Today, on World Health Day, WHO celebrates 75 years of improving public health and well-being in the South-East Asia Region and globally, fully committed to achieving Health for All through universal health coverage (UHC), when all people can access the health services they need, when and where they need them, without financial hardship. For many decades now and since even before the 1978 Declaration of Alma-Ata, high-level leaders and policy makers from across the Region have recognised the critical role that access for all to quality, affordable and comprehensive primary health care (PHC) can play in achieving UHC, and therefore Health for All. However, global enthusiasm for UHC and the PHC approach has witnessed several peaks and troughs, resulting in public health services and programmes that have often become siloed, fragmented and divorced from wider multisectoral, social and economic processes and determinants. Today, in the shadow of the Covid-19 crisis, around 40% of the Region’s population is unable to access essential health services. In 2017, around 299 million people faced catastrophic health spending, and an estimated 117 million were pushed or further pushed below the purchasing power parity poverty line of $ 1.90 a day, a figure that has since been exacerbated.&nbsp; History’s lesson is as clear as it is urgent: sustained whole-of-government, whole-of-society action is needed to achieve UHC and Health for All, one of eight Regional Flagship Priorities since 2014, and a core pillar of the Region’s vision to build back better from the Covid-19 pandemic. We must all contribute.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230405150412_4f70dbbce169dea526df0ad6802705ba848ac4c51e48800ee98d050794c20fca.jpg" data-media-id="editor_0" data-image-id="20230405150412_4f70dbbce169dea526df0ad6802705ba848ac4c51e48800ee98d050794c20fca" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="hospitals in Nepal"> <figcaption>Photos: GOPEN RAI</figcaption> </figure>  First, high-level leaders from across the Region must maintain and strengthen political and financial commitment to achieve UHC, accelerating momentum ahead of the second UN General Assembly meeting on UHC in September this year. The Covid-19 crisis has shown that when health is at risk, everything is at risk. It has shown that investments in UHC and health system resilience underpin not just health, but social and economic security, as well as the achievement of an array of Sustainable Development Goals. Second, policy makers and programme managers must continue to implement the Region’s Strategy for PHC, launched in December 2021. Of specific focus should be strengthening public health infrastructure, workforce and financing, while at the same time increasing equity for those at risk of or who are already being left behind. Shared learning must continue to be a core priority, leveraging the full power of the Region’s new Forum for PHC-Oriented Health Systems. Third, people and communities must increasingly assert their voice and Right to Health, including by directly engaging in local health decision-making processes. As highlighted by the 2021 WHO handbook on social participation for UHC, as well as the Region’s recently adopted resolution on enhancing social participation in support of PHC and UHC, individuals and communities can play a key role in monitoring health service performance and holding health providers and policy makers to account. Fourth, partners, donors and other stakeholders in the Region must go all in on UHC and Health for All, recognising that the PHC approach is the most effective, efficient and equitable way to build national health systems that are unified, and which achieve healthier populations, health security and UHC. In all countries, policy makers must lead, and partners must support. Assistance must be fully aligned with national priorities, avoiding duplication and fragmentation. Crucially, given the magnitude of the challenge, we must recognizse that progress may not always grab headlines, but will nevertheless make a real difference to people’s lives. Between 2010 and 2019, the Region increased its UHC service coverage index from 47 to 61. Between 2000 and 2017, the Region reduced the number of households impoverished or further impoverished from out-of-pocket spending on health from 30% to 6%. Since 2014, the density of doctors, nurses and midwives in the Region has improved by over 30% – a tremendous achievement that must continue to be built upon. On this, WHO’s 75th founding anniversary, let us unite in purpose and be driven by action to achieve UHC and Health for All, ensuring all people have good health for a fulfilling life in a peaceful, prosperous and sustainable world. &nbsp; Poonam Khetrapal Singh is the WHO SEARO Regional Director.

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United by purpose, driven by action

