Khushboo Daga, CEO of VINS Bioproducts Ltd—a key supplier of equine-derived immunoglobulins—emphasizes the urgent need for wider RIG access. VINS supports India’s immunization programs and exports to 100+ countries
Published Jun 22, 2025 | 7:00 AM ⚊ Updated Jun 22, 2025 | 7:00 AM
Synopsis: India’s battle against rabies remains urgent, with thousands of preventable deaths each year. A Lancet study shows while 80% of public health facilities stock anti-rabies vaccines, only 20% provide vital rabies immunoglobulin (RIG) for severe cases. Khushboo Daga of VINS Bioproducts highlights the gap and India’s crucial role in global immunization efforts.
India’s fight against rabies is at a critical juncture. Despite being entirely preventable, the country continues to witness thousands of dog-mediated human deaths each year.
A recent nationwide survey published in The Lancet Regional Health – Southeast Asia revealed a troubling gap: While 80 percent of public health facilities stock anti-rabies vaccines (ARV), only 20 percent have rabies immunoglobulin (RIG) — a vital component of post-exposure prophylaxis (PEP) for severe bite cases.
Khushboo Daga, Chief Executive Officer of VINS Bioproducts Ltd, a leading Indian biopharma company and global supplier of equine-derived immunoglobulins for rabies and other critical conditions, weighs in on the issue. VINS exports to over 100 countries and plays a key role in India’s public immunization programs.
Q. To begin with, could you briefly explain what rabies immunoglobulin (RIG) is, how it works in tandem with anti-rabies vaccines, and why it’s crucial for managing severe animal bite cases, such as Category III or IV bites in India?
A: So basically, RIG — which stands for rabies immunoglobulin — is derived from equine plasma, that is, the plasma of a horse. When the plasma is separated from the horse’s blood, it is processed and manufactured into an injectable form, commonly known as anti-rabies serum.
These are essentially antibodies that should be administered ideally at the time of the bite, in any Category II or above bite cases. The reason is simple: while the vaccine takes anywhere between 7 to 14 days to begin acting, RIG provides immediate passive immunity and helps neutralize the virus during that window period.
So yes, it should always be given along with the vaccine. According to WHO guidelines as well, it is mandatory to administer RIG — either equine immunoglobulin or human rabies immunoglobulin — in every Category II and above bite case.
Q. The recent nationwide survey showed that while ARV is available in 80 percent of public facilities, only 20 percent stock RIG. Why do you think this gap exists, and what are the real-world consequences of this shortfall?
A: The gap used to be quite wide, but thankfully, due to increasing awareness, the consumption of equine rabies immunoglobulin is going up. That said, the low availability still persists in many areas, and this could be due to a combination of factors.
First, there may be a lack of awareness among doctors and paramedical staff that RIG also needs to be administered, especially in severe bite cases. Second, whether or not the patient is willing to take it can be a factor — sometimes due to misinformation or fear.
Third, it might be an availability issue — the supply chain not reaching all public health facilities uniformly. And fourth, there’s the perception around cost. However, I want to emphasize that equine rabies immunoglobulin is not a very expensive drug. It is quite affordable, especially considering it’s a life-saving intervention. So cost should not be a barrier.
Unfortunately, when RIG is not administered in time, patients are at a much higher risk of developing rabies, which, once symptomatic, is almost always fatal.
Q. Despite rabies being entirely preventable, India still sees an estimated 5,700 dog-mediated human deaths annually. In your view, what are the key bottlenecks leading to these preventable deaths — particularly from the perspective of access to passive immunization like RIG?
A: As I mentioned earlier, Sumit, there are multiple contributing factors. If these aren’t addressed properly, they can lead to patients not receiving RIG when it’s needed.
Sometimes doctors themselves may not be fully aware that RIG should be administered along with the vaccine. In other cases, the patient may be unwilling to take the immunoglobulin, either due to misinformation or fear. And, of course, there are instances where the product simply isn’t available at the point of care.
