Goa has become the first state in India to eliminate rabies in humans

Goa has become the first state in India to eliminate rabies in humans, with no cases since 2018. The project, led by the NGO Mission Rabies, began in 2014. 

The NGO's approach consists of remote teams of dog vaccinators, who systematically work their way through towns and villages vaccinating dogs.

Vaccination teams rotated through the talukas of Goa, re-starting the state campaign cycle on an approximately annual basis. A combination of door-to-door and capture-vaccinate-release (CVR) methods were used to access dogs for vaccination. 

CVR involves catching street dogs in large nets, before vaccinating them and marking them in non-toxic green paint, and then releasing them again.

Their progress was recorded in a smartphone app, which collects data on dog sightings, geographical areas covered by the team, and the details of the vaccinated dogs. 

The annual vaccination output increased, both in terms of geographic extent and a total number of dog vaccinations, through program refinement from 2013 to 2017. Intensive state-wide vaccination was achieved for the first time in 2017, vaccinating 97,277 dogs in an estimated total population of 137,353 dogs. Thus, a 70% dog vaccination coverage rate was achieved for the first time in 2017 using this method. This output was sustained through 2018 and 2019.

Both ownership and confinement data were available for over 90% of dog vaccination records. 52% were owned dogs and 48% were unowned dogs. Unowned dogs were inherently always roaming, while owned dogs were either always roaming (17.9%), allowed to roam for some of the time (50.3%) or always confined (never roaming) (31.7%). Consequently, most dogs vaccinated (83.5%) were among the roaming dog population for some or all of the time.

Smaller two-person vaccination teams were introduced in 2018 to more efficiently vaccinate dogs that could be restrained by hand, which was the case for 64.2% of all dogs vaccinated.

Nevertheless, specialist equipment was still needed to access a considerable proportion of dogs, with 16.3% of owned dogs and 56.5% of unowned dogs being restrained by a net.

Mission Rabies 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 in 2018, from 15 in 2014, when the campaign started. 

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.

The Goa program for human rabies elimination consisted of three core areas of activity: dog vaccination; rabies education; and intensified human and animal rabies surveillance.

The second pillar of the program was an education initiative whose primary focus was on teaching school children about rabies, how to avoid dog bites and what to do if bitten. The program also emphasized the importance and social value of ensuring as many dogs as possible were vaccinated against rabies each year. 

In total, school-based rabies education classes were delivered to 694,271 school children and 31,251 teachers between 2014 and 2019. 

Activities to distribute rabies educational messages throughout communities intensified with a similar timeframe which resulted in the delivery of rabies lessons to 155,079 people through community groups, local authorities, and public events.

Seventy-three canine rabies cases were confirmed in the first 6 months of surveillance in 2014. The mean state-wide occurrence of canine rabies cases decreased from 10.6 cases per month in 2014 to 0.8 in 2019, a decrease of 92%.

Thus the Mission Rabies project in Goa was "very cost effective", not only saving the state government money on healthcare-associated costs, but also reducing economic loss from death.

As well as vaccinating dogs, the methodology emphasizes ramping up disease awareness in society, such as running education programs in schools across Goa. 

Children are taught how to avoid dog bites, as well as what to do if bitten. Currently, many rabies deaths occur due to incorrect post-bite treatment. 

The Kerala state government now plans to partner with Mission Rabies to replicate the Goa program. 

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.