<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 width="1098" height="732" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1d329c7e80680e0af39djpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The fact that Omicron was detected in an individual who had arrived in Nepal five days before the new variant was first identified in Botswana is proof it was already circulating and travel bans do not work.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">The new strain</a> has been detected in over 40 countries mere two weeks after it was first detected. What is known so far of Omicron is that it is highly transmissible but likely not very severe as there has been no significant increase in hospitalisations among infected individuals in places with outbreaks.
“Looking at preliminary findings I don’t think it will lead to another <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">major surge or lockdowns like Delta</a>, but having said that we must be prepared and contain it to prevent further mutation and more virulent strains,” says epidemiologist Lhamo Yangchen Sherpa of IPAS Nepal.
She adds: “We do that by vaccinating as many people as possible including boosters if they are nearing expiry date as we know them to be, following safety measures especially indoors and by better communicating government policies to control the spread of new strains.”
One of the main concerns with Omicron is mutations in the spike protein that binds it to the receptor. Most vaccines including Pfizer, Moderna, AstraZeneca and J&amp;J primarily target this spike protein, so there are worries that the new variant will escape immunity afforded by jabs.
Mutations are natural, but coronaviruses make fewer of them than other viruses because of their much stronger <a href="https://www.sciencedirect.com/science/article/pii/S1097276520305189" target="_blank" rel="noopener noreferrer">proofreading system</a> to survive.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.indiaspend.com/indiaspend-interviews/omicron-wont-be-much-more-dangerous-than-other-circulating-covid-19-variants-790812" target="_blank" rel="noopener noreferrer">Speaking with India Spend</a>, Polly Roy, professor of virology at the London School of Hygiene &amp; Tropical Medicine said: ‘Even though we have a mutation, it’s not in the receptor-binding site area so much. Thus, if they change too much, the virus will not bind to host cells and will not survive. And the vaccines target that area, so the vaccines will still work against Omicron infection.’
Says infectious disease specialist at HAMS Hospital Anup Subedee: “Even if the vaccines are less effective against this variant, it will still provide significant immunity to fight off new infections. And given that antibodies wane over time, <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">Nepal’s frontline workers</a> and the elderly should be prioritised for boosters, if possible with vaccines known to have higher efficacy.”
There are also concerns that despite registering only mild symptoms Omicron could affect vulnerable populations much later as it is the younger mobile population who are usually infected first without much impact on their health. 
Most of the initial Omicron infections are said to be mild and among young and vaccinated people, which means Nepal could be ripe for another surge. 
“Don’t be surprised if we do,” says Sushil Koirala, a Nepali public health expert based in Bangkok. “We have all the necessary fuel to start the wildfire: low vaccination coverage, poor adherence to public health measures, lackluster preparedness, and questionable surveillance,” Koirala warns.
But <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">the moral dilemma over booster</a> remains when over 60% of Nepal’s targeted population is yet to even receive the first dose.
“In an ideal world, universal coverage is the way to go but the government hasn’t been able to vaccinate the majority of Nepalis, so we cannot wait forever for boosters either,” adds Subedee.With the rapid spread of Omicron in the region, the Nepal government has announced that it will vaccinate at least 200,000 people a day and the Health Minister Birodh Khatiwada has asked people who have inoculated with two doses of vaccine to also receive the third dose to prevent <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">the risk of the third wave</a>.
Khatiwada was quoted as saying that the government had a stock of 20 million doses of different jabs and it will start administering the booster from mid-December with 16,000 vaccination centres across the country.
So far Nepal has received 25,658,630 doses of the Covid vaccine of which some 660,000 doses still in stock. In the next three months, a total of 34,594,460 doses of different jabs are arriving in Nepal: 9,403,000 doses of AstraZeneca, 3,000,000 Coronavax, 2,386,800 VeroCell (one vial, one dose), 2,174,400 J&amp;J and 1,965,600 Moderna.
But the government’s focal person for vaccine Shyam Raj Upreti told Nepali Times health authorities are authorised to administer only an additional dose, not <a href="https://www.nepalitimes.com/latest/booster-lack-strands-israel-bound-nepalis/" target="_blank" rel="noopener noreferrer">a booster</a>, and only for immunocompromised people and individuals above 60 who had received VeroCell, as recommended by the WHO.
“Our priority is still to vaccinate the targeted population and hence those who are still not vaccinated,” adds Uprety. “And for this, we are focusing on activities to convince more people to inoculate, add vaccination booths to increase access and where required administer the doses door to door.”
At present, 29% of Nepal’s population has been fully inoculated while 33.9% have been vaccinated partially. Experts say better communication about vaccination schedules a few days before the campaign in local language and on platforms most consumed is crucial in further <a href="https://www.nepalitimes.com/opinion/giving-all-nepalis-a-shot-at-the-covid-vaccine/" target="_blank" rel="noopener noreferrer">increasing the uptake</a>.
Equally important is building a storage facility for Pfizer and Moderna vaccines that are in the pipeline to vaccinate children 12 and above. A limited number of students who revived Pfizer jabs last month are yet to receive their second dose, recommended after three weeks of the first.
Speaking on his social platform, Sameer Dixit of the Centre for Molecular Dynamics Nepal recommended patience over panic: “Let’s wait and watch until we have more concrete findings on Omicron. Until then mask up and vaccinate as soon as it is available. As for boosters, those in vulnerable groups should get it.”

