Indian public health experts have projected the third wave to hit that country in late August. What happens in India usually follows in Nepal within 12-13 days, and if that is true this time too, Nepal cannot be unprepared like in March.
“If the vaccination program progresses as smoothly as it is happening now compared to the first two surges, the third wave might not be as significant if it happens at all. By Dasain, a significant chunk of Nepalis should have been vaccinated,” explains Sameer Dixit of Centre for Molecular Dynamics Nepal.
Apart from vaccines, in case of a sudden surge, hospitals need to be ready with sufficient beds and ICUs, oxygen, life-saving medical equipment, drugs and functioning oxygen plants. Hospitals must also prepare their paediatric wards since the third wave could affect a younger population.
Since the peak of the second wave when there were close to 10,000 new cases a day and over 200 daily fatalities, international donors have been supplying essential medical equipment to Nepal.
The Health Ministry received 385 ventilators and 970 oxygen concentrators in May June from various donors. District hospitals at local levels have also received direct supplies from aid agencies. These should be in running condition and on standby instead of being stockpiled in Kathmandu, say doctors interviewed for this report.
With the vaccine supply chain less constrained, there is now a debate about reprioritising the doses and a more strategic distribution of supply. Some experts have suggested a ‘firewall strategy’ wherein densely populated cities are fully vaccinated to reduce transmission, and to revive the economy that will in turn restore jobs.
Equitable vaccination is ideal, but in epidemiological terms inoculating a thinly-spread population is not the best use of limited doses. Inoculating younger adults mean they are less likely to carry the virus and transmit it to children, the largely unvaccinated group. Even within cities, the focus must be on the urban poor in congested areas.
“Moving forward, we must now prioritise crowded cities and highly mobile groups for vaccination to help blunt the effect of another wave and save as many lives as possible,” says Sher Bahadur Pun, a virologist at Teku Hospital.
However, epidemiologist Lhamo Yangchen Sherpa worries that focusing in cities may mean the underserved are neglected. “While reprioritising, our strategy should be such that the supply isn’t misused and the neediest aren’t missed out.”