<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1e259c7e80680e0af3f5jpeg.jpg" alt="" width="1524" height="1000"/><figcaption>The 4.1 million doses of Moderna and J&amp;J vaccines sent by Germany via COVAX facility arrived in Kathmandu this week. Photo: UNICEF</figcaption></figure>Till a few months ago, Nepal was struggling with a critical shortage of vaccine doses, and the situation was so dire that the 1.4 million senior citizens were <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">waiting past the due date for their second doses</a>.How the tables have turned. Today, the vaccine stockpile is so large that there is a danger of vials having to be destroyed because of the lack of refrigerated storage — and there are millions more vaccines in the pipeline.“There is no shortage of vaccines anymore, there are millions of doses in stock and we now need to inject them into arms as soon as possible,” says Buddha Basnyat, a physician at the Patan Academy of Medical Sciences.“The best strategy now is to continue inoculating those who haven’t yet been vaccinated while simultaneously also administering boosters, given the decreasing antibody levels and the rise of new variants,” he adds.Health experts are now recommending that the Nepal government also <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">start booster shots for high-risk populations</a> such as the immuno-compromised, senior citizens and frontline workers. They urge better planning and clarity from the government about booster shots, and who should get them to prevent influential people from jumping the queue, or misusing the doses.So far Nepal has got 20 million doses of vaccines, and has used an estimated 10 million. In the next three months, the country will be taking delivery of over 34 million doses of AstraZeneca, Coronavax, VeroCell, J&amp;J, Moderna and Pfizer vaccines. This week alone, Germany sent 4.1 million doses of Moderna and J&amp;J vaccines via the COVAX initiative. It also supported the procurement of ultra-low temperature freezers.But it is not only the lack of storage facility and nearing expiry date that validates the logic behind booster shots. Studies have shown that the antibody levels afforded by vaccines and natural infections wane significantly over time. The memory cells also provide immunity against the infection, but there is uncertainty about how long that lasts.“From the perspective of science, a booster dose is necessary especially with <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">Omicron in the picture</a>, boosters have been shown to significantly reduce hospitalisations” explains Lhamu Yangchen Sherpa, an epidemiologist with IPAS Nepal.She adds, “However, we in Nepal have a moral dilemma because a majority of our population haven’t yet received even a single dose. We need to balance this and come up with protective mechanisms that will save the most lives.”Indeed, despite adequate vaccines in the stock and millions more in the pipeline, only 30% of Nepal’s target population have been fully vaccinated against Covid-19. Some 36% have been partially inoculated.Some of Kathmandu’s hospitals are starting to observe an increase in hospitalisations, severity and deaths among people who had been fully vaccinated six months ago. This makes the case for boosters, starting with those with co-morbidity, or those above 60.“This can be an early warning for what is in store for us, the best way to prevent future surge is proper management and distribution of the vaccines we have,” says Sher Bahadur Pun, a virologist at Kathmandu’s Teku Hospital.“Nepal’s priority remains <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">vaccination for all</a>, but this does not mean we leave those who have taken two doses to die. Individuals above 60 and those more vulnerable to Covid-19 must get boosters on time and that is now,” Pun adds.Going by this week’s figures, Nepal is registering on an average of 260 new Covid a day with the positivity rate at 2.3%. While this figure is not as alarming as <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave in April-May</a>, the arrival of the Omicron variant is of serious concern.The new variant has been credited for a steep increase in the number of infections across the globe. The UK reported over 76,000 cases a day on Wednesday, and the WHO has warned that Omicron is spreading at an unprecedented rate across the world.“The new variant while comparatively less virulent than the Delta is at least two to three times more transmissible, which means it can still cause a significant number of deaths given the higher number of infections and more morbidity, underwhelming our health infrastructure,” warns Anup Subedee, infectious disease specialist at HAMS hospital.“It may not lead to another big surge like the second wave but we have to be on a high alert,” he adds.Nepal’s poor health infrastructure is not <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">fully prepared for another spike</a> in infections. While doctors and nurses may have experience with the pandemic, and city hospitals are mostly well-equipped, ventilators are gathering dust due to the lack of skilled workers to operate them. New oxygen plants have not been monitored properly, and ICUs do not have enough trained nurses.“Everything Covid wise is now under control, we haven’t had a single case in the last two weeks but we are no better prepared,” says Binod Dangal of Charikot Hospital in Dolakha District. “If there is another wave, we are done for. <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">Our equipment is not functional</a> and we don’t have trained staff either.”There is once again a false sense of security, and the public cannot wait to go back to pre-Covid days with marriage parties, political conventions, packed classrooms, and crowded markets. For the foreseeable future, experts say we must continue to mask up and follow safety protocols despite the vaccine rollout, especially with the rise of new variants.Says physician Buddha Basnyat: “The mask is the best vaccine. It is cheap and effective, while we attempt to vaccinate everyone and give boosters.”

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From scarce vaccines, to storage shortage in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01119c7e80680e0a360ejpeg.jpg" alt="" width="1313" height="882"/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>In terms of <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">global vaccine equity</a>, the answer to the question of whether it is ethical for rich countries to boost with a third dose of  Covid-19 vaccine, seems like a no brainer.But ethics aside, it has been pointed out that no one is safe until everyone is safe. It is in the public health interest of rich countries to ensure that as many people around the world are vaccinated to <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">prevent new variants and spikes</a>.The graph below starkly illustrates the big gap between the jab and jab-nots – showing the wide chasm between rich and poor countries in terms of the proportion of the population which has got even the first dose.Booster vaccination is a moot point for low-income countries because at the moment the option is limited to high- income countries, where some research has shown waning antibody presence and the authorities in the US are advising a third dose eight months after the second one.As of now there is only scant data to show that boosting will help real-life protection in the general population. Clearly the vast majority of the people who received the full dose of approved  vaccines, including the Chinese VeroCell here in Nepal, already have adequate <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">protection against severe</a> (as opposed to mild or moderate infections) Covid-19 disease with the present vaccine schedule.Crucially, a strong international drive to vaccinate the unvaccinated could potentially save many more lives than would boost the already vaccinated.But this is a very wily virus which almost overnight changed the rules of the game by mutating into the <a style="letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">highly infectious Delta variant</a>. We need look no further than what happened in neighbouring India earlier this year as this variant ripped through the unvaccinated population regardless of herd immunity that was thought to be widespread.Delta surged across the open border into Nepal, where it overwhelmed the country’s inadequate and inequitable health care system. There is credible data to suggest that there might have been 3-5 million excess deaths in India during the second wave.<a href="https://covid19.healthdata.org/nepal?view=cumulative-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNGVkeZeMBLFWPxAOLd86V8RWL22gQ">Estimates for Nepal</a> by the <a href="http://www.healthdata.org/covid" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNG9rCQIZqojh5um31-iM7GlGaMZPA">Institute of Health Metrics and Evaluation</a> of the University of Washington in Seattle show that although the official cumulative deaths due to Covid-19 as of this week was nearing 11,000, the real figure with excess mortality is closer to 40,000.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01159c7e80680e0a360fjpeg.jpg" alt="" width="1774" height="1118"><figcaption> </figcaption></figure>It is among the vast number of the unvaccinated that the virus has a greater chance of randomly mutating and becoming a variant (from alpha to omega and now the mu variant in South America) and potentially spreading worldwide.Every time the virus replicates, its likelihood of mutation increases. The novel coronavirus, unlike the other SARS-CoV-1 from 2003 may not be as keen on killing people as it is in perpetuating infections by replicating as much as possible .After India, the Delta virus affected the UK population in a widespread manner, but there was one huge difference -- in Britain it infected many who had already been vaccinated, even though the severity of the illness was significantly lower in this subset.Hence, as these variants generally develop in the unvaccinated population and some (there are 15 variants at present) turn out like the Delta variant, it would be in the enlightened self-interest of the richer countries to have as much of the world vaccinated as possible so that random mutations and variants will be substantially limited, and will not reach their shores.But such enlightened self-interest seems to be lacking in high-income countries, especially because there are <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">not enough vaccines to go around</a>, and rich nations perceive an immediate benefit from boosting.Israel is already giving third jabs and France, UK and the US are strongly considering boosters. Boosting may be a good idea if the Covid-19 vaccine supply was plentiful. But currently the supply is limited and more than half the world’s population has not received even a single dose of the vaccine.Sadly, many in low and middle income countries are waiting for doses through the COVAX facility and drug manufacturers like Serum Institute of India scramble to fulfill previous contracts while grappling with the Delta virus at home.What is even more unconscionable is that many rich countries are throwing away expiring vaccines. And now with new orders for booster vaccination programs from high income countries, the developing world will have to wait even longer to have their contracts filled.With booster doses planned for the rich world, it may indeed be a zero sum game for the world if the supply of the approved Covid-19 vaccines is not dramatically increased. The good news is that Serum Institute of India, where Nepal sourced its first lot of Astra Zeneca Covishield vaccine until the pandemic took a turn for the worse in India, has greatly increased its production capacity.Given the experience of the past nearly two years, most high income countries are likely to ignore ethical considerations regarding vaccine equity and booster doses.Many institutions in the West that deal with global health may be embarrassed about not being able to persuade their governments to put their money where their mouth is and do the right thing.So far, their pleas for <a href="https://www.nepalitimes.com/opinion/global-solidarity-needs-intensive-care-in-pandemic-battle/" target="_blank" rel="noopener noreferrer">vaccine equity</a> have generally been ignored – even though they know an effective global vaccination drive would ultimately benefit them by reducing the risk of new variants emerging.In practice, if the production of vaccines revs up and COVAX is able to ship more vaccines to poor countries, regardless of boosting or no boosting by the richer countries, millions of people in the Global South will benefit.In the meantime, we have to continue to mask up, avoid crowds and sanitise, because the vaccine per se <a href="https://www.nepalitimes.com/opinion/dying-to-get-vaccinated/" target="_blank" rel="noopener noreferrer">will not stop transmission</a>.The other bit of good news is that the Nepal Health Research Council in conjunction with other local collaborators is  sequencing (identifying the molecular structure) of Covid-19 virus samples from various parts of Nepal.The Sanger Center, the world’s premier genomic institute based outside Cambridge in the UK, will validate the results from Nepal and enhance our capacity building in molecular medicine.This should help us in promptly identifying variants of Covid-19 so Nepal can deal with future infectious disease outbreaks in a scientific and orderly manner. <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">Covid-19</a> has emphasised the additional significance of sequencing even for other rampant diseases like  tuberculosis and typhoid in South Asia.Buddha Basnyat is a physician and clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNH6pJWJpOhLqwh7C7o4x6py0843Jg">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