Sonia Awale

Omicron may not be as risky, but take care

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161144/636d1cd69c7e80680e0af37ejpeg.jpg" alt="" width="1331" height="888"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>After a dozen or so people were admitted to a hospital in Delhi with suspected omicron strain of Covid, neighbouring <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">Nepal is on a high alert</a> fearing a similar outbreak that ravaged the two countries earlier this year.Although the new variant is said to be more transmissible and resistant to existing vaccines, the good news is that those infected have only reported mild symptoms.Studies the European Centre for Disease Prevention and Control (ECDC) have found out that the omicron strain was already circulating in Nigeria from October, and it was already in Europe before flights arrived from South Africa last week.Until more is known about the new virus strain, public health experts in Nepal have recommended that people get vaccinated if they have not done so already, wear masks and avoid crowds for now. The WHO on Thursday advised those above 60 and with co-morbidities to avoid air travel for now.Epidemiologists have recommended strengthening safety measures over travel restrictions, which is often too late to entirely stop the surge as seen during 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 the subcontinent. Nepal has issued travel ban on eight African countries and Hong Kong.“General people are now letting their guards down, public places are most crowded than during normal times, people have all but forgotten about social distancing, and masking has become minimal,” says virologist Sher Bahadur Pun at Teku Hospital.Mutations are natural but the higher the spread of the existing virus, the higher the threat of more virulent variants to arise. Public health experts have blamed the rise of new strains on <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">inequitable vaccine distribution globally</a>.Roughly 30% of Nepalis are now fully vaccinated and with 30 million more doses of various vaccines in the pipeline, the Health Ministry has set a goal to vaccinate the entire targeted population by mid-April. The government has also expanded vaccinations to everyone above 12.Nepal’s vaccine infrastructure and network of community health workers have played a significant role in reaching the far corners of the country with <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">Covid-19 jabs</a>. But now the challenge is to increase vaccine acceptance among those who have so far refused to take it.This means better communicating pandemic risks and training more healthcare workers to administer the vaccine. The information that is regularly shared through the Viber group, composed of hundreds of health officials and open to the public, is not necessarily accessible to everyone due to language barriers.“Covid related information is either in English or Nepali, people who don’t speak either have a hard time accessing them. Language equity has been a major issue,” says Bijay Acharya of the Nepal-Johns Hopkins University Advocacy Group, adding that this has also exacerbated misinformation spreading through Whatsapp and Facebook as people attempt to informally translate and interpret information about the virus.Lack of translation can also affect the ability of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">community health workers</a>, who act as the front line of information about the pandemic, to counsel their communities on the vaccine and how to best protect themselves.In what is now termed as ‘vaccine discrimination’, the US, Australia and the majority of the European countries do not recognise all the Covid vaccines equally. Such discrepancies have been most notable in the case of labour migrants and foreign students who have been barred from their station because they didn’t receive mRNA vaccines such as Pfizer or Moderna.“Even those who are fully vaccinated with a viral vector booster will only be considered partially vaccinated and there will be lot more issues like this in the future,” adds Acharya.China’s VeroCell <a href="https://www.nepalitimes.com/banner/the-jabs-and-jabnots/" target="_blank" rel="noopener noreferrer">is still largely unaccepted</a> while Indian-made Covishield is not recognised even in countries that accept AstraZeneca. This is unfortunate at a time when Omicron with multiple mutations in the spike protein is on the rise. mRNA vaccines primarily target this protein, rending it ineffective against the new strain.Experts say that only VeroCell, Covaxin which is manufactured by Bharat Biotech, are made from inactivated viruses and are better placed to ward off new spike proteins in mutants.The pandemic has also affected routine <a href="https://www.nepalitimes.com/latest/pandemic-hits-non-covid-vaccines-for-children/" target="_blank" rel="noopener noreferrer">childhood immunisation</a> in countries like Nepal. Lockdowns and fear of contracting the virus have stopped many parents from travelling to health clinics for measles, polio, whooping cough or tetanus shots. Nepal has also seen a <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">rise in  maternal and infant death rates</a> during the pandemic due to reduced institutional deliveries.Officials say it will be important for the Nepal government to be prepared with oxygen, ICU beds, medicines and medical staff to prepare for a new Coid-19 surge in spring. A measurement widely used by epidemiologists, called excess mortality, is applied to contextualise the differences in deaths during a pandemic compared to a normal year.Excess mortality data, however, may not be applied in the case of stateless people, have no documentation or property and where families have no interest in reporting deaths. There might also be deaths that cannot be recorded or accounted for. Nonetheless, this will help governments prepare for <a href="https://www.nepalitimes.com/banner/economic-cost-of-5-months-of-nepal-lockdown/" target="_blank" rel="noopener noreferrer">economic slumps</a> and with informed decision-making.Adds Acharya: “Excess mortality data can be used to predict the future and inform future preparation. Just looking at excess deaths in Nepal in the past five years will give us a good idea about how to respond to pandemics.”

