A government doctor in Himachal Pradesh created history when his cheap rabies treatment protocol was adopted by the WHO
Omesh Bharti, 50, is a real-life superhero. His commitment to his profession and selfless service is exemplary. A government doctor in Himachal Pradesh, Bharti made history when the World Health Organisation (WHO) recently adopted his low-cost treatment for rabies, describing it as revolutionary. Indeed, it’s revolutionary for the cost of treatment would reduce by one hundredth—a Rs 35,000 treatment per patient would now cost merely Rs 350. This is significant, as globally more than 59000 people die every year of Rabies, one third of them in India.
Behind this extraordinary success is an unassuming man who is passionate about what he does. Bharti belongs to a humble family; both his parents were government teachers who were transferred to inaccessible parts of Himachal every other year. “I grew up in remote areas, forests, wherever my parents would be transferred. My parents inspired me to live a disciplined life,” says Bharti.
In 1992, he finished his MBBS from a medical college in Shimla. He was inclined to social service. Soon after he became a doctor, joined an NGO, Himachal Gyan Vigyan Samiti, to help spread literacy. He travelled extensively in the hill state, was face to face with a sordid reality, many die an avoidable death due to snake or dog bite. Hospitals weren’t equipped, and if some were, many of the poorer folks couldn’t afford the treatment. It was not just the cost of vaccination, but for treatment people had to hire a taxi to travel from Lahaul and Spiti all the way down to Kasauli, some 200 kilometres. Bharti realised that deaths due to dog or snake bite was quintessentially a problem of the poor and the neglected. This was not acceptable to him.
In 1995, he joined Jan Swastha Abhiyan, a national level NGO, committed to providing cheap medicine to the deprived sections of the society. It was around this time that Bharti started his own research to provide viable treatment to poor against rabies. There are two ways of dealing with a dog/monkey bite, he explains, either by vaccination, Rabies immunoglobulins (RIM), within seven days or by injecting serum soon after the dog attack. Vaccination done intradermally (via skin) is more effective than intramuscular (on muscle), and the former costs five times less that the latter.
WHO and Government of India issued directives to use intradermal techniques, but was not implemented for a long time. Bharti was a lone crusader for it. He had to face all kinds of inertia, he was even laughed at when he proposed the idea by fellow doctors and seniors weren’t ready to do things differently. “Nobody seems to be willing to provide cheap treatments options to the poor,” recounts Bhrati. Despite stiff resistance, he persuaded a senior to allow him to try new protocol. He went to Bangalore to get trained and in turn many doctors in Himachal to administer intradermal treatment. in 2007, he developed the ‘pooling method of using vials’ between four patients using intradermal method that was appreciated by the WHO as a significant step towards ensuring access to cheap treatment to the poor. Later, because of this economical way of using vials, the vaccine was made available for free in the state by the state government.
All this while, Bharti self-funded his research to find cheap ways of treating dog bite cases. He realised, that if one switches to serum instead of vaccine, the cost would go down further. There were still many deaths reported due to dog bite despite having been administered the vaccines, like the case of a young tourist from Delhi—she was a charted accountant. Bharti found in his field research that people are dying because serum—given soon after the dog bite—was not available, and not because of vaccine. Vaccine is only effective against rabies after a lapse of a week. In many cases, it was found, people got infected within a week, hence the vaccine was no good. By directly injecting serum at the wound, only a small amount of serum is sufficient to safeguard against rabies within a few hours to the treatment. A vial of serum could treat nearly 20 patients. He communicated his findings to higher authorities in the health department and recommended that serum treatment should be adopted. It was a personal struggle to get technical and ethical clearance for this new protocol of treatment.
Initially, in 2014, this treatment was performed on 269 cases, out of which there were 26 confirmed cases of bites by rabies infected dogs. The treatment was very effective. Bharti wrote a paper with help of Dr SN Madhusudana in the reputed Journal of Human Vaccines and Immunotherapeutics. This paper attracted the attention of Dr Bernadette Abela-Ridder who heads the Neglected Zoonotic Diseases in the Department of the Control of Neglected Tropical Diseases at the WHO. She interacted with Bharti and secured more information about his research.
In 2017, the same field report was repeated, but this time the sample size was that of 7,000 cases, instead of only 269 earlier. The conclusion, however, was not very different. This time, Bharti teamed up with Dr Henry Wilde of Chulalongkorn University in Bangkok whose an expert in Public Health, Epidemiology and Clinical Immunology, and wrote another paper. WHO took note of Bharti’s work, his protocol was adopted as the cheap and effective way of preventing rabies. This protocol has now also been extended to prevent rabies in animals, thanks to Bharti’s initiatives, and proved equally effective a treatment.
He lives in Shimla with his wife, Archana Phull, a journalist by profession; his 20 years old son is a studying veterinary science and his 18 years daughter wants to be a doctor like her father. He’s a standing example for all of is of how small steps adds up to big results.