To boost or not to boost

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08649c7e80680e0a6014jpeg.jpg" alt="" width="1319" height="1975"/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/eu-will-stand-by-nepal-in-hard-times/" target="_blank" rel="noopener noreferrer">European Union</a> has renewed its committment to sharing more than 200 million doses of Covid-19 vaccines with low and middle-income nations, including Nepal, by the end of 2021.The doses will be delivered mainly through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">the COVAX initiative</a>, which has so far provided 122 million doses to 136 countries. This is far less than the quantity originally promised because of supply chain issues and India’s ban on export of its AstraZeneca Covishield vaccine.“Team Europe takes its responsibility in helping the world fight the virus, everywhere. Vaccination is key – that's why it is essential to ensure access to Covid-19 vaccines to countries worldwide,” said EU President Ursula von der Leyen at this week’s Global Health Summit in Rome.In parallel, Europe is providing better access to vaccines, medicines and health technologies in Africa, in part by helping create the right conditions for local vaccine manufacturing in Africa.The initiative will be backed by a €1 billion grant from the EU, and European development finance institutions such as the European Investment Bank (EIB).On 9 July, Team Europe agreed to support large-scale investment in vaccine production by the Institut Pasteur in Dakar. The new plant will reduce Africa's 99% dependence on vaccine imports and strengthen future pandemic resilience in the continent.The European Union is one of the biggest donors of COVAX and has contributed at least €2.47 billion to the initiative, which had committed to providing free vaccines for 20% of Nepal’s population.It sent its first consignment to Kathmandu back in March with 348,000 doses of AstraZeneca Covishield manufactured by Serum Institute of India. But owing to a global manufacturing bottleneck and the export ban in India on vaccines, it was <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">unable to deliver any more doses</a> till recently.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08679c7e80680e0a6015jpeg.jpg" alt="" width="448" height="537"><figcaption></figcaption></figure>Even as Nepal was in the grip of the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave</a> in May-June when there were close to 10,000 new cases daily and up to 250 fatalities a day, there was a complete stop to vaccinations.Nearly 1.4 million Nepalis above 65 are <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">still waiting for their second doses of Covishield</a>, which they may now get with a grant of 1.6 million doses of AstraZeneca from Japan.In early July, the Americans flew over 1.5 doses of single-shot Johnson &amp; Johnson to Kathmandu under COVAX, which is sending another 350,000 doses by August.At present VeroCell and <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">J&amp;J vaccination</a> drives are running in parallel across Nepal and the vaccine supply chain is <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">less constrained</a>.But the decline in the number of new infections and deaths has now stalled. Public health experts have warned <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">of a third wave</a> and there are threats of newer, more virulent variants as long as a major chunk of the population remains unvaccinated.Covid mortality rose by 50% this week, and urban centres in Kathmandu, Lalitpur, Chitwan, Kaski and Jhapa have recorded the most new cases.On Friday, there were a total of 2,977 new cases across the country, taking the total active infections to 28,518. There were 18 fatalities in the last 24 hours and 1,678 recoveries. So far, 9,679 people have succumbed to Covid-19 in Nepal since the outbreak in January 2020.

EU to share 200 million vaccines by 2021

<img width="768" height="512" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d066a9c7e80680e0a5f5fjpeg.jpg" alt=""/>Much-delayed <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">vaccine supplies to Nepal</a> appear to be picking up after another lot of Chinese Sinopharm vaccines arrived in Kathmandu on Friday, and assurances that the country will get additional doses through the COVAX facility in the coming weeks. In a government-to-government deal, Nepal ordered 4 million doses of Sinopharm’s VeroCell vaccines, which will be enough to inoculate an additional 2 million Nepalis. The first shipment of 800,000 doses was flown in by Nepal Airlines from Beijing on Friday. The United States has confirmed that it is working on the legal and logistical aspects of sending 1.5 million doses of its single-jab Johnson &amp; Johnson vaccine to Nepal under the COVAX initiative.  The British Minister of State for South Asia and the Commonwealth, Lord Tariq Ahmad in a written response to House of Commons MP Sir John Hayes on 30 June said that Britain would be sending more vaccines through COVAX by next month. ‘COVAX has allocated 2,000,000 vaccine doses to Nepal, of which 348,000 have already been delivered and we understand another tranche will arrive by August,” Lord Ahmad’s letter, which was made available to Nepali Times, states. However, it is not clear if the additional COVAX vaccines are the ones already pledged by the Americans, and if it is another lot how many doses of what kind of vaccines are involved. The Ministry of Health has said another 348,000 vaccines are coming through COVAX by August.  This fact is critical for the nearly 1.4 million Nepalis above 65 years who got their <a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer">first doses of AstraZeneca</a> more than 12 weeks ago, and their second doses are overdue. The elderly were inoculated first with Covishield AstraZeneca manufactured by Serum Institute India of which Nepal got 1 million doses as initial grant from India and then purchased another 2 million of which only <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer">1 million were delivered </a>before New Delhi banned vaccine exports. Less than 3% of Nepalis have so far received both doses of Covishield or VeroCell, and another 2.6 million have got both shots. Nepal needs to inoculate at least 22 million of its eligible population. COVAX had originally promised 13 million doses of Covishield to inoculate 20% of Nepal’s population. The American announcement of 1.5 million J&amp;J doses are a part of the 7 million pledged by President Joe Biden to South Asian countries last month, of the 1 billion doses from the G-7 promised at a summit in the UK last month. ‘The majority of the doses will go through COVAX,” Lord Ahmad says in his letter. ‘In addition, the World Bank and the Asian Development Bank (both partially UK-funded) have made available significant funding to enable the Government of Nepal to purchase vaccines. This financing together with COVAX supplies can vaccinate 70% of the population of Nepal.’ Indeed, the World Bank has provided Nepal with a $100 million loan, and an additional $160 million from the ADB for vaccine procurement. World Bank country director Faris Hadad-Zervos told reporters in Kathmandu on Thursday that Nepal may have to wait a long time to get vaccines as grants through COVAX, and it might be a better idea to buy them. The EU had negotiated with vaccine manufacturers to provide 1.2 billion vaccines at cost to low income countries through COVAX. The EU has exported 340 million doses of vaccines, half its production, to countries around the world. Head of the EU Delegation to Nepal <a href="https://www.nepalitimes.com/opinion/eu-will-stand-by-nepal-in-hard-times/" target="_blank" rel="noopener noreferrer">Nona Deprez</a> says the EU is not sitting on a big stockpile of vaccines at the moment, and has not been blocking individual member states from having direct vaccine deals with countries like Nepal. <figure><img width="1017" height="652" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d066d9c7e80680e0a5f60jpeg.jpg" alt=""><figcaption> </figcaption></figure>A group of European, Nepali and Bhutanese personalities had written an <a href="https://www.nepalitimes.com/latest/nepal-bhutan-vaccine-appeal-to-european-commission/" target="_blank" rel="noopener noreferrer">open letter</a> to the European Commission president this week demanding that countries be allowed to send surplus vaccines directly to countries without having to go through Brussels and COVAX.“Nepal is very much on our radar, and direct vaccine supply depends very much on individual member states who are owners of the vaccines,” Deprez told Nepali Times. “In fact, we have received requests from 20 countries, including Nepal, and have tried to facilitate the bilateral donations.”The UN’s COVAX facility is mainly funded by the UK and EU, but its reliance on India’s Covishield as well as legally-binding shipments of doses to donor countries has set back its programs in Africa and Asia.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" target="_blank" rel="noopener noreferrer">Pressure has been building in the UK</a> from Gurkha veterans, MPs, and activists for Britain to provide AstraZeneca vaccines at least for the second doses. At least 63 Gurkha veterans have died in Nepal from Covid-19 during the second wave.  <img width="640" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06709c7e80680e0a5f61jpeg.jpg" alt="">Nepal’s second wave has crested, but public health officials have warned of a second peak because of what they said was a premature relaxation of lockdown rules while the virus was still spreading in the community and not enough people had been vaccinated.On Thursday, there were 29 more deaths from Covid-19, and the number of infected people, while much lower than at the peak last month, was higher than the total recovered patients for the third day in a row. The number of active cases in Nepal has risen slightly again to 26,447, after dropping from 120,000.However, many experts have pointed out that the daily death and infections are severely undercounted.

