Philippines' Animal Bite Treatment Centres Are Having 10 People Share A One Dose Vial of Rabies Vaccine

As I wrote previously I was bitten by a kitten I rescued and I thought it best to get a rabies shot. The bite happened at 5:30am on a Saturday and two hours later I was at City Health hoping to avail of the free vaccine they offer.  No good. City Health is closed on Saturday!

Padlocked!

As if people don't get sick on the weekend!  So it was on to the hospital. I wasn't sure if they had the vaccine.

Of course they did not have it. But all is not as it seems. The hospital as a rule does not stock Verorab, which is the vaccine, but they will either give a recommendation to City Health or a prescription. With the prescription you go to the pharmacy, plunk out P5,500 for three vials, and then return to the hospital so they can administer the shot. I opted for the City Health recommendation because P5,500 is too much.

In the waiting room there was a lady whose daughter needed a shot and the hospital staff asked if we wanted to share the vaccine with her. We each pay half and we each get a dose from the one dose vial. She said no and opted for the City Health recommendation because there would be more people to share with at City Health and that would make the bill much less expensive. I really did not think much about sharing a vaccine with this lady but later the enormity of this incident would become much more clear.

Bright and early Monday morning we left for City Health. They open at eight and the place was packed already. All the staff were busy with the flag raising ceremony which took forever.

They started off with the song The Prayer then the sang the national anthem then they sang three more songs plus a Happy Birthday song and then finally they got to work. What a waste of time. Instead of getting the offices ready they were out there singing and clapping.  And the audio was awful because it was all being piped in via a microphone put close to someone's smartphone.

After looking around I finally found the place to sign up.  It was a double sided sheet and already filled. I was number 89. Names started being called at about 8:05. We waited for about an hour until I saw the following signs and then decided it would be better to just leave and never come back. It wasn't just these signs the turned me away either. I was told the names being called were all from Friday and Saturday! Anyone who had signed up on Monday morning would likely not get called especially since I was told they only see 100 people per day.

There is no vaccine at City Health. What happens is people line up in groups of 10 and then they split the money on the expensive vaccine. A one dose vial magically becomes a ten dose vial! No wonder the lady at the hospital wanted to go to City Health. In fact there she was waiting in the crowd.

How the heck can they extract 10 doses from what is specifically a one dose vial? I took my prescription to several pharmacies and asked to look at the vaccine.

Those are the tiny vials. You mix the solvent with the powder. You get one dose. So says the box.

The instructions specifically say to dispose of  any remaining medicinal product..

http://www.fda.moph.go.th/sites/drug/Shared%20Documents/Vaccine/U1DR1C1042470033911C-SPC.pdf

I asked each pharmacist about sharing doses. I said, "City Health is going to make 10 of us share this vial to split costs, do you think we can really get 10 doses out of this one dose vial?" Some were noncommittal saying that it is up to the doctor. One was very enthusiastic saying yes I will have to share with ten people and another gave me a what-are-you-talking about look as if I were crazy. She is the only one who seemed to have any problem with 10 people sharing a one dose vial.

What's going on here is that the rabies vaccine is being wilfully misused. Verorab comes in a one dose vial and local clinics are having 10 people at at a time share one vial of the vaccine. How can anyone be sure they are getting a proper dosage? They cannot. Perhaps more ironically is the fact that Verorab is made by Sanofi Pasteur which is the same company who makes Dengevaxia. It was the misuse of that vaccine by indiscriminately vaccinating 800,000 children which led to a public panic and criminal charges against government officials as well as Sanofi Pasteur.

The expense of the vaccine is by no means an excuse for misuse.  It's too bad that a full course of treatment is cost prohibitive for those who need it most, that is the poor. Even well off folks will find it hard to budget P5,500 immediately. I looked all over for articles, stories, statistics, anything about sharing vaccines and there is no information about this practice. Either it is unknown or people do not wish to talk about it or it's nothing controversial and is an acceptable practice. I highly doubt it though. The vial is a one dose vial and to extract any more than that is to misuse the medicine.

This is a practice that definitely deserves more scrutiny from the DOH and even Sanofi Pasteur. The state of Animal Bite Treatment Centres in the Philippines is dismal enough without doctors misusing the vaccine.