Couple of weeks ago when preparing my slides for a World Rabies Day Webinar by the Veterinary Association India, I was reading through the document ‘Rabies-Free City Initiative – Operational Guidelines’ – published by the Indian Government under the National Action Plan for (dog mediated) Rabies Elimination by 2030.
This is an excellent document that covers well most of the actions required to proceed towards rabies control in dogs, and elimination of dog-mediated human rabies deaths. It also acknowledges that rabies control in dogs requires effective mass dog vaccination programs and that the role of spay/neuter programs is to reduce the risk of rabies transmission (because rabies transmission risk is highest in a high-density dog population with low vaccination coverage). For sure one could hope the document to include more emphasis on the importance of annual vaccination of dogs and how as the first step all owned dogs should come under a system that ensures access to annual rabies vaccination regardless of the owner’s socio-economic status.
One specific detail that caught my attention in this document is on the page 32, under the chapter Activity 11: Dog Population Management (DPM), sub activity 11.1: …”Resource Mapping: Identify available resources, including veterinary services, infrastructure for sterilisation, and human resources such as dog catchers and veterinarians.” And, on the same page, the sub-activity 11.2: Execution of Dog Population Management with NGO collaboration, states that “to ensure effective implementation, local NGOs experienced in animal welfare should be engaged.”
There is a lot packed in these sentences, and I will use this blog post to explore what these statements mean.
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- Resource Mapping. By all logic, if we are to ensure effective implementation (as per sub-activity 11.2) and the possibility to implement this program across India to achieve zero dog-mediated human rabies deaths by 2030, as per NAPRE, we need to be looking at mapping ALL resources. All veterinary services and veterinary infrastructure available. All human resources available. And we also need to acknowledge in our resource map if some resources are not available – for example dog catchers.
Also, by all logic, one would and should expect that most private and government veterinary clinics and hospitals come under what would be considered as available infrastructure for sterilization of dogs. If they don’t have the human resources with surgery skills or if they don’t have the required equipment, this should be noted in the resource mapping, just like the lack of dog-catchers should be noted.
However, if the area has a network of private clinics – or even just a few private veterinary clinics or individual practitioners who are already doing spay/neuter surgeries, this is an important available resource and existing infrastructure that should not be missed. To ensure effective implementation, we need to be including the private sector. Interestingly, the Rabies-Free City -document acknowledges the need to collaborate with private sector for rabies vaccination drives, even mentions Public-Private-Partnerships (PPP), but does not specifically recognise the potential that the private sector would have in effectively providing spay/neuter surgery services.
This is surprising indeed, when you think how private veterinary clinics that are already doing spay/neuter surgeries, obviously already possess the skilled human resources as well as the required equipment, to perform surgeries. Surgical sterilization is the single most education, technical skills, and specific equipment -requiring component of the entire program (of the animal component). And the role that the private sector could have in providing this, is mostly left out. At this point, some readers will be asking “but isn’t it only AWBI-recognized ABC centers that can be operating stray dogs?” According to the ABC Rules 2023 that is indeed the case when it comes to sterilization of ownerless stray dogs. However, as I have been talking and writing for some time now – the first step, the low-hanging fruit in effective roaming dog population control would be to prevent unwanted owned dog pregnancies. Those pregnancies that result in puppies being abandoned in baskets and boxes to roadsides or dumped to shelters. This is where the private veterinary sector, under a suitable public-sector partnership, could play a bigger role to make the program implementation more effective.
That said, involvement of private vet clinics in dog vaccination programs is included in the Rabies-Free City Initiative document (page 42), but I would like to see also more emphasis placed for the need of government veterinary hospitals and dispensaries having adequate stock of rabies vaccine to cover all the owned dogs in their areas. The network of government hospitals and dispensaries is another available resource that needs to be included in the mapping and effectively utilized in rabies vaccine delivery for all owned dogs to start with.
Into comprehensive resource mapping belongs also existing potential for vaccine delivery methods and logistics. Animal Husbandry department may have vehicles and mobile veterinary service teams that could be utilised for rabies vaccine delivery in small towns and rural areas. There are also existing field programs on a national or state level, such as the annual/bi-annual FMD vaccination program that could be utilised to include also owned dog rabies vaccination delivery alongside of cattle FMD vaccinations.
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- “To ensure effective implementation… NGOs experienced in animal welfare should be engaged”
This is somewhat of a mysterious statement but not surprising when you understand the evolvement and historical perspective of canine rabies control activities in India. When the only practice to attempt to control rabies transmission, was to cull roaming dogs, the animal welfare organizations became involved, suggesting a more humane way for the dog population control – surgical sterilization. Unfortunately, the role and importance of veterinary sector (both private and government) to ensure annual rabies vaccination for all dogs, starting with owned dogs, was not considered equally important and therefore still now – over 120 years since rabies vaccine for dogs was developed in Japan, we have thousands and thousands of dog owners without access to annual rabies vaccine for their dogs.
While it is true that in India there are many long-existed NGOs with sufficient resources who can be of great help in organizing mass dog vaccination programs or campaigns to sterilize ownerless stray dogs, such NGOs do not exist in every town, less so the smaller the town is. What is to be done in those cases? I acknowledge that the Rabies-Free-City -document is primarily aimed for tier I and tier II cities where there are often effective and experienced NGOs working on this field already for years or even decades. In such a case it makes lot of sense to engage their help and expertise in the rabies control collective, provided there is sufficient funding available for the NGO to carry out the tasks given to them in this collaboration.
However, according to a recent publication by the Tamil Nadu Public Health Department, most human rabies deaths (70%) in the state in 2018-2022 were from rural areas and that is why a program that is aiming to eliminate dog-mediated human rabies deaths by 2030 need to address the rural areas if it is to be effective. If 70% of human rabies deaths are reported in rural / small town areas, making every tier I and II city rabies free would only reduce the human death toll by 30%. While that would be a good start, and every human life saved from rabies death is worth working for it, it would still be a far cry from the aim of #zeroby2030.
A fundamental question needs to be addressed here: Why are animal welfare NGOs, expected to be taking such a major role in a matter that is a public health issue? Experience in animal welfare does not automatically equal to experience in veterinary surgery or experience in public health, even though many animal welfare organizations are increasingly getting involved with rabies control programs – this being of course a good thing. Conversely, why there is no alternative structure explored for the implementation of the animal component; annual vaccination of dogs as the main activity, apart from collaboration with NGOs, especially in situations where such NGOs do not exist in the area?
Is the effective implementation of the animal component hindered by the limitations of the NGOs? Limitations including their existence all over in India in the first place and then secondly their ability to provide the required infrastructure and surgery services. Is the non-existence of an adequately funded and equipped NGO an excuse to not even begin to implement any part of the animal component of this program even though comprehensive resource mapping, if properly done, would reveal that alternative options exist?
I look forward to hearing your comments and thoughts!
