Explained: The burden of rabies, and the shortage of vaccines
According to World Health Organisation (WHO) figures, India bears over a third of the global burden of rabies, and accounts for 59.9% of deaths from the disease in Asia, and 35% globally.
The order was passed in response to a plea by an advocate alleging that government hospitals didn’t hold a sufficient supply of the vaccines.
India’s drug price regulator, the National Pharmaceutical Pricing Authority (NPPA) has held consultations with the manufacturers of anti-rabies vaccines and various states, to normalise the supply of anti-rabies vaccines after a shortage was reported in some parts of India.
The shortage of anti-rabies vaccine is not new in India. On August 13, the Delhi High Court directed the Centre, the state government, and municipal bodies to stock sufficient supplies of the vaccine in the national capital. The order was passed in response to a plea by an advocate alleging that government hospitals didn’t hold a sufficient supply of the vaccines.
Burden of rabies
In 99% of cases worldwide, the infection is transmitted through the bite of an infected dog. According to World Health Organisation (WHO) figures, India bears over a third of the global burden of rabies, and accounts for 59.9% of deaths from the disease in Asia, and 35% globally.
Ninety-five per cent of the deaths associated with rabies occur in Asia and Africa; 80% of these are of people living in rural areas. The WHO says that the cost of post-exposure prophylaxis (PEP) — the regimen of human rabies immunoglobulin and anti-rabies vaccine that is administered on the day of the exposure and on subsequent days to prevent becoming infected — is the highest in Asia.
Dog-mediated rabies has been eliminated from Western Europe, Canada, the United States, Japan, and several Latin American countries, according to the WHO. Australia and many Pacific Island nations have always been free from dog-mediated rabies.
Vaccine shortage in India
Chiron Behring Vaccines Pvt Ltd, based in Ankleshwar, Gujarat, is one of the largest manufacturers of anti-rabies vaccines in the world, with a capacity to produce 15 million doses annually in a WHO pre-qualified plant. Chiron was recently acquired from GlaxoSmithKline (GSK) by biotechnology major Bharat Biotech International Ltd.
India, which has a stray dog population of perhaps 100 million, is estimated to need 35 million doses of the anti-rabies vaccine. India is estimated to currently face a shortage of about 15 million doses, as a significant chunk of the vaccines produced in the country is exported.
In July, Panchkula’s Civil Hospital ran out of vaccines even as the number of registered dog-bite cases doubled between 2018 and 2019. In February this year, Lok Nayak Hospital, the Delhi government’s biggest hospital, ran out of anti-rabies vaccines. The hospital sees over 250 cases of dog-bites every day.
Dr Sunil Kumar, medical director of Delhi’s GTB Hospital had told The Indian Express at the time, “The vaccine is not easily available in the market. With vendors not being able to meet the demand, we have to turn away patients. We have raised the issue with the Delhi government’s Central Procurement Agency (CPA), but even it has not received the supply.”
The three Municipal Corporations of Delhi recorded over 17,000 cases of dog bites in 2018. Speaking to The Indian Express earlier this year, Dr Ashok Rana, Director General of Health Services (DGHS), Delhi government, had said: “There is only one manufacturer supplying anti-rabies vaccines, and at present they are being supplied only to central government hospitals. Due to excessive demand, the supply of the vaccines cannot be met.”
A dangerous disease
There is no cure for rabies, which is a viral disease and is transmitted from the saliva of a rabid animal to humans. It is fatal by the time of clinical onset.
Symptoms include fever, pain, unexplained and unusual pricking or burning sensation at the wound site. The virus spreads to the central nervous system through the nerves, eventually leading to the inflammation of the brain, subsequently resulting in death.
Even so, it is a 100% vaccine-preventable disease, when treatment is given immediately.
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