The National TB Center under the Department of Health Services had to purchase multidrug-resistant (MDR) tuberculosis vaccine from a black market in India due to a chronic shortage of tuberculosis vaccine in the country.

"To prevent discontinuity in the treatment of patients infected with multidrug-resistant TB, we were compelled to purchase Kanamycin vaccines from Indian black market," Dr Sagar Kumar Rajbhandari, director at the center told the Post. "We did not have much time to fulfil the procedures of the Department of Drug Administration."

The department does not allow the import of the vaccine without registration.

More than 250 people suffering from multidrug-resistant TB are availing the Kanamycin vaccine from various state-run TB treatment centres across the country. Patients suffering from multidrug-resistance TB have to immunise themselves with Kanamycin vaccine for four to six months after taking a regular multidrug-resistant drug for nine months.

The center has purchases 3,850 vials of Kanamycin vaccines from India and has ordered additional vials.

Each TB patient needs to immunise six times a week, which requires about 150 vials of vaccine, according to the center.

Rajbhandari said the Kanamycin vaccine shortage was precipitated by the discontinuation of production by the concerned pharmaceutical companies.

The companies are now manufacturing Amikacin vaccine in line with the changed treatment protocol.

"We, too, are making preparations to phase out Kanamycin vaccine and introduce Amikacin," Rajbhandari said. "For now, we are working towards addressing the shortage of Kanamycin vaccine seen in this transition period. We have also issued a circular to all TB treatment centres to give Amikacin vaccine to all new patients."

Health experts say if the treatment is stopped in the middle or withdrawn without completing the course, the TB patient could develop multidrug resistance, which could also lead to drug-resistant TB.

People suffering from multidrug-resistance TB transmit the same bacteria to others. The center has been running several facilities across the country to prevent the transmission of multidrug-resistant and drug-resistant TB.

Nepal had committed to eradicating TB by 2035 by implementing the World Health Organization's “END TB Strategy” at a United Nations’ high-level meeting on TB in 2018.

However, a reportof a prevalence survey carried out by an independent Joint Monitoring Mission for Tuberculosis shows that Nepal is “not on track to end TB by 2035.”

According to the report, TB in Nepal is significantly larger than previously thought—two-thirds higher than previously estimated, which significantly increases the number of “missing cases”.