No unified strategy to fight rabies so far

ISLAMABAD: Pakistan shares space among those South Asian countries where rabid dog-bite cases and the resulting fatalities, mainly among children, seem to be a never-ending show. With approximately 300,000 cases of dog bites per year, Pakistan has yet not decided a unified strategy to combat the lethal disease.

On the one side, NGOs and different animal-related departments are busy sterilising rabid dogs, and on the other, the provincial governments are carrying out stray-dog culling campaigns. The two campaigns, both polls apart, have left no considerable change in controlling rabid dogs and dog-bite cases in the country.

Apart from Balochistan, which contains a lower population of stray dogs, rabies and cases of dog bites are a cause of concern for every province. Out of all provinces, Sindh’s condition of rabies and dog-bite cases is the worst. Sindh registered around 200,000 dog-bite cases in 2020, while Punjab registered 19,000 such cases in 2019. Khyber-Pakhtunkhwa registered 14,000 dog-bite cases in the first four months of the current year. The data gathered by The News from different sources showed that over 300,000 dog-bite cases were reported in a year in Pakistan.

The number of deaths, caused by rabid dog bite, was however not known yet, as a large number of cases went unreported. A survey conducted by The News revealed that most people were unaware of the risk of rabies when bitten by rabid dogs, and they did not seek the right treatment for its prevention. It caused more deaths due to rabies across the country. Most of the clinical staff in the country also lacked expertise regarding the treatment of rabies, called 'Post-exposure treatment'.

The exact population of stray dogs in the country is also not known. However, The News came to know from official sources the total number of stray dogs in Punjab stood at around 470,000 in 2019.

With worsening situation of rabies in the country, experts suggest that a unified strategy must be adopted by all provinces to counter the deadly virus. Adequate supply of anti-rabies vaccines in all clinics, sterilization and birth control system of stray dogs and awareness regarding post-exposure treatment among the public and local clinics are the three major steps that need to be focused in Pakistan to make it a rabies-free country.

The World Health Organisation (WHO) and other relevant international institutions have rejected the idea of culling stray dogs to prevent rabies. Instead, they stressed countries to control rabies by managing dog population and sterilizing them. According to the WHO, these steps are not only environment friendly, but also cost effective.

According to a report, published by the International Organisation of Animal Protection (OIPA), more than 50,000 dogs die every year on streets of Pakistan, and the government also orders mass killing and poisoning of stray dogs in all cities of the country.

The News conducted an investigation and found that Punjab is making the most efforts to eradicate rabies. The provincial government is all set to implement its ‘Stray dog population control policy’, introduced recently by the departments concerned, in the first week of July 2021.

The Punjab Local Government Department will provide its resources for sterilization of dogs in which the Livestock and Dairy Development Department Punjab and other agencies will give their full support, it was decided in a meeting, chaired by the chief secretary, The News learned.

Pakistan Veterinary Council President Prof Masood Rabbani told this correspondent that the newly introduced policy is expected to be implemented in the first week of July in Punjab. The official said that the province had finally moved from killing of stray dogs to stray dog population management. He said Rs74 million had already been released by the Health Department Punjab for the purpose. Even before implementation of the policy, around 6,000 stray dogs had been vaccinated in Punjab, added Masood.

Prof Masood said that a recently held meeting, chaired by Punjab Chief Secretary Jawad Rafique Malik, decided that killing of any animal with cruelty would be punishable with Rs50,000 fine and three months imprisonment. In efforts to sterilize stray dogs, Punjab has adopted the Turkish model to reduce the stray dog population, instead of shooting or poisoning them, added the official. He said the exercise of TNVR (trap, neuter, vaccinate and release) to control the population of stray dogs has already been started in Punjab. District monitoring committees and tehsil implementation committees have also been formulated for effective implementation of the new policy.

Prof Masood said the total population of stray dogs in Punjab is over 460,000 and it could cost the Punjab government around Rs350 million to vaccinate them. “If the TNVR is carried out across Pakistan to control rabies and stray dog population, it could cost the government over 600 million rupees,” added Prof Masood.

According to sources, Peshawar city is also working on a plan to vaccinate all stray dog, there is no plan to launch the project across Khyber-Pakhtunkhwa province yet. When contacted, Dr Ikram, ADG Services KP, told The News that around 1,500 stray dogs were captured recently and vaccinated by the Livestock Department in Peshawar. He said that 15,574 dog-bite cases were reported in the first four months of this year. The official hoped that after Peshawar, the project would be extended across the province.

In Sindh, over 150,000 dog-bite cases had been reported in the year 2021 till date, noted a news report published earlier. Dr Naseem Sallahuddin, head of Department of Infectious Diseases in Indus Hospital, the chairperson of the Rabies-Free Pakistan campaign, and a member of the WHO team working against rabies, told this correspondent that there was a chaos-like situation due to dog-bite cases in Sindh.

Dr Naseem said that they started the Rabies-Free Pakistan campaign in 2018, and got over 30,000 stray dogs vaccinated with over 3,500 dogs castrated. In addition, she said that they also held training sessions for the local clinical staff regarding the Post-exposure treatment and also tried to ensure steady supply of anti-rabies human vaccines in some areas.

However, she noted with grief that the dogs vaccinated through months of hard work were all killed by the government of Sindh in February.

She said only their department was treating hundreds of rabies patients on regular basis. Around 200 dog-bite cases occur only in Karachi daily, added Dr Naseem. According to a newspaper report, almost 11,000 dog-bite patients were treated at the Jinnah Postgraduate Medical Centre in Karachi in 2019. She said the biggest issue in Pakistan was unavailability of trained clinical staff in hospitals to deal with rabies cases. She said Rabies Immune Globulin (RIG) vaccine is absent in nearly half of the clinics and the remaining ones which have the supply, their staff is untrained and unprofessional.

The News also contacted Director General Health Sindh Dr Irshad Memon, who denied that there was any negligence on part of the government. About supply of RIG vaccine across the province, he said the Sindh Health Department had demanded the NIH to provide vaccines for the year. Out of total 300,000 doses, half had already been distributed among the local clinics. However, he insisted that their duty was only to supply vaccines when needed, and they could not force clinics to take RIG vaccines.

Recently, Sindh health minister supported the idea of culling dogs. The News tried several times to contact her but failed. However, Irshad Memon, when asked, said that in order to avoid their attacks on little children, the government must kill them. "How can you value a life of a stray dog over an innocent child," said Irshad Memon.

NIH Executive Director Maj-Gen Dr Aamir Ikram told The News the problem of rabies could only be resolved through a collaborated effort by all provinces. He declared the idea of culling of stray dogs ineffective and suggested implementation of the WHO guidelines on the issue. Taking cue from Malaysia, Turkey and Indonesia, Pakistan could also make its land free of rabies if a unified effort was made on part of all provinces. Only consistent efforts would prove effective in overcoming the issue, the NIH executive director said.