Nepal needs to prepare for new Covid wave

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016110/636d12069c7e80680e0a98b4jpeg.jpg" alt="" width="844" height="570"/><figcaption></figcaption></figure>I knew I wanted to get vaccinated as soon as the Covid-19 jabs were made available to the general public in the US, and that when it was my turn I would have access to it.It was not the same for people in Nepal, and I remember family and friends back home telling me how hard it was to get a vaccine earlier this year. And a lot of it depended on whether you had the right connections.People in Nepal were <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/">struggling to find their first doses</a>, whereas in the US people did not want to get vaccinated against Covid-19 despite a raging pandemic. Those without access to jabs were confused with those who did not want to get vaccinated.All international students studying in the US must provide proof of immunisations against <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/">MMR (Measles, Mumps and Rubella)</a>, Varicella Tdap (Tetanus, Diphtheria, Pertussis) and Meningitis.I completely understand the reasoning behind requiring those vaccinations, it is to keep people safe, and it never entered my mind to argue the logic.Did I ever feel like my freedoms were being curtailed because I needed to show proof of those inoculations? No. Did I feel like someone was infringing on my choice? No. Did I have a problem getting the necessary vaccine for the greater good? No.So why is it different with the Covid vaccine? The main reason to be vaccinated was so that I do not spread the infection further, as well as protect myself. The sooner we all got vaccinated, the sooner we would be post-pandemic.Which is why it surprised me that unlike <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/">Nepal</a>, where the vaccine acceptance rate is 97%, many in the US were choosing to not to get the jab because it curtailed their freedom of choice. The anti-vaxxers were also anti-maskers — and the puzzling thing was that they would however not protest against wearing seat belts to abide by laws against drinking and driving.They say Pfizer and Moderna have side effects. Of course they do, every modern medicine has some side effect. Even junk food has horrible side effects, but that hasn't stopped people from eating fries and burgers.And while anti-vaxxers are worried about their health, they have not taken the time to consider the health of millions of others they directly or indirectly interact with.I had spent most of my life in the US in liberal and progressive cities, so when I was met with the comparatively conservative crowd, I felt it was pointless to argue the subject because they had made up their minds and were not open to other opinions.Nothing has brought out the gap between haves and have nots than the Covid-19 pandemic. The global gap between the jabbed and jabbed nots is growing, increasing the chances of mutant strains evolving.In Nepal, we are not privileged enough to choose whether or not we will get a vaccine for a disease that has killed millions. We cannot even choose which vaccine we want: <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/">AZ-Covishield</a>, VeroCell, J&amp;J. We take whatever is available.For most Nepalis, if there is a disease and there is a way to protect yourself from it, you just do it. There are no what-ifs.The fact that you even have the option to decide if you want to get inoculated against the virus in a country which has the highest national total of fatalities from Covid-19 shows how privileged people are in the US.When you are a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/">daily wage worker</a>responsible for feeding and clothing your family, and when your government doesn’t give you a weekly unemployment allowance for staying at home unable to go to work, you want to return to your job as soon as possible. The only way to do that at the moment is to vaccinate and make it safe for everyone to be out again.I would respect the choice of the anti-vaxers not to get vaccinated if they stayed home and did not interact with the public. But they are out and about (and without masks) claiming that it is their right to do so.Being a citizen means having a sense of responsibility towards oneself and others and not using selfish excuses in the name of freedom to do whatever you want.It is a sensitive topic, and those who are most vocal and against the vaccine seem to be also the least informed about masks, <a href="https://www.nepalitimes.com/banner/climate-change-is-a-disaster-in-the-nepal-himalaya/">the climate emergency</a>, guns, abortion and politics. They live in social media echo-chambers where algorithms expose them to ever more radical posts.Recently, I asked a friend in the US if he had been vaccinated. Later, I was told that it is impolite to ask such questions. But if someone is out in public, mingling and exhaling, they need to be responsible about the health of those around them.The boundary of an individual’s freedom is when it infringes on someone else’s freedom.The decision not to be vaccinated is a matter of life or death for those not fortunate enough to have access to doses. While Americans are refusing to take <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/">booster third shots</a>, 70% of Nepalis have not even got their first doses.The next time I see a person drinking a beer while smoking a cigarette trying to rationalise their choice to not vaccinate, you know how that conversation will go.I can already tell you that my Thanksgiving and Christmas in the Land of the Free and the Home of the Brave will be a lot of fun.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

To vax or not to vax

<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.”

Vaccines too little, too late for Nepal?