Vaccines start trickling into Nepal

<figure><img width="1430" height="872" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06329c7e80680e0a5f4djpeg.jpg" alt=""/><figcaption></figcaption></figure>A group of European, Nepali and Bhutanese personalities have sent an <a href="https://www.petitions.net/vaccines_to_himalayas" data-saferedirecturl="https://www.google.com/url?q=https://www.petitions.net/vaccines_to_himalayas&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNEuu109cz_uT0mzvuFORxCpVo-70A">open letter</a> to the European Commission, asking it to allow member states to send surplus vaccines directly to Nepal and Bhutan, by-passing delays through COVAX.
EU member states have millions of doses of excess vaccines, but donations or transfers of these surplus doses are severely constrained by the <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNEOGELikZJFPj6cPmuERuwgR5_tDA">contracts between EU, member states and vaccine manufacturers. </a>
‘We appeal to European Commission to facilitate a mechanism which would allow member states to transfer vaccines bilaterally to other countries or enable member states to target their vaccine contributions multilaterally to the countries where it is most urgently needed,’ the appeal states. 
Millions of people in Nepal and Bhutan are in urgent need of Covid-19 vaccines, especially AstraZeneca, in order to vaccinate their citizens with second doses. Nepal needs 1.4 million doses immediately for people above 65 years who got their first doses, and are still waiting for their second jabs because India banned the export of Covishield AZ. 
Nepal has not even got an additional 1 million doses<a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNG91MGxSlsuyUqVeeU6-wQZv9jkrg"> it already paid Serum Institute of India for</a>, and needs a further 20 million doses for the rest of its population. Nepal government is buying 4 million doses of VeroCell from SinoPharm in China and the first of the weekly shipments will start arriving on Thursday. 
Similarly, Bhutan has inoculated most of its eligible population of 500,000 with Covishield AZ from Serum Institute India, but only with their first doses. 
Some European countries like Denmark, Norway and the Czech Republic have excess AZ vaccines which they want to send to Nepal and Bhutan directly, but they are constrained by legal agreements to go through the EU and COVAX.
However, WHO’s COVAX facility has also not been able to dispatch promised vaccines to Nepal, Bhutan and other developing countries because it had sourced it from Serum Institute India. COVAX has only sent 835,000 of the 2.26 million it promised before India stopped its export. 
Nepali officials disclosed this week that 1.5 million doses of Johnson &amp; Johnson vaccines from the United States through COVAX would be delivered later this month.
The open letter states: ‘While COVAX is a fair mechanism of vaccine distribution among the low and mid income countries, its prioritisation is not taking into account the receiving country's actual situation amid Covid-19 pandemic, its specific vaccination needs and its vaccine administration preparedness. Ability to direct at least part of the available supplies to the places where the vaccines are currently most needed would overcome these shortcomings.’ 
Despite the urgency of second doses, the COVAX mechanism prioritises countries by population and not by the current pandemic situation. The open letter argues that European countries have stockpiles of vaccines that are nearing expiry, and the European Commission could expedite shipments if it facilitated direct transfer of doses from EU member states.  
It also says that by denying the requests by Bhutan and Nepal for direct vaccine donations, EU is ‘damaging its international image ... and reinforces the EU’s stereotypical image as bureaucratic, inflexible and alienated’. 
It says failure to respond to the urgent requests from Nepal would hurt the EU because other vaccine manufacturing countries ‘are successfully using vaccine diplomacy to increase their soft-power’. 
Signatories of this open letter are known personalities from EU countries, Nepal and Bhutan. This includes members of European Parliament Tomáš Zdechovský and Kateřina Konečná, academics Françoise Pommaret and Karma Phuntsho, former under secretary general of the United Nations<a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNHDSyw9q0gS0XWMLZzZS82mvNgKcg"> Kul Chandra Gautam from Nepal, </a>artists, mountaineers, activists, public health workers and others. 
Other prominent Nepalis include writers Manjushree Thapa and Budhhisagar, as well as former Miss Nepals Malvika Subba and Srinkhala Khatiwoda.
The open letter idea was initiated by a group of Czechs with close ties with the Himalaya who sent an earlier open letter to the Czech Government calling on it to gift its surplus vaccines to Nepal and Bhutan. 
“In subsequent unofficial consultations, it became clear, that Czech Government is not at a liberty to donate or sell its excess doses of AstraZeneca vaccine due to the constraints of the contract between EU, Czechs and the vaccine manufacturer,” explained photographer Michal Thoma, one of those behind the initiative. “It also became apparent that the same situation applies for other EU countries which purchased vaccines through the EU vaccine procurement mechanism.”
So Thoma teamed up with Věra Exnerová, the Nepal Country Director of humanitarian organisation People in Need, mountaineer Jan Tráva and filmmaker Petr Horký to write to the European Commission with other Nepalis and Bhutanese.
On 1 July, Denmark announced that it would donate 250,000 vaccines to Bhutan. However, it is understood that these grants still need to be facilitated by the EU. 
Says Thoma: “The European Commission should stand up to its responsibility so that the EU can fight the pandemic not only within its borders but everywhere else around the world.” 
Those interested can sign the petition at <a href="https://www.petitions.net/vaccines_to_himalayas" data-saferedirecturl="https://www.google.com/url?q=https://www.petitions.net/vaccines_to_himalayas&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNE8S4KxCeyaljq2uj4jL7emQuTHgg">https://www.petitions.net/vaccines_to_himalayas</a>.
Full Text of the Open Letter:
European Commission Ms Ursula von der Leyen President of the European Commission 
Open Letter to the European Commission to facilitate direct transfers of excess Covid-19 vaccines from EU member states to the countries with most urgent needs, namely Nepal and Bhutan 
Dear Commission President von der Leyen, 
We would like to bring to your attention the pressing issue of excess vaccines which were purchased by the member states through the centralized EU vaccine acquisition mechanism. Many of these vaccines, such as Vaxzervia produced by AstraZeneca, are not being administered or their use in most EU member states is substantially restricted. As a result, millions of doses are now idly awaiting other allocation. 
Many foreign governments, namely Bhutan and Nepal, asked for donation or purchase of excess vaccines from EU member states. Many public initiatives in EU member states also appealed to their respective governments to facilitate transfer of excess vaccines to Nepal and Bhutan or other mid and low income countries. 
However, EU member states are not in liberty to donate the surplus vaccines directly due to the legal constraints of the contracts between vaccine manufacturers, member states and EU. 
We, an informal group of people with close relationship to the Himalayas, namely Bhutan and Nepal, are nonetheless convinced that these countries, currently affected by regional outbreak of Delta variant, would be best helped by direct vaccine donations. Nepal and Bhutan urgently need almost two millions doses of AstraZeneca vaccine in order to administer second rounds to its citizens. Unfortunately, it has been reported by the media that WHO’s COVAX facility asked Nepal and Bhutan to request doses from other vaccine manufacturers. This may cause delays and complications for rapid response to fight against Covid-19 pandemic in these countries.
We thus appeal to European Commission to facilitate a mechanism which would allow member states to transfer vaccines bilaterally to other countries or enable member states to target their vaccine contributions multilaterally to the countries where it is most urgently needed. 
The reasons for above are as follows: 
<ol><li>While COVAX is a fair mechanism of vaccine distribution among the low and mid income countries, its prioritization is not taking into account the receiving country's actual situation amid Covid-19 pandemic, its specific vaccination needs and its vaccine administration preparedness. Ability to direct at least part of the available</li>
</ol>Prague, 6th July 2021 
supplies to the places where the vaccines are currently most needed would 
overcome these shortcomings. 2. By denying the foreign government requests for direct vaccine donations, EU 
member countries and the EU itself is damaging its international image. At the same time, other vaccine manufacturing countries are successfully using vaccine diplomacy to increase their soft-power and will certainly yield from that in the future. 
<ol start="3"><li>Inability to react positively to the appeals of member states’ citizens to donate vaccines to countries in urgent need reinforces the EU’s stereotypical image as bureaucratic, inflexible and alienated. Allowing member states and its people to decide on how to distribute the excess of vaccines would counteract such feelings among EU citizens.</li>
<li>The USA just recently decided to distribute its excess vaccines partly through COVAX and partly bilaterally according to US foreign policy prioritization. We believe that this is an example to follow.</li>
</ol>On top of that, many EU member states will soon have vast caches of soon to expire vaccines for which there will be no recipients among the EU citizens. In such a case, European Commission should pave the way for the member states for the swift transfers of such expiring doses to the third countries which are ready to receive and administer such supplies in the short time. 
We would like to request you to consider the above points thoroughly. We have full faith and hope in the European Commission's ability to make the right decisions that would be taking into account a global responsibility of the EU as well as the international relations priorities and wishes of EU citizens. 
Yours sincerely, 
Michal Thoma, photographer and writer, Czechia 
Věra Exnerová, Nepal director of the humanitarian organisation People in Need, Czechia 
Jan Tráva, mountaineer, Czechia 
Petr Horký, filmmaker, Czechia 
Kunda Dixit, editor and publisher of <a href="https://www.nepalitimes.com/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNFueSB5zZbscyAgy7DPVj7QFyZZuQ">Nepali Times</a>, Nepal 
Françoise Pommaret, ethnohistorian and Tibetologist, France &amp; Bhutan 
Karma Phuntsho, Loden Foundation, Bhutan and Cambridge University, UK 
Stanislav Tomka, entrepreneur, Slovakia 
Gabriel Točka, Namasté, Society for Nepal-Slovakia Friendship, Slovakia 
Zdeňka Karky, former Czech honorary consul in Nepal, Czechia 
Kul Chandra Gautam, former deputy executive director of UNICEF, Nepal 
Manjushree Thapa, essayist, fiction writer, translator and editor, Nepal &amp; Canada 
Tomáš Zdechovský, Member of European Parliament, Czechia Buddhisagar, writer, poet, columnist, author of Karnali Blues and Firfire, Nepal 
Saurav Dhakal, curator, Story Cycle, Nepal 
Malvika Subba and Shrinkhala Khatiwoda, both Miss Nepal, Nepal
Buddha Basnyat, Himalayan Rescue Association and Mountain Medicine Society of Nepal 
Kateřina Konečná, Member of European Parliament, Czechia 
Šimon Pánek, director of the humanitarian organization People in Need, Czechia

