Rabies In Bali — Do You Need The Vaccine Before You Travel?

Editor’s Note: This editorial draws on more than 25 years of independent travel, first-hand experience and publicly documented evidence and regulatory changes. Many of these editorials were written years before the issues became mainstream, and have been updated to reflect current developments while remaining true to their original arguments.

Rabies is an ongoing problem in Bali, and for travellers heading to an island where encounters with dogs, cats and monkeys are common, that raises some obvious questions. How much of a risk is it to you? Should you get the rabies vaccine before travelling? And what happens if you are bitten while you’re there? These are sensible questions to ask before you go, and with a little preparation, rabies needn’t become something you spend your entire trip worrying about.

Neither should you be afraid of the animals themselves. Free-roaming dogs are deeply intertwined with Balinese life and culture, guarding homes and holding spiritual significance. Many dogs and cats are looked after communally, and they are wonderful, pure souls that deserve kindness and care. Monkeys also have religious significance in Bali, and attractions such as Ubud’s Sacred Monkey Forest bring people and monkeys into close proximity.

My love of these animals sits alongside my background in emergency and travel nursing, and this is why I consider rabies vaccination an important part of the discussion when preparing for Bali. That doesn’t mean every traveller will receive the same recommendation, but understanding the protection it offers and the realities of getting treatment after an animal bite can help you make an informed choice.

I first wrote this article in 2015 in response to a rabies emergency and a severe shortage of post-exposure treatment on the island. It was also a condemnation of the authorities’ cruel and idiotic dog-culling programme, which killed animals instead of building on effective vaccination efforts. The article has since been updated into a practical guide for travellers, but that animal-welfare argument remains central. BAWA’s work deserves recognition and support, and understanding why vaccinating dogs protects both animals and people is part of understanding why rabies remains an issue in Bali.

What Is Rabies? Quick Answer

Rabies is a viral infection that affects the brain and nervous system. It is usually passed to people through a bite or scratch from an infected animal, most commonly a dog. The virus can also be transmitted if infected saliva gets into broken skin or the eyes, nose or mouth.

Rabies is almost always fatal once symptoms develop, but it can be prevented with prompt treatment after a possible exposure. Vaccination before travel provides an additional layer of protection and can make that treatment more straightforward.

How Travellers Can Be Exposed To Rabies In Bali

You don’t have to be trekking through remote jungle or working in an animal rescue centre to encounter animals in Bali. Dogs wander along beaches and village streets, cats settle around accommodation and restaurants, and monkeys share the grounds of popular temples and attractions. They are part of everyday life on the island, and most encounters pass without incident. For most travellers, the risk of developing rabies is very low, but knowing how to prevent exposure and act promptly after a bite or scratch is important because the consequences of an untreated infection are so serious. Understanding what actually constitutes an exposure helps put the risk into perspective.

Rabies is transmitted when saliva from an infected mammal enters the body, most commonly through a bite that breaks the skin. A scratch can also be an exposure, particularly if it breaks the skin and is contaminated with saliva. The wound doesn’t have to be dramatic or bleed heavily to deserve attention. Saliva getting into an existing cut or graze, or directly into your eyes or mouth, can also provide a route for infection.

Simply being near an animal is different. A dog walking alongside you, a cat brushing against your legs or touching an animal’s fur does not, by itself, constitute a rabies exposure. A lick on intact, unbroken skin is not considered an exposure either. You don’t need to become anxious about every animal you pass. Simply sharing a beach, street or café with an animal is not a reason to worry about rabies.

Dogs are the main source of human rabies worldwide, but cats, monkeys and bats can also transmit the infection. An animal doesn’t have to be snarling, foaming at the mouth or behaving strangely to be infectious. Looking healthy, being friendly or belonging to someone cannot reliably rule out the risk.