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238939c7e80680e0c7392jpeg.jpg" alt="" width="960" height="640"/><figcaption>VECTOR FOR VIRUS: Stagnant pools of water, an ideal breeding site for the dengue mosquito, outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku, which on Thursday saw 250 new dengue patients. Photo: SUMAN NEPALI</figcaption></figure>It is not called ‘breakbone fever’ for nothing. Every bone, every muscle, every joint throbs with searing pain, as my body burned with high fever. It was not just for a day or two, it lasted weeks. The fever has finally subsided, but I am too weak even to walk.As a public health graduate myself, and someone who has covered health and environment for this publication, I am used to covering disease outbreaks. But my experience with Covid last year, and now being struck down by dengue, I became the story I was reporting on.It has been two months since the first cases of dengue surfaced in Kathmandu Valley. There was  an outbreak in 2019, and everyone thought it would pass.But this monsoon, there has been no letup. The virus has spread like wildfire, exposing just how woefully unprepared national and local governments are in preventing a disease that has no cure.The fever has now spread to all 77 districts with 10,000 patients in hospitals, many thousands more are recovering at home. Doctors have reported Covid patients with dengue complications.“We are at the peak of the dengue outbreak,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical &amp; Infectious Disease Hospital in Kathmandu which is seeing 250 patients a day. “I wish I had better news, we are at the mercy of the virus, and will just have to wait for winter.”But Kathmandu Mayor Balen Shah posted on Facebook asking the public not to wait for winter. He said money had been allocated for wards, many are carrying out  ineffective fumigation.Roshan Pokhrel, Secretary at the Ministry of Health says: “There is no cure for this. The only way is to search and destroy mosquito breeding grounds.”Read also: <a href="https://www.nepalitimes.com/banner/state-of-malaise/">State of malaise</a>, Sonia AwaleBut that is easier said than done. Draining stagnant pools is too late, infected mosquitos are already inside homes. The female Aedes aegypti mosquito has ideal breeding areas during this wet monsoon, and climate change is letting the virus move to higher elevations.A female mosquito can lay up to 700 eggs even in a small pool of water, and can pass on the virus to its offspring. The mosquitos then can fly and infect in a radius of 300m, and they bite mainly in the daytime so that mosquito nets while sleeping are not really a deterrent. When the pools dry up, the larvae lie dormant and carry the virus next summer.“Preventing mosquito bites is still the priority, people need to know about effective repellents, especially the ones containing DEET (diethyltoluamide), recommended by WHO and CDC as the most active ingredient in insect repellents,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.Also important is to assure patients that although painful, dengue is rarely fatal, Basnyat assured me this week as I tried to regain my strength after two weeks of high fever.Last month, I was preparing a review of new studies about air pollution when I started feeling feverish. It got difficult to even sit at my desk. Wincing with pain, I barely met the deadline for page 1. At that point, air pollution seemed to be the least of my problems.The next two weeks are a blur. Fever that reached and stayed at 103°F for days on end, even touching my skin was painful, my eye sockets hurt. Paracetamol was the only medicine, and I needed cold presses to keep the fever down.One evening, the temperature hit 104°F and that was when I felt like I was hallucinating. With such high fever, sleep is impossible. I could not even toss and turn because of the pain.Eating was out of the question, even drinking water took enormous effort. Aside from the pain was the nausea and retching, which made the pain worse.Read also: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom RobertsonI cannot explain in words just how unpleasant dengue is. God forbid, you have to experience it yourself.The other experience of my convalescence was how the medical profession in Kathmandu from doctors to pharmacies are abusing this epidemic for unethical profit. There is no medicine for dengue, just paracetamol to numb the pain, water to replenish the body’s fluids, and rest – lots of it.My neighbourhood in Patan is a dengue hotspot, every household has at least one person who is sick. Some neighbours have been prescribed antibiotics, even though they are harmful to dengue patients.“Dengue is a viral infection, prescribing antibiotics does no good,” Buddha Basnyat told me. “They are prescribing Azithromycin used for typhoid and typhus. This misuse can actually lead to resistance against those diseases.” Virologist Pun at Teku Hospital says he is getting patients at his fever clinic with complications because of antibiotic intake. Patients buy antibiotics over the counter in the misguided notion that it will make the fever go down.The only effective prevention is to remove mosquito breeding grounds, but with the city being in the state it is in with garbage piles, open drains and potholes, it will need a mass awareness campaign with enforcement and fines as is done in other tropical Asian cities.Climate change means that mosquito vectors and their pathogens are moving up, and besides dengue we will also have to watch out for malaria or encephalitis in areas they were unheard of before.“Vector insects are moving from the southern plains to the northern mountains and with them the diseases they carry,” explains Pun.This means Nepalis may have to experience more deadly outbreaks before the most vulnerable people become a priority for the state.Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale-----------------------------<h2>Operation Search and Destroy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238959c7e80680e0c7393jpeg.jpg" alt="" width="1000" height="699"><figcaption> </figcaption></figure>Dengue is a viral infection transmitted to humans through the bite of infected Aedes aegypti or Aedes albopictus mosquitos. Because there are four different serotypes, an individual previously affected can get even more severe dengue due to the body's auto-immunity.There is no cure for dengue. A vaccine is available, but it is recommended only for those previously infected. Patients can be tested for dengue with RT-PCR or enzyme-linked immunosorbent assays (ELISA).Prevention is better than cure, and this is most true for dengue. Some 80% of dengue cases are asymptomatic, but for the rest it could be a very painful experience for up to 2 weeks.Painkillers are not advised, only paracetamol, up to 1,000mg at one time 3 times a day.The only antidote to dengue is to deprive the mosquito of stagnant pools of water to breed. It can be a plastic bottle cap in a garbage dump or the inside of a discarded tyre, anything is suitable for the female mosquito to lay her eggs.She can lay up to 700 eggs in their two-week lifetime. And if the mother is infected, all her offspring are born with the virus too. These mosquitos can fly and infect everyone in a 300m radius.Dengue was first detected in Nepal in 2004 on a visitor. Since then there have been cases every year with the biggest outbreaks in 2019 and this year. Once present in the environment, the virus can remain for years since the infected mosquito larvae can carry it into next summer.The only way to prevent dengue and other mosquito borne diseases like malaria and encephalitis is to declare Operaton Search and Destroy on their breeding grounds.Read also: <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/">Climate-health emergency</a>, Sonia Awale