<figure><img width="720" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b95289c7e80680e06f23fjpeg.jpg" alt=""/><figcaption>Migrant workers, including Nepalis, in Kuwait after being vaccinated. A Nepali worker gets his jab (right). Source: Ram Bahadur Basnet</figcaption></figure><img width="720" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b952b9c7e80680e06f240jpeg.jpg" alt="">In February 2020, Nepali migrant worker Min from Sindhupalchok was excited to visit Nepal after completing two years working in Kuwait. More than a year later, he is still here, due to a Covid-19 travel ban by Kuwait.  He could have returned by taking an indirect route via the UAE since there were no direct flights from Nepal. But since quarantining in the UAE was too costly, he decided to wait for travel restrictions in Kuwait to be lifted. “Now it looks like new rules regarding mandatory vaccination in Kuwait will further delay my return,” says Min.Another worker in Kuwait is Lila from Chitwan. He had spent 15 years there, but has been stuck ever since he came home for a break. Lila’s employer in Kuwait is getting impatient.Stories of stranded migrants are common, but with new vaccination requirements by destination countries, the situation has only become even more uncertain. “From 1 August, Kuwait will allow entry of non-citizens <a href="https://www.khaleejtimes.com/coronavirus-pandemic/covid-19-kuwait-to-allow-fully-vaccinated-non-citizens-entry-from-august-1" data-saferedirecturl="https://www.google.com/url?q=https://www.khaleejtimes.com/coronavirus-pandemic/covid-19-kuwait-to-allow-fully-vaccinated-non-citizens-entry-from-august-1&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNGRqFuLUOQyHv8xigeCvXBJcBO4MA">only if they are fully vaccinated</a> by one of the four vaccines: Pfizer BioNTech, Oxford/AstraZeneca, Moderna and Johnson &amp; Johnson,” says Nepal’s ambassador to Kuwait, Durga Bhandari. None of these vaccines are currently available in Nepal, and other countries that send workers to the Gulf also face the same problem. Saudi Arabia is also set to impose similar vaccination requirements from 1 August. Until then, those who are not vaccinated have to undergo quarantine for a week. While Qatar is allowing Nepali passengers with mandatory institutional quarantine, there has been no announcement regarding vaccines yet. Nepal is currently banned <a href="https://www.hindustantimes.com/business/uae-ban-on-flights-from-india-pakistan-and-12-other-countries-to-continue-101624791232360.html" data-saferedirecturl="https://www.google.com/url?q=https://www.hindustantimes.com/business/uae-ban-on-flights-from-india-pakistan-and-12-other-countries-to-continue-101624791232360.html&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNGNiLYfuDmDxMx29zavs0qeaH_35w">by the UAE</a> and <a href="https://www.arabianbusiness.com/culture-society/463675-bahrain-to-ban-travellers-from-india-pakistan-sri-lanka-bangladesh-nepal" data-saferedirecturl="https://www.google.com/url?q=https://www.arabianbusiness.com/culture-society/463675-bahrain-to-ban-travellers-from-india-pakistan-sri-lanka-bangladesh-nepal&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNEAlpu8KOlC-kc1Zsa4tH4PqRrmLg">Bahrain</a> for public health reasons. The UAE has approved Sinopharm, Pfizer, Sputnik V and Oxford-AstraZeneca, and has imposed double vaccination mandate to South Africa, Nigeria and India, which will likely be applied to Nepalis as well once the ban is lifted, according to UAE-based travel entrepreneur Krishna Bhusal. As the Gulf countries ramp up their vaccination drives and set ambitious targets for universal vaccination, they have started to <a href="https://gulfnews.com/world/gulf/saudi/saudi-arabia-bans-access-to-shopping-malls-for-unvaccinated-1.79888953" data-saferedirecturl="https://www.google.com/url?q=https://gulfnews.com/world/gulf/saudi/saudi-arabia-bans-access-to-shopping-malls-for-unvaccinated-1.79888953&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNGatchZ14YZDxeTeuO6gYsybD3TyQ">require proof of full vaccination</a> for all activities including workplace visits, public events, restaurants and malls. Nepal, on the other hand, is bearing the brunt of the global vaccine inequality with a dismal vaccination rate of 2.6%. It is uncertain when outgoing migrants will get their turn, and as they wait, how many will lose lucrative opportunities or have visas or contracts expire. “Even without these flight bans and the new vaccination requirements, it has been difficult for workers with expensive quarantine and testing costs,” says labour recruiter Saroj Pokharel.  <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b952d9c7e80680e06f241jpeg.jpg" alt=""><figcaption> </figcaption></figure>It can cost from $800-$2,000 for institutional quarantine in Qatar depending on the standard of facilities, and many employers are reluctant to cover these expenses which get passed down to workers.  “The only way out is widespread vaccination, but at the rate we are progressing, I do not see the foreign employment sector recovering anytime soon,” Pokharel says. Quarantine costs are about $1,000 in Saudi Arabia as well. “Employers <a href="https://www.facebook.com/nepalembassysaudiarabia/photos/pcb.4383977018335352/4383976668335387/" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/nepalembassysaudiarabia/photos/pcb.4383977018335352/4383976668335387/&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNEmtN1gYwebB1uttNn6azamjkR9Ew">are required to foot the bill</a> and have to commit in writing in the job demand approval letter that they will bear the costs of quarantine. The Saudi authorities will also notify employers regarding this rule,”  says Nepali Labour Attaché Prem Upadhaya at the Consulate in Jeddah. However, given that workers are desperate it is likely that they will pay for it covertly, no matter how high the cost, or how inconvenient.  