Mumbai, Jan. 26 -- Despite clear directions from the National Medical Commission (NMC) that all hospitals must have a stock of anti-rabies vaccine and rabies immunoglobulin at all times, several major Brihanmumbai Municipal Corporation (BMC)-run facilities in the city continue to face shortages, forcing patients with severe dog bites to be referred to advanced or specialised centres. The NMC circular, issued on December 29, 2025, followed a Supreme Court order in the suo motu case regarding stray dogs. The circular categorically stated that "all government and private hospitals must maintain mandatory stock of anti-rabies vaccine (ARV) and immunoglobulin (RIG) at all times." The importance of stocking up on anti-rabies medications stems from the fact that rabies is almost always fatal once symptoms develop. However, at least three civic hospitals, VN Desai Hospital, Cooper Hospital and Jogeshwari Trauma Hospital, were found to be either out of stock or inadequately stocked with rabies immunoglobulin in January, according to multiple patient accounts and hospital records accessed by HT. A senior doctor from a BMC-run hospital explained that rabies treatment involves two crucial components. "Anti-rabies vaccination is given in a schedule. But in severe cases, vaccination alone is not enough," the official said. "In Category 3 bites, where there is deep bleeding, multiple wounds or bites on the upper body, the virus can enter the nervous system very quickly. Rabies immunoglobulin is essential in such cases because it provides immediate antibodies that neutralise the virus at the wound site," the official added. The official acknowledged challenges related to the procurement of rabies immunoglobulins but added that there was no ambiguity in the court's and the NMC's directions. "Immunoglobulin is expensive and not required in all cases, which is why it was earlier selectively used. But once the guidelines are issued, hospitals are duty-bound to keep it available. There is no room for interpretation now," the doctor said. "Any delay in administering immunoglobulin increases risk (of death). Once symptoms appear, rabies is untreatable and fatal." The lack of rabies immunoglobulin in civic hospitals has led to several complications in recent months. In one case, an 18-year-old girl who suffered a Category 3 dog bite on her upper body arrived at the VN Desai Hospital at around 6 pm on January 9. While tetanus and anti-rabies vaccine were administered, she was referred to an advanced facility due to the unavailability of immunoglobulin, despite the high risk of neurological issues which could develop from the bite. A 30-year-old professional dog trainer too said he was turned away from Cooper Hospital on January 21. "I was bitten while training dogs and went to Cooper Hospital early in the morning. They checked me and told me that immunoglobulin was not available and asked me to go to the trauma hospital," he said. "I had already taken my tetanus shot and was extremely anxious because I know how serious rabies is. It was frustrating to have to wait. I finally received treatment at the trauma centre, but the delay was stressful and frightening," he added. Additionally, due to constant referrals to the Jogeshwari trauma centre, the hospital has now flagged a shortage of immunoglobulin. Repeated calls and messages to senior BMC officials seeking clarity on stock availability and procurement timelines did not elicit a response....