key: cord-0808389-meollvq4
authors: Siddiqui, Adeel; Ahmed, Ali; Tanveer, Maria; Arshad, Asma
title: The crux of Pakistan's prolonged rabies vaccine shortage: A rising mortal threat in the COVID‐19 pandemic
date: 2021-04-23
journal: J Med Virol
DOI: 10.1002/jmv.27024
sha: cfdf9e4c144910e2bb85691edd0018eea49fd4bf
doc_id: 808389
cord_uid: meollvq4

The shortage of Rabies vaccine and Rabies Immunoglobulin (RIG) in rural Sindh, Pakistan, has resulted in the death of a 10-year-old boy 1 . This article is protected by copyright. All rights reserved.

The shortage of rabies vaccine and rabies immunoglobulin (RIG) in rural Sindh, Pakistan, has resulted in the death of a 10-year-old boy. 1 The boy was bitten by a stray dog in a rural town of Sindh, where he was first taken to a primary care clinic but, due to unavailability of vaccine, had to be taken to a tertiary care hospital in Larkana. 1 In a similar scenario, 4 months ago, a 7-year-child died due to a lack of rabies vaccine in Shikarpur. 2 Currently, Pakistan is facing a shortage of more than 800 000 doses. 2 Due to this chronic shortage, the available vaccine supply is dwindling, and with additional COVID-19 restrictions, 3 there is an increased risk of rabies-related fatalities.

Rabies places a significant strain on Pakistan's healthcare system. 4 In the general trend, the bites from rabid dogs tend to increase in the summers during May-August. 4 Generally, men and children are more susceptible to dog bites. 4 Previous studies have reported up to 5000 deaths per year due to rabies in Pakistan. 5 Although the surveillance is not organized at the national level, nor is WHO's Rabinet active online to survey through the rising trends or mortality. 5 Lack of awareness about the rabid animal and rabies treatment is also a critical issue that the government has not addressed and according to a study up to 60% of respondents in a survey were found to have not sought medical attention after a suspected animal bite. 5 There is also concern about the adequate training of medical staff to deal with cases of dog bites, especially the lack of knowledge about the administration of rabies vaccines and RIG is an issue that requires prompt attention. 6 Recently, there has been a closure of rabies immunization centers due to a lack of attention from the local authorities. 7 Victims are forced to seek rabies vaccine from private sources due to their shortage at government facilities. 7 However, the issue of dog bites has reached such proportions in the province of Sindh that the court has suspended the membership of two lawmakers in the provincial assembly due to an increase in dog bites in their constituencies. To counter rabies, it is expected to require the vaccination of 500 000 dogs in the given province alone. 8 Whereas it is essential to note Recently, due to the economic turmoil in Pakistan, there has been a shortage of life-saving medicines. 11 In this case, 5-day treatment of rabies vaccine will cost around Rs. 4000 (USD 27) 1 and whereas treatment with RIG therapy of an adult (70 kg) patient will cost around Rs. 35 000 (USD 235). We conducted a telephonic survey to check the availability of these medicines in government and private sector hospitals and community pharmacies in two urban cities of Punjab, Pakistan. The data was astounding, as these vaccines were only available at two major private sector hospitals and one government hospital. In community pharmacies, only two pharmacies (large chain pharmacies) had rabies vaccines at selected outlets, while RIG was only available at one outlet. As a result,

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