The rules on quarantine and vaccines do not just involve Nepali workers, and other countries face the same problem. In response, <a href="https://www.khaleejtimes.com/coronavirus-pandemic/covid-overseas-filipino-workers-now-priority-for-vaccinations-in-philippines" data-saferedirecturl="https://www.google.com/url?q=https://www.khaleejtimes.com/coronavirus-pandemic/covid-overseas-filipino-workers-now-priority-for-vaccinations-in-philippines&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHnyJI2Ct6KhHvrodMix3HHdQo45A">the Philippines</a> has put its overseas contract workers in the ‘essential’ category alongside health staff which moves them up in the vaccination priority list.  <a href="https://www.thedailystar.net/bangladesh/news/migrant-get-pfizer-moderna-vaccines-2119989" data-saferedirecturl="https://www.google.com/url?q=https://www.thedailystar.net/bangladesh/news/migrant-get-pfizer-moderna-vaccines-2119989&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNELsJNafXsHgtlEvgStbVvrBX2UQQ">Bangladesh</a> will prioritise workers heading to Kuwait and Saudi Arabia for the Pfizer vaccines that it received as part of the global COVAX initiative. It is set to receive 2 million doses of the <a href="https://www.newagebd.net/article/142013/bangladesh-to-get-25m-doses-of-moderna-covid-vaccine-from-usa-soon" data-saferedirecturl="https://www.google.com/url?q=https://www.newagebd.net/article/142013/bangladesh-to-get-25m-doses-of-moderna-covid-vaccine-from-usa-soon&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNFbi4BS2QNvFQRAy-CH1Y9JsT1W0Q">Moderna vaccine</a> from the United States through COVAX. The country also has a scheme to reimburse quarantine costs of workers to Saudi Arabia.  In Pakistan, Saudi-bound expats <a href="https://edition.cnn.com/2021/06/28/asia/pakistan-expatriates-vaccination-center-intl-hnk/index.html" data-saferedirecturl="https://www.google.com/url?q=https://edition.cnn.com/2021/06/28/asia/pakistan-expatriates-vaccination-center-intl-hnk/index.html&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNFJRRpihnsIY9ucUrvaWzFkopcjsw">broke into a vaccination centre</a> in Islamabad after fears that the AstraZaneca vaccines would run out. Prime Minister Imran Khan has asked Saudi Arabia and other countries to accept the WHO-approved Chinese vaccine with which Pakistan is inoculating its population.  <a href="https://www.dailynews.lk/2021/06/28/local/252607/slbfe-arrange-covid-jabs-free-foreign-job-seekers" data-saferedirecturl="https://www.google.com/url?q=https://www.dailynews.lk/2021/06/28/local/252607/slbfe-arrange-covid-jabs-free-foreign-job-seekers&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHjFonIPKoFSEU0CaUMXKxyigNsCA">Sri Lanka</a> has also announced free vaccines for those with confirmed overseas jobs, but is also dependent on the Sinopharm Chinese vaccine, which is not accepted by key destination countries.  In <a href="https://telanganatoday.com/relief-for-nris-as-saudi-approves-covishield" data-saferedirecturl="https://www.google.com/url?q=https://telanganatoday.com/relief-for-nris-as-saudi-approves-covishield&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNExwn7EkYkTzX80oqjEd5UFS0uLTw">India</a>, many migrant workers are stranded because their vaccine certificates refer to Covishield, and not Oxford AstraZeneca. However, Saudi Arabia finally recognised Covishield as equivalent to AstraZeneca after diplomatic dialogue. Vaccination camps have been set up for outgoing students and workers, although <a href="https://www.thehindu.com/news/cities/Tiruchirapalli/vaccination-camp-for-people-with-plans-to-go-abroad/article34889852.ece" data-saferedirecturl="https://www.google.com/url?q=https://www.thehindu.com/news/cities/Tiruchirapalli/vaccination-camp-for-people-with-plans-to-go-abroad/article34889852.ece&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHEBvKQtQVlQtUD1cKoW-dlOYF1RA">demand far outweighs supply</a>. In Nepal, however, there is growing frustration with the lack of progress in sourcing vaccines. Says Sujit Shrestha of NAFEA (Nepal Association of Foreign Employment Agencies): “We need a way out because there is demand in these countries for Nepali workers. The government should get vaccines and prioritise outgoing workers, or coordinate with destination countries to provide quarantine and vaccines for workers. For many Nepali families, foreign employment is the only source of income.” After a few months of slow and uneven recovery of emigration, the second wave impacted both new and current Nepali workers. But even with cases falling and limited flights allowed, there is uncertainty because of the vaccines.  It is not just about whether Nepal can inoculate outgoing workers soon, but also whether the vaccination provided is accepted by the destination country.  Saudi Arabia has a demand for 40,000 Nepali workers that are waiting to be filled. In Kuwait, employers are struggling with labour shortages. This is in addition to thousands stranded in Nepal while on holiday like Min and Lila, who are at risk of losing their jobs overseas. Says Kuwait-based Nepali Ram Bahadur Basnet: “If flights normalise and the issue of vaccinations gets sorted out, Nepalis will be able to find attractive opportunities here.”  Some names have been changed. Additional reporting by Hom Nath Giri.

