From Goa’s Gold Standard to the Heartland’s Hurdle
India’s rabies crisis is a map of extremes: Goa has achieved zero-death status through rigorous vaccination, while high-burden states like Uttar Pradesh still face hundreds of annual fatalities. Elimination is no longer a scientific question, but a matter of geography.
To convey the heterogeneity of India’s rabies landscape, three state case studies – Goa, Kerala, Uttar Pradesh – illustrate that elimination is technically feasible, but implementation is uneven.
Goa: proof of concept for elimination
Goa is India’s clearest demonstration that mass dog vaccination + strong human PEP + surveillance can drive human rabies deaths to zero.
- From 2013 onwards, Goa, in partnership with Mission Rabies and other partners, launched state‑wide dog‑vaccination campaigns, often vaccinating >60,000 dogs in a few weeks using smartphone‑enabled teams.
- By 2017, the state recorded its first year of zero human rabies deaths; by 2019, Goa had two consecutive zero‑death years, meeting WHO criteria for canine‑mediated human rabies elimination at state level.
- In June 2021, Goa was officially declared a “Rabies Controlled Area”, with a shift from elimination to maintenance mode – border surveillance, community engagement, and periodic vaccination to prevent re‑introduction.
- High dog‑vaccination coverage (≥70%) sustained year on year.
- Robust human PEP access, with rabies clinics and stock monitoring.
- Education programmes in schools and communities, teaching children about dog behaviour, safe interaction and wound care.
- Integrated surveillance, including lab confirmation of suspect dogs and mapping of bite incidents.
Goa answers a crucial sceptical question: “Can India really eliminate rabies?” Goa shows yes – if political will, partnerships and long‑term investment align.
Kerala: surveillance and PEP completion as force multipliers
Kerala offers a different but complementary model: intensive surveillance and very high PEP completion, even amid political disputes over strays. The state has:
- A relatively strong primary‑health network, ensuring that most bite victims can reach facilities with vaccines.
- Rigorous reporting of bites and suspected rabies through IDSP and state systems.
- High PEP completion rates (>90%) in many districts, sharply lowering the proportion of bites that progress to disease.
Kerala has still experienced controversial episodes – including dog‑bite spikes and localised culling debates – but from a rabies‑mortality perspective, its combination of health‑system strength and surveillance discipline has kept deaths low compared with high‑burden states.
Uttar Pradesh: the archetype of persistent high burden
In contrast, Uttar Pradesh (UP) remains one of India’s epicentres for dog bites and, by extension, rabies risk.
A 2025 state‑wise geospatial analysis of dog‑bite burden found that UP, Bihar and Maharashtra consistently reported the highest absolute numbers of dog‑bite cases between 2018 and 2023, with UP alone recording several hundred thousand dog‑bite incidents annually. In 2018–2023 maps, UP is repeatedly in the darkest‑burden band, reflecting both large human population and extensive stray‑dog presence.
Multiple sources, including state statistics and national reviews, indicate that UP continues to report hundreds of suspected human rabies deaths each year, far above Goa‑ or Kerala‑level outcomes. Contributing factors include:
- Vast rural population with lower health‑facility density.
- Delayed or incomplete PEP due to distance, cost and awareness barriers.
- Insufficient dog‑vaccination and ABC coverage, with limited integration between animal‑ and human‑health sectors.
This three‑state contrast underscores a key narrative point: India does not have one rabies story; it has many, and policy must be tailored to state‑level starting points.
– Prakash Desai