If RIG is not administered at the right time — or is given too late — the patient may unfortunately succumb to rabies, despite the bite being entirely manageable with timely post-exposure prophylaxis.
Q. Can you walk us through how the supply chain for RIG typically works in India — from manufacturing to reaching a primary health centre — and where you see the most friction or delays?
A: Equine rabies immunoglobulin is predominantly procured by the Ministry of Health through a tender-based system. Every state has its own health department or procurement agency that floats tenders for such products.
When a state, let’s say Rajasthan or Kerala, finalizes its supplier — for example, if VINS is selected — we receive a purchase order with specific quantities and a list of delivery destinations, which are typically various district-level warehouses or designated cold-chain points.
Our responsibility is to ensure the product is shipped from our manufacturing or central warehouse to these destinations while maintaining the cold chain. Since RIG is a liquid formulation, it must be stored and transported at 2 to 8 degrees Celsius. We use temperature-controlled logistics to ensure that the product reaches all consignees in the required condition.
Once it reaches the state’s designated warehouses, they take over the storage and further distribution to primary health centres or hospitals. From that point on, storage and last-mile delivery are the responsibility of the respective state health authorities.
Q. A quick follow-up — the Lancet report mentioned gaps in cold-chain infrastructure at public health facilities. In such cases, where does the manufacturer’s responsibility end? Can manufacturers also provide cold chain support to strengthen public infrastructure?
A: Honestly, things have significantly improved — especially post-COVID. The pandemic forced rapid strengthening of cold-chain systems across the country because vaccines also needed to be stored between 2 to 8 degrees Celsius.
Compared to many countries, especially in Africa, India’s situation is relatively better. That said, yes, there can be limitations — particularly regarding the capacity of existing cold-chain storage at public health facilities.
There are so many vaccines and biologics requiring refrigeration that facilities may not always have enough space to stock large volumes of equine rabies immunoglobulin.
As manufacturers, our responsibility is to ensure that the product reaches state or district warehouses in proper condition. Beyond that point — the maintenance and adequacy of cold-chain storage — is the responsibility of public health infrastructure. However, we are always open to supporting partners in improving logistics where needed.
Q. VINS runs special horse farms to produce life-saving medicines like rabies immunoglobulin. These farms follow strict animal welfare guidelines set by the government’s CPCSEA. Can you explain how these horses help in making the medicine, and what steps your company takes to ensure the animals are treated ethically and kept healthy during the process?
A: Absolutely. Each of our animals is treated like a child — with utmost care, compassion, and responsibility.
We are strictly governed by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA). They have comprehensive guidelines covering everything from housing to veterinary care, and our facilities are regularly inspected to ensure compliance, both in documentation and on-site operations.
To produce antivenoms or antisera like rabies immunoglobulin, we procure horses at a specific age deemed appropriate for immunization. Before beginning the process, every animal undergoes extensive health and quality checks. We ensure they receive proper nutrition, rest, and regular veterinary care throughout their stay.
The immunization process involves administering a very small dose of the virus or venom — just enough to stimulate an immune response without affecting the animal’s health or organ function. Over time, the horse develops antibodies, and once their antibody levels are high enough, we collect blood — a process done under strict supervision with minimal discomfort to the animal.
Importantly, there are rest periods built into this process to ensure the horses are not overburdened. At every step, animal welfare remains our top priority. There is no harm to the animals if the process is conducted properly — and ethically — as we do at VINS.
Q. There’s increasing global attention on monoclonal antibodies (RmAb) as an alternative to traditional RIG. How do you see the future of passive immunization? Is it about coexistence, or is a shift inevitable?
A: Honestly, it’s a complex picture. Monoclonal antibodies are already available and represent a promising advancement — particularly in terms of precision and purity.
But when we talk about large-scale public health challenges like rabies in India — where the number of bites is huge and the population is massive — affordability, production capacity, and availability become critical factors.
Equine rabies immunoglobulin remains the most widely used option today because it’s significantly more affordable and scalable compared to monoclonals. So while monoclonal antibodies will certainly have a role to play, especially in niche or high-risk scenarios, I believe we’re likely to see coexistence for quite some time.
