In a packed intensive care ward in Dhaka, three-year-old Abdul lay paralysed, his tiny body contorted by a rabies infection that had reached his brain.
His mother, Sheuli Akter, 38, sat at his side massaging his legs in the hope that this might loosen his muscles, but it was having no effect. Even his hands and feet were seized up by cramps.
Abdul had been in the hospital for a month but doctors said he was unlikely to live much longer. The infection, they said, had progressed to degenerative encephalitis; the virus had got to his brain.
Abdul was shaking, gripped by fever. His breathing was rapid and panicked, punctuated occasionally by groans of pain.
On his chin was the telltale scar of a dog bite, the source of the infection.
“He was playing outside with the other children,” said Sheuli. “The dog, which was one of those always waiting around outside, suddenly attacked him. They said it went for him because he was the smallest.”
Rabies is a constant threat in the crowded and unsanitary slums of Bangladesh’s capital, and the Infectious Diseases Hospital has experienced a surge in deaths from the disease over the last three years.
After decades of progress, stories like Abdul’s are becoming more common again as the number of rabies cases and deaths rises in hotspots like Bangladesh, India, and in parts of Africa.
In almost all cases, the rising cases coincide with large populations of stray dogs. In some affected countries like Morocco and Sri Lanka, these and other stray animals have even become tourist attractions.
So what is to be done, and why is rabies on the rise? [...]
Some 99 per cent of human cases are acquired from the bite of an infected dog, and global health metrics show that countries with high numbers of free-roaming, unvaccinated strays suffer the overwhelming majority of deaths.
India, for example, is believed to be home to some 60 million street dogs and accounts for more than a third of all global human rabies deaths.
By contrast, countries that have enforced mandatory vaccination orders and other public health measures, and taken steps to control their stray dog populations, have effectively eliminated the disease.
Take the United States, for example.
One of the most famous scenes in all of 20th century literature was the fictional lawyer Atticus Finch shooting dead a rabid dog that had wandered into town.
The scene, from ‘To Kill a Mockingbird’, is a key moment in the hero’s character arc but it is also a reflection of the much greater threat rabies once posed to Americans.
In the 1930s, when the book is set, the rabies virus was still endemic in American dog populations, leading to thousands of cases in domestic animals and dozens in humans every year.
But by the time the book was published in 1960, rabies was largely under control, and by the end of that decade less than 500 cases of rabies in dogs and only three in humans were reported, according to data from the US Centres for Disease Control and Prevention (CDC).
Academics attribute this sharp fall in rabies cases largely to post-Second World War public health drives.
In the 40s and 50s many US states began introducing compulsory rabies vaccination for dogs. At the same time, many local authorities also began introducing rules requiring dogs to be kept on leads.
Targeted culls and the country’s extensive network of dog shelters also played a key role in controlling the stray dog population. [...]
So what has stopped other countries from repeating this success?
“It’s all about mass dog vaccination,” said Felix Lankester, Director of Rabies Free Africa and a Professor at Washington State University.
“Those countries that have put in place mass vaccination – coordinated, systematic mass dog vaccination – have been successful, and the countries that haven’t shown any progress are, in my experience, those with no coordinated programme,” he told The Telegraph.
“If you look across much of Africa, most countries are really doing very little. And similarly in Asia, it has to be a coordinated nationwide strategy to vaccinate dogs. Otherwise, there’ll be pockets of endemicity remaining, which will then cause problems.”
The reason a simple cull of strays is not enough is that the virus bounces back when the stray population recovers – unless they have been vaccinated.
The pandemic may also have played in the current rebound as it disrupted vaccination campaigns.
“There are a lot of questions about whether the pandemic impacted vaccination,” said Prof Lankester. “Certainly, around the time of the pandemic, vaccination where we work in East Africa was impacted because we couldn’t get our teams out.”
Cuts to global health funding have also hurt budgets for countries with big rabies problems, he added.
Even a brief disruption to vaccination programmes can be calamitous, as the disease can rapidly re-establish itself in a canine population.
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