The Government of India is scrambling to address the shortage in anti-rabies vaccine, in the public and private market after several cases of vaccine unavailability was reported in various states.

India's drug price regulator – the National Pharmaceutical Pricing Authority (NPPA) has held consultations with various states and manufacturers of rabies vaccine to normalise supplies.

The NPPA had asked manufactures and distributors to supply stocks immediately in those areas where a shortage has been reported. It advised state governments to issue quantity based tenders and place long term firm orders specifying the quantity and supply schedule.

Rabies is a virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a dog's bite or other animals. Vaccine is an effective way of preventing rabies.

According to a WHO report, rabies is a vaccine-preventable disease that claims over 55,000 lives each year, mostly in Asia and Africa. India accounts for 36 percent of total rabies deaths in the world.

Exit of GSK

Sources from the vaccine industry told Moneycontrol that one of the main reasons for the current shortage is because of the exit of Chiron Behring Vaccines, a unit of GlaxoSmithKline (GSK). The unit's February supply contributed to one-fourth of the total supplies in the market.

India requires 40 million doses of rabies vaccine, of which GSK supplied 10 million doses. Chiron Behring was acquired by Bharat Biotech and the change of hands of the company is believed to have impacted production.

Adding to decline in supplies from Chiron Behring, another Delhi-based supplier of the vaccine Bio-Med, restricted its supplies over quality issues the company has been facing. It has been battling charges of for supplying contaminated oral polio vaccine.

Issues with order placements by states

Manufacturers have cite lack of firm orders by state governments and late payments as key issues, for many companies not participating in the tenders.

"The state government tender documents doesn't cite specific quantities or time schedules, once you get a contract, the state can change the status at a whim," said an executive at a private vaccine company, who didn't want to be named.

"Unlike a paracetamol, which can be produced overnight at any given quantity, we can't suddenly increase a vaccine production, which is a complex product," the executive averred.

The rabies vaccine is a price controlled product listed under the National List of Essential Medicines (NLEM), there isn't much incentive for companies to scale-up capacities and margins on the product would be much lower if a tender is submitted.

Any person bitten by a rabies-infected dog needs to take five doses of the vaccine, with each costing around Rs 350.

A representative from Indian Immunologicals, a unit of the National Dairy Development Board, which has the biggest capacity to produce rabies vaccine in India told Moneycontrol that it is responding to the situation by restricting its exports to 25 percent and diverting the stocks to address the shortage.

"We have produced 17 million doses, we are investing Rs 75 crore to add another 8 million," said K Anand Kumar, Managing Director of Indian Immunologicals.

He added that about 50 percent of Indian Immunologicals rabies vaccine is supplied to government hospitals in various states through tenders, the rest is for the private market and exports.

Kumar further stated that supplies don't meet the domestic demand as compliance for rabies treatment improved with companies sending timely remainders to patient to complete the full course of treatment.

A person needs to take five doses of rabies vaccine, if he is bitten by dog to get full protection.

Many pet-owners too have started taking rabies vaccine shots as a precautionary measure to protect themselves from acquiring the diseases.