Nepal-Bhutan vaccine appeal to European Commission

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fb9c7e80680e0a5f3ajpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>There is breaking news every other day: the United States donates 2 million Moderna shots to Bangladesh and Pakistan. Denmark announces 250,000 AstraZeneca doses to Bhutan. Japan pledges surplus AZ vaccines to Sri Lanka and the Pacific Islands.Nepal is never in the news, even though <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">1.4 million people still wait for their second doses</a> of Covishield AZ vaccines and another 20 million people need to be inoculated before a possible third wave this year. So far, Nepal has only been gifted or bought vaccines from India, China or the COVAX initiative. It has not even got 1 million vaccines from Serum Institute India that it paid for, and <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">all other promises from western countries were never kept</a>.  Nepal’s vaccine diplomacy has failed miserably. And the only silver lining is that there are four million doses of the Chinese Sinopharm VeroCell starting next week to immediately inoculate its above 55 population.Nepal is still recording an excess of 2,000 new cases a day and is seeing a slight daily increase following the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">relaxation in travel restrictions</a>. Everyone, the public and the government, seem to have forgotten that the real peak during the first wave last year took place only after the lockdown was eased.“The third wave is already on its way, our figures are going up and we must assume we will be hit by new variants,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences (PAHS). “We must vaccinate as many people as quickly as possible, if not we will get more difficult variants that are potentially resistant to the vaccines.”In other news, the Oxford Vaccine Group which developed the AstraZeneca (AZ) vaccine has found that administering two doses 44-45 weeks produced the highest antibody boost. This news, announced by <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">Andrew Pollard</a>, one of the developers of the AZ, is glad tidings for countries like Nepal where people above 65 are waiting for their second doses.Pollard said antibody levels remained elevated for close to a year with <a href="https://www.thehindu.com/sci-tech/health/ten-month-gap-between-astrazeneca-doses-sees-highest-antibody-boost-oxford-study/article35019890.ece" target="_blank" rel="noopener noreferrer">a ten-month gap between AZ doses</a>, as well as antibody levels twice that after the second dose among volunteers who were administered a third booster dose, pointing to a long-term, possibly life long immunity, also against variants.“This is great news for the elderly, many of whom are panicking, unable to get their second dose in the recommended time frame. The additional time the study has afforded us shouldn’t lead to complacency in our effort to procure vaccines,” says Sher Bahadur Pun, an epidemiologist at Sukraraj Tropical and Infectious Disease Hospital. <figure><img width="950" height="633" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fe9c7e80680e0a5f3bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Norway, Czech Republic and Denmark have unused AZ shots they want to donate to Nepal, but have been forced to go through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">COVAX, which is unlikely to deliver</a> the doses before the end of 2021.On 1 July, Denmark announced that it would donate 250,000 vaccines to Bhutan. However, it is understood that these grants still need to be facilitated by the EU. Also in the news this week is the result of a new modelling study published in the European Centre for Disease Prevention and Control’s medical journal Eurosurveillance that further strengthens the link between <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AZ vaccines and a rare blood clot</a>.The study models four months of a vaccine distribution strategy in France from May 2021 and concludes that using AZ on the entire adult population would avert 10 deaths from Covid among 18-39-year-olds. However, it would be associated with 21 deaths from blood clots in the same age group over the same time period. In other words, <a href="https://www.irishexaminer.com/news/arid-40328123.html?type=amp" target="_blank" rel="noopener noreferrer">clot risk to younger people from the AZ vaccine</a> is twice as high as Covid death risk. But public health experts in Nepal maintain that the benefit of mass vaccination still far outweighs the risk. “Similar studies in the context of the South Asian population are needed but as it is, transmission risk of Covid is much higher than the individual risk of blood clots here,” says epidemiologist Lhamo Yangchen Sherpa.Buddha Basnyat of PAHS concurs: “The UK with over half of its population fully vaccinated is now being hit by the <a href="https://www.nepalitimes.com/latest/covids-regional-threat-needs-regional-response/" target="_blank" rel="noopener noreferrer">delta variant</a>, although it has been largely spared from severity due to the mass inoculation. Nepal being mostly unvaccinated is unprotected both from transmission and severity. This should show us where our priority should lie.”The European Centre for Disease Prevention and Control finding about clot risk therefore could indirectly be a blessing in disguise for countries like Nepal by further freeing up AZ stockpiles in Europe, as well as Korea and Japan.Even so, blood clot risk has prompted leaders including Germany’s Angela Markel to opt for Moderna as a booster shot to her first dose of AZ jab.Several EU nations including Germany have said mix-and-match doses are safe for Covid prevention, which according to new findings also point to <a href="https://www.bbc.com/news/health-57636356" target="_blank" rel="noopener noreferrer">a better immune response</a>. This could also offer much-needed flexibility when vaccine supplies are uneven or limited.“We need to introduce mixing and matching also in Nepal in the face of more virulent delta variants, particularly for the elderly who are at the higher risk of developing severity from an infection, instead of waiting endlessly for Covishield,” says Basnyat.At a time when Nepal is yet to recover from a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second surge</a>, only an equitable vaccination strategy will prevent an even more deadly third wave. But a mere 2.6% of Nepal’s population has been fully vaccinated, and less than 9% has received a single dose of either Covishield or VeroCell shots.  <figure><img width="1594" height="898" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06009c7e80680e0a5f3cjpeg.jpg" alt=""><figcaption> </figcaption></figure>And even the doses are unevenly distributed within the country. More than half the first dose of VeroCell was distributed in Bagmati province, according to the government’s own figures. Moreover, 97% of the booster jabs of VeroCell were used only in Bagmati Province. “We are seeing a similar kind of disparity in vaccination that we saw in testing, concentrated in urban centres and in particular Kathmandu,” notes epidemiologist Lhamo Yanghen Sherpa. “The excuse for using most of the doses in Kathmandu is that people elsewhere refused to inoculate. If that’s the case what is the government and others doing to dispel vaccine myths?” Virologist Sher Bahadur Pun says the government should immediately deploy its 60,000 or so <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">female community volunteers</a> and healthcare workers who have historically done such effective work in non-Covid childhood vaccination drives.He adds, “They are spread across the country and are best placed to communicate the significance of vaccines and increase vaccination uptakes at  local levels.”

