In an earlier report, I had raised simple questions. Let's go over them once more:
1. One third of global rabies deaths come from India (WHO numbers, not ours). Rabies is not caused by vaccinated dogs. How much money has the AWBI spent on vaccination and sterilisation of stray animals? (The answer, as given in response to an RTI, is quite pathetic) and how many of these dogs are certifiably vaccinated? (No answer given)
2. The number of dog bites that India has to deal with, is massive to say the least.
This Twitter handle will take you to individual cases of stray dog menace. In 2017, feral dogs killed at least 19 children in Sitapur, India, at the beginning of the year. But it did not even make news.
20,000 people a year die from Rabies - that is 2.2 people per hour or roughly one person every 27 minutes. These are the deaths. NOT the bites. The bites are 1.75 million per year. That is 3.3 bites per minute. At least 2
other reports I read used much higher numbers than these. These are the lowest reported numbers.
These numbers are understated. Why? Because many animal bites are never reported. And because rabies is, till date, not a notifiable disease in India. This means that it does not have to be reported to the govt. The cases that reach private hospitals and take treatment there are not mentioned. In short, these are just the government numbers. Not the total numbers.
Now, we have another worrisome side of the story.
Not only are people being bit literally every minute, but also that the standard treatment protocol - the anti rabies vaccine, is in short supply.
Since August, 2018, at least, there are reports of shortage of vaccine.
Why is shortage of vaccine an issue?
When a stray animal bites a human, the person has to mandatorily take the rabies vaccine. Rabies, once got, cannot be cured and is invariably fatal. Not only that, the death is particularly painful and there is no legal provision for euthanasia. The brain is affected last and so the patient is acutely aware of what is happening with them. They are aware of hydrophobia and the acute thirst and that they are going to die of it. They often die through drowning in their own spit or blood. It is one of the most gory ways to go.
A friend told me that his friend's brother died from the disease and even after all these years, it haunts him. Imagine, then, the state of this couple, who did take the injections, but not the first immuno-globulus serum. The child died after they thought they had protected her!
Shortage of vaccine means that people who are getting bit will die, and not in a nice way.
Why is the vaccine not available?
India's demand is 48 million vials p.a.. Our current production is about 50 million vials. Half o this is exported. The government has been mulling a ban on exports since April, 2019, but so far, nothing has been done.
Since last year, GSK's factory in Ankleshwar, Gujarat, has stopped producing the vaccine. The factory was taken over by Bharat Pharma.
But even if we do take the drastic step of banning exports, that only meets our needs for the current year. What about next year? The growth in cases is not slow. It is rising year on year because not enough money is being spent on sterilising animals. Higher animal population means more human-animal conflict (please see that twitter handle to know what I mean, and the Sitapur stories still haunt me).
How bad is it?
The last 2 tenders floated by the govt for the procurement of the vaccine got no responses. The states with the most acute shortage include (but are not limited to) Kashmir, Karnataka, Himachal and Delhi (where the shortage has now prompted a crisis. Even international media has taken note of the health crisis in India's capital. Sample these:
1.
https://www.europeanpharmaceuticalreview.com/news/89681/rabies-vaccines-shortage-puts-delhi-on-brink-of-crisis/
2.
http://www.bbc.com/future/story/20150915-indias-rabid-dog-problem-is-running-the-country-ragged
Kerala and Rajasthan have long term contracts with vendors (3 to 5 years) and therefore don't have an immediate crisis. Kerala has now agreed to send some vaccines to Karnataka. In my view, these are the only two states who don't have a shortage - right now.
The shortage is almost 80% in the affected states. That means 80% of the poorest of the poor, who are bit by animals, do not get this vaccine.
Will it make a difference if we correct the vaccine imbalance?
Canada has reported a shortage of the vaccine. But not the US.
Sample this article from the US to understand how utterly avoidable, unnecessary this disease, and the painful deaths associated with it are.
When we read this article, the 20,000 people we lose to the disease appear to be state sponsored crime.
What can we do?
Elementary, my dear Watson. These steps are not rocket science, nor can one accept things like "No Money" as an excuse. The only reason that no one is taking the issue seriously is that no one takes central ownership of the holistic issue. The AWBI goes on to push its own agenda, not realising that human-animal conflict is eroding the core Indian ethos of co-existence. Indian homes keep water for the birds, and make 2 extra rotis with every meal - one for the dog and one for the cow.
The municipal bodies of India - forever understaffed and overstretched, want to just push the envelope. The govt hospitals worry about not receiving the vaccine. They are not in a position to check why the demand is going up so much. There is a national Rabies control program, but I got to know of it only today, hidden under layers of official documentation.
- Make breeding illegal: It is inhuman. Time to declare it illegal. Those who want pets can take the strays. These are hardy breeds with much to offer by way of disease resistance and high immunity.
- Increase production capacity of the vaccine: 50 million vials are grossly inadequate. We NEED to step up production capacity Urgently. All the 5 producers in India are private companies who should, hopefully, see the opportunity and try to seize it.
- Make Rabies a notifiable disease: So that we at least have our numbers right!
- Educate, Educate, Educate: Ensure that all local doctors, esp in rural areas, know the treatment protocol and advise the patients properly. Even washing the wound reduces the chances of getting the disease by as much as 40%!
- Set up a supply chain: What is crucial is to get the immunoglobulus into the wound as quickly as possible after the bite. Set up a supply chain so that people do not have to frantically wait for the vaccine. The people who die, routinely, are the poor. The ones who cannot afford the treatment. They are the ones who need to be protected, educated, and taken care of.
- Population Control: It is time to ensure that we take human and animal population control on a war-footing. This is not just important for rabies. It is important for many, many other reasons.
And lastly,
Are you blaming the dogs?
NO. You cannot blame the dogs and the monkeys and the bats.
The only people responsible for human-animal conflict are the humans. Animals live on the principle of territorial aggression and follow the law of the jungle. They cannot be blamed for having their instincts.
The only people we should blame are the ones who design the ABC rules (which, as I have explained in an earlier post, are flawed in design, not in execution) and then do not plan for the population explosion that this will lead to. The dogs are ok. It is the dog lovers that need to answer for their actions. They have effectively alienated society, which directs its ire against the dog lovers, at the dogs.