Sonia Awale

Dengue days are here to stay

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238919c7e80680e0c7391jpeg.jpg" alt="" width="960" height="640"/><figcaption>VECTOR FOR VIRUS: Stagnant pools of water, an ideal breeding site for the dengue mosquito, outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku, which on Thursday saw 250 new dengue patients. Photo: SUMAN NEPALI</figcaption></figure>Although debilitating, fatality from dengue is rare. But the epidemic raging across Nepal’s cities has killed at least 12 people. The latest is a 29-year-old Nepali PhD student.The current outbreak comes on top of the Covid pandemic, and is a reflection of everything that is wrong with Nepal: political negligence, governance failure, misplaced priorities, lack of accountability, state apathy. Dengue is the symptom, the disease is political.A wetter than usual monsoon and <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener noreferrer">climate change</a> mean that dengue mosquitos have found ideal breeding grounds even in roadside pools outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku (above) which is seeing 250 new dengue patients every day.The virus-carrying female Aedes aegypti mosquito has a wide choice of places to lay her eggs: on water-filled bottle caps in garbage piles, inside discarded tyres, stagnant pools in open drains, and even balcony flowerpots. Kathmandu Valley is now a magnet for mosquitos.We could have learnt from the 2019 dengue outbreak when there were 17,000 hospital cases, and at least 6 fatalities. The monsoon is not over, and this year we have already  surpassed those numbers.Read also: <a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay/">Dengue days are here to stay</a>, Sonia Awale“Unfortunately we learned nothing from the 2019 outbreak, we allowed infected mosquitos to breed everywhere,” says Sher Bahadur Pun, a virologist at the Clinical Research Unit at Teku. “The problem has magnified this year. The mosquitoes are now inside our homes, offices, and schools making it difficult to avoid infection.”The fact that local and central governments are gearing up to deploy a ‘search and destroy larvae’ two months into this large-scale outbreak is proof of slow-motion response. Fumigation is ineffective, and it is too late to drain breeding pools.The dengue virus can remain in the larvae of infected mosquitos for several years. So, the only way to prevent next year’s outbreak is to search and destroy breeding grounds now. Next monsoon will be too late. As with the garbage crisis and the air pollution emergency, dengue is problem for which the only solution is political will.Removing local breeding ground for the mosquito vector and spreading mass awareness about prevention is the responsibility of local governments. Federalism is supposed to make elected mayors accountable. They can start draining the swamps.For now, physician Buddha Basnyat’s advice is: “Avoid mosquitos, particularly at dusk and dawn, use the most effective repellent and don’t take antibiotics.”Read also: <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak/">As Covid abates, Nepal sees dengue outbreak</a>, Anita Shrestha

State of malaise

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205c69c7e80680e0b28d5jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: SONIA AWALE</figcaption></figure>The last Sunday in January is World Leprosy Day. Since 2006, I have issued an annual Global Appeal to End Stigma and Discrimination against Persons Affected by Leprosy, supported by influential individuals and organisations around the world.Amid the coronavirus pandemic, which has shown how easily fear and anxiety about a disease can fuel prejudice, I believe this call to eliminate <a href="http://archive.nepalitimes.com/news.php?id=711#.YfYlNi2B3ow" target="_blank" rel="noopener noreferrer">stigma and discrimination</a> is more important than ever.Leprosy, also known as Hansen’s Disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It mainly affects the skin and peripheral nerves and is one of the oldest diseases in human history. Yet each year, around 200,000 new cases are reported globally.In Nepal, 2,304 new cases were reported in 2020 and it is one of 23 countries on the WHO’s priority list for leprosy. Most cases are found in Madhes Province bordering India.Today an effective treatment exists in the form of multidrug therapy (MDT) and with early detection and treatment, the disease can be cured without complications. But if treatment is delayed, <a href="http://archive.nepalitimes.com/news.php?id=39#.YfYl-S2B2b8" target="_blank" rel="noopener noreferrer">leprosy can cause progressive impairment</a> and lead to permanent disability.There are an estimated 3-4 million people living with some form of disability due to leprosy. This fact, together with deep-seated fears and misperceptions about this age-old disease, has subjected persons affected by leprosy and even their family members to severe discrimination, which continues to this day.Since becoming WHO Goodwill Ambassador for Leprosy Elimination in 2001, I have visited some 120 countries to see the situation for myself. This has led me to think of leprosy in terms of a motorcycle: the front wheel symbolises curing the disease, and the back wheel represents eliminating discrimination. Unless both wheels are turning together, we will not reach our ultimate goal of zero leprosy.As regards to the front wheel, efforts against the disease, including new case detection, have been badly disrupted by the spread of the novel coronavirus and efforts to prevent transmission. In 2020, the number of new cases reported was down to 37% year on year, according to the WHO, largely due to the impact of Covid-19.Concerning the rear wheel, I have worked hard to have leprosy recognised internationally as a human rights issue since the early 2000s, when I first approached the Office of the UN High Commissioner for Human Rights. One result has been the adoption in 2010 of a UN General Assembly on elimination of discrimination against <a href="http://archive.nepalitimes.com/news.php?id=15213#.YfYl_y2B2b8" target="_blank" rel="noopener noreferrer">persons affected by leprosy</a> and their family members.But the real measure of success will be when principles and guidelines accompanying the resolution are fully implemented. Because of the pandemic, however, awareness-raising efforts in many areas have stalled, and some people have found that Covid-19 is exacerbating the discrimination they already experience as persons affected by leprosy.This is why last August I launched a <a href="https://www.shf.or.jp/en/dont-forget-leprosy-campaign/" target="_blank" rel="noopener noreferrer">campaign called ‘Don't Forget Leprosy’</a> to ensure that leprosy and the needs of those affected by the disease are not overlooked, even amid the pandemic. The campaign stresses the importance of early detection and treatment, as well as the need to eliminate stigma and discrimination.The term 'don't forget' covers many things: that leprosy still exists, that people affected by leprosy and their families still face social prejudice, and that there are healthcare professionals doing their best in difficult circumstances to provide needed services.In Nepal, a country I have visited many times over the years, what has impressed me has been the strong cooperation I have found between the <a href="http://mohp.gov.np/eng/program/communicable-disease/leprosy-control-program" target="_blank" rel="noopener noreferrer">Ministry of Health and Population</a> and leprosy NGOs. They make the most of their respective strengths and complement each other’s efforts, and in this way have helped to advance measures against leprosy throughout the country.Working in partnership with the ministry’s leprosy control program, <a href="https://tlmnepal.org/blog/anandaban-hospital/" target="_blank" rel="noopener noreferrer">Anandaban Hospital</a> near Kathmandu, Lalgadh Leprosy Hospital &amp; Services Center in Janakpur and the Green Pastures Hospital in Pohkara provide both medical and social support. They provide treatment and rehabilitation, and assist with reintegration into the community.I would also like to give a mention to the leprosy center established in Surkhet with the support of the Sasakawa Health Foundation, operated with the dedicated effort of local people and contributing to community medical care.Nepal has also pioneered a <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/" target="_blank" rel="noopener noreferrer">revolutionary treatment for leprosy wounds</a> saving money and prolonged pain for the patients. The technique called Leukocyte Platelet Rich Fibrin (LPRF) originally devised for dental surgery accelerates the healing of tissue and is now being used widely in the country to treat hard-to-heal skin lesions of diabetes and leprosy patients.Over the past 50 years we have come a long way toward our goal of a world free from leprosy and the discrimination it causes. We must not allow the progress we have made to be undone by the impact of <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">the Covid-19 pandemic</a>.Together with my annual Global Appeal and the activities that partner organisations will be carrying out for World Leprosy Day this year, I hope it will put the disease back in the spotlight and show that our work to end the medical and social problems related to leprosy is not yet done.Please add your voice to the campaign and make this a collective effort. Together we can be heard loud and clear: “Don’t Forget Leprosy.”Yohei Sasakawa is WHO Goodwill Ambassador for Leprosy Elimination as well as the Japanese Government Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy. He is the chair of The Nippon Foundation.

During the pandemic, don’t forget leprosy

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205539c7e80680e0b28adjpeg.jpg" alt=""/><figcaption>Frontline workers waiting for their booster dose at a hospital in Kathmandu last week. Photos: AMIT MACHAMASI</figcaption></figure>As elsewhere in the world, the <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> in Nepal is starting to peak, but experts say the pandemic is far from over. The Health Ministry had previously projected new cases to soar to 20,000 a day, and the Omicron surge to peak in mid-February. But the fact that the variant spread rapidly like wildfire right across the country giving a majority of the population milder symptoms meant that it equipped them with antibodies to fight the infection.At Nepal’s biggest infectious diseases centre at