Nisha Pandey

Bhutan Eliminates Rabies While India Battles Persistent Deaths: What Can India Learn From Its Neighbour?

<span>Bhutan</span> has achieved a major public health milestone that several countries, including <span>India</span>, are still attempting to. 

The World Health Organization (WHO) has validated Bhutan’s elimination of dog-transmitted <span><a href="https://www.healthandme.com/health/rabies">rabies</a></span> as a public health problem, making it the first country in the WHO South-East Asia Region to achieve this milestone. 

Bhutan's achievement comes after it recorded zero human deaths from dog-induced rabies since June 2023. It also demonstrated that it has the systems needed to prevent the disease from returning. 

In India, rabies continues to remain a major public health concern. Bhutan’s public health achievement, therefore, offers an important lesson for India and other countries. Eliminating rabies means tackling the disease at its source, rather than relying only on treatment after a dog bite. 

<h2>How Did Bhutan Eradicate Rabies? </h2>

Bhutan’s progress towards <a href="https://www.healthandme.com/health-news/abhayrab-rabies-vaccine-batch-found-misbranded-not-of-standard-quality-dcgi-alerts-states-article-156095134" data-type="tilCustomLink">rabies eradication</a> was built over more than a decade through a One Health approach, bringing together human health, veterinary services, local governments and communities. 

The country’s Nationwide Accelerated Dog Population Management and Rabies Control Programme focused on mass dog vaccination, population management, surveillance and community awareness. 

“Bhutan has shown that eliminating dog-mediated human rabies is possible when strong national leadership, a mature One Health approach and communities come together around a shared goal,” said Dr Nilesh Buddha, Officer-in-Charge, WHO South-East Asia Region. 

Bhutan also became the first country to sterilise its entire dog population that roamed freely on the streets through a nationwide programme. 

WHO said Bhutan maintained universal, free access to <a href="https://www.healthandme.com/health-news/bat-encounter-while-sleeping-why-you-shouldnt-ignore-the-risk-of-rabies-article-156020124" data-type="tilCustomLink">post-exposure prophylaxis</a> (<span>PEP</span>) across all 20 districts, while continuing mass dog vaccination and integrated human-animal surveillance. Cross-border coordination with Indian states is also being strengthened to protect the achievement. 

“Bhutan's success shows that the health of humans, animals and the environment we share is inextricably linked,” WHO Director-General Dr <span>Tedros Adhanom Ghebreyesus</span> said. 

He added that the fight against rabies is won by bringing health workers, veterinarians and communities together rather than working in silos.

Also read: <a href="https://www.healthandme.com/health-wellness/fact-check-rahul-duas-cancer-claims-immunotherapy-isnt-always-better-superfoods-dont-cure-article-156102848" data-type="tilCustomLink">Fact-Check Rahul Dua’s Cancer Claims: Immunotherapy Isn’t Always Better, ‘Superfoods’ Don’t Cure</a>

<h2>What Can India Learn From Bhutan? </h2>

In terms of rabies eradication, India has made progress, but the burden remains substantial. 

WHO estimates that 5,726 people die from rabies in India every year, based on an <a href="https://www.healthandme.com/health-wellness/the-difference-between-zoonotic-non-zoonotic-and-reverse-zoonotic-diseases-article-151134152" data-type="tilCustomLink">ICMR-National Institute of Epidemiology</a> study. Around 9.1 million animal bites occur annually, with more than three-quarters caused by dogs. 

The Indian government’s <span>National <a href="https://www.healthandme.com/health/rabies">Rabies</a> Control Programme</span> also states that around 96% of rabies mortality and morbidity is associated with dog bites. 

India already has systems in place that could help with elimination of rabies. The <span>Animal Birth Control Rules</span>, 2023 provide for sterilisation and vaccination of stray dogs, while the National Rabies Control Programme focuses on ensuring access to PEP for people exposed to animal bites. 