We need all tools available to ensure no one dies of a preventable disease like rabies — and that means focusing on what’s accessible, affordable, and effective at population scale.
Q. You mentioned earlier that government procurement happens through tenders. But do you see any hurdles in the supply chain due to delays in tendering or the time states take to finalize them?
A: Yes, that can happen. India has a fairly systematic process when it comes to floating tenders, finalizing them, and managing procurement policies.
However, sometimes challenges arise at the state level. A tender may not get finalized on time due to factors like delays in fund allocation, administrative bottlenecks, or other internal issues. These delays can, in turn, disrupt the supply chain and access to life-saving products.
Q. What reforms do you think could improve the procurement process, especially in states where tenders take a long time to be finalized?
A: That’s a valid concern. Typically, what happens is that if an existing Rate Contract (RC) is still valid for a few months, the state usually tries to finalize the new tender before the RC expires. In some cases, if there’s a delay, the RC is extended for two or three months to ensure there’s no disruption in supply.
But yes, there is room for improvement.
One possible reform could be centralized procurement — where the central government handles procurement and distributes to various states. This could help streamline timelines, reduce redundancies, and ensure more uniform access across regions.
Q. VINS supplies to over 100 countries. How does India’s demand planning and public health coordination for rabies prophylaxis compare with other countries where you operate? Are there global best practices India can learn from?
A: Honestly, I would say India is very systematic in its procurement — especially when you consider the sheer scale and complexity of the country.
As I mentioned earlier, with so many states and such a large population, the system needs to be decentralized to function efficiently. That said, India’s procurement mechanisms are well-organized in many respects.
Where we can still improve is in last-mile access — ensuring availability in rural and remote areas, equipping primary health centres with proper infrastructure, maintaining the cold chain, and training health workers and paramedical staff to administer these critical products effectively.
That’s where some other countries might have an edge — particularly in consistent access and localized delivery systems. If we can strengthen those aspects, India’s rabies prophylaxis efforts can become a global benchmark.
Q. I was recently reading about snakebite cases — a topic we’ve covered in our publication too. VINS also manufactures antivenom. One concern is that snakebite wasn’t a notifiable disease for a long time. Due to that, many areas don’t seem to have the vaccine (antivenom) available. How is the supply for snakebite treatment different from vaccines in India?
A: You’re absolutely right — snakebite only recently became a notifiable disease in India, just a few months ago. That in itself is a big step forward.
Now that snakebites need to be officially reported, we’ll finally start seeing accurate statistics on the number of cases and deaths. This data will help both government agencies and manufacturers — enabling better planning of procurement and production.
With better visibility into the demand, we can ensure timely availability of antivenom, especially in snakebite-prone areas. I believe this will significantly reduce mortality and complications related to snakebites in the coming years.
Q. India has committed to the ‘Zero by 30’ global goal — eliminating human deaths from dog-mediated rabies by 2030. What would be your top three actionable recommendations to improve access to Rabies Immunoglobulin (RIG)?
A: There are three key areas, I believe, that can make a big difference:
Systematic Procurement:
First, a well-structured, streamlined procurement process is essential — from the state to the central level. If RIG is not procured on time, it’s impossible to make it available when and where needed.
Mandating RIG Administration & Better Clinical Awareness:
The government could consider making RIG administration mandatory in certain exposure categories. We often see tragic cases where a patient receives only the vaccine, not the immunoglobulin, or the RIG is administered too late — sometimes only when the patient’s condition is deteriorating.
We need greater awareness and training among doctors to ensure timely and appropriate use of RIG, as per protocol.
Availability + Cold Chain Management:
Even if the product is procured, it must be available at the point of care — including rural and remote health centres.
Alongside this, cold chain infrastructure is crucial. RIG needs to be stored between 2–8°C, and if the storage conditions are not maintained, its efficacy can drop — even if the product is technically available.
Ensuring these three things, procurement, medical awareness, and reliable cold storage, can significantly boost our fight against rabies.
(Edited by Ananya Rao)