Upasana Khadka

Job-seekers now also jab-seekers

<img width="640" height="290" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181144/636be7309c7e80680e0877e7jpeg.jpg" alt=""/> The introduction of vaccines against the coronavirus have been described as the light at the end of the tunnel. But for most of the poorest people in poor countries, there is no chance to get inoculated in 2021.Only one out of 10 people in nearly 70 countries will be able to get Covid-19 vaccine in the next year unless an urgent action is taken by governments and pharmaceutical industries to produce enough doses, campaigning organisations have warned.Indeed, Nepal has yet to make any concrete deals, and is far behind many countries that have paid advance money to ensure future supplies. Belatedly, the government last month set up a committee of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as procurement procedures. Experts say it will take upwards of six months for the vaccines to get to Nepal and ever longer to remote parts of the country.By contrast, wealthier countries have hoarded enough doses to vaccinate their entire populations three times over by the end of 2021 if all the shots currently in clinical trials are approved, whilst poor countries don’t even have enough to even reach health workers and people at risk. Canada tops the chart with enough doses to vaccinate each Canadian five times.Amnesty International, Frontline AIDS, Global Justice Now and Oxfam, which are part of The People’s Vaccine Alliance, used data collected by analytics company Airfinity to analyse the vaccine deals.They found that 67 low and lower middle-income countries risk being left behind. Rich nations represent just 14% of the world’s population but have bought up 53% of all the most promising vaccines so far. Five of the 67 countries – Kenya, Myanmar, Nigeria, Pakistan and Ukraine -- have alone reported nearly 1.5 million Covid-19 cases between them.“No one should be blocked from getting a life-saving vaccine because of the country they live in or the amount of money in their pocket. But unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for COVID-19 for years to come” says Anna Marriott of Oxfam.Adds Heidi Chow of Global Justice Now: “All pharmaceutical corporations and research institutions working on a vaccine must share the science, technological know-how, and intellectual property behind their vaccine so enough safe and effective doses can be produced. Governments must also ensure the pharmaceutical industry puts people’s lives before profits.”The Pfizer/BioNTech vaccine started being administered in the UK this week, and is likely to receive approval within days from the US. Moderna and Oxford in partnership with AstraZeneca are expected to submit or are awaiting regulatory approval. The Russian vaccine, Sputnik, has announced positive trial results and four other candidates are in phase 3 clinical trials. <img width="640" height="539" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181144/636be7339c7e80680e0877e8jpeg.jpg" alt=""> <img width="640" height="623" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181144/636be7359c7e80680e0877e9jpeg.jpg" alt=""> <img width="640" height="517" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181144/636be7389c7e80680e0877eajpeg.jpg" alt=""> <img width="640" height="458" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181144/636be73a9c7e80680e0877ebjpeg.jpg" alt=""> All of Moderna’s doses and 96% of Pfizer/BioNTech’s have been acquired by rich countries. In welcome contrast Oxford/AstraZeneca has pledged to provide 64% of their doses to people in developing nations. But they can still only reach 18 % of the world’s population next year at most.Oxford/AstraZeneca deals have also mostly been made with some of the big developing countries like China and India, while the majority of developing countries have not done deals and have to share the COVAX pool of vaccines between them.As one company alone cannot supply vaccine for all and bring an end to the Covid-19 pandemic, collaboration is mandatory. As such the People’s Vaccine Alliance has called on all pharmaceutical corporations to share their technology and intellectual property through the World Health Organization (WHO) Covid-19 Technology Access Pool, so that billions more doses can be manufactured and safe and effective vaccines can be available to all who need them free of charge.A first step would be to support South Africa and India’s proposal to the World Trade Organisation Council this week to waive intellectual property rights for Covid-19 vaccines, tests and treatments until everyone is protected.“The hoarding of vaccines actively undermines global efforts to ensure that everyone, everywhere can be protected from Covid-19. Rich countries have clear human rights obligations not only to refrain from actions that could harm access to vaccines elsewhere, but also to cooperate and provide assistance to countries that need it,” says Steve Cockburn of Amnesty International.The vaccines developed by AstraZeneca/Oxford, Moderna and Pfizer/BioNTech have received more than $5 billion dollars of public funding, which places a responsibility on them to act in the global public interest. Pharmaceutical using government funding for research, retaining exclusive rights and keep their technology secret to boost profits could cost many lives, stress experts.Says Lois Chingandu of Frontline AIDS: “The global economy will continue to suffer so long as much of the world does not have access to a vaccine. We need to put pharmaceutical industry profit aside during this unprecedented pandemic, both to save humanity and the economy.”

