<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 width="1334" height="889" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14189c7e80680e0a995ejpeg.jpg" alt=""/><figcaption>Children aged 12-17 started getting inoculated with the Pfizer BioNTech Covid vaccine in Kathmandu on Monday. Photo: AMIT MACHAMASI</figcaption></figure>Not long ago, <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">to boost or not to boost </a>was the dilemma of rich countries, even as developing nations were struggling to vaccinate their frontline workers and elderly with the first dose.
The argument <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">has now reached our part of the world</a>, with some health experts even in Nepal recommending boosters shots for the immune-compromised and frontline workers. In fact, the government’s Teaching Hospital and a few others in Kathmandu this week administered a third booster shot to some patients suffering pre-existing diseases.
The recommendation has been met with some conflicting opinion at a time when only a little over 30% of Nepal’s target population has been fully inoculated against Covid-19. While over half the people in densely populated urban centres like Kathmandu have been vaccinated, parts of rural Nepal are still largely unable to access jabs.
“Our first and foremost priority must be to vaccine everyone, and if we have plenty more vaccines, which we are more than likely to have, the next step is to provide booster shots to people with co-morbidities and the elderly,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.
Infectious disease specialist at HAMS hospital Anup Subedee agrees: “If the question is what is more advantageous in terms of controlling the pandemic, vaccinating the unvaccinated or offering booster shots, the answer is to vaccinate everyone first.”
Having said that, Subedee adds that Nepal should provide the third dose of VeroCell to individuals who were inoculated with the Chinese vaccine, for higher efficacy, as recommended by the World Health Organisation (WHO).
The concern about boosters is mainly because antibody levels decline significantly after 6-9 months of being inoculated, as proven by studies around the world. And as one of the first countries in South Asia to start its Covid-19 vaccination drive, it has been six months since<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer"> frontline workers</a> were given jabs.
Some experts, however, say that the human body provides protection also from so-called ‘memory cells’ so that even if vaccine immunity drops, the T and P cells which produce antibodies only when a pathogen attacks. There is no exact estimate of how long the memory cells provide protection, but it is most likely long-term, which means the general population may not need booster shots just yet.  
Those who recover from Covid-19 are even better placed to ward off the infection and its complications, with natural immunity being more effective than that gained by vaccination. And according to the recent seroprevalence survey, over two-third of Nepalis have SARS-CoV-2 antibodies that provide them natural immunity.
“Given that 68% of people in Nepal have some form of protection and a significant chunk of the population is fully vaccinated, we don’t have to worry about boosters yet. Our infection rate, hospitalisations and morbidities have all largely declined,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal, which conducted the seroprevalence survey.
The new surge in Europe has been associated with the Delta variant, which has already swept through every corner of Nepal and India, which means a majority of the people here have developed some immunity against it.
“So, we don’t have to panic about another major surge as of now,” Dixit adds.
This is <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">not to say Nepal is out of the woods</a> yet. With a declining number of daily cases and fatalities, schools have reopened, there are wedding parties, crowded marketplaces and indoor seminars are happening all over the country.
Safety measures must be maintained despite higher vaccination rates and declining hospitalisations. This means, continuing to mask up, avoiding crowds and maintaining distance -- especially with the onset of winter and the seasonal risk of coronavirus, influenza and pneumonia infections. There are already reports of students, parents and teachers in Kathmandu schools testing positive for Covid-19.
The government had <a href="https://www.nepalitimes.com/latest/pfizer-vaccines-arrive-in-nepal/" target="_blank" rel="noopener noreferrer">set aside Pfizer </a>vaccines for the immunocompromised, but a lack of uptake meant that students up to age 12 are now being offered the US-made vaccine that has been certified for children.
Shyam Raj Upreti, Nepal’s focal person for the Covid-19 vaccine maintains that the government will start administering booster shots only after nearly 100% of the targeted population has received its first dose, the figure currently stands at about 40%.
Nepal has so far received 25 million doses of vaccines in <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">donations or purchase</a>, 30 million more are in the pipeline. “We now have more than enough vaccines for our targeted population, and we are now starting with students,” says Upreti. “The new challenge is to increase vaccine acceptance among those who have so far refused to take it.”
Although surveys have shown that 97% of Nepalis trust vaccines, many pregnant women and those with co-morbidities are refusing to get shots, <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">fearing side-effects</a>.
Experts caution that Nepal’s response to the pandemic needs to <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">extend beyond vaccinations</a>. The country has to be prepared for a possible surge, and this means contact tracing including the testing of the children, stringent quarantine and isolation, well-equipped health infrastructure and trained medical staff to operate them.
“Another surge might not be a major one but it could still be on a scale sufficient to significantly impact our economy and lives,” adds Anup Subedee. “So we have to be prepared. But a lot of it boils down to political will, and an efficient bureaucracy that is focused on controlling the pandemic.”
Indeed, Covid-19 is here to stay which means continued vigilance and precautions like <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">masking and physical distancing</a>. Warns physician Buddha Basnyat: “Covid-19 is a wily virus, and it is still a formidable foe. We can’t let down our guards yet.”

