Eliminating rabies: understanding sociocultural ethos can help achieve zero by 2030

Every day at sunrise, Rani leaves the shelter that a road-side mechanic arranged for her and her puppies when she was abandoned by her owner due to her pregnancy. First, she goes meet the old couple who always drops off some biscuits to her on their morning walk to the temple.

Before the streets are cleaned up, Rani looks for some leftovers in a garbage heap. Other dogs and some malnourished cows are competing for the same food and a violent skirmish breaks out among the canines. Around lunch time, she spots the dead body of a horse dumped in a field. Then, she moves on to inspect the train tracks looking for faeces from train toilets or people living in the nearby slum, where latrines are insufficient.

At dinner time, she swings by the crowded local market. Several customers and sellers shoo her away, but the baker and the butcher allow her to eat some of their scraps. They notice something strange in her behaviour, but they move on with their busy lives.

As Rani goes back to her puppies for the night, she suddenly bites Ajay, a kid who is falling asleep on the pavement where he lives with his family. The wound on his arm does not look too bad and the family does not have easy access to water, so his parents simply wrap up his wound. The day after, a neighbour suggests applying some chili powder and to visit the local healer. Rani dies that night, but no one notices.

Several weeks later, Ajay starts to complain about itch at the wound site and his parents bring him to a government hospital. The queue is too long and Ajay’s father will lose his job if he arrives late. So, they go to a private clinic. Immunoglobulin is not available, but the post-exposure vaccination is on sale at a nearby drug store.

Ajay’s father manages to buy it and his son receives his first shot. Some days later, while his father tries to collect the money for the second shot, Ajay’s health quickly deteriorates. Doctors tell his family that nothing can save the kid’s life.

Ajay dies of rabies on the pavement where Rani bit him. 

The sociocultural context of rabies through the One Health lens

Millions of animals live in the streets of India. The rabies virus circulates among them and from them to people, particularly those living in poverty.

It is estimated that about 21,000 human lives, a third of the global burden of rabies, are lost to rabies every year in India. Dogs are the most common source of infection.

The Global Framework for the Elimination of Dog-Mediated Human Rabies currently used by the WHO, the OIE, the FAO, and the GARC centres around the five pillars of rabies elimination, the first of which is sociocultural (followed by technical, organizational, political, and resources).

This pillar acknowledges the key role of at-risk communities as stakeholders in rabies control and the influence of the sociocultural context on rabies perceptions (for example on bite prevention and treatment, post-exposure prophylaxis, etc.) and dog-keeping practices (for example on dog ownership, dog population management, dog vaccination, etc.).

Assessing the social pathways and drivers of disease transmission, the factors that shape people’s health seeking behaviours, and the barriers to healthcare at the local level is an essential component of any infectious disease control plan.

In the case of zoonoses like rabies, this assessment must necessarily include the human-animal relationship and consider how people live alongside animals and how they approach animal and interspecies health issues.

It is unlikely for any rabies control intervention to succeed in the long-term if insufficient attention is devoted to the complex and culture-specific web of factors that bring people into contact with animals and create favorable conditions for the rabies virus to thrive.

Diseases, and infectious diseases, cannot be controlled only with biomedical knowledge, because their social component is an integral part of them. Also, no single model of rabies control can be expected to be successful in all communities, as every society experiences rabies in a different way.

Contribution from anthropology and other social sciences is critical for an in-depth understanding of the different sociocultural landscapes of dog-mediated human rabies that exist around the world and for the One Health strategy to successfully eliminate this disease by 2030.

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Source: Rabies in the Streets: Interspecies Camaraderie in Urban India - Deborah Nadal - 2020 (https://muse.jhu.edu/book/74893)
Pictures: Deborah Nadal