90% in poor countries will miss Covid vaccinations

<img width="640" height="290" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191112/636bee344b0ad905ca02ef30jpeg.jpg" alt=""/> The introduction of vaccines against the coronavirus have been described as the light at the end of the tunnel. But for most of the poorest people in poor countries, there is no chance to get inoculated in 2021.Only one out of 10 people in nearly 70 countries will be able to get Covid-19 vaccine in the next year unless an urgent action is taken by governments and pharmaceutical industries to produce enough doses, campaigning organisations have warned.Indeed, Nepal has yet to make any concrete deals, and is far behind many countries that have paid advance money to ensure future supplies. Belatedly, the government last month set up a committee of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as procurement procedures. Experts say it will take upwards of six months for the vaccines to get to Nepal and ever longer to remote parts of the country.By contrast, wealthier countries have hoarded enough doses to vaccinate their entire populations three times over by the end of 2021 if all the shots currently in clinical trials are approved, whilst poor countries don’t even have enough to even reach health workers and people at risk. Canada tops the chart with enough doses to vaccinate each Canadian five times.Amnesty International, Frontline AIDS, Global Justice Now and Oxfam, which are part of The People’s Vaccine Alliance, used data collected by analytics company Airfinity to analyse the vaccine deals.They found that 67 low and lower middle-income countries risk being left behind. Rich nations represent just 14% of the world’s population but have bought up 53% of all the most promising vaccines so far. Five of the 67 countries – Kenya, Myanmar, Nigeria, Pakistan and Ukraine -- have alone reported nearly 1.5 million Covid-19 cases between them.“No one should be blocked from getting a life-saving vaccine because of the country they live in or the amount of money in their pocket. But unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for COVID-19 for years to come” says Anna Marriott of Oxfam.Adds Heidi Chow of Global Justice Now: “All pharmaceutical corporations and research institutions working on a vaccine must share the science, technological know-how, and intellectual property behind their vaccine so enough safe and effective doses can be produced. Governments must also ensure the pharmaceutical industry puts people’s lives before profits.”The Pfizer/BioNTech vaccine started being administered in the UK this week, and is likely to receive approval within days from the US. Moderna and Oxford in partnership with AstraZeneca are expected to submit or are awaiting regulatory approval. The Russian vaccine, Sputnik, has announced positive trial results and four other candidates are in phase 3 clinical trials. <img width="640" height="539" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191112/636bee374b0ad905ca02ef31jpeg.jpg" alt=""> <img width="640" height="623" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191112/636bee394b0ad905ca02ef32jpeg.jpg" alt=""> <img width="640" height="517" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191112/636bee3c4b0ad905ca02ef33jpeg.jpg" alt=""> <img width="640" height="458" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191112/636bee3e4b0ad905ca02ef34jpeg.jpg" alt=""> All of Moderna’s doses and 96% of Pfizer/BioNTech’s have been acquired by rich countries. In welcome contrast Oxford/AstraZeneca has pledged to provide 64% of their doses to people in developing nations. But they can still only reach 18 % of the world’s population next year at most.Oxford/AstraZeneca deals have also mostly been made with some of the big developing countries like China and India, while the majority of developing countries have not done deals and have to share the COVAX pool of vaccines between them.As one company alone cannot supply vaccine for all and bring an end to the Covid-19 pandemic, collaboration is mandatory. As such the People’s Vaccine Alliance has called on all pharmaceutical corporations to share their technology and intellectual property through the World Health Organization (WHO) Covid-19 Technology Access Pool, so that billions more doses can be manufactured and safe and effective vaccines can be available to all who need them free of charge.A first step would be to support South Africa and India’s proposal to the World Trade Organisation Council this week to waive intellectual property rights for Covid-19 vaccines, tests and treatments until everyone is protected.“The hoarding of vaccines actively undermines global efforts to ensure that everyone, everywhere can be protected from Covid-19. Rich countries have clear human rights obligations not only to refrain from actions that could harm access to vaccines elsewhere, but also to cooperate and provide assistance to countries that need it,” says Steve Cockburn of Amnesty International.The vaccines developed by AstraZeneca/Oxford, Moderna and Pfizer/BioNTech have received more than $5 billion dollars of public funding, which places a responsibility on them to act in the global public interest. Pharmaceutical using government funding for research, retaining exclusive rights and keep their technology secret to boost profits could cost many lives, stress experts.Says Lois Chingandu of Frontline AIDS: “The global economy will continue to suffer so long as much of the world does not have access to a vaccine. We need to put pharmaceutical industry profit aside during this unprecedented pandemic, both to save humanity and the economy.”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2bb9c7e80680e083ec6jpeg.jpg" alt="" width="1656" height="750"/><figcaption>Vaccine trial of a Covid-19 vaccine at Oxford University’s Jenner Institute. Photo: UNIVERSITY OF OXFORD/JOHN CAIRNS</figcaption></figure>Many Nepalis who had felt their government had not done enough <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">‘vaccine diplomacy’</a> to for Covid-19 immunisation could have been assured by visiting Indian Foreign Secretary Harsh Vardhan Shringla’s remarks on Thursday that India would give preference to Nepal when trials are over.Indeed, it may be more practical and cheaper for Nepal to rely on vaccine supplies from research centres in India and China than multinationals, whose supplies of new vaccines are ‘booked’ by the world’s richest countries into next year.Handing over 2,000 vials of the broad-spectrum antiviral drug, Remdesivir, to Foreign Minister Pradeep Gyawali, Shringla said: "We will make the vaccine accessible and affordable, and it goes without saying that first priority will be for our closest neighbours like Nepal. We will put our health ministers and regulators in touch when this vaccine enters the market, Nepal will have the fullest benefit."<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2be9c7e80680e083ec7jpeg.jpg" alt="" width="1920" height="1080"><figcaption> </figcaption></figure>This week, the vaccine made by Oxford University in collaboration with the British-Swedish firm AstraZeneca was said to have 60-90% efficacy against Covid-19. The Oxford Vaccine has relevance for Nepal because the <a href="https://www.seruminstitute.com/" target="_blank" rel="noopener noreferrer">Serum Institute of India had</a> started manufacturing millions of doses of this vaccine long before the preliminary results of the trial came in.The Serum Institute of India is the world’s largest vaccine producer and already well-known in Nepal, especially for its anti-rabies vaccine that is commonly used here. The company had so much faith in the Oxford Vaccine, and it felt there would be such a rush later on, that it just went ahead and started manufacturing the vaccine, glass vials and stainless steel vats.Sure enough, preliminary results of the Oxford Vaccine now show that this gambit may have paid off for all concerned, including the people in India and its neighbouring countries.Adar Poonawallah, CEO of the Serum Institute of India has clearly made it his mission to manufacture the Covid-19 vaccine for the world’s poor. None other than Bill Gates is so impressed with his dedication that his foundation has committed millions of dollars to help with the project.Even as global Big Pharma roll out new vaccines, the difficult part will be to find ways to pay for the poorest people in the world’s poor countries to be immunised against Covid-19. Collaborative efforts like the one by the Serum Institute of India and COVAX appear to be the way to go.There is another interesting connection between the Oxford Vaccine and Nepal. The Chief Investigator of the Oxford Vaccine study, Prof Andrew Pollard has a long history of working in Nepal, especially in the prevention of typhoid fever. In December 2019, a paper on the milestone typhoid conjugate vaccine trial was published in <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener noreferrer">The New England Journal of Medicine</a> by doctors at Patan Hospital in collaboration with Pollard and colleagues. This breakthrough may well lead to policy changes around the world where typhoid is still rampant.The unusual thing about the Oxford Vaccine is that, for some reason, the scientists administered only a half-dose of the vaccine on one group followed by the full second dose, as opposed to administering two full doses. Amazingly, the group that got the half dose followed by the full dose had a 90% vaccine efficacy compared to the group that was administered the full two doses, which registered only a 60% efficacy.It will be intriguing to see if the half dosage was planned, or was an oversight that leads to this welcome finding. The history of medical breakthroughs abounds in such serendipitous discoveries.The Oxford Vaccine announcement was preceded by American companies Pfizer and Moderna unveiling the breathtaking efficacy (&gt;90%) of their own Covid-19 vaccines. However, besides the $60 cost per dose, the cold chain maintenance of -70oC for Pfizer’s vaccine would be impossible for countries like Nepal.The Oxford Vaccine, on the other hand, does not require such extreme cold chain maintenance. The regular vaccine cold chain 2-8oC will suffice. More importantly, the cost is thought to be substantially less.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2c19c7e80680e083ec8jpeg.jpg" alt="" width="1214" height="690"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2c49c7e80680e083ec9jpeg.jpg" alt="" width="1188" height="754">It is clear that <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">for Nepal, just the discovery of an efficacious vaccine will not be enough</a>. We must be able to have access to it, and also afford it. In addition, whether the vaccine prevents transmission or not is also going to be important -- together with whether or not it prevents severe illness.Their important considerations are all pending, but for now, we need to continue to wear masks, wash hands, and maintain social distancing. We may have to continue that practice even after the vaccination campaigns start.Because the Oxford Vaccine will be distributed by governments (not Oxford University) the Nepal government will need to liaise with the <a href="https://www.who.int/initiatives/act-accelerator/covax" target="_blank" rel="noopener noreferrer">World Health Organization-initiated COVAX</a>, which is the only global inter-governmental initiative working with manufacturers to ensure Covid-19 vaccines are available worldwide to both the rich and the poor.Most industrialised countries have already started placing orders for vaccines from Pfizer, Moderna and AstraZeneca, so there is every likelihood that COVAX will concentrate on ensuring vaccine supply to less-developed countries.Along with the Indian vaccines, results of the Chinese vaccine against Covid-19, which may well be just as effective and affordable, will probably be announced soon.The <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government needs to coordinate closely</a> with groups like COVAX and keep its attention focused on obtaining the vaccine for Nepalis of all socio-economic strata.With Harsh Vardhan Shringla’s assurance this week in Kathmandu, it may also be useful to connect directly with the Serum Institute of India, which can play an instrumental role in supplying this all-important vaccine against Covid-19.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and contributes this <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer">health column</a>, Dhanvantari, for Nepali Times.

