THE past several weeks have exposed Sindh’s weak governance. On Dec 15, a large number of patients and their families arrived at Indus Hospital’s Rabies Prevention Centre (RPC). A dog, frothing at the mouth, had run amok in Juma Goth in Karachi’s Korangi district, mauling men, women, and children, as well as chickens, cats, and dogs.

The scene in the RPC was hellish. Frightened children screamed and wailed, bleeding from gashes on cheeks, lips, and eyelids, and torn earlobes. Adults had deep lacerations on arms and legs. Announcements in mosques called up more victims, and by the next morning, the total count reached 28. The team of nurses and doctors worked around the clock under the able command of the clinic manager, flushing and washing each wound with soap and water, infiltrating rabies immune globulin (RIG) into the wounds, and injecting vaccine into arms, ensuring no patient would suffer fatal rabies.

The pharmacy supplied vaccine and RIG without interruption. Each patient was registered, and demographic, wound, and treatment data were entered into the electronic database. All returned to complete the vaccine series, while many are seeing the plastic surgeon for wound repair.

Such episodes occur periodically and are reported in the press until the outcry subsides. Patients who acquire rabies from untreated wounds die in their hometowns, as there is no hope of survival. Nine such patients arrived at Indus Hospital over 10 months, and at least four more called from distant cities. These deaths could have been averted had treatment been administered promptly and correctly at the time of injury.

Only a collaborative effort can control rabies.

Our collaborative research in 2023-24 with Erasmus University in the Netherlands yielded a shocking result: we tested 100 fresh, unwashed, untreated deep wounds inflicted by stray dogs. Most victims were from the Korangi district. PCR results for the rabies virus were positive in 64 per cent of samples, while control samples were negative. This proves beyond doubt that the risk of rabies from stray dogs in Karachi is exceptionally high, and we are bound to see an escalation of rabies among people and in random dogs, which will further perpetuate this dangerous disease in the population.

No discipline of medicine owns rabies; neither the physician, surgeon, nor the veterinarian does. Municipalities, public health advocates, and animal rights activists are at loggerheads. Controlling this neglected disease is unlike controlling other infectious diseases. It involves a sentient four-legged animal that can be a friend or a foe. The community is frustrated and wants a rapid end to the population, while friends of canines want to see them happy and healthy. The two factions do not agree on a via media, and neither offers a feasible long-term solution.

There are caveats to treatment after a bite; the first is the lack of expertise among health professionals. In a rapidly changing scientific landscape, new modalities are overlooked, and obsolete methods are used. Those who are up to date report that treatment options are unavailable. These accidents occur mainly among the poorest, for whom purchasing the vaccine and RIG is prohibitive.

To further complicate treatment, a few high-quality vaccines are imported, while several untested vaccines enter through dubious channels. Rabies is too serious a disease to be prevented with substandard vaccines. Equine RIG, developed from horse serum, is life-saving but has not

yet been listed as an essential drug by DRAP. Rabies Monoclonal Antibody, a substitute for RIG, is used effectively in many countries. We hope we will, too.

WHO has slated rabies to be eliminated globally by 2030 — just four years away. It is ready to assist any country with political will and sincerity. GAVI offers a high-quality rabies vaccine at a nominal cost, but Pakistan has not responded to this generous offer. It is time to act now. I suggest establishing a ‘Cell for Rabies Prevention’ under the aegis of the provincial government and administered by relevant personnel. It should draw membership from physicians, veterinarians, civil society, animal rights activists, dog owners, communities, the pharmaceutical industry, and philanthropists. The debate should address vaccination and population-control solutions, as well as the intricacies of post-bite treatment.

Rabies has been eliminated or significantly reduced in several countries where governments have implemented targeted interventions. In Pakistan, where myriad issues beg attention, rabies is nowhere on the radar. Meetings with busy health officials are unproductive; funds are tied up in flood relief and vehicle purchases. Yet, I am confident that the communities’ challenges can be mitigated through sincere, concerted effort from all quarters.

The writer is a member of WHO Expert Panel for Rabies.

Published in Dawn, January 1st, 2026