Sonia Awale

Vaccines too little, too late for Nepal?

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015114/636d058b9c7e80680e0a5f12jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Then Health Minister Hridayesh Tripathi receiving the first batch of 348,000 doses of Covishield AstraZeneca vaccines from the UN Resident Coordinator in Nepal Sara Beysolow Nyanti in March. The remaining 1.92 million doses promised by COVAX never arrived. Photo: UN</figcaption></figure>As a previously unknown mystery disease caused by the novel coronavirus struck Planet Earth in the winter of 2019-20, public health officials and the World Health Organization (WHO) recommended universal mask wearing, physical distancing, lockdowns and travel restrictions, while awaiting the arrival of preventive vaccines and effective therapies.On two sides of the Atlantic, two contrasting approaches emerged to tackle what came to be known as the Covid-19 pandemic.On the one hand, there was the erratic and eccentric Donald Trump (seconded by his Brazilian buddy Jair Bolsonaro) who denied the seriousness of the pandemic or peddled his “genius” discovery of miscellaneous medications and magical cures like injecting disinfectants into human body or irradiating patients’ bodies with UV light.Blaming China and WHO was Trump’s fallback position to hide his own policy failures. But he also invested billions of dollars to bankroll several American pharmaceutical companies to speed up the production of Covid vaccines through his Operation Warp Speed.Consistent with his ‘America First’ priority, the vaccines were meant primarily for Americans, of course, though any leftovers could be sold or given away to friendly countries abroad depending on the MAGA Leader’s mood and magnanimity.On the other side of the Atlantic, at the urging of the WHO Director-General Tedros Adhanom, many European leaders took a seemingly more enlightened global approach. Recognising that “no one is safe until everyone is safe”, European Commission President Ursula von der Leyen, French President Emmanuel Macron, German Chancellor Angela Merkel and their fellow Nordic counterparts declared that they would eschew “vaccine nationalism” and embrace the concept of a Covid vaccine as a ‘global public good’ to be made available equitably to all countries. The United Nations, the developing world, civil society organisations and celebrities welcomed this enlightened approach.Encouraged by this idealistic vision, WHO launched a clumsily worded but ambitious ‘Access to Covid-19 Tools (ACT) Accelerator’ that would speed up the development, production, and equitable access to Covid-19 tests, treatment, and vaccines. The ACT Accelerator brought together a grand alliance of governments, scientists, businesses, civil society, and philanthropists, including the Gates Foundation, GAVI, the Vaccine Alliance, the Global Fund, the Coalition for Epidemic Preparedness Innovations (CEPI), the World Bank, Unicef.It was a who’s who of the global health partnership. The most important ‘pillar’ of the ACT Accelerator was the ‘COVID-19 Vaccines Global Access’, abbreviated as <a href="https://www.who.int/initiatives/act-accelerator/covax" target="_blank" rel="noopener noreferrer">COVAX</a>.COVAX is hosted and administered by GAVI, and its main vaccine procurement and delivery partner is Unicef. A high-level COVAX Coordinating Mechanism with representation of a cross-section of its partners and multiple technical groups is responsible for ensuring equitable allocation and access to Covid-19 vaccines worldwide.Participating in COVAX are two groups of countries: the fully self-financing high-income countries (HICs), and nearly 100 low and middle-income countries (LMICs) that generally rely on donor funding to receive some vaccines, but can also purchase some more with their own resources.A mechanism called the Advance Market Commitment (AMC) through which GAVI guarantees the purchase of a large quantity of vaccines to incentivise manufacturers to produce doses and sell them at an affordable price. Initially, the donors were expected to capitalise on the COVAX facility with a contribution of $9 billion to purchase and distribute 2 billion doses of vaccines to meet the needs of some 20% of high-risk groups in participating countries, including frontline health workers and senior citizens.Launched with much fanfare in April 2020, long before there were any viable vaccines, COVAX was hailed as a futuristic model of enlightened international cooperation to ensure that vaccine development and delivery would progress at ‘a speed, scale, and access never before seen in human history’.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015114/636d058e9c7e80680e0a5f13jpeg.jpg" alt="" width="1226" height="678">Realpolitik of vaccine nationalismWhile most poorer countries <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">patiently waited for COVAX to be fully-functional</a>, most richer countries, particularly the G-7 and EU members, decided to jump the queue and cut bilateral deals for their own citizens. Not to be left behind in the competition for public relations and profits, China, India and Russia, the three major vaccine producers outside Western Europe and the US, engaged in carefully orchestrated ‘<a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">vaccine diplomacy</a>’ to bolster their image of solidarity with LMICs.COVAX remained under-funded and unable to compete with the HICs that quickly reserved huge quantities of vaccines directly from the manufacturers, often exceeding their actual requirements. By August 2020, the Trump administration had signed seven bilateral deals with six companies for more than 800 million doses, enough to vaccinate 140% of its population.The Biden administration substantially increased this. The EU was not far behind in reserving half a billion doses secured through two deals. The UK signed five bilateral deals for 270 million doses, equivalent to 225% of its population. Canada was at the head of the class reserving four times more vaccines than the total requirement for its population.These bilateral deals severely undercut COVAX’s ambition of becoming the global coordinator of vaccine procurement, allocation and distribution. By the time it managed to secure the $8.3 billion it needed to procure and deliver the promised vaccines to 92 poorer countries in June 2021, manufacturers had no more vaccines to sell, as practically all their production was contractually committed to the HICs.COVAX was caught in a Catch-22. Whereas initially it did not have enough money to buy the vaccines, now it has the money but there are no vaccines in the market. Besides HICs hoarding a huge cache of excess vaccines, two other problems are responsible for the global vaccine shortage.The huge <a href="https://www.nepalitimes.com/latest/first-signs-of-the-second-wave/" target="_blank" rel="noopener noreferrer">second wave</a> of Covid infection in India in the Spring of 2021 led it to ban the export of the AstraZeneca Covishield vaccine manufactured by the Serum Institute of India (SII). This was a huge shock and disappointment for both COVAX and most lower-income countries like Nepal. They were counting on SII, the world’s largest vaccine producer, to be their main supplier.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/south-asias-vaccine-geopolitics/" target="_blank" rel="noopener noreferrer">South Asia's vaccine geopolitics</a>, Christopher TanBut an even bigger and more systemic problem is the unwillingness of a handful of Big Pharma to give up their exclusive patent rights to produce life-saving vaccines and medications. Although the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) provides for waiving patent rights in the case of life-saving medicines and vaccines, in public health emergencies like global pandemics, most HICs have refused to grant such waivers.President Biden did express a willingness to consider waiving the intellectual property rights for Covid  vaccines. But the same European leaders who loudly proclaimed Covid vaccines as ‘global public goods’, have stubbornly and hypocritically resisted waiving the IP rights of their pharmaceutical companies.The hypocrisy is compounded because billions of dollars, euros and pounds of public funds were given to private Big Pharma companies to accelerate research and development of new vaccines for which they now claim exclusive patent rights to maximise profits for their private shareholders.The G-7 charade There were high hopes that the G-7 Summit of the world’s richest democratic countries in Cornwall in June 2021 would lead to a breakthrough in Covid response, revive COVAX and accelerate delivery of vaccines to developing countries. While the absence of an arrogant and unpredictable Trump created an atmosphere of congenial camaraderie at the G-7, its outcome was long in lofty rhetoric but woefully short in concrete and urgent action to tackle the global pandemic.The IMF had estimated that an investment of $55 billion now would not only save the lives and protect the health of millions, but would help revive the world economy and yield a return of $9 trillion by 2025. Sadly, the G-7 accounting for 60% of the world’s economy did not pledge even 6% of the investment recommended by the IMF.The G-7 commitment to donate less than one billion doses of the surplus vaccine they have hoarded, and that too over an extended period stretching well into mid-2022, was a huge disappointment in the face of a dramatic surge of newer and deadlier Covid variants <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">ravaging countries like Nepal</a>, much of Southeast Asia and the African continent.COVAX estimates that it needs 2 billion doses in 2021 to reach the most vulnerable 20% of people in the developing world, and 11 billion doses to reach herd immunity by 2022. Alas, if current trends continue, if TRIPS patent waiver is not granted and technology transfer not facilitated to vastly increase and diversify vaccine production in many more countries, it might take decades before people in LMICs can expect to reach herd immunity.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015114/636d05919c7e80680e0a5f14jpeg.jpg" alt="" width="1220" height="664">The People's Vaccine Alliance estimates that, at the current rate, low-income countries could take 57 years to fully vaccinate their populations, whereas G-7 countries are likely to reach that milestone in the next 6 months.Contrary to the mantra of ‘vaccine equity’ chanted ad nauseum at the UN, at WHO, and at COVAX, the action and inaction of the G-7 actually promote vaccine nationalism. As the Secretary-General of the UN and Director-General of WHO have pointed out, vaccine nationalism in rich countries (and more recently in India) are perpetuating a two-tier world. Of the 2.1 billion Covid-19 vaccine doses administered worldwide so far, only 4% were provided to poorer countries by COVAX.As UN Secretary-General António Guterres has noted poignantly, “Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. This is not only manifestly unjust, it is also self-defeating.”COVAX and an unequal world COVAX has been criticised harshly for making tall promises but failing to deliver. As a bold and nascent initiative, it is going through teething problems, and has made some mistakes and miscalculations. GAVI that administers COVAX, made some early compromises on its egalitarian founding principles by agreeing to certain double standards applied to the HICs vs LMICs.For example, it allowed donor countries like the UK and Canada to pick and choose which vaccines they preferred to fund or purchase for themselves through COVAX rather than requiring their funding to be co-mingled as part of COVAX’s funding pool for all countries and products.There was some consternation when the UK and Canada managed to purchase through COVAX fairly large quantities of their chosen vaccines, despite the fact that they had already procured plenty of vaccines through direct bilateral contracts with several vaccine manufacturers, even as COVAX was struggling to deliver minimal quantities of vaccines for LMICs.Canada managed to procure through COVAX 1.6 million doses of the AstraZeneca vaccine while Nepal (a country of similar population size) only received 348,000 doses. An added irony is that some of those AZ vaccines in Canada remain unused and are on the verge of expiry, whereas 1.4 million senior citizens in Nepal are desperately waiting for their second jab of the AZ vaccine.Some of these examples go to show that notwithstanding the lofty principles underlying the enlightened concept of COVAX, we still live in a world where, as the old saying goes, ‘one who pays the piper calls the tune’. On a larger scale, a similar situation prevails at the United Nations, where the principle of ‘sovereign equality of all member states’ is rendered meaningless by five veto-wielding permanent members of the Security Council, and a handful of other influential donors.Despite such shortcomings, the UN, COVAX and other initiatives are important building blocks towards a fairer world of greater human solidarity. Imperfect as they are, humanity is better off with such organisations striving to harness the power of partnership and solidarity than a dog-eat-dog world driven solely by narrow national or other parochial interests.Some of the weaknesses and hypocrisy seen in the early functioning of COVAX are not the result of its model being wrong, but because some of its key sponsors not playing by agreed rules.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015114/636d05949c7e80680e0a5f15jpeg.jpg" alt="" width="1442" height="588">In a world of sovereign nation-states, leaders have a legitimate responsibility to protect their own populations first. Hence vaccine nationalism is understandable and should have been built into the design of initiatives like COVAX from the start -- although pursuing vaccine equity must be its ultimate objective.Without putting all our eggs in the COVAX basket, and while exploring all other options to meet our urgent vaccine needs, it is in the interest of countries like Nepal to help build a more robust COVAX to help the world better cope with future pandemics.<a href="http://www.kulgautam.org/" data-saferedirecturl="https://www.google.com/url?q=http://www.kulgautam.org/&amp;source=gmail&amp;ust=1625197419711000&amp;usg=AFQjCNFM7lv53rOVMJQdg4WABZK4M09vvw">Kul Chandra Gautam</a>, a Nepali diplomat, is a former Assistant Secretary-General of the UN and Deputy Executive Director of Unicef. He is also the author of Global Citizen from Gulmi: My Journey from the Hills of Nepal to the Halls of the United Nations. He was also a board member of GAVI.

