Capital facing shortage of rabies vaccine amid rising dog-bite cases

ISLAMABAD: Despite the alarming surge in reported cases of dog bites across different sectors of Islamabad and its suburbs, major public health facilities and pharmacies are facing a critical shortage of anti-rabies vaccine (ARV) and immunoglobulin, causing the victims and their attendants to scramble from one place to another in a frantic search for these life-saving products.

On average, approximately 100 dog-bite victims seek treatment at prominent healthcare institutions such as the Pakistan Institute of Medical Sciences (PIMS), Federal Government Polyclinic, and Federal Government Hospital (FGH) Chak Shahzad. However, despite their urgent need for vaccination, these institutions are met with the distressing reality of being directed to purchase the ARV and immunoglobulin from private pharmacies, where these essential medications are also scarce.

Experts say administration of ARV and immunoglobulin after a dog bite is part of a post-exposure prophylaxis (PEP) protocol recommended by the health authorities worldwide to prevent the development of rabies in individuals who have been bitten or scratched by a potentially rabid animal.

Rabies is a viral infection transmitted through the saliva of infected animals, most commonly through the bite of a rabid animal like a dog. Once the rabies virus enters the body, it travels through the nerves to the brain, where it causes inflammation and ultimately leads to severe neurological symptoms and death if left untreated.

“I was attacked by a stray dog in G-11/3 today, and it bit me on my leg. Upon rushing to the emergency ward at PIMS, I was informed that I needed to procure the anti-rabies vaccine and immunoglobulin from pharmacies outside the hospital premises. Unfortunately, neither of the drugs was available anywhere, so I had to seek treatment at a private hospital,” recounted Irfan Ahmed, a resident of sector G-11/3.

Interviews conducted with patients across all three public health facilities confirmed that the anti-rabies vaccine and immunoglobulin were unavailable both at these institutions and at private pharmacies and medical stores throughout Islamabad. Consequently, the dog-bite victims have resorted to seeking treatment at a leading private health facility in the city, which has been sourcing the crucial vaccine from Karachi, where importers acquire it from India and China in limited quantities.

While officials at the aforementioned hospitals refrained from providing comments on the availability of ARV and immunoglobulin, doctors in the emergency sections corroborated that these essential vaccines and biological products were indeed out of stock at the health facilities. As a result, victims’ attendants were being advised to procure the vaccine and immunoglobulin from the market.

According to data from the National Institute of Health (NIH) Islamabad, approximately 2,562 dog-bite cases were reported in the 10th week of 2024 from across Pakistan, excluding Punjab and Islamabad, which do not share such data with the NIH.

“Although we lack concrete data on the total number of dog-bite cases nationwide, as Islamabad and Punjab do not share their data with us, it is estimated that around 10,000 to 12,000 people are bitten by stray dogs in the country on a weekly basis,” disclosed an official from the NIH.

The official further highlighted that stray dogs serve as the primary source of nearly all human rabies deaths in Pakistan, emphasising the urgent need for adequate vaccination coverage. However, despite efforts by the NIH to produce a batch of anti-rabies vaccine, which is expected to be available in the market by the end of April or early May, the production capacity remains insufficient to meet the overwhelming demand.

“Even if half a million people are bitten by stray dogs in Pakistan, approximately 2 million doses of ARV and immunoglobulin are required. Unfortunately, the NIH alone cannot fulfill this requirement due to its limited production capacity,” the official lamented.

Officials from the Drug Regulatory Authority of Pakistan (Drap) and the drug section of the Islamabad health department echoed similar concerns, attributing the shortage of anti-rabies vaccine and immunoglobulin to the devaluation of the rupee against the dollar, which has led to increased prices in the international market. Consequently, importers are compelled to import these vital medications in limited quantities, exacerbating the crisis faced by dog-bite victims across Islamabad.