Every year from November to March, when the weather improves across most of India, and people begin to spill out of their homes, the mating season for dogs begins. This brings on aggression and bites and attacks increase. “There are on an average 6 to 7 million dog bites every year in India. Each dog bite will require five doses of vaccine. Many cases may also go unreported and not all patients who are bitten by dogs get their vaccines on time,” says Dr. Simmi Tiwari, joint director, Public Health in National Centre for Disease Control (NCDC).
Between March 6 and 12, for instance four deaths by dog bite were reported by NCDC, according to its latest weekly outbreak report. None of the deceased had got the rabies vaccine after the bite. Those who had come into contact with the people who had died were advised vaccination.
Yet, in States like Uttar Pradesh and Chhattisgarh, the emphasis on procurement of rabies vaccine is low, say government officials. “In other States like Kerala there was a shortage, so they raised demands for stocks to be moved from neighbouring Tamil Nadu,” another official from NCDC said. But earlier this year Central Research Institute in Kasauli had to discard excess vaccine vials due to lack of demand.
India’s rabies vaccine market is growing at a steady rate. Coherent Market Insights, a market research agency, says in 2022 its market value stood at US$141.4 million. The 2023 estimated value is at US$147.6 million. In expected to grow at a compound annual growth rate (CAGR) of 4.2% between 2023 and 2030.
But in September last year, the Municipal Corporation of Delhi (MCD) reported that it had only 5,000 doses of vaccine left for 2022, with many municipal corporation hospitals not having them at all. There had been nearly 13,000 dog bites registered in Delhi alone from January to December. A late tender meant that the 30,000 additional doses they had wanted to procure would be delayed.
Managing the supply chain
Manufacturers say both State and Central governments fail to forecast demand, leading to delays. “A low manufacturing capacity requires orders to be placed in advance so we can cater to larger volumes on time. At times, demands from States are delayed by many months making it difficult for us to cater to the demand on time,” a senior executive working closely with one of rabies vaccine manufacturers said.
The rabies vaccine is lyophilized (freeze dried) and filled in vials in powdered form. In a period of 24 to 32 hours, most Indian companies currently have the capacity to produce close to 50,000 vials. “In the case of polio, production of vials can go up to a lakh or two lakh in the same time frame. With the polio vaccine, one vial has upto 10 doses. However, the rabies vaccine vial can be used only in the measure of one dose per person,” the executive added.
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Currently, there are seven big Indian manufacturers: Indian Immunologicals’ Abhayrab, Bharat Biotech’s IndiRab, Cadila Pharma’s ThRabis, Serum Institute of India’s Rabivax-S, Sanofi Pasteur’s Verorab, BIO-MED’s SureRab, and Chiron Behring’s ChiroRab are available in the Indian market.
Indian Immunologicals has a market share of 27.6%, with Bharat Biotech commanding 15.6%, followed by Chiron Behring at 8.7%, and Cadila Pharma at 7.9%.
A senior official from Bharat Biotech says that the company has the capacity to manufacture 4 to 5 million vaccine vials a month. Even if the manufacturing plant is functioning at 80% of its full capacity, the company can churn out 3.2 million to 4.2 million vials each month. In an ideal situation, States should forecast demand and stockpile rabies vaccine over a period of two years. “But, if tenders are delayed and domestic demand is not forecast properly, manufacturers are compelled to produce according to demand,” the official said.
Pricing challenges
“Major Indian manufacturers supply rabies vaccine to countries like Turkey, Bangladesh, Myanmar and some African nations, among others. Although the rabies vaccines are produced in adequate amount to meet the demand of the country, the manufacturers focus on exporting more than 30% of their production as they get a higher price through exports,” says Raj Shah, Lead Consultant, Coherent Market Insights.
Cadila Healthcare exports its product Vaxirab between $5.1 and $5.6 (₹417 and ₹458, approximately). “In private hospitals in India each vial of rabies vaccine is sold at ₹350 to ₹400 per dose,” says Mr. Shah. In the government system, vials are procured at a further discounted rate.
The World Health Organization says that India’s true burden of rabies is not fully known, “although as per available information, it causes 18,000 to 20,000 deaths every year”.