Hope, hyperbole and hypocrisy of COVAX

<figure><img width="722" height="482" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86609c7e80680e06784ejpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The flood of social media posts of <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNFw4HGIaJzWsPjE6KDbOCN9BO71nA">donated medical supplies</a> being unloaded at Kathmandu airport every day, gives the impression that the outside world cares more about the humanitarian emergency in Nepal than the country’s own leaders.
This week proved that the <a href="https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGnYd3WYcqcWZhTuAO1fDLmr6DWrw">Nepali politicians still do not get it</a>. Except for the chatting classes locked up at home, not many Nepalis follow, or care, about a dissolved Parliament, elections in November, or writs at the Supreme Court. They are preoccupied with trying to prevent relatives from <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG0TkkaP2byuZ7gTldxbjVgjSti9w">breathing their last</a>.
Prime Minister K P Oli has proven that he is not just a shrewd manipulator, but also has elastic ethics. In the past year, he has shown that he will stop at nothing: split the NCP that he himself united, dismantle his own UML, dissolve a Parliament in which he had a two-thirds majority. All is fair, it seems, in love and politics. 
Nepalis might have followed the political games in Kathmandu more closely if the alternatives to Oli inspired more confidence. But they are all tried, tested and failed ex-prime ministers themselves. The main contender Sher Bahadur Deuba of the Nepali Congress lined himself up to be PM for the fifth time, and has still not given up.
The crises due to the pandemic would have been the opportunity to form a national unity government, and work together to fight the virus. This would be the time for all the parties to skip a generation and bring up some young do-ers. That is what they may have done if this was a war. But <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/this-is-war/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEWgT9G992ZUlwbDLKjh5yVL3iW-A">this is a war</a>.
The needs are great: ensuring <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEbjbLTsFcBFUFjyD0KkohRt6dD0w">adequate oxygen supply</a>, rushing relief for the millions who have lost their income during the lockdowns, ensuring that ICU care is available and affordable to the general public, and negotiating a reliable vaccine pipeline. Preoccupied with politicking, the leaders had little time for any of this. 
Most of Nepal’s politically-appointed ambassadors overseas are more beholden to their patrons back home than to the people. With the exceptions of our female envoys in <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Oman and Spain</a>, other missions have not stepped up to the task of conveying the emergency like we did after the 2015 earthquake.
The oxygen cylinders and medical equipment that have arrived are mostly through donations from the <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Nepali diaspora</a>, citizens groups that have mobilised through social media, and friends of Nepal. 
No wonder the rest of the world does not take us seriously. When a state does not demonstrate accountability towards its own citizens, there is little trust even from governments that genuinely want to help, to provide urgently needed material. 
And there is not much the outside world can do when the malaise is within. Nepal has to resolve its own governance crisis that has messed up its Covid-19 response. 
Having said that, the international community could show more concern for the urgent need for vaccines. There are many flights bearing ventilators, concentrators, PPEs and test kits, but much vacillation on vaccines. 
Nepal is not getting the urgent help it needs to immediately vaccinate 1.4 million people whose default date for the second dose is now. On Monday, the government extended the dose gap to 16 weeks in the hope that someone somewhere will quickly send the <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG_KLW5M52MZ3Y7ijjHYNDTM3xYdQ">AstraZeneca (AZ)</a> vaccines we paid the Serum Institute of India for, but which were never delivered.
This is a major <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGmt0XUUHhxlq6n1BtsGFdw3YfM_w">failure of Nepal’s vaccine diplomacy</a>, but it is also India, Britain, the EU, US, the WHO that have let us down in this hour of need. We get it that vaccines are now a geo-strategic item, and countries are stockpiling it for the third wave. But some countries have enough doses to vaccinate their populations several times over, at a time when their own citizens are refusing to take AZ because of the panic over clots. 
Across France, AZ vaccines are being dumped because they are nearing expiry, the <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHGyEJVpvRxkfBu00MFW-UbFzLJxQ">United States has a cache</a> of 80 million Covid-19 vaccines, and nearly half its population refuses to be vaccinated. <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNF0Zuj2D_3iMclB9cP3qSBYR8nxPQ">Ship the shots </a>to people who want and need the vaccines.
We would like to see fewer Tweets of donated items that Nepal can afford to buy, and more timetables for vaccine deliveries.

