Why Bali Still Has Rabies: Vaccination Gaps, Roaming Dogs and the 2030 Deadline

Nearly 70,000 bites expose gaps in Bali's rabies response

Bali recorded 69,412 bites from animals capable of transmitting rabies and 16 human rabies deaths in 2025, according to Indonesia's Ministry of Health. Human rabies vaccination was recorded for 50,384 of those bite cases, or 72.59%, placing access to treatment alongside dog vaccination at the centre of the island's effort to stop deaths by 2030.

The ministry's 2025 health profile puts Bali ahead of East Nusa Tenggara, with 39,167 reported bites, and North Sumatra, with 15,174. Bali's total was about 1.8 times East Nusa Tenggara's, yet its recorded human vaccination coverage was lower: 72.59% against 96.62%.

Those figures bring two connected tasks into focus. Health services must quickly assess and treat people after exposure, while veterinary teams must prevent the virus from circulating among dogs. Rabies attacks the brain and nervous system and is almost always fatal once symptoms appear. Treatment after exposure can prevent the disease before that happens.

Bali's continuing deaths have renewed calls for stronger action against dogs roaming without supervision, including proposals for euthanasia. However, the Food and Agriculture Organization of the United Nations (FAO) and research based on Bali's outbreak identify repeated, comprehensive dog vaccination as the central route to elimination. Their findings challenge the argument that reducing dog numbers alone will end transmission.

The practical issue is reaching dogs that are difficult to catch, keeping newly born animals protected and ensuring that people bitten anywhere on the island receive prompt care.

How rabies took hold after decades without it

Bali had been regarded as free of rabies from 1926 until the outbreak recognised in 2008. Research by Udayana University veterinary virologist I Gusti Ngurah Kade Mahardika and colleagues traced the outbreak virus to an Indonesian lineage with ancestry linked to Kalimantan.

Their study, published in Epidemiology and Infection on August 19, 2013, combined genetic analysis with investigation of contacts involving infected people and dogs. It suggested that the virus arrived between January and April 2008, possibly aboard a fishing vessel carrying a dog to southern Bali, around beaches such as Kedonganan.

The early human cases show how infection preceded official recognition of the outbreak. A four-year-old girl bitten on September 6 died on November 13, 2008. A man aged 32, bitten on September 9, died on November 14. Other deaths followed that month, including a three-year-old boy.

• January to April 2008: Researchers place the likely introduction of the virus within this period.
• November 2008: Several people died following dog bites in southern Bali.
• November 30, 2008: Governor I Made Mangku Pastika declared a rabies outbreak.
• December 12, 2008: Agriculture Minister Anton Apriyantono issued Decision No. 1696/Kpts/Pd.610/12/2008, designating Bali a rabies quarantine area.
• By the middle of 2010: Rabies had spread across all nine of Bali's regency and city jurisdictions.

Bali's surrounding sea offered a boundary where animal movements could be controlled. Once infected dogs were on the island, however, movement between communities helped the virus spread beyond the original outbreak area.

What the deaths and bite figures show

Bali's annual human death toll fell from 22 in 2022 to nine in 2023 and seven in 2024, before rising to 16 in 2025. Provincial disaster agency figures cited for February 9, 2026, recorded another 10 deaths since the beginning of that year. At least 239 people have died since the outbreak began in 2008.

The Ministry of Health's 2025 figures leave 19,028 reported bite cases without a recorded human rabies vaccination in that dataset. The report does not explain the clinical assessment or treatment history of each of those cases. For health services, the immediate task is to ensure every exposure receives a timely assessment and the treatment required.

Bali's Disaster Management Agency, BPBD, had already documented the burden in its July 2025 update. Between January 1 and July 20, it recorded 34,845 bites, 23,705 recipients of human rabies vaccine and 12 deaths.

Badung had the largest bite total at that point, with 6,166, followed by Denpasar with 4,978 and Tabanan with 4,440. Badung also recorded four deaths. Buleleng, Jembrana and Karangasem recorded two each, while Tabanan and Gianyar recorded one each. The burden extended across both tourist districts and other communities.

Why killing roaming dogs failed to stop transmission

Veterinarian Soeharsono has proposed taking dogs without owners into shelters and euthanising those that are not adopted. He has also called for euthanasia of adult dogs without owners and dogs allowed to roam by their owners. The proposal reflects continuing concern about unmanaged animals and repeated fatal infections.

FAO's Bali vaccination review offers a different assessment of the island's early experience. It says initial culling temporarily reduced dog numbers but did little to control rabies and contributed to wider spread.

FAO identifies mass vaccination as the recommended strategy for controlling rabies in dogs and, through them, protecting people:

Mass dog vaccination is the recommended strategy for the control of rabies in dog populations, and subsequently in human populations.

At the beginning of the outbreak, more than 90% of Bali's dogs roamed freely. Many owners struggled to bring animals to fixed vaccination stations. Early vaccines also required a booster after three months, making lasting protection difficult to achieve when dogs were hard to reach.

FAO describes targeted euthanasia of rabid dogs as part of an integrated response to bite cases. Its wider strategy keeps vaccinated dogs alive and protected, creating a buffer of immune animals within communities.

The research points to coverage, not dog density

A 2013 Bali modelling study by Sunny E. Townsend and colleagues examined whether the island's dense dog population made elimination especially difficult. Researchers used an estimated population of 400,000 dogs, with urban densities exceeding 250 dogs per square kilometre.

They estimated rabies's basic reproductive number, known as R0, at about 1.2, with a 95% interval of 1.0 to 1.3. R0 describes how many new infections one infected animal causes on average in a population without immunity. A value above one allows an outbreak to grow; vaccination aims to bring actual transmission below one.

