Health authorities finding ways to avoid saline shortage as dengue outbreak looms

As an increased number of off-season dengue cases in the country suggests that the situation might get worse this season, health authorities are finding ways to avoid a shortage of injectable saline, a critical treatment for the mosquito-borne disease.

Last year, Bangladesh experienced a severe dengue outbreak, with 3,21,179 cases and 1,705 deaths. The situation was aggravated by a shortage of injectable saline, which is used to rehydrate patients who are experiencing dehydration, a common symptom of dengue.

To avoid a repeat of the injectable saline crisis this year, the Health Services Division in a recent meeting decided to increase the stock of injectable saline in government hospitals to ensure that there is a steady supply of the drug.

Currently, there are six companies in Bangladesh that produce injectable saline. The government procures such saline from the domestic market through Essential Drug Company Limited.

An official who attended the meeting told TBS that the Health Services Division thinks that it is necessary to produce more injectable saline than the demand to prevent an artificial crisis in the market.

The Health Services Division has instructed Essential Drug to launch the injectable saline production unit, which was supposed to have been launched last December, by next June, he said.

Health Secretary Jahangir Alam instructed every hospital to purchase and store injectable saline through using the Medical and Surgical Requisites fund. He also directed the Health Services Division and the Directorate General of Drug Administration to verify and investigate whether it is possible to import plasma and human albumin for the treatment of dengue haemorrhagic fever.

Essential Drug Managing Director Ehsanul Kabir informed the meeting that the company could supply some 5.66 lakh litres of injectable saline to government hospitals against the demand for nearly 30 lakh litres as of 24 March this year.

The six companies, however, supplied over 50 lakh litres of injectable saline to the market during this time, he said.

During the period, Essential Drug imported 13 lakh litres of injectable saline against approval for the import of 23 lakh litres from India, Kabir said, adding that efforts are being made to meet the rest of the demand from domestic manufacturers.

Health Services Division Director (Hospitals and Clinics) Mainul Ahsan informed the meeting that during the dengue peak season, about 10,000 patients remain admitted to hospitals daily and monthly demand stands at 7.5–8 lakh litres as 2.5 litres of injectable saline are required for each admitted patient per day.

Additional Health Secretary Md Anwar Hossain Akand informed the meeting that the number of dengue patients and deaths from the disease in 2023 was higher than in 2022. The dengue infection rate this year is higher than in the same time last year, he said.

In 2023, when the dengue outbreak was at its peak, due to a lack of availability of injectable saline, its price, which is usually less than Tk100, rose by four to five times at places, health officials said.

The March–October period is the peak season when the monthly demand for injectable saline reaches around 50 lakh litres, they said. The monthly demand during the off-peak season from November to February remains at around 30 lakh litres, the officials said.

Manufacturers not producing according to their capacity

The six manufacturers of injectable saline are Beximco Pharma, Libra Infusion, Orion Infusion, Popular Pharmaceuticals, Acme Laboratories and Opsonin Pharma. Besides this, Square Pharma has a unit that is not operational now.

Orion Infusion Assistant Vice President Khairul Bashar told TBS that currently injectable saline manufacturers are not able to produce according to their capacity for various reasons.

"Letters of credit (LCs) have to be opened for the import of injectable saline bags and other raw materials with a 100% margin. On the other hand, the price of the dollar has also increased. But the price of injectable saline has not increased in the past nine years. As a result, the companies are not able to produce according to their capacity."

He also said, "No new company is interested in setting up an injectable saline production plant now."