Vacillating on vaccines

<figure><img width="1236" height="856" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a09c7e80680e067804jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure><h2>1. Oxygen</h2> To save lives, Nepal’s most urgent need now is oxygen. Not just cylinders, but oxygen generators, concentrators and liquid oxygen. Most infected people are not succumbing to Covid-19, they are <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">dying because of low oxygen saturation</a> in the blood, and lack of hospital beds -- patients who need not have died of coronavirus. Dire as the situation is in the cities, Nepal’s pandemic has now <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">infiltrated the remotest villages</a> where there is no hospital care and no oxygen. The virus is preying on people already suffering malnutrition, previous ailments, and decades of structural state neglect. In Rolpa, Humla and other remote districts, between 80-90% of PCR tests are coming back positive, and it takes a week to get results. Patients are either not isolating, or not following precautions.Kathmandu's doctor-to-patient ratio is 1:850, but in rural Nepal it is one doctor for every 15,000 people, and hospitals and medical staff there <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">are already overstretched</a>.Close to 60% of all swabs collected nationwide are from Bagmati Province, with nearly half of them in Kathmandu Valley, says epidemiologist Lhamu Yangchen Sherpa. She adds: “There just aren’t enough tests and contact tracing is minimal, official total cases and fatalities are grossly underestimated.” <figure><img width="1497" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a39c7e80680e067805jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="984" height="519" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a69c7e80680e067806jpeg.jpg" alt=""><figcaption> </figcaption></figure>Hospitals in Kathmandu Valley with roof helipads have multiple daily rescue flights, but even these facilities are <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">at breaking point</a> with patients being turned away. Understaffed and under-equipped hospitals in the districts do not stand a chance. Even where hospitals exist, many families avoid them for fear of being infected and take wrong medication from pharmacies.Case in point are recent deaths due to misdiagnosis across the country. <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">Typhoid disease</a> simulates Covid-19 with similar symptoms, and the widespread Widal test is known to give false positives.“Covid patients are being prescribed antibiotics to fight typhoid, only to turn critically ill in a few days’ time,” says Buddha Basnyat of Patan Academy of Health Sciences. “This is the reason behind some of the latest Covid fatalities.” <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a89c7e80680e067807jpeg.jpg" alt=""><figcaption> </figcaption></figure>As in India, Nepal is beginning to see a slight bending of the curve for new infections, but health experts expect the fatality rate to remain high for some more time.  There were 190 Covid deaths in the past 24 hours and 6,543 recoveries. Of the total 8,305 new cases on Thursday, Kathmandu Valley accounts for 3,232 infections. 7,814 people are undergoing treatment in hospitals with 1,748 in ICU and 492 in ventilator support. “After the relentless patient pressure of the past month, we have seen a decline in those requiring admissions,” says virologist at Teku hospital Sher Bahadur Pun. “The virus has now infected a majority of people in the cities, and this combined with the lockdown means we may be getting to the halfway mark of the second wave.” <h2>2. Vaccines</h2> A prolonged lockdown is not the answer. If it was, the <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/" target="_blank" rel="noopener noreferrer">reduction in the number of cases and the positivity rate</a> this week would have been steeper. Even while the government tries to increase oxygen supply to hospitals, the only long-term strategy is to vaccinate at least 70% of Nepal’s eligible population.Doctors report a marked difference between the recovery of people who are vaccinated against those who are not. Says virologist Pun at Teku Hospital: “Except for a few rare cases, all patients in critical condition and those dying are the ones who for one reason or another had not been vaccinated.”But Nepal has run out of its vaccine stock, leaving 1.4 million people still waiting for their second dose of AstraZeneca Covishield in a lurch, after India banned its export, and the COVAX Facility could not supply its remaining 1.8 million vaccines to Nepal because of the global supply bottleneck.  <figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ac9c7e80680e067808jpeg.jpg" alt=""><figcaption> </figcaption></figure>The Nepal government and pressure groups in Nepal and the United States <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">have strongly urged the Biden administration</a> to immediately rush some of its AstraZeneca doses to Nepal.Meanwhile, the UK, the US and Canada have authorised vaccines for use in children and adolescents, sparking outrage in the global public health community for prioritising an age group that is rarely critically affected by Covid-19. The World Health Organisation’s director-general Tedros Adhanom Ghebreyesus has urged rich countries to instead donate doses to the <a href="https://www.nepalitimes.com/latest/unicef-urges-g7-to-dispatch-vaccines/" target="_blank" rel="noopener noreferrer">COVAX Facility</a> for poorer states that have barely covered health workers and the most vulnerable groups. Speaking at the British Parliament last week, noted vaccinologist and the principal researcher of Oxford University’s AstraZeneca vaccine, Andrew Pollard, called the decision to inoculate children in wealthy nations ahead of high-risk groups in poorer countries “morally wrong.” Pollard has worked extensively in the region, leading research into the burden and transmission of typhoid in Nepal, Bangladesh and Malawi, and the impact of typhoid vaccine in these areas. He also runs surveillance for invasive bacterial diseases, and studies the impact of pneumococcal vaccines in children in Nepal.In Nepal, vaccination will grind to a halt this week after the current campaign to inoculate 300,000 people in the 18-59 age group with their second dose of the Chinese VeroCell ends.  <figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85af9c7e80680e067809jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b29c7e80680e06780ajpeg.jpg" alt=""><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b49c7e80680e06780bjpeg.jpg" alt="">Although <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">Foreign Minister Pradeep Gyawali says</a> the government is in “final negotiations” for 2 million doses of Sinopharm VeroCell vaccines by June, there is no movement at the Ministry of Health. Ongoing talks to procure 8 million doses of <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Sputnik V</a> have hit a production capacity snag in Russia. “We can implement lockdowns only for so long, the only exit strategy is vaccines. Science delivered, now our politicians must do the same,” says Buddha Basnyat, a physical at the Patan Academy of Health Sciences. “The Nepal government must procure vaccines using every diplomatic channel possible, and rich countries must realise that they are not safe until countries like Nepal are also vaccinated.” Activists have been trying to convince <a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/" target="_blank" rel="noopener noreferrer">the US government and Europeans</a> that Nepal has a lot of experience in successful vaccination campaigns against polio, smallpox, measles. It has over 50,000 female community health volunteers (FCHVs) reaching children with vaccines every year.  <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b79c7e80680e06780cjpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="2048" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ba9c7e80680e06780djpeg.jpg" alt=""><img width="1920" height="864" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85bd9c7e80680e06780ejpeg.jpg" alt="">Similarly, Nepal’s health system has amassed vast experience in maintaining the vaccine cold chain even in the remote mountains. It also has trained human resource overseeing DOTS (Directly Observed Therapy, Short-course) for tuberculosis management all over the country who can lend a hand in equitable distribution of vaccines in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">rural Nepal</a>.Says epidemiologist Lhamo Yangchen Sherpa: “It’s not too late, we can still use existing resources like FCHVs to better mobilise vaccination, conduct contact tracing, dispel any remaining vaccine hesitancy, and use public health professionals in prevention.”