Bhutan’s experience shows that rabies elimination cannot depend only on giving vaccines to people after bites occur. Vaccinating dogs, controlling dog populations, strengthening surveillance, ensuring rapid access to PEP and improving community awareness have to work together. 

Dr Soneet Yadav, ER Consultant, Ruby Hall Clinic, Pune, told <strong><em>HealthandMe</em></strong>, "Rabies keeps claiming lives mainly because people wait long for post‑exposure treatment and because we do not control Rabies in stray and free‑roaming dogs well. To get rid of rabies, India must use a coordinated "One Health" plan that brings together health workers, city officials, vets and animal‑care groups.” 

He added, “The important goal is to make sure many dogs get vaccinated all the time while we also run birth‑control programmes and keep a tighter watch on animal‑bite incidents. In hospitals in rural and underserved areas, anti‑rabies shots and <a href="https://www.healthandme.com/health-wellness/rabies-pre-exposure-prophylaxis-vaccine-can-protect-you-even-before-a-dog-biteheres-how-article-153317975" data-type="tilCustomLink">Rabies Immunoglobulin</a> (RIG) should always be available. I think people need to hear that every suspected Rabies exposure means they must go to a doctor fast.”

Also read: <a href="https://www.healthandme.com/health-news/newborns-nail-infection-leads-doctors-to-aggressive-brain-tumour-what-are-glioblastomas-symptoms-in-babies-article-156102417" data-type="tilCustomLink">Newborn’s Nail Infection Leads Doctors To Aggressive Brain Tumour: What Are Glioblastoma's Symptoms In Babies?</a>

<h2>What You Should Do Immediately After A Bite? </h2>

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<a href="https://www.healthandme.com/health-wellness/36-of-rabies-death-comes-from-india-this-is-what-you-should-do-after-a-dog-bite-explains-doctor-article-153355760" data-type="tilCustomLink">Rabies</a> is one of the few diseases with a 99.9 per cent fatality rate once symptoms appear. It starts off with flu-like signs: fever, fatigue, and maybe a horrendous headache. But things escalate quickly. You can suffer from hallucinations, paralysis, seizures, <span>hydrophobia</span>, and eventually coma. 

Once the virus reaches your nervous system, modern medicine will not be able to help you as there is no cure. But rabies is 100 per cent preventable if treated in time. 

The moment you realise you have been licked, scratched, or bitten by an animal, especially one that is unvaccinated or unknown, Dr Yadav recommends the following things: 

<ol><li>Wash the wound thoroughly with soap and running water for at least 15 minutes.</li><li>Apply antiseptic like iodine or alcohol.</li><li>Avoid putting chilli, turmeric, oil or other ingredients on the wound</li><li>Rush to a doctor; do not wait for swelling, itching or any other sign. You will need a post-exposure prophylaxis (PEP) shot, which includes a course of anti-rabies vaccines and sometimes immunoglobulin injections.</li><li>Keep a record of the animal if possible. If it is someone’s pet, you will want to confirm their vaccination history. </li></ol>

