Why Are Children Still Dying of Rabies in India?

In early April 2025, in quiet Kunnicode in Kerala’s Kollam district, seven-year-old Niya Faisal was bitten by a stray. Her parents did not delay. The bite was washed. The hospital visit was swift. The full course of post-exposure prophylaxis—five anti-rabies vaccine doses and immunoglobulin—was administered. And still, 22 days later, Niya died. In the final hours, as hydrophobia set in and convulsions took hold, the SAT Hospital in Thiruvananthapuram could only confirm what the virus had already declared.

Niya’s death was the eleventh rabies fatality reported in Kerala in just four months of 2025. Three of those were children. All had received the vaccine. It was not supposed to happen. Rabies is one of the few viral diseases where medicine knows the answer. There is a vaccine. There is a window—short but definite—in which to administer it. And there is a playbook, written in thousands of papers and guidelines, on what to do next. But what happens when the protocol is followed and still the child dies? That is the question now being whispered in Kerala’s hospitals and demanded in its assembly.

Doctors in the state are calling for what was once considered excessive: pre-exposure rabies vaccination, especially for children in high-risk zones. “We cannot wait for the bite anymore,” says Dr Sundar Krishna, a paediatric infectious diseases specialist in Bengaluru. “If this trend continues, we need to flip our approach.”

This shift—from reactive to preemptive immunisation—is no small thing. It means acknowledging that the infrastructure to manage India’s stray dog population is no longer just inadequate. It is dangerous. And that the state cannot outpace the virus with catch-up medicine alone.

India has seen a more than 2.5-times jump in rabies deaths since 2022, with over four people dying each month in 2024. The numbers are still far below historic estimates—studies such as the Lancet Infectious Diseases paper peg the actual number at around 5,700 deaths annually, many of them unreported in rural districts. But even the government’s conservative figures suggest that something is wrong.

Kerala is not the only state reporting an uptick. Karnataka registered 12 rabies deaths in the first quarter of 2024 alone, alongside more than 1 lakh reported dog bite cases. In comparison, Tamil Nadu reported only two rabies deaths over the same period, presumably due to the aggressive vaccination drives and tighter dog sterilisation protocols in urban zones like Chennai and Coimbatore.

Goa, often overlooked in national health metrics, has become a quiet success story. In 2018, it became the first Indian state to report zero human rabies deaths, following a joint initiative between the state government and the global NGO Mission Rabies. The programme included door-to-door awareness campaigns, GPS-tracked dog vaccinations, and a real-time bite response network. Goa’s model is not perfect—but it is functional, and, crucially, replicable.

Children account for 30% to 60% of all rabies deaths in India. Kids are more likely to be bitten in high-risk areas—playgrounds, school compounds, gullies where the garbage doesn’t get picked up. They are more likely to miss telling adults about a minor nip or scratch. And their smaller bodies make the virus’ journey to the brain quicker.

In Niya’s case, the bite was not minor. But the outcome has re-sparked an urgent conversation about the quality of the vaccine itself. Several experts, including senior clinicians at Kerala’s Government Medical College, have suggested that some batches of the rabies vaccine may be compromised by cold chain failure, a recurring issue in India’s sprawling public health supply system.

The stray dog population in India is now estimated at over 62 million. Sterilisation rates are abysmally low. The Supreme Court’s orders to balance animal rights with public safety have been interpreted—by state governments, municipalities, and street-level enforcement—as a bureaucratic riddle rather than a mandate.

In 2022, India formally committed to the Zero by 30 global goal of eliminating dog-mediated human rabies deaths by 2030. It launched the National Action Plan for Dog-Mediated Rabies Elimination (NAPRE), which outlines intersectoral coordination between urban local bodies, veterinary departments, and health agencies. But while the roadmap is sound, the terrain on which it is deployed is uneven.

In districts like Pathanamthitta and Idukki in Kerala, not a single sterilisation was carried out in 2023, according to the state’s own data. Waste management remains broken. People feed strays but fear vaccinating them. Local bodies plead budget constraints. And in the meantime, children are dying of a disease eradicated in much of the developed world a long time ago.

Unlike tuberculosis, which incubates in poverty, or malaria, which comes with the rains, rabies is a public health crisis that thrives on indifference. It is as much a governance issue as a medical one. A dog bite turns into rabies not because the pathogen is clever, but because the system is disjointed.

Doctors now find themselves asking for unlikely things: immunity in advance, for children, for sanitation workers, for people living near garbage dumps or temple steps. Some want rabies added to India’s national immunisation schedule in endemic districts. Others argue for a stronger legal framework to make local bodies responsible for both the dog population and cold-chain compliance.

Meanwhile, on WhatsApp groups and local television, Niya’s story plays out in miniature. Her parents—stunned, grieving—have asked the government for answers. None have been forthcoming.

 

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