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A protocol devised by a Himachal Pradesh doctor has brought down the cost of rabies vaccines from Rs 35,000 to Rs 350.

Shimla: Dr Omesh Bharti, an epidemiologist in the Himachal Pradesh health department, had never imagined his life would turn out like it has.

Among this year’s winners of the Padma Shri, India’s fourth-highest civilian honour, Dr Bharti is credited with devising a protocol that has drastically brought down the cost of rabies prevention — from Rs 35,000 to Rs 350 — bringing survival within reach of thousands of bite victims.

“Padma Shri is a reward. I feel humbled,” Bharti told ThePrint. “At times, I just wonder how my passion as a government doctor led me to such a herculean task,” he added. “If I had messed up, it could have cost me my job.”

Dr Bharti’s protocol, which involves localised intradermal injections to the site of the wound, was notified by the World Health Organisation (WHO) as the new global standard last year.

The treatment of a bite patient generally involves the intramuscular and intradermal administration of the rabies immunoglobulin (RIG), a medication comprising antibodies against the virus, in proportion to their body weight.

But RIG is expensive and not easily available, and the entire treatment could cost up to Rs 35,000, which made it unaffordable for the poor.

Looking for a solution to this problem, Bharti said, “I searched a lot of medical literature, examined clinical tests and field studies, chasing every single case to its logical end.”

“The results are before the world now,” the Kangra native told ThePrint.

“I just knew one thing, my therapies for a post-exposure rabies prophylaxis (preventive action) will definitely reverse the trend of the several rabies deaths every year,” he added.

“Most of these deaths were of poor villagers who could not afford treatment,” he said, recalling a poor bus driver who died of a dog bite as he could not afford treatment and a woman tourist who died in Manali because RIG was not available.

As part of his efforts, Bharti conducted an experiment to see if the vaccine would be effective if the RIG was just administered intradermally, i.e. to the dermis, the layer below the epidermis, in the area around the wound.

He then noted in his study that “as against 363 vials of RIGs required for all these cases (269 study participants) as per WHO recommendation based on body weight the study could be done with only 42 vials thus saving significant quantities of ERIG (equine RIG) and cost”.

His clinical tests on patients bitten by lab-confirmed rabid dogs ensured 100 per cent prevention.

“It was found that directly injecting a small amount of serum on affected wound was sufficient to save the life of a person,” said Dr Bharti.

Since 2014, Himachal Pradesh has adopted Dr Bharti’s protocol.

Also read: Who will be the next king of vaccines — India or China?

‘A poet at heart’

Currently working as an epidemiologist in the Himachal Pradesh Directorate of Health, which has a full-fledged Intradermal Anti-Rabies Clinic and Research Centre, Bharti admits that bites of rabid dogs and monkeys remain a big problem, especially in villages.

According to WHO figures, around 36 per cent of all rabies deaths across the world occur in India.

Ever since his protocol was accepted by the state government, the number of animal bite cases reaching the Intradermal Anti-Rabies Clinic and Research Centre in Shimla has come down drastically, Bharti said.

Over 20,000 bite patients have already been cured in the state with the new protocol, he added, including some bitten by lab-confirmed rabid dogs.

Dr Bharti said that India’s goal to eliminate rabies by 2030 could now well be achieved before the deadline.

“Being a poet at heart, I feel happy about having done something for the poor,” he added. “The real achievement, however, will be when there is no single death due to rabies.”

Also read: The 6 developments that will determine the future of health in India — Kiran Mazumdar Shaw

An earlier version of the report said Dr Omesh Bharti’s protocol dealt with rabies ‘treatment’. It is actually administered to dog- and monkey-bite patients to prevent the disease, which remains incurable.

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