For travellers, closer encounters might involve stroking a dog outside a café, giving a kitten a little bit of fish from your lunch or posing for a photograph with a monkey. Most of these happen every single day without incident, but every now and then an accident can happen. Monkeys may still approach or climb onto visitors at the Monkey Temple, and an unexpected movement or struggle over a possession can result in a bite or scratch. Running and cycling can also bring unexpected encounters with dogs, while animal volunteering involves more frequent contact through handling and care.

None of this means the animals deserve fear or hostility. The safest advice is still to avoid handling unfamiliar animals, but that advice should be understood as a precaution against an unpredictable encounter, rather than a suggestion that every affectionate dog or cat is dangerous. Give animals space, give them respect, let them move away and avoid disturbing them while they are eating, sleeping or caring for their young. If there is any interaction, let it be on their terms, not yours.

You can appreciate their company and care about their welfare without needing close physical contact. Supporting a reputable local animal-welfare organisation is another way to help, with benefits that last far beyond a brief encounter on your travels.

Why Is Rabies Still A Problem In Bali?

Rabies was first confirmed in Bali in 2008, and the island has been struggling to eliminate it ever since. In that time, there have been programmes and initiatives that made real progress, particularly through vaccinating dogs and working with local communities. Unfortunately, that progress was held back and, in some cases, sabotaged by poor decisions and a cruel, idiotic approach to the animals themselves.

The frustrating thing is that Bali has already seen what can be achieved when the right measures are put in place. Vaccinating dogs against rabies protects the animals, reduces the spread of the virus and ultimately protects people too. Yet instead of building consistently on that progress, the authorities have repeatedly turned to killing dogs as part of their response.

The Problem With Dog Culling

When rabies first appeared in Bali, the authorities responded in the most horrific way possible by killing dogs en masse, often using the cruel poison strychnine. BAWA campaigned against the culling and began vaccinating dogs to demonstrate that there was a better, more humane way to control the disease. Its pilot programme helped secure an agreement for an island-wide vaccination campaign, on the understanding that culling would stop. And the programme worked. It worked well, vaccinating almost 250,000 dogs in the first campaign. The average number of confirmed rabies cases in dogs fell from around 45 a month before island-wide vaccination to around 11 a month during that campaign, and fell further during the second. But despite that success and the agreement to stop the culling, the killing never completely ended, and in 2015 the government supported targeted culling again.

I have absolutely no hesitation in saying that this has been a disgusting and indefensible response to the problem and it is the governments own efforts that have allowed Rabies to continue. Dogs have been killed with strychnine, a particularly cruel poison, and healthy, owned and vaccinated animals have been caught up in the killing too. These were innocent animals who were part of their communities, and in many cases were already protected against the very disease the authorities claimed to be fighting.

I cannot put into words how sick and angry this makes me. These dogs were poisoned and killed in the name of controlling rabies, even when many were healthy, owned and already vaccinated. The people responsible had evidence that a humane vaccination programme could work, yet the killing continued. I find that utterly abhorrent, and I make no apology for saying so.

And what makes it even more infuriating is that mass killing has been shown time and again to not be an effective substitute for vaccination. It causes enormous suffering without establishing the widespread immunity needed to stop rabies circulating in the dog population. If vaccinated dogs are killed too, you are destroying part of the very protection you have worked to build.

The killing that followed BAWA’s initial vaccination work was a significant part of undoing that progress. When vaccinated dogs are removed, protection within the population is weakened, and unvaccinated dogs can still become infected and spread the virus. The result is that the job of controlling rabies becomes harder, not easier.

There have been other problems too. Vaccination coverage needs to be maintained across communities, not treated as a one-off campaign. Dogs are born, populations change and new animals need to be vaccinated. If coverage falls, the virus has more opportunity to circulate again. That takes sustained funding, organisation and cooperation with local communities, all of which matter far more than another round of killing.

BAWA’s Work Protecting Animals And People

The Bali Animal Welfare Association, or BAWA, has been doing vital work for Bali’s animals for years, and its role in the response to rabies deserves far more recognition than it gets.