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Bhutan has achieved a major public health milestone that several countries, including India, are still attempting to. The World Health Organization (WHO) has validated Bhutan’s elimination of dog-transmitted rabies as a public health problem, making it the first country in the WHO South-East Asia Region to achieve this milestone. Bhutan's achievement comes after it recorded zero human deaths from dog-induced rabies since June 2023. It also demonstrated that it has the systems needed to prevent the disease from returning. In India, rabies continues to remain a major public health concern. Bhutan’s public health achievement, therefore, offers an important lesson for India and other countries. Eliminating rabies means tackling the disease at its source, rather than relying only on treatment after a dog bite. How Did Bhutan Eradicate Rabies? Bhutan’s progress towards rabies eradication was built over more than a decade through a One Health approach, bringing together human health, veterinary services, local governments and communities. The country’s Nationwide Accelerated Dog Population Management and Rabies Control Programme focused on mass dog vaccination, population management, surveillance and community awareness. “Bhutan has shown that eliminating dog-mediated human rabies is possible when strong national leadership, a mature One Health approach and communities come together around a shared goal,” said Dr Nilesh Buddha, Officer-in-Charge, WHO South-East Asia Region. Bhutan also became the first country to sterilise its entire dog population that roamed freely on the streets through a nationwide programme. WHO said Bhutan maintained universal, free access to post-exposure prophylaxis (PEP) across all 20 districts, while continuing mass dog vaccination and integrated human-animal surveillance. Cross-border coordination with Indian states is also being strengthened to protect the achievement. “Bhutan's success shows that the health of humans, animals and the environment we share is inextricably linked,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. He added that the fight against rabies is won by bringing health workers, veterinarians and communities together rather than working in silos.Also read: Fact-Check Rahul Dua’s Cancer Claims: Immunotherapy Isn’t Always Better, ‘Superfoods’ Don’t CureWhat Can India Learn From Bhutan? In terms of rabies eradication, India has made progress, but the burden remains substantial. WHO estimates that 5,726 people die from rabies in India every year, based on an ICMR-National Institute of Epidemiology study. Around 9.1 million animal bites occur annually, with more than three-quarters caused by dogs. The Indian government’s National Rabies Control Programme also states that around 96% of rabies mortality and morbidity is associated with dog bites. India already has systems in place that could help with elimination of rabies. The Animal Birth Control Rules, 2023 provide for sterilisation and vaccination of stray dogs, while the National Rabies Control Programme focuses on ensuring access to PEP for people exposed to animal bites. Bhutan’s experience shows that rabies elimination cannot depend only on giving vaccines to people after bites occur. Vaccinating dogs, controlling dog populations, strengthening surveillance, ensuring rapid access to PEP and improving community awareness have to work together. Dr Soneet Yadav, ER Consultant, Ruby Hall Clinic, Pune, told HealthandMe, "Rabies keeps claiming lives mainly because people wait long for post‑exposure treatment and because we do not control Rabies in stray and free‑roaming dogs well. To get rid of rabies, India must use a coordinated "One Health" plan that brings together health workers, city officials, vets and animal‑care groups.” He added, “The important goal is to make sure many dogs get vaccinated all the time while we also run birth‑control programmes and keep a tighter watch on animal‑bite incidents. In hospitals in rural and underserved areas, anti‑rabies shots and Rabies Immunoglobulin (RIG) should always be available. I think people need to hear that every suspected Rabies exposure means they must go to a doctor fast.”Also read: Newborn’s Nail Infection Leads Doctors To Aggressive Brain Tumour: What Are Glioblastoma's Symptoms In Babies?What You Should Do Immediately After A Bite?                Rabies is one of the few diseases with a 99.9 per cent fatality rate once symptoms appear. It starts off with flu-like signs: fever, fatigue, and maybe a horrendous headache. But things escalate quickly. You can suffer from hallucinations, paralysis, seizures, hydrophobia, and eventually coma. Once the virus reaches your nervous system, modern medicine will not be able to help you as there is no cure. But rabies is 100 per cent preventable if treated in time. The moment you realise you have been licked, scratched, or bitten by an animal, especially one that is unvaccinated or unknown, Dr Yadav recommends the following things: Wash the wound thoroughly with soap and running water for at least 15 minutes.Apply antiseptic like iodine or alcohol.Avoid putting chilli, turmeric, oil or other ingredients on the woundRush to a doctor; do not wait for swelling, itching or any other sign. You will need a post-exposure prophylaxis (PEP) shot, which includes a course of anti-rabies vaccines and sometimes immunoglobulin injections.Keep a record of the animal if possible. If it is someone’s pet, you will want to confirm their vaccination history. 

bhutan eliminates rabies while india battles persistent deaths: what can india learn from its neighbour?

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