It’s an Emergency

<figure><img width="2560" height="1436" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636ced739c7e80680e09adc8jpeg.jpg" alt=""/><figcaption></figcaption></figure>Special interview in Saglo Samaj tv magazine program with Foreign Minister Pradeep Gyawali, who is also a member of the government’s Covid-19 Control and Management Committee (CCMC). Kanak Mani Dixit asks him about the government’s response to the Covid-19 pandemic so far, and its strategy to deal with the crisis now that there is a brief respite from the political stalemate.Kanak Mani Dixit: We have often heard that both the government and citizens are responsible for the second wave. But was it not the government’s job to warn people of the risks and make sure precautions were taken? Pradeep Gyawali: I have just come from a meeting in which the prime minister instructed the new Cabinet that the complete focus of our work henceforth should be to fight against Covid-19 by using every means at the government’s disposal. It is true that there were lapses, we knew the wave was coming but the state was bogged down with party power struggles and that prevented us from concentrating on battling the pandemic. But it is not that the government has stood idly by, since last year we had added testing centres, HDUs, ICUs, ventilators. But this second wave was so aggressive, all this was not enough. For example, last year only the really serious patients needed oxygen, this time there are more patients needing critical care, which means more oxygen flow. Our preparations were not enough to deal with the severity of the second wave.If the situation is so serious, why does the government not declare a health emergency?The existing Infectious Disease Act gives the government the power to punish those flouting rules to stop the spread of communicable diseases. But the situation is serious, and many have advised us that we should declare a health emergency which would allow the state to deploy private hospitals to treat patients, and get all agencies of the state to concentrate solely on health. But so far, the existing laws are adequate to deal with the situation.The CCMC has not been effective as the main state mechanism in tackling the emergency. Are there plans to change that?We set up the CCMC because the war against Covid needs various ministries of government to work together. The Health Ministry is the frontline agency, but it has to coordinate with the Home, Foreign, Finance, Tourism, Supplies and other ministries. If the CCMC had not been there, there would be chaos. The CCMC is empowered with the authority to take its own decisions. Obviously, its work needs to be more effective and visible. Maybe we need more than ‘coordination’? Maybe we need more effective and accountable leadership. The Health Ministry gives a good daily briefing. But Covid response is not just a health issue, there are decisions regarding supplies, transport, enforcement that need to be conveyed better to the public. We will activate the CCMC to be more proactive in communicating its decisions and situation reports. The prime minister told CNN that Nepal had the pandemic under control, a few days later in an appeal in The Guardian, he asked the international community for urgent help. Why this mixed message?It also depends on how the question is framed. CNN asked if it was true that the Covid-19 pandemic was out of control in Nepal. Even in the current situation, we cannot say it is out of control, and it is not. It is true that we are overstretched, and there are <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/" target="_blank" rel="noopener noreferrer">shortages of hospital beds and oxygen</a>, but that does not mean that it is out of control, and we have surrendered. We have been telling the international community that the country is in difficulty at the moment, and the reason is that we have a 1,800km open border with India and even last year the trend was that what happens in India follows in Nepal within 12-13 days. This has really stretched us to the limits.What is the reason for the delay in bringing vaccines? Nepalis have not got a clear answer.There is a huge rich-poor vaccine gap in the world. As soon as vaccines were available last year, we approached manufacturers and international agencies. We had to look at affordability, efficacy, and the logistics for refrigeration. The most suitable was AstraZeneca’s Covishield vaccine. I was in India in January, and we put forward our case. Nepal became the second country in South Asia to start vaccinations. We got 1 million doses as a grant from India, after that we bought 2 million, of which 1 million doses were delivered. Then China gifted us 800,000 VeroCell vaccines, under the COVAX initiative we got 348,000 doses. India separately provided 100,000 doses for the Nepal Army. So we have received more than 3.2 million doses so far, and about 2.2 million so far have been fully or partially vaccinated which is about 8-9% of the total population. This means we rank 80th in the world in vaccinations, which is not bad. We paid for 2 million doses of Covishield at $4 a dose, a price the government set, of which 1 million doses were sent immediately. But then the pandemic suddenly spread in India and the court and government there banned exports. There was no other reason for the non-delivery of the remaining 1 million doses, it was not because of any middlemen or commissions. The allegations are totally false, I am willing to go to any court in the world to debate this. The remaining doses will come to Nepal.But this issue came up because the <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/" target="_blank" rel="noopener noreferrer">Health Minister himself accused middlemen</a> of behind the delay. He was not talking about the 2 million. After this we tried to buy another 5 million doses from India and that deal did not happen because there was demand for vaccines within India itself, but it is true that the Serum Institute of India told us to talk to their authorised agent in Nepal. However, we said we sent you advance payment of which half the doses have not even been delivered. It is unfortunate that without even understanding the issues, the opposition parties have turned this humanitarian issue into a political agenda.We are in talks with Sinopharm to buy 2 million doses of VeroCell for delivery by June. The second is <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Russian Sputnik vaccine</a> for which we have already provided permission for emergency use, but the problem is that Russia is not producing enough. Even so, we have said we need 8 million doses, of which 4 million are required right away. We are waiting for their answer. Then there is America which has <a href="https://www.nepalitimes.com/latest/no-astrazeneca-list-us/" target="_blank" rel="noopener noreferrer">booked and bought 60 million doses of AstraZeneca</a>, and there is a debate within the United States about whether this vaccine stockpile can be donated to other countries. We have activated diplomatic channels to convince the Americans that they should provide us some of these doses. But the US Food and Drug Administration, the Centre for Disease Control and even the security agencies need to give approval for export. But I am sure that once these requirements are fulfilled, Nepal will be a priority.In addition, we are also knocking on COVAX’s doors. The problem there is that its most important supplier of vaccines is India’s Serum Institute. It should have already received 90 million doses from there by March, but it has only got a small fraction of that. But they have also put Nepal on a priority to provide enough vaccines for 20% of our population, which is 1.4 million doses.https://www.youtube.com/watch?v=YsNYIuN2TVwWatch the complete interview in Nepali here.What of those 18 and above who should have got the Sinopharm vaccine, the 100,000 above 65 who didn’t get their shots of Covishield, and why were the 59-65 age group left out?Our plan was to use the next consignment of 1 million doses to inoculate the 800,000 people in the 59-65 age group with the first dose, but when those vaccines did not come, we could not deprive those who had already got their first shots from their second doses. So we decided to give it to the above 65, but even here as you point out, 100,000 were left out. So far, we have administered 1.75 million AstraZeneca Covishield, and for the second dose we need that same amount of Covishield, as well as for those above 65 who were missed out. Our strategy now is to get at least 2.5 million Covishield for this cohort, either from the Serum Institute or other AstraZeneca plants. For those below 65, we are trying the other vaccines, whichever we can get first. We are aware of those who were left out, and are trying to cover them as quickly as we can.   Isn’t it possible for your ministry to work with Nepali organisations abroad that have been lobbying with the US and British government to rush some of their unused vaccine stockpiles to Nepal?I thank <a href="https://www.nepalitimes.com/latest/international-help-for-nepal-picks-up/" target="_blank" rel="noopener noreferrer">American Senators and Congressmen who raised Nepal’s needs</a> in the committees last week, as well as Nepali groups that made this happen. We have been in touch with the British government as well, and I can disclose that <a href="https://www.nepalitimes.com/latest/the-double-burden-of-climate-and-covid/" target="_blank" rel="noopener noreferrer">the UK</a> is soon going to announce a major aid package for Nepal. Similar assistance is also coming from Switzerland. <a href="https://www.nepalitimes.com/latest/concern-in-china-over-nepal-covid-19-surge/" target="_blank" rel="noopener noreferrer">China has also announced a RMB 10 million</a> through which we are acquiring oxygen cylinders, concentrators, ventilators and other medical equipment. The Sichuan and Tibet provincial governments are also sending help, in fact the Tibet government is providing 150 large containers that can hold 200 litres of liquid oxygen each. The shortage of oxygen is nothing short of disaster. What can be done to manage oxygen supply equitably within the country, and what is being done to source oxygen from abroad?We definitely did not do enough to install adequate oxygen generators in the past year. This time, after the oxygen crisis hit, we stopped the non-medical industrial use of oxygen which used to make up about 30% of our production. This meant we could deploy 10,000 cylinders from industries to hospitals. We have also directed all oxygen plants to operate at 100% capacity, and to increase production in others. Despite all this, the demand is so high that we need liquid oxygen, but its import from India was stopped for ten days even as our cases were rising. Due to our diplomatic efforts, India agreed to lift the ban and we are trying to add more tankers. We still need cylinders, but much more urgent is increasing the capacity to generate oxygen, and we are trying to increase the import of liquid oxygen, and bring in medium-sized air-based oxygen plants.We have an open border with India, what are the plans regarding people travelling across it in both directions?We have raised this with India, we have said that both sides cannot be infection-free as long as the disease rages on the other side. This is why the question of vaccines and other medical supplies is so important. Because India itself is in crisis right now, it is not in a position to help much, but I think we have managed to get the message across. We have also apprised the international community that they have to help both countries together otherwise the region will not be Covid-free. Are you giving too much attention to Kathmandu Valley and forgotten about the rest of the country? I don’t think so. Ever since last year, we have tried to increase the capacity of the provinces and municipalities to deal with the crisis. What we were not prepared for was just how contagious and lethal this variant would be. Nepalganj got hit first and the infection rate there is still high, but they are managing. Butwal and Sudur Paschim Province are also under a lot of stress. Other than that, the hospitals and local governments are trying to cope with this crisis. How do you see the role of non-profits and civil society in dealing with the crisis?Last year, we had to conduct an emergency repatriation of Nepali workers from the Gulf and Malaysia, and non-resident Nepalis played a very important role. This year too, Nepalis abroad have been helping, for example like with <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer">the cylinders sent from Oman this week</a>. I would also request them to continue lobbying with the governments of the countries they work in to assist Nepal at this time of crisis.Within the country, it pains me to say this, but it seems that some sections of civil society feel that their sole role is to oppose everything the government does. As if they are not citizens unless they oppose the government. This is not right. Civil society includes media, NGOs, and others and which play an important role in disseminating correct information, to raise public morale at a time of crisis. This is not to say that the media should suppress news about fatalities or the lack of oxygen, but when you say there were 9,000 deaths today why leave out the fact that 5,000 recovered? The government should not be alone in this fight, every citizen needs to be a part. We have encouraged non-governmental organisations to help fight the pandemic, but without overlapping with the government, and to coordinate so that it conforms to our priority areas. We are also wondering why some of them are not putting in more effort. On the part of the government we will do our best to facilitate. Let’s just try not to have a case of too much in one place, and too little in others. We face difficult days. But however difficult they may be, they will soon pass. So let us keep our hope, beliefs and self-confidence levels up. Let us remember that only if we ourselves are safe can we make society secure.

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