BAWA was involved in establishing a coordinated vaccination programme with the Balinese authorities and international animal-welfare partners. Before the island-wide campaign, its teams vaccinated around 73,000 dogs in Gianyar and Bangli, working directly with communities to reach the animals who needed protection.

The wider island campaign that followed vaccinated almost 250,000 dogs and reached more than 70% of the dog population in most communities. That level of coverage was designed to create a protective barrier against the virus: when enough dogs are vaccinated, rabies has fewer opportunities to spread from one animal to another. Cases in dogs subsequently fell substantially.

That is the point. Protect enough dogs through vaccination and you can reduce transmission among the animals and the risk to the people who live alongside them. The dogs get to live, communities are safer and there is a genuine prospect of bringing rabies under control.

Yet instead of consistently building on that work, the authorities took control of subsequent stages of the programme and BAWA’s operational role changed. The later return to killing, alongside gaps in maintaining vaccination coverage, undermined the progress that had been made. It is hard not to be angry when a practical, humane approach had already shown what it could achieve.

BAWA’s work goes well beyond rabies vaccination. The organisation also helps animals through rescue, treatment, sterilisation and community education, working with local people to improve animal welfare across the island. Its work continues to include vaccination and community initiatives, including cooperation with local authorities. It is exactly the kind of practical, compassionate work that deserves recognition and support.

For travellers, this is part of the bigger picture. Rabies is a serious disease, but Bali’s dogs are not the villains here. They are animals caught up in a public health problem, and protecting them through vaccination helps protect the people who live alongside them too.

Who Should Consider Rabies Vaccination Before Visiting Bali?

Rabies vaccination is worth considering before a trip to Bali because rabies is present on the island and encounters with animals are a normal part of travelling there. That doesn’t mean every traveller will need or be advised to have the vaccine. The recommendation depends on the trip you are planning, what you expect to do and how easily you could access appropriate treatment if you needed it.

For most travellers, the chance of actually getting rabies is very low. But because the disease is almost always fatal once symptoms develop, it is worth considering what you can do before you go to reduce that risk and make any treatment you might need afterwards more straightforward.

The recommendation becomes stronger if you are planning to volunteer or work with animals, particularly if you will be handling dogs or cats as part of their care. Spending long periods in Bali can also increase the opportunities for an unexpected encounter, whether you are staying in one place or travelling around the island. If your gap year plans are flexible and you aren’t entirely sure where you will end up or what activities you might take part in, that is worth considering too.

You don’t have to be working in an animal sanctuary to have a reason to consider vaccination. Running or cycling can bring you into contact with dogs, while visiting temples and other attractions may put you close to monkeys. Travelling through rural areas or spending time somewhere that makes it harder to reach appropriate medical care promptly can also make vaccination a more important consideration.

Children deserve particular consideration because they may be more likely to approach animals, are closer to them in height and may not always tell an adult about a bite or scratch. To be fair, being likely to approach animals is the exact same reason I personally had the vaccine! A travel health professional can take a child’s age, your family’s plans and the likelihood of animal contact into account when discussing vaccination.

For someone visiting Bali for a short, organised holiday, with little planned animal contact and ready access to medical care, the likelihood of an exposure may be lower and vaccination may not be recommended as strongly. But a shorter trip doesn’t rule it out. An animal encounter can be unexpected, and you may decide that the added protection is worthwhile for your own peace of mind.

In terms of contraindications, there really aren’t very many reasons why the rabies vaccine can’t be given. A previous severe allergic reaction to the vaccine or one of its components would affect the advice you are given, but the vaccine can generally be given to children, people who are pregnant or breastfeeding, and those with a weakened immune system. Tell your travel health professional about any allergies or medical conditions so they can advise you appropriately.

Personally, I have the rabies vaccine as part of my fairly well-established ‘just in case’ policy, and for me it’s an easy win. It’s a backup, a failsafe. The chances of needing it are low, but if something does happen, I have given myself an extra layer of protection and made the treatment I might need afterwards more straightforward. I love animals, I’ve volunteered with them and I know full well that I’m likely to be tempted by every dog and cat I meet along the way. For me, the extra protection is worth it. Your plans and priorities may be different, and that’s absolutely fine.

