Death from rabies will increase if vaccines are not provided free of cost.
In Nepal, a months-long failure of federal vaccine procurement has left hundreds of thousands of people exposed to one of medicine's most unforgiving diseases — rabies, which is nearly always fatal once symptoms emerge. Since November, district hospitals across six provinces surrounding Kathmandu have run dry, forcing the sick and the bitten to converge on a single overwhelmed hospital in the capital, itself days from exhaustion. The crisis illuminates a recurring truth in public health: the distance between a government's commitments and its logistics is often measured in lives, and those lives belong almost always to the poor.
- Over 500 people a day are arriving at Kathmandu's last functioning rabies treatment center, many having already been turned away from multiple district hospitals with no stock and no answers.
- The federal Ministry of Health failed to procure vaccines for months, forcing provincial governments and hospital committees to scramble for emergency doses that were consumed within days.
- Rationing has begun — second doses are now restricted to daytime clinic hours only, slowing treatment for people already exposed to a disease with a near-100% fatality rate once symptomatic.
- WHO has pledged 4,500 emergency doses, enough to last roughly three days, while a new government tender process will take at least a month to produce a contractor.
- Doctors are warning openly that rabies deaths will rise, falling hardest on working-class people bitten by stray dogs who cannot afford private pharmacies or the cost of traveling to the capital.
Gayatri Pandey, a 55-year-old from Kavrepalanchok, was bitten by a stray dog in late May and spent the following week being turned away from every health facility in her district. She paid out of pocket for one dose at a private pharmacy, returned to find the same empty shelves for her second shot, and ultimately had no choice but to travel to Sukraraj Tropical and Infectious Hospital in Kathmandu — a journey now being made by hundreds of people every day.
More than 500 patients arrive at Sukraraj daily, drawn from six surrounding districts where hospitals have had no stock for months. The facility itself was nearly bare, with only a few hundred doses remaining and staff estimating they would last less than a week. Emergency purchases by the Bagmati Provincial Government — first 1,000 doses, then 2,000 more — were exhausted within days. Hospitals were requesting 1,000 doses at a time and receiving 30 or 40. Dozens of desperate calls came in daily with no answers about resupply.
The shortage traces back to a federal procurement failure that began in November. The Epidemiology and Disease Control Division eventually acknowledged the collapse, asked local governments to buy independently, and appealed to the WHO Nepal office for emergency assistance. WHO confirmed it would supply 4,500 doses — roughly three days' worth. A new tender process was set to begin, but officials admitted it would take at least a month to select a contractor, meaning the crisis would persist well into July.
The burden falls most heavily on those with the least. Rabies requires four doses to be effective, and delays in completing the course can be fatal — the disease kills nearly everyone it reaches once symptoms appear. Doctors at Sukraraj stated plainly that deaths would increase if vaccines were not made freely available. Nepal already loses an estimated 100 or more people to rabies each year, and dog bite cases have risen annually. The country had pledged to eliminate dog-transmitted rabies by 2030; that goal now looks increasingly distant as the gap between political commitment and procurement reality continues to cost lives.
Gayatri Pandey made the journey to Kathmandu on a Wednesday in early June because her district had run out of rabies vaccine. The 55-year-old from Nala in Kavrepalanchok had been bitten by a stray dog a week earlier and needed protection against a disease that kills nearly everyone it infects once symptoms appear. She tried Scheer Memorial Hospital in Banepa first, then facilities in Dhulikhel. Both turned her away with no stock and no timeline for resupply. She paid 1,000 rupees out of pocket at a private pharmacy for one dose, then returned to the same empty facilities for her second shot. When they refused her again, she had no choice but to travel to Sukraraj Tropical and Infectious Hospital in Kathmandu—a journey many others are now making.
Over 500 people arrive at Sukraraj each day seeking rabies vaccination, a surge driven entirely by shortages across district hospitals. Patients are traveling from Sindhupalchok, Dhading, Kavrepalanchok, Nuwakot, Rasuwa, and other surrounding districts, all converging on the capital because nowhere else has doses. Shankar Pandey, a senior auxiliary health worker at Sukraraj, described the situation plainly: people either pay private pharmacies out of pocket or come to his hospital. But Sukraraj itself is nearly empty. The facility had only a few hundred doses remaining and estimated they would last less than a week.
