A simple telephone call made a day before a scheduled vaccination visit can significantly improve completion of the life-saving anti-rabies vaccine (ARV) schedule, according to a study by researchers at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
The findings highlight how low-cost telemedicine interventions can strengthen primary healthcare delivery and prevent deaths from one of the world's most fatal infectious diseases.
The quality improvement initiative, conducted at a rural Primary Health Centre (PHC) in Puducherry between June 2022 and November 2024, found that structured telephonic reminders increased completion of the four-dose post-exposure anti-rabies vaccination schedule from 60.2 per cent to 70.4 per cent. After adjusting for other factors, people who received the intervention were 60 per cent more likely to complete the full course than those in the pre-intervention period.
The researchers said the findings demonstrate that telephonic reminders, integrated into routine health services without additional expenditure, can substantially improve adherence to vaccination schedules and strengthen India's efforts to eliminate dog-mediated human rabies deaths by 2030.
Rabies remains one of the deadliest infectious diseases, with virtually 100 per cent fatality once symptoms develop. Yet it is entirely preventable if wound care and post-exposure vaccination are completed on time.
India accounts for one of the world's largest rabies burdens. According to the National Centre for Disease Control, nearly 3.7 million dog bite cases were reported in 2024 under the National Rabies Control Programme. Dogs account for almost all human rabies infections, and children constitute a large proportion of victims.
Despite the availability of effective vaccines, completing the prescribed vaccination schedule remains a major challenge. Earlier nationwide studies have shown that nearly 60 per cent of dog bite victims fail to complete the full course of anti-rabies vaccination. Qualitative research has identified forgetfulness as the single biggest reason for defaulting, accounting for nearly half of all missed vaccinations.
It is this seemingly simple behavioural barrier that prompted researchers from JIPMER's Department of Preventive and Social Medicine to test whether timely telephone reminders could improve adherence.
The intervention required no sophisticated digital platform or additional manpower. Healthcare workers telephoned beneficiaries one day before every scheduled vaccine dose using the existing PHC telephone during routine working hours.
If a patient did not answer, repeated calls were made over the following two days. For individuals without mobile phones, contact numbers of relatives or neighbours were recorded. Phone numbers were verified during the first visit to minimise incorrect contact details, and beneficiaries were informed in advance that reminders would come from the PHC's official number.
Researchers emphasised that the programme was incorporated into routine services without disrupting regular clinical work or requiring additional financial resources.
The study included 695 first-time animal bite victims, with 377 enrolled before introduction of telephonic reminders and 318 afterwards.
Completion of the full four-dose vaccination schedule rose by 10.2 percentage points, from 60.2 per cent before the intervention to 70.4 per cent afterwards.
Interrupted time-series analysis showed both an immediate improvement after introducing the intervention and a sustained increase over time, suggesting that the gains were not temporary or influenced by seasonal variations.
Researchers noted that sensitivity analyses accounting for seasonal changes and implementation transition periods produced similar findings, strengthening confidence that the improvement resulted from the reminder intervention itself.
The study also explored which population groups benefited the most.
The intervention showed its strongest impact among male beneficiaries, with vaccination completion increasing by more than 17 percentage points. Although improvements were also observed among younger individuals, those with Category II animal bites and people bitten by dogs or cats, these differences were not statistically significant compared with other subgroups.
The relatively smaller gains among elderly people and women suggest that reminders alone may not overcome all barriers to completing treatment.
Researchers believe transport dependence, limited mobility and reliance on family members to visit health facilities may reduce adherence among these groups, indicating the need for complementary community-based support.
The study illustrates how telemedicine need not always involve sophisticated video consultations or advanced digital platforms. Even basic telephone communication can become an effective public health tool when integrated into routine primary healthcare.
Unlike many digital health initiatives requiring expensive infrastructure, smartphone applications or internet connectivity, telephonic reminders can be implemented using existing government resources and ordinary mobile networks.
India's high mobile phone penetration further enhances the feasibility of such interventions. National survey data indicate that mobile phones are available to nearly nine out of ten adults in Puducherry, making telephone-based follow-up an accessible strategy for most beneficiaries.
The researchers said reminder systems could be replicated for several other public health programmes requiring repeated follow-up visits, including childhood immunisation, tuberculosis treatment, diabetes monitoring and hypertension control.
They pointed out that similar reminder-based interventions have previously improved treatment adherence for tuberculosis and chronic diseases in India and elsewhere.
Importantly, the intervention imposed virtually no additional burden on the health system. Existing nursing staff delivered the reminders using the PHC's prepaid telephone during normal working hours, demonstrating that behavioural interventions can produce measurable public health gains without major investments.
The authors acknowledged certain limitations. As the study was conducted in a single rural PHC without a concurrent control group, the findings may not be directly generalisable to all settings. Information on education, occupation and socioeconomic status was also unavailable because these variables were not routinely recorded in vaccination registers.
Nevertheless, the researchers believe the programme offers a practical model that can be scaled up across primary healthcare facilities.
They recommended integrating telephonic reminders into routine anti-rabies vaccination services while complementing them with targeted community support for elderly people, women and other groups facing access barriers.
Future research, they said, should evaluate automated reminder systems using SMS, WhatsApp and other digital platforms, alongside qualitative studies exploring why some patients continue to default despite receiving reminders.
As India works towards the global goal of eliminating dog-mediated human rabies deaths by 2030, the study suggests that one of the most effective interventions may also be among the simplest: a timely phone call reminding patients to return for a vaccine that can save their lives.
