requesting him to check the efficacy of the vaccines in Kerala.1 And on 9 September, India’s Supreme Court heard a public petition that questioned the government’s inability to clear the rapidly growing population of stray dogs,2 the main transmitter of rabies in India.

India continues to have the world’s highest burden of rabies: 20 000 deaths a year, according to the World …

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