The shortage began in November and has persisted through the spring. The federal Ministry of Health and Food Safety failed to supply doses for months, leaving Sukraraj Hospital to write urgent requests to the Kathmandu Metropolitan City for emergency stock. The Bagmati Provincial Government had already sent 1,000 doses, which were consumed in two days. The hospital's development committee procured 2,000 more—also exhausted. Because of the crisis, Sukraraj stopped administering second doses during emergency hours and now restricts them to regular outpatient clinic times, a rationing measure that slows treatment for people who have already been exposed to rabies. The Bagmati Provincial Health Logistic Management Center, which had purchased 7,000 doses after the federal government failed to act, reported being critically low. Officials there said hospitals were requesting 1,000 doses at a time but receiving only 30, 40, or 70. They fielded dozens of calls daily from desperate facilities with no answers about when supply would resume.
The Epidemiology and Disease Control Division, the agency responsible for supplying anti-rabies vaccines nationwide, acknowledged its procurement attempt had failed and asked provincial health agencies and local governments to buy vaccines independently. The division also requested emergency assistance from the World Health Organisation's Nepal office. WHO confirmed it would supply 4,500 doses—enough to last approximately three days. A new tender process was set to begin Thursday, but officials admitted contractor selection would take at least a month. The vaccine crisis, in other words, would persist for weeks.
The human cost is concentrated among those least able to absorb it. Doctors emphasized that delays in vaccination could drive up rabies deaths, particularly among working-class people most exposed to stray dog bites and least able to afford private treatment. The rabies vaccine normally requires four doses. Dr. Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj, stated plainly that deaths from rabies would increase if vaccines were not provided free of cost. Nepal's health ministry data showed dog bite cases rising every year. Over 60,000 people receive rabies vaccinations at state-run facilities annually, with thousands more seeking treatment privately. Officials estimate over 100 people die of rabies each year throughout the country. Globally, the World Health Organisation reports rabies kills 59,000 people yearly—one person every nine minutes, mostly children and the poor.
Nepal had committed to eliminating dog-transmitted rabies by 2030, a target set by WHO. That goal now appears at risk. As long as vaccine supplies remain unavailable, patients will continue traveling to Kathmandu or paying private pharmacies, and preventable deaths will climb among the populations with the least resources to navigate either option.
Notable Quotes
For the second dose also, I had reached those health facilities, but they turned me away saying that they do not even know when vaccine supplies will arrive.— Gayatri Pandey, 55-year-old dog bite victim from Kavrepalanchok
Death from rabies will increase if vaccines are not provided free of cost.— Dr. Sher Bahadur Pun, chief of Clinical Research Unit at Sukraraj Hospital
The Hearth Conversation Another angle on the story
Why does a shortage in one district force people all the way to Kathmandu? Couldn't they just wait for their local hospital to restock?
Because rabies doesn't wait. Once a dog bites you, you have days to get vaccinated before the virus reaches your nervous system. After that, it's almost always fatal. So people can't afford to wait for supply trucks that may not come for weeks.
But the main hospital in Kathmandu is also running low. How is that supposed to help?
It's not, really. Sukraraj is the last resort, and it's barely holding on. They had a few hundred doses left and expected them to last less than a week. The hospital had to stop giving second doses at night just to stretch what little they had.
Who's responsible for this? Is it just bad planning?
The federal Ministry of Health failed to supply doses for months. The Epidemiology and Disease Control Division—the agency that's supposed to manage this—couldn't complete its procurement. So provinces had to buy their own stock, which ran out in days. It's a system-wide failure.
What about the WHO doses they mentioned?
4,500 doses sounds like a lot until you realize Sukraraj alone sees 500 patients a day. Those WHO doses would last three days, maybe. And a new tender process won't be resolved for a month.
So people like Gayatri Pandey are paying out of pocket?
Yes. She paid 1,000 rupees at a private pharmacy. But most people bitten by stray dogs are working-class—they can't afford that. The doctors are saying deaths will rise because the people most exposed to dog bites are the least able to pay for private treatment.
And this was supposed to be eliminated by 2030?
That was the goal. But dog bite cases have been rising every year, and now the vaccine supply has collapsed. It's a public health target that's slipping away in real time.