The Rabies Vaccine Edition

On getting bitten, getting treated, and "vaccine complacency."

Benoît Pellevoizin (BP) is a finance CMO who also writes My Apophenia (myapophenia.xyz), a Substack where he gathers his thinking on geoeconomic issues, finance, and crypto.

Benoît here. I was halfway through a run in the Sri Lankan countryside when my reptilian brain took over. Ten stray dogs had surrounded me, and I panicked. That’s when one of them, a small, unremarkable mutt, decided to nip my calf.

In Sri Lanka, rabies is endemic. Every animal, from dogs to squirrels to monkeys, is presumed to be a potential carrier. And rabies is 100% fatal. If you contract it, you die. There is nothing to be done.

I’d spent three weeks falling in love with the country. Sri Lanka is culturally extraordinary (did you know Buddha’s tooth is protected at the Temple of the Tooth in Kandy, making the island uniquely sacred for Buddhists worldwide?), visually stunning, and home to remarkable endemic wildlife: elephants, leopards, kingfishers, monitor lizards. On this second-to-last day, I’d wanted to end my trip with a long run through the lush countryside near Weligama, where rice paddies reflect the island’s peculiar, Turner-like sky, and every shade of green cascades down the hillsides.

I’d been advised that if dogs bothered me, I should stop, lock eyes, and mime throwing a stone. It had worked for three weeks. Until it didn’t.

So I took a tuk-tuk to Galle National Hospital, where I discovered something remarkable: a dedicated counter just for rabies vaccinations. It’s a national priority. Sri Lanka records 250,000 animal bites annually. Over 100,000 people receive post-exposure treatment each year. Rabies vaccines are administered in 207 hospitals across the country. In the 1970s, 400 Sri Lankans died of rabies annually; today it’s around 10. An hour after walking in, I walked out with a tetanus shot, two rabies injections, and a protocol to follow back home.

Then I returned to Paris and discovered there are exactly two rabies treatment centers in the entire city.

Two.

Why is this interesting?

There’s a profound contradiction at the heart of Western attitudes toward medicine. We’ve become so insulated from fatal diseases that we’ve grown complacent about the tools that insulated us.

UNICEF calls it “vaccine complacency.” In 2024, nearly 300,000 people contracted whooping cough across Europe: triple the previous year. Measles cases doubled. Meningitis, flu, and pneumonia are rising. In Rockland County, New York, a man developed paralysis from polio, the first case in decades. Local vaccination rates had fallen to 60%.

COVID probably accelerated this. The politicization of vaccines, the speed of development, the messy public communication, all of it fed a growing suspicion that vaccines were less about health than about control. For populations that haven’t lived with 100% lethal diseases, that suspicion found fertile ground. Vaccines stopped feeling necessary. They became abstract, optional, even dangerous in the popular imagination.

But in Sri Lanka, where rabies lurks in every stray dog’s bite, the calculation is visceral: you’re far more likely to die from the disease than from any reaction to the vaccine. The needle is less of an imposition, and more like a miracle.

Buddhist countries have a different relationship with nature. Animals aren’t hostile; they’re part of the ecosystem, and humans are just one species among many. Cars stop when dogs nap in the road. Everyone feeds the strays. Yet this coexistence with nature also means coexistence with its dangers. The 207 hospitals administering rabies vaccines aren’t a sign of backwardness… They’re a sign of clear-eyed realism about the world.

The West has achieved something remarkable: we’ve pushed fatal diseases so far from daily life that we’ve forgotten they exist. When science becomes invisible, it starts to look like a luxury.

But the women I saw waiting calmly at that Galle hospital counter understood something we’ve lost: that medicine isn’t a lifestyle choice. It’s the thin line between a dog bite and a death sentence. (BP)