ISLAMABAD: While public sector hospitals have been facing acute shortage of anti-rabies vaccine (ARV), the National Institute of Health (NIH) cannot supply already manufactured 80,000 vials of the vaccine to public sector hospitals as the federal cabinet has not determined its price, causing problems for the masses.

Because of the delay in taking a decision by the federal cabinet, the people who mostly rush to public sector hospitals to get treatment in dog-bite cases, have been facing problems and left with no other option but to procure Indian vaccine from the open market.

Finally, the Federal Ombudsman has intervened and directed the federal secretary of health, Nadeem Mehbub, to play his role in fixing the price so that already manufactured vaccines could be dispatched to public sector hospitals.

The ombudsman has further directed the government to fix the price of ARV on priority basis by separating the same from other 47 drugs.

NIH unable to supply 80,000 vials of already manufactured vaccine to hospitals due to cabinet failure to set its price

An official of the Drug Regulatory Authority of Pakistan (Drap) told Dawn that the authority did all the documentation for fixing the drug price along with 47 other drugs and forwarded the case to the ministry to get the approval for enhanced price.

An official of the NIH, requesting anonymity, said that bulk quantity of the vaccine has been imported from China and then packed in the NIH.

“The price of vaccine has almost doubled in the international market. Moreover, the devaluation of rupee over the last few years has also badly affected the cost of the vaccine. So we requested Drap to revise prices so that public sector hospitals could procure it. Drap has done its job and now the federal cabinet has to approve the price, but the matter has been delayed for the last few months,” he said.

“We have 80,000 vials of ARV manufactured by Liaoning ChengDa company of China, which have been packed in the NIH, but government hospitals cannot procure it without fixation of its price. So the people have been left with no other option but to procure Indian vaccine from the open market,” he said.

The Federal Ombudsman, he said, has time and again intervened for the fixation of Maximum Retail Price (MRP) of ARV and has directed the health secretary to play his role.

The letter of the Federal Ombudsman, seen by Dawn, stated: “l would like to invite your attention to the issue of non-availability of anti-rabies vaccine in public sector hospitals. A complaint was filed on 29th December 2023, expressing concern about the non-availability of the Anti-Rabies Vaccine (ARV) in Federal General Hospital, Chak Shahzad, Islamabad, for treatment of his child who was bitten by a stray dog.

“Considering the gravity of the issue, the complaint was treated on priority basis and thoroughly investigated by involving seven Federal Agencies. The complaint was closed on 28th Feb 2024 with certain directions,” the letter said.

The letter further said that on May 20, a meeting for implementation was held with representatives of the Ministry of National Health Services, NIH, Drap, Pakistan Institute of Medical Sciences (Pims) and Polyclinic (FGPC) Hospital.

“During the implementation proceedings the representative of Drap informed the meeting that the Drug Pricing Committee (DPC) of Drap has already recommended MRP of ARV for NIH from Rs891.65 to Rs1,981 per vial along with 47 other prices,” it stated.

The letter further said that the federal cabinet’s approval was required for fixation of the price.

“The NIH has prepared almost 80,000 vials of Anti-Rabies Vaccine to date. Despite production, the NIH is unable to sell/supply the vaccine to public sector hospitals due to the non-revision of its price by Drap which requires approval of the Federal Government. The shelf life of the ARV is 18 months and two-and-a-half months have already lapsed. As per SOPs the ARV is required to be supplied to the hospitals/health institutes at least six months prior to the date of its expiry,” the letter stated.

“As per recommendations of the Federal Ombudsman, the Ministry of National Health Services was directed to ensure uninterrupted availability of ARV for the general public and furnish monthly consolidated reports having the progress of all the Agencies to the Registrar’s Office till such time the vaccine becomes available/accessible to the general public by the end of May. However, the Ministry did not comply with the recommendations.

“In view of above, it is reiterated to implement the findings of the Wafaqi Mohtasib and finalise the issue of price revision of ARV on priority basis by separating the same from other 47 drugs keeping in view the directions of the Wafaqi Mohtasib, emergent need of general public and shelf life of the ARV which is deteriorating day by day which may cause financial loss to the national exchequer,” the letter said.

Published in Dawn, June 4th, 2024