Kerala's Rabies Battle: Dog Vaccinations Outperform Child PrEP in Life-Saving Impact

A new study is shaking up how Kerala plans to fight rabies, suggesting that vaccinating dogs is a far better way to save lives than giving routine pre-exposure vaccines to children. Published in The Lancet Regional Health - Southeast Asia, this groundbreaking research indicates that getting 70% of dogs vaccinated could bring human rabies deaths in the state to almost zero within just three years. This shifts focus significantly from previous debates about vaccinating children before any exposure. Kerala has been grappling with a serious rabies crisis, reporting 33 human deaths in 2025 and 28 so far this year, despite providing free post-exposure treatment to nearly one million people annually. The study found that routinely giving children Pre-exposure Prophylaxis (PrEP) for rabies would prevent very few additional deaths – less than 10 over a decade – while costing millions. Worryingly, diverting funds from dog vaccination to this child PrEP could even lead to hundreds more deaths, highlighting a critical need to re-evaluate current strategies. The state also faces a major challenge with a stray dog population potentially much larger than official numbers, making widespread vaccination efforts tricky but crucial. With these findings, Kerala public health approach is set for a major rethink. The government is already stepping up its efforts in stray dog management, recently approving Standard Operating Procedures (SOP) for the humane euthanasia of rabid or dangerous dogs, following a Supreme Court order. This focus on tackling rabies at its source – the dog population – through mass vaccination and improved stray animal control looks like the most effective path forward for the state to achieve its 'Zero by 30' goal against this deadly disease.