Buddha Basnyat

Glimmers of hope for Nepal on vaccine

<figure><img width="2048" height="1282" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1af9c7e80680e083e61jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>With the <a href="https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/">pre-winter resurgence of Covid-19</a> around the world and in Nepal, pressure is mounting on governments to procure vaccines to protect their populations.
Last week, the <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government set up a committee</a> of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them. But Nepal is far behind other countries, which have already ‘booked’ their future supplies.
On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">VAX POPULI</a>, Sonia Awale
However, there is no effective strategy to ensure vaccines for all as distribution in Nepal comes with the challenge of taking it to poor and remote corners of the country. Experts fear that even when the vaccines become available, the campaign will be plagued by the same socio-economic inequities that afflict the medical sector.
“We need to immediately start identifying vulnerable groups like <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a>, <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> or those with comorbidities to prioritise for immunisation,” says Bikash Gauchan, a physician at Bayalpata Hospital in the under-served western district of Achham.
“We also need to set up proper cold chain facilities across the country as soon as possible and have a well thought out distribution plan so that when the vaccine does arrive, we can hit the ground running,” he adds.
The silver lining is that Nepal already has a successful <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">childhood immunisation</a> network that has successfully mobilised <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and they can deliver vaccines to the homes of the elderly who cannot make it to clinics. Monitoring the follow-up second dose for some of the vaccines will be crucial, although Nepal’s health system has experience with maintaining a cold chain for other campaigns.
<a href="https://www.nepalitimes.com/latest/nepali-diaspora-hit-by-covid-surge/">Nepali diaspora hit by Covid surge</a>, Nepali Times
Despite recent breakthroughs in trials (see box) public health experts stress the importance of exploring vaccine supply options closer to home. As of now, 11 vaccines developed in several parts of the world are in the third phase of <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener noreferrer">clinical trials</a> with many of them expected to be as effective.
Neighbouring China and India are at the forefront. And Nepal should have begun its ‘vaccine diplomacy’ much before this to secure its supply of shots.
There is also the uncertainty of vaccine efficacy depending on the strain: the same vaccine could be highly effective against people in the West but not as much in South Asia where people suffer from chronic malnutrition and multiple infections.
“For a working vaccine to be made within a year is an amazing victory for science but we also need to know that these vaccines are designed for their population. So I’d want to know more about the vaccines in India and China,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Particularly China, as it was where the pandemic started but <a href="https://www.nepalitimes.com/latest/what-nepal-can-learn-from-china-about-covid-19/" target="_blank" rel="noopener noreferrer">has since controlled it effectively</a> unlike rest of the world.”
<a href="https://www.nepalitimes.com/opinion/the-truth-about-the-chloroquine-scam/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Buddha Basnyat</a> of the Patan Academy of Health Sciences agrees. He says: “China looks at the reality in our backyard. So a more suitable vaccine for us could come from the Chinese, particularly because they have a track record of having developed better vaccine for this part of the world.”
Indeed, the JEVAX made by the researchers in Chengdu is now the most widely used jab against Japanese Encephalitis because it’s more cost effective compared to its western vaccines.
Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.
In India, The Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.
Similarly, researchers at the Indian Institute of Science have designed a protein-based heat-tolerant vaccine that can stay stable for a month at 37°C, and could endure temperatures as high as 100°C if freeze dried, a feature that could be a game changer for mass vaccination campaigns in lower and middle income countries in Asia and Africa.
The other factor to consider will be the duration of the immunity after each vaccine shot, as well reinfection groups and if antibodies developed in the first episode helps fight the mutated forms of the virus.
With Covid-19 crisis continuing to spread rapidly across Nepal and at 10 fatalities per million population (same as Pakistan and much higher than China’s 3), it is not too early to start dialogue with Gavi, the vaccine alliance, COVAX and agencies like the World Bank and World Health Organisation to help procure the most cost effective approach to vaccines most suitable to Nepal’s conditions.
Alternatively, many pharmaceutical companies will want to play the field in order to boost their profile. In fact, embassies and foreign donors are already hard at work pushing for trails and deals.
“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”
In all this excitement, Nepal’s health authorities must also keep an eye on the plight of infected people and many more to come as <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">they wait for a vaccine</a>. The results of current treatment regimens ranging from plasma therapy to administering Remdesivir have been patchy. And as scientists study the long-term impact of Covid-19 on patients even after they recover, making an optimal use of resources becomes even more significant.
So far, the government has been faulted for squandering months of lockdown, not carrying out sufficient tests and contact tracing, not increasing hospital capacity and equipment, and letting the people fend for themselves.  
The result is that Nepal is <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">suffering a sustained surge</a>, with more than 1,400 new cases a day, over 60% of them in Kathmandu Valley alone and a quarter of those tested coming out positive. There is also a surge in symptomatic patients, even among those without pre-existing conditions, and those sick enough to require ICU and ventilator.
Even when the government does act, the <a href="https://www.nepalitimes.com/latest/coronavirus-coordination-committee-doesnt-coordinate/" target="_blank" rel="noopener noreferrer">priorities seem to be misplaced</a>. For instance, health experts say the emphasis in the past months should have been on high flow oxygen therapy or High Dependency Units rather than Intensive Care Units in hospitals.
“It would have been cheaper, it does not require highly trained staff or sophisticated equipment, and it would have freed up the ICUs for the really critical patients,” adds Pun, who himself is at the Health Ministry, and this possibly means his advice is not being taken.
Insiders say it will likely take upwards of six months for the first vaccines to arrive in Nepal, and there will be a rush by the rich, the powerful and those with political connections to get their shots. The marginalised, poor, those in remote areas will be the last to get their injections, unless the government has fair and effective rules in place and implements them.
Till then, there is little else to do than <a href="https://www.nepalitimes.com/opinion/silver-linings-in-the-covid-cloud/" target="_blank" rel="noopener noreferrer">keep masking up this winter, avoid large gatherings, keep distance and wash hands regularly</a>.
Says <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a>: “The mask is the best vaccine we have at the moment. These safety measures have largely reduced hospitalisation due to other infections in 2020, masks in particular will also protect us from winter pollution in the coming months.”<h2>The Vaccine Race</h2>The global resurgence of Covid-19 in the northern winter has coincided with breaking news every day of successful new vaccine trials.First the Russians announced a vaccine in September that is 92% potent against SARS-CoV-2.  Last week Pfizer unveiled a 90% effective vaccine, which on Wednesday was upgraded to 95% efficacy without side effects. Moderna was next with an efficacy of 95%, and not needing extreme refrigeration. More companies in China, India and Europe are conducting their own trials.Public health experts have hailed the developments, but warn that vaccines will not be universally available till late 2021 and even so will not provide full protection. They suggest continuing with masking up, keeping distance and avoiding crowded indoor places.Pfizer and its German partner BioNTech’s mRNA-based vaccine came out declaring over 90% effectiveness but only at -70°C ultra cold chain which will be a challenge even for countries with the best health facilities in the world.Massachusetts-based Moderna’s RNA shot has 94.5% efficacy, seems to also prevent severe infections and remains stable in medical and home refrigerators for up to 30 days, in freezers (-20°C) for up to six months, and at room temperature for up to 12 hours.Even so, poorer countries are unlikely to get coronavirus vaccine any time soon. Even the biggest pharmaceutical multinationals can only manufacture a limited quantity of the vaccine over the next year.Pfizer has capped its production at 1.4 billion for 2021, 80% of which has already been booked through advance purchase agreement by the US, UK, EU, Canada and Japan. Moderna expects to manufacture 20 million doses this year and up to one billion in 2021.On the other hand, <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">Russian’s Sputnik V</a> has been overshadowed by new developments, and due to lack of sufficient data to back up its claim of 92% efficacy. Although geopolitical rivalry with the West has given it negative publicity, some health agencies have not ruled it out.

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