Nepal Faces Critical Shortage of Rabies Vaccines as Public Health Concerns Mount

A 17-year-old male arrived at Teku Hospital to receive his final dose of the rabies vaccine after being bitten by a dog. When asked why he traveled to the hospital for the final dose, he explained that his local health center had run out of supplies.

Similarly, another woman reported visiting Teku Hospital because her nearby health center was out of stock.

In recent weeks, an increase in animal bites—particularly from dogs and cats—combined with shortages at local health centers has forced patients to travel to Teku Hospital. This indicates a widespread scarcity of rabies vaccines across many parts of Nepal.

Rabies is a viral zoonotic disease transmitted through the bite of an infected animal. It is often considered a neglected disease globally. Statistics show that dozens of people die from rabies in Nepal every year.

However, there is little public discourse or focus on controlling this disease, confirming its status as a neglected health issue in Nepal.

Two or three decades ago, vaccines were not as easily accessible as they are today. Unfortunately, despite current availability, there has been no significant decline in rabies-related deaths. The primary reasons are a lack of understanding and persistent misconceptions about the disease.

This is the main conclusion drawn from my years of observing rabies patients. Most deaths occur in districts outside Kathmandu, a trend that remains consistent.

However, this does not mean the Kathmandu Valley is unaffected. Recently, deaths from rabies have occurred in Kathmandu and Bhaktapur. In fact, veterinarians report that rabies infection is also present in community dogs within the Kathmandu Valley.

It is estimated that many lives in Kathmandu are saved because people visit local pharmacies for the first dose immediately after being bitten, and then travel to hospitals for the remaining doses.

Many people arrive at the hospital in a state of panic, believing they must receive the vaccine within 24 hours. In reality, while it is best to get vaccinated as soon as possible, there is no strict 24-hour deadline. The incubation period for the virus is long, which allows for flexibility.

Symptoms can appear anywhere from two to three months to several years after infection. In my two and a half decades of experience, I have not seen the incubation period exceed one year; patients typically show symptoms and succumb to the disease within a year of the bite.

The timing of symptom onset depends on the site of the bite, the depth of the wound, the number of wounds, and the viral load. The primary symptoms include hydrophobia and aerophobia.

While aggression can occur, it is less commonly observed in recent patients, which warrants further research. Once symptoms like hydrophobia appear, death typically occurs within an average of one week.

There is significant confusion regarding vaccination protocols. Many private clinics and pharmacies still administer a five-dose regimen.

However, the Government of Nepal has updated its guidelines. Vaccines are administered either intradermally or intramuscularly. The intradermal method involves two injections in the arms, completed in three sessions over one week. The intramuscular method requires four doses over two weeks, with one injection per arm. The intradermal method requires a trained healthcare professional.

Decades ago, many died due to a lack of vaccines. Today, while vaccines are readily available, the failure to significantly reduce rabies cases is tragic. With the current shortage, the risk of rising rabies cases in the future cannot be ignored.

The inability of patients to travel to Kathmandu when local centers run out of stock is directly linked to the potential increase in rabies-related deaths. Although rabies is fatal, it is entirely preventable with timely vaccination.

Therefore, authorities must address the current shortage immediately and identify high-risk areas to ensure proactive vaccine management and prevent such crises from recurring.

Pun is the Coordinator of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital.