The 'rabid' spectre that stalks Pakistan

Lacks of testing facilities, ineffective vaccines have combined together to make rabies challenge a ticking time-bomb

ISLAMABAD: The tragic death in Larkana of a pre-teen boy, whose final gasps in his mother arms were caught on video that circulated widely on social media, has for the moment brought rabies back into the country’s focus.

But as debate continues on whether a lack of awareness on part of the boy’s parents or a shortage of vaccines led to the heart-rending episode, experts and medical officials have highlighted several factors that suggest the country’s rabies challenge may in fact be a ticking time-bomb.

Although easily preventable by the timely administration of vaccines, according to estimates, rabies continues to claim between 2,000 and 5,000 lives every year. The lack of rabies testing facilities and a reliance on cheaper vaccines sourced from China, which experts say are largely ineffective, has come together to ensure that the spectre of the deadly virus continues to haunt Pakistan.

The rabies virus, as deadly as it is for both humans and other animal species, cannot be transmitted directly. The virus is spread when an infected animal scratches or bites another. The infected animal’s saliva, in particular, is considered highly contagious when it comes to rabies.

Upon being bitten, individuals who contract rabies usually develop symptoms six weeks after contact. Early symptoms can include fever and tingling at the site of exposure. These are then followed by violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. Once these symptoms appear, the result is nearly always death.

Although most mammal species can carry the disease, in Pakistan dogs are considered the main vector for the rabies virus. Punjab’s health department, in particular, has linked a rise in rabies cases to the growing number of dogs. As such, it has recently issued orders to expedite the culling of stray dogs. The dispatch, issued by the Punjab Health Services director general, not only insisted that shooting or poisoning stray dogs is the cheapest, most effective solution to contain the spread of the disease, it also directed staff tasked with carrying out the exercise to maintain a visual record of the animals they kill in their report.

Contradictorily enough, department officials have admitted that dog culling campaigns in the past have largely been ineffective with dog numbers increasing shortly after such drives were carried out.

Local and international NGOs have also termed the government’s culling policy to be completely unbeneficial, not to mention inhumane. Experts explained that once a pack of dogs which inhabits a particular area is eliminated, a different pack takes over the niche thriving on the territory and resources left behind.

“The only long term solution for rabies is to vaccinate and neuter stray dogs, as is observed in other countries worldwide,” said Aiza Haider, who works for an animal welfare NGO in Lahore. She said ad hoc measures, like the ones being carried out by the Punjab government, would hardly make a dent on the challenge to contain rabies.

”We have forwarded our recommendations discouraging such cruel policies to the government time and again, but to no avail,” Aiza said. She added that the Punjab Animal Health Bill 2019, which is aimed at curbing animal-borne epidemics, also remains unapproved.

Rabies Control Programme Manager Dr M Aftab Gohar, meanwhile, expressed deep concern over the non-availability of rabies test facilities. He pointed out that incidents of rabid-dog bites are most prevalent in low-income areas. As such, those less well off are more exposed to the deadly virus than those whose economic condition is much better. “Because those who contract rabies usually tend to be poor, the issue is seldom reported in media,” he lamented.

Dr Gohar also pointed out that life-saving anti-rabies vaccines are also by and large unavailable at public hospitals due to limited provision by the state, placing the poor at an even greater risk of dying from the viral disease. “A single dose of rabies immunoglobin used to treat the disease costs around Rs900 at private health facilities. This is prohibitively expensive for any poor individual who suffers from the disease,” he said.

Even when available and administered timely, the effectiveness of the vaccines currently being supplied to Pakistan has drawn significant concern from medical experts. Though vaccines from Europe have been proved to be the most effective against rabies, their high-cost price tag has put them beyond Pakistan’s reach. The second-choice Indian vaccines had proven to be significantly effective but ever since the Indian government stopped exporting them on grounds of excessive internal demand, ineffective Chinese vaccines have been the only available alternative for the Pakistani public.

When contacted, Prime Minister’s Adviser on Health Dr Zafar Mirza insisted that there is no shortage of anti-rabies vaccines in the country. He also stressed that the government is fully aware of the gravity of the rabies challenge in Pakistan. In this connection, he said the government is planning to raise awareness by observing the World Rabies Day, which falls today.