Rabies vaccine crisis worsens as Indian makers stop supplies to Pakistan

With an unprecedented rise in dog-bite cases, health institutions in Pakistan, especially in Karachi are facing an acute shortage of anti-rabies vaccine (ARV) as three leading Indian vaccine manufacturers have stopped exporting vaccines to Pakistan citing an increased domestic demand, health officials said on Thursday.

The Indian manufacturers have gradually reduced ARV supplies to Pakistan, and at the moment none of them is supplying the vaccine to any Pakistani importer or pharmaceutical company.

“There is a worldwide crisis regarding the availability of anti-rabies vaccine due to recall of Chinese vaccine from the market due to safety concerns. In the absence of Chinese vaccine, India used to fill the gap, but at the moment Indians are unable to meet their own demands so they have reduced ARV exports to other countries, including Pakistan,” said Usman Ghani, an expert associated with vaccine imports in Pakistan, while talking to The News.

Authorities at Jinnah Postgraduate Medical Centre (JPMC), Civil Hospital Karachi (CHK), Indus Hospital and many private health facilities said they were facing an acute shortage of the ARV and immunoglobulin as their suppliers were unable to acquire the vaccine from the Indian makers.

Currently, Pakistani institutions are using anti- rabies vaccines, including Indirab from the Bharat Biotech, Abhayrab from the Human Immunologicals Limited and Equirab manufactured by the Bharat Serums and Vaccines Limited, but all of them have almost stopped the ARV supplies citing their domestic demands, they said.

Reports from the interior of Sindh show several children have died in Larkana, Sukkur and the adjoining areas in the recent weeks due to rabies, as they could not be given the ARV and immunoglobulin due to its shortage in the market.

Vaccine suppliers said PPHI (People’s Primary Healthcare Initiative) was the biggest buyer of the ARV in the interior of Sindh after district health hospitals, but they were unable to meet the demand in Karachi so no vaccine was being supplied to the interior of Sindh.

“In fact, the entire Pakistan is facing any acute shortage of ARV at the moment due to recall of the Chinese vaccine and the Indians’ refusal to supply us the vaccine citing their domestic needs,” said Ghani.

Officials at the JPMC, which has the largest dog-bite centre in Karachi, said that after meeting the ARV requirement from various suppliers, they were now unable to acquire the vaccine, and, from now onwards, only a few and extremely serious patients would be vaccinated in case of dog-bite incidents.

“All our ARV suppliers have expressed their inability to provide the vaccine and there is a serious crisis looming over Karachi and Sindh. Dog-bite cases are on the rise and every day dozens of people are brought to our casualty for vaccination, but at the moment there is no vaccine available in the market,” Executive Director JPMC Dr Seemin Jamali said.

She said the federal authorities should intervene and arrange the ARV on an emergency basis, and steps should be taken for its local production as even Bangladesh is manufacturing dog-bite and anti-snake venom vaccines. “When Indians and Bangladeshis can produce the vaccine, why can’t we do so in Pakistan?” she questioned.

Ghulam Hussain Brohi, additional medical superintendent (Stores) at the CHK, said the number of patients requiring the ARV had tripped during the last few weeks after private and charity hospitals ran short of the vaccine and they started sending patients to the CHK, where it was still available.

“We are working day and night to meet the demand for anti-rabies vaccine and we are switching from one to other vaccine with each passing day to vaccinate dog-bite victims. But it is becoming very hard as supplies from the manufacturers have stopped.”

On the other hand, people associated with the Pakistani pharmaceutical industry said that instead of promoting local production of vaccines and encouraging the multinational and local companies to bring in technology and investment, authorities discourage local production, and as a result of this these companies were taking their expertise and resources to other regional countries.

“Pakistan pharmaceutical companies are establishing their manufacturing plants in Afghanistan, Sri Lanka, Vietnam and African countries where they are being given incentives,” an expert said on condition of anonymity.