Speak to a qualified travel health professional before you leave, ideally around eight weeks ahead, so you have time to discuss your plans and complete the course if you decide to have it. Rabies vaccination for travel usually has to be paid for privately, so it is worth asking about the cost early too. If you have already been vaccinated, take your records to the appointment so your clinician can check whether you need any further doses.

What Does The Rabies Vaccine Do?

The rabies vaccine prepares your immune system to recognise and respond to the virus before you might be exposed to it. For travellers, this is known as pre-exposure vaccination: you complete a course before your trip so that you already have that protection in place if an animal bites or scratches you.

In the UK, the course usually consists of three injections given over 28 days, although shorter schedules may be available in some circumstances. If you are considering the vaccine, it is best to arrange your consultation around eight weeks before you leave, giving you time to discuss your plans and complete the course. If you are leaving sooner, still ask for advice; your travel health professional can discuss the options available.

Most travellers won’t need regular booster doses. However, if you have previously completed a course and are travelling somewhere rabies is a risk more than a year later, a one-off booster may be recommended depending on your circumstances. Take a record of your previous vaccinations to your appointment so your travel health professional can advise you.

The important thing to understand is that vaccination before travel is only one part of protection against rabies. If you are bitten or scratched by an animal that could be carrying the virus, you will need an urgent medical assessment and may need treatment afterwards, even if you completed the vaccine course before leaving home.

This treatment is called post-exposure prophylaxis, or PEP. ‘Post-exposure’ means it is given after a possible exposure to the virus, while ‘prophylaxis’ simply means treatment intended to prevent a disease from developing. It can include doses of the rabies vaccine and, for some people, an additional treatment called rabies immunoglobulin, which contains ready-made antibodies.

That can sound confusing because the rabies vaccine is used both before and after exposure. The difference is when and why it is given. Before travel, the course prepares your immune system in advance. After a possible exposure, further vaccine doses help your immune system respond before the virus can cause illness. This matters because the vaccine you had before travelling does not guarantee that the virus will be stopped without further treatment.

Having the vaccine beforehand generally makes PEP shorter and simpler. If you have completed a course before travelling, you will usually need fewer vaccine doses afterwards and will not need immunoglobulin, which can be difficult to obtain. Your medical history, including any condition or treatment that affects your immune system, can change the treatment advised.

If you haven’t had the vaccine before travelling, PEP can still prevent rabies when given promptly and appropriately. You may need a longer course of vaccination and, depending on the exposure, immunoglobulin as well. Either way, the important thing is to seek medical attention as soon as possible after a potential exposure and tell the clinician whether you have previously been vaccinated.

Bitten Or Scratched In Bali? What To Do Now

If you are bitten or scratched by an animal in Bali, try not to panic. Most animal encounters don’t result in rabies, and prompt treatment after a possible exposure can prevent the disease. What matters now is taking the right steps straight away, whether or not you had the rabies vaccine before travelling.

Wash The Wound

Wash the bite or scratch immediately and thoroughly with soap and running water for at least 15 minutes. This helps remove saliva and reduce the amount of virus that may have entered the wound. If you don’t have soap available, flush it thoroughly with water.

If you have an iodine-based antiseptic, you can apply it after washing. Don’t put irritants or home remedies on the wound.

If animal saliva has entered your eyes, nose or mouth, flush the area thoroughly with water and seek urgent medical advice.

Get Medical Help As Soon As Possible

Once you have washed the wound, go to a hospital or medical clinic for an urgent assessment. Do this even if the bite or scratch looks small, the animal appeared healthy or you have been vaccinated against rabies before travelling. You don’t need to wait for symptoms or for the wound to become painful.

Tell the clinician what happened, where and when it happened, and what kind of animal was involved. Let them know if you have previously had rabies vaccinations and show them your records if you have them. They can assess the exposure and advise whether you need post-exposure treatment.

