A new study suggests that expanding dog vaccination programs is a more effective and affordable strategy for eliminating rabies deaths in Kerala, India, compared to introducing routine pre-exposure rabies vaccines for children. The research, led by the University of Glasgow and involving multiple institutions in India and the UK, was published in The Lancet Regional Health - Southeast Asia journal. It highlights that while pre-exposure vaccination for children could be costly and prevent relatively few additional deaths, increasing the number of vaccinated dogs could significantly reduce human rabies deaths at a much lower cost. According to the study, if 70% of the dog population in Kerala were vaccinated, the number of rabies-related human deaths could drop to nearly zero within three years. The researchers also found that the actual dog population in the state may be much higher than previously estimated. Their analysis of rabies surveillance data suggests that the number of unowned dogs—those not kept as pets—could be about five times larger than official estimates. This implies that current vaccination efforts may be reaching only a fraction of the total dog population, limiting their effectiveness. The study also explored the potential cost savings of switching to a one-week post-exposure prophylaxis (PEP) regimen, which is recommended by the World Health Organization. This change could save around $6.3 million (INR 580 million) over a 10-year period without increasing the risk of death. Researchers emphasized that while pre-exposure vaccination for children might still be useful for high-risk groups, such as those in remote areas with limited healthcare access, the most effective way to prevent rabies deaths is through sustained dog vaccination and maintaining access to post-exposure vaccines. Martha Luka, the lead author of the study from the University of Glasgow, noted that rabies deaths are entirely preventable and that Kerala has already made significant investments in human rabies prevention. However, avoidable deaths still occur annually, and the research shows that focusing on dog vaccination is a more efficient use of resources. Katie Hampson, a professor at the University of Glasgow, added that underestimating the number of unowned dogs makes it harder to achieve the vaccination coverage needed to stop rabies transmission. She emphasized the need to improve dog population estimates and find better ways to vaccinate unowned dogs. Professor Zinia from Kerala highlighted that the same barriers that prevent people from accessing post-exposure vaccines may also hinder the uptake of pre-exposure vaccines. She argued that eliminating rabies at its source through dog vaccination is a more equitable and effective approach, especially for marginalized communities. The researchers stressed that their findings do not rule out the use of pre-exposure vaccines entirely but suggest that they should be reserved for specific high-risk groups, while the broader strategy should focus on mass dog vaccination.