Bali's estimate was similar to estimates from dog populations only one tenth as dense. The researchers concluded that achievable reductions in dog density would not eliminate rabies. Repeated vaccination reaching a large share of dogs across the island was the decisive measure.

The simulations showed why one large campaign is insufficient. Two campaigns reaching 80% coverage, or three reaching 60%, achieved elimination in more than 90% of model runs. A single campaign reaching 80% succeeded in about 60%.

Small gaps mattered too. Leaving areas containing less than 0.5% of the dog population unvaccinated could jeopardise elimination. A high provincial average can therefore conceal villages where enough vulnerable dogs remain for transmission to continue.

Reaching dogs that owners cannot bring to a clinic

Bali has already demonstrated ways to vaccinate animals that are difficult to handle. FAO's Emergency Centre for Transboundary Animal Diseases supported visits to homes and mobile vaccination teams using techniques developed by the Bali Animal Welfare Association.

Trained teams equipped with nets, known as A-Teams, reached dogs missed by fixed vaccination stations. The 2013 study described a pilot in which more than 80% of dogs could be vaccinated, with a team of six vaccinating around 100 dogs a day.

FAO says these methods, combined with a vaccine providing protection for three years, helped bring transmission below the level needed to sustain the outbreak. By 2013, human cases had fallen to a fraction of their peak.

Maintaining that protection requires repeated work. Puppies enter the population, dogs move between communities and immunity declines. The research therefore places importance on measuring coverage locally and returning to places where animals were missed, rather than relying only on the number of doses delivered.

Free vaccination, sterilisation and existing rules

Bali's agriculture authorities scheduled the launch of the 2025 vaccination campaign for May 6 at the mini field opposite the ITDC office in Nusa Dua. The programme included vaccination and sterilisation around ITDC Nusa Dua and the neighbouring communities of Bualu, Peminge and Kampial.

Animal rabies vaccination was offered without charge through mass campaigns and daily services during government office hours. Grand Hyatt Bali initiated the Nusa Dua activities with local authorities, ITDC, the Indonesian Veterinary Medical Association's Bali branch, BAWA and Seva Bhuana.

Provincial Regulation No. 15 of 2009 governs rabies control. Article 28 of Provincial Regulation No. 5 of 2023 also prohibits allowing pets or livestock into public places without supervision, abandoning animals, abusing them and trading dog meat. Authorities therefore already have rules addressing several practices that complicate control.

Sterilisation is intended to slow population growth, particularly among roaming dogs. Research by Udayana University veterinary surgery professor I Gusti Ngurah Sudisma and colleagues, presented at a seminar on November 6, 2026, described community vaccination and sterilisation in Sedang village, Abiansemal, Badung. They called for continuing population management and regular monitoring of vaccination.

The two measures serve different purposes: sterilisation reduces births, while vaccination protects animals against rabies. Sustained programmes need to keep both tasks connected without allowing population management to displace infection control.

Connecting treatment for people with action on animals

Bali had established 103 rabies centres and stockpiled human rabies vaccine and serum by 2023, according to a WHO coordination update. Vaccine helps the body develop protection; rabies serum supplies antibodies for exposures where it is needed.

A provincial workshop that year brought together 50 participants from health, agriculture, disaster management and other agencies. Dr. Imran Pambudi, then Indonesia's director of communicable diseases control, identified reliable dog population estimates, animal vaccines, operating funds, human vaccine and serum stocks, shelters and rabies centres as priorities.

The resulting plan focused on coordination, emergency funding, public communication, animal vaccination, enforcement of local rules, surveillance and case management. These are practical requirements: teams need transport and trained staff to reach dogs, while clinics need supplies available when a person arrives after a bite.

Integrated Bite Case Management links the two services. A report of a person being bitten triggers veterinary investigation of the animal as well as medical care for the person. FAO describes rapid responses that included euthanasia of rabid dogs and vaccination of bite victims.

WHO also reported Australian support for procuring human vaccines and serum for provinces at high risk, including Bali, and support for vaccination into the skin, a method used for treatment after exposure.

What the 2030 goal requires

Bali's tourism districts share the same animal health problem as the island's residential communities. The July 2025 red zones included South Kuta, Nusa Dua, Jimbaran and parts of the wider Canggu area. Local protocols allowed a village to receive that designation after one confirmed animal case, triggering measures including vaccination, surveillance and animal movement restrictions.

The global Zero by 30 programme aims to end human deaths from rabies transmitted by dogs by 2030. Bali also seeks to regain freedom from rabies. Preventing human deaths requires prompt treatment after exposure; ending animal transmission requires sustained protection across the dog population.

The evidence from Bali identifies concrete priorities for the remaining effort: reach roaming dogs, repeat vaccination campaigns, check coverage village by village, respond quickly to bites and keep human treatment available. Animal movement controls matter because transporting an infected dog can carry the virus beyond the area where teams are working.

Indonesia faces this task beyond Bali. WHO reported rabies as endemic in 26 of the country's 38 provinces. Bali's experience offers both a warning about interrupted protection and evidence that mobile vaccination teams, coordinated services and sustained funding can bring transmission down.

Key Points

• Bali recorded 69,412 animal bite cases and 16 human rabies deaths in 2025.
• The Ministry of Health recorded human rabies vaccination for 50,384 cases, or 72.59% of the bite total.
• FAO says early dog culling did little to control the outbreak and contributed to wider spread.
• Research identifies repeated vaccination across the island, including hard to reach roaming dogs, as the central strategy for elimination.
• Bali offers free animal vaccination and has regulations against abandoning animals and allowing pets into public places without supervision.
• The 2030 effort requires both prevention of human deaths and sustained control of infection among dogs.