The clinician may also need to consider other care for the wound, including antibiotics or a tetanus vaccination. Animal bites can cause infections apart from rabies, so the whole injury needs to be assessed.

Contact Your Travel Insurer

Contact your travel insurer or their emergency assistance team as soon as you reasonably can. They may be able to help you find an appropriate medical facility, discuss payment and make arrangements if you need to travel elsewhere for treatment. Don’t delay getting medical help while you wait to reach them.

Keep A Record Of Your Treatment

If you are given treatment, ask for a written record of the vaccine or other medication you receive, including the dates and the name of the products used. Keep this with your travel documents and take it to any follow-up appointments.

If you are due to travel onwards or return home before the course is complete, tell the clinician so you can make a plan for the remaining treatment. If you return to the UK after a possible exposure, contact your GP and share the details of any treatment you received, even if you have completed the course.

Most importantly, you don’t need to work out for yourself whether an animal had rabies or whether a small scratch was serious enough. Wash the area, get it assessed and let a qualified professional help you decide what happens next.

Getting Rabies Treatment In Bali

There are hospitals, clinics and designated rabies centres in Bali that can assess animal bites and provide treatment. If you are bitten or scratched, seek medical help locally as soon as possible rather than waiting until you return home.

The clinician will assess what happened and decide whether you need post-exposure prophylaxis, or PEP. Depending on the exposure, your previous vaccinations and your medical history, this may involve a course of rabies vaccine and, in some circumstances, rabies immunoglobulin. They will also assess the wound and whether you need treatment for other infections.

Bali has experienced severe shortages of rabies treatment in the past. Although treatment is available on the island, access can vary between facilities, particularly for rabies immunoglobulin. A clinic may have the vaccine available but not immunoglobulin, so the two should not be assumed to be equally available.

Not everyone needs immunoglobulin. The clinician will consider the type of exposure and your vaccination history when deciding whether it is needed. If you completed a rabies vaccine course before travelling, you will generally need a shorter course of vaccination after an exposure and won’t need immunoglobulin. Certain medical circumstances, including a weakened immune system, can affect that advice.

If immunoglobulin is needed but isn’t immediately available, the rabies vaccine should still be started as soon as possible. Don’t wait for one treatment before beginning the other. The medical team can advise where to obtain any additional treatment you need.

That may mean travelling to another hospital or a larger town or city. In some circumstances, appropriate treatment may require travel to another country. Your treating clinician and your travel insurer’s emergency assistance team can help you work out where to go and arrange any necessary onward care. If you are in a remote area or on a nearby island, go to the nearest appropriate medical facility for assessment and ask for their help.

You may need to pay for treatment upfront, particularly at a private hospital. Contact your insurer as soon as you reasonably can and keep your receipts, but don’t delay medical care while waiting to speak to them.

Before leaving the clinic, make sure you understand what further treatment you need, when it is due and where you can get it. Ask for a written record of the products and doses you have received, including the dates. If you are travelling onwards, discuss how you will complete the course.

Treatment schedules can differ between countries. If you return to the UK after a possible exposure, contact your GP and give them your treatment records so they can check whether any further treatment is needed under UK guidance.

Be Prepared And Enjoy Bali

Rabies is a serious disease, but it doesn’t need to overshadow your trip to Bali. Most travellers will enjoy their time on the island without experiencing an animal bite or scratch, and knowing what to do if an encounter does happen is a sensible part of preparing before you go.

Talk to a qualified travel health professional about your plans, consider whether the rabies vaccine is right for you and make sure you have appropriate travel insurance. Once you have made those decisions, you can get on with enjoying everything Bali has to offer, from its beaches and temples to its food, culture and wonderful animals.

And if you want to help those animals while you are there, consider supporting BAWA or another reputable local animal-welfare organisation. Their work helps protect Bali’s animals and the communities they are part of, and supporting them is a lovely way to give something back to an island that gives travellers so much.