Do Nepalis need Covid booster shots?

<figure><img width="1415" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d197f9c7e80680e0ac821jpeg.jpg" alt=""/><figcaption>The 100,620 doses of Pfizer's Covid-19 vaccine arrived in Kathmandu on Monday. Photos: AMIT MACHAMASI</figcaption></figure>The first 100,620 doses of Pfizer’s Covid-19 vaccine under the global COVAX initiative arrived in Kathmandu on Monday, even as <a href="https://www.nepalitimes.com/banner/the-jabs-and-jabnots/" target="_blank" rel="noopener noreferrer">the country’s rate for fully vaccinated</a> population nears 23%.The BioNTech doses, however, will not be administered to children above age 12 as previously expected, but to cancer and kidney patients undergoing treatment in hospitals across the country.  The consignment was taken from the airport directly to the ultra-cold storage facility of the Department of Health in Teku. Pfizer vaccines have to be stored at -70o Celsius, even while most hospitals in Kathmandu only have standard refrigeration facilities and the government is yet to build required infrastructure across the country to store the jabs.Pfizer with Moderna are the only Covid vaccines so far approved for <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">children</a> above 12 years of age, and as such younger population was prioritised for the shots. However, the limited number of doses meant that children will now be inoculated only once Nepal secures more doses. Nepal government has reportedly already paid for 4 million doses of Moderna through the World Bank, which will be arriving in February 2021.According to the Health Ministry, given that Pfizer shots have been effective in containing the spread of Covid-19 patients suffering from chronic illnesses elsewhere around the world, people with cancer and kidney ailments will now be prioritised for the next round of inoculation. <figure><img width="2048" height="1366" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19839c7e80680e0ac822jpeg.jpg" alt=""><figcaption></figcaption></figure>The US under the COVAX facility previously donated <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">1.53 million of the one-shot Johnson &amp; Johnson vaccine</a> in July, which was administered to migrant workers, students leaving for colleges abroad, people with disabilities and individuals between 50-55 years of age.Close to 19 million doses of Covid-19 vaccines have arrived in Nepal so far. Apart from 4 million doses of Moderna, 5.9 million Chinese VeroCell is in the pipeline. Another 1.6 million pledged by the Chinese foreign minister Wang Yi to his Nepal counterpart Narayan Khadka does not have an arrival date yet, nor the 1 million Sinovac, also promised by China.India has also resumed the export of its Covishield vaccine, but is yet to send the remaining <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" target="_blank" rel="noopener noreferrer">one million does Nepal paid for earlier this year</a>.Some 15 million doses of the Covid-19 vaccine have been administered across Nepal, with 22.3 of its targeted population inoculated fully. Close to 30% Nepalis have been partially vaccinated. Over half of Kathmandu’s population has been vaccinated against the virus but public health experts have warned of a <a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer">post-Dasain surge</a> in the number of cases.Meanwhile, the District Health Office Kathmandu is administering second dose of AstraZeneca in eight municipalities including KMC, Kirtipur, Chandrafiri, Nagarjun, Kageswori Manohora, Tarkeswor, Tokha and Gokarneswor for people above 18 years of age from 26 October. <img width="1366" height="911" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19869c7e80680e0ac823jpeg.jpg" alt=""><img width="1440" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d198a9c7e80680e0ac824jpeg.jpg" alt=""><img width="1440" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d198d9c7e80680e0ac825jpeg.jpg" alt=""><img width="1219" height="813" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161132/636d19909c7e80680e0ac826jpeg.jpg" alt="">Vaccines that have arrived in Nepal so far:Covidshield donated by India: 1 million dosesCovidshield bought from India: 1 million dosesCovishield via COVAX: 348,000 dosesCovidshield donated to Nepal Army: 100,000VeroCell donated by China: 800,000VeroCell donated China: 1 millionJohnson &amp; Johnson via COVAX: 1.53 millionVeroCell bought from China: 4 millionAstraZeneca donated from Bhutan: 230,000AstraZeneca donated from Japan: 1.6 millionVeroCell bought from China: 1.6 millionVeroCell donated from Red Cross: 100,000

Pfizer vaccines arrive in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17b19c7e80680e0ac780jpeg.jpg" alt="" width="856" height="571"/><figcaption>Kathmandu's Dasain shopping crowd this week. Photo: AMIT MACHAMASI</figcaption></figure>Nearly half of Kathmandu Valley’s population is fully vaccinated against Covid-19, but the national average is only a little over 20%. In essence, this is a microcosm of <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">vaccine inequity seen globally</a> – but it also reflects Nepal’s in-built socioeconomic inequalities.In Asia and Africa, a majority of the population including health workers and the elderly are yet to receive even their first dose. But the US, France, Germany, and Israel are already <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">providing booster shots</a> to their vulnerable populations.On one hand, this is a stark reminder that Nepal is not on the priority of wealthy nations. Just as it was not during the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave in May</a> when, despite the prime minister and the president calling on foreign governments for vaccine shipments, <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer">the response was tepid</a>.On the other hand, the imbalance in vaccine distribution within Nepal is a reflection of long-standing inequities in healthcare services, education, drinking water, and food that predate Covid-19.Despite a federal Constitution that has devolved decisions and delivery of basic services to local governments, it is still Kathmandu that holds the purse strings and power. Isolated and beyond the state’s reach even at the best of times, Nepal’s hinterland this year has been cut off by <a href="https://www.nepalitimes.com/banner/still-chasing-the-melamchi-mirage/" target="_blank" rel="noopener noreferrer">destructive floods blamed on the climate crisis</a>.A village in Kailali with 200 Tharu and Dalit families has been marooned by floods for the past month, where the submerged roads block access to even the rudimentary healthcare available.It is not surprising, therefore, that very few in this village are inoculated. In fact, those who need to be vaccinated the most now face a triple whammy: historical state neglect, international apathy, and now <a href="https://www.nepalitimes.com/opinion/mountainous-regions-face-catastrophic-impacts-without-urgent-climate-action/" target="_blank" rel="noopener noreferrer">climate-induced extreme weather</a>.This in turn has set off a vicious cycle, and the poor are getting poorer. The official death toll from Covid-19 in Nepal is nearly 12,000, but the ‘excess deaths’ that were not counted in remote villages across the country is probably several times higher.An estimated <a href="https://www.nepalitimes.com/banner/helping-nepals-covid-orphans/" target="_blank" rel="noopener noreferrer">1,200 children have become orphans</a> because of the death of one or both parents due to Covid-19. Many of them do not have support for food, healthcare, and education – setting a stage for intergenerational inequity.In Kathmandu and urban centres, on the other hand, there is complacency and false sense of security as <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">the festive season approaches</a>. Unvaccinated children have also started <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">attending in-person schools</a>. The Health Ministry’s recent seroprevalence study has revealed that 67% of people have SARS-CoV-2 antibodies, and therefore have natural immunity against the virus. This, combined with half of the valley’s targeted demography being vaccinated on paper, makes a case for a fully immune population.But that is not the case. There is now growing proof that antibodies provided by vaccines wane over time, which means many of us who were vaccinated earlier this year have weaker protection than we think. Only those newly infected with the virus might have sufficient antibodies to fight off the next infection.It is not as important to know what portion of the population has antibodies as to how much of it they have. Vaccinated individuals are less susceptible to hospitalisation, severe symptoms, and death, but they can still be contagious, especially as the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">more virulent Delta variant</a> continues to circulate in the region.The Dasain shopping spree has started, and there are throngs of <a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer">shoppers in Asan and other bazar streets</a>. Many have stopped wearing masks, or use them inappropriately. The situation will be worse when Kathmandu residents travel to their hometowns this week. They will be visiting elderly parents and grandparents, exposing vulnerable elderly relatives with lower immunity to the virus.The government is bringing in 100,000 doses of Pfizer vaccines after the festivals, with plans for 10 million more by March. But provincial and district hospitals must have deep refrigeration equipment in place, and make necessary collaboration with private hospitals.To make sure that each Nepali child, even those in remote Karnali, gets <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">a shot at the Covid-19 vaccine</a>, our expansive network of community healthcare workers must be mobilised and, where required, administer vaccines at the household level.Lhamo Yangchen Sherpa is an epidemiologist and a senior research monitoring and evaluation advisor at IPAS Nepal.

Giving all Nepalis a shot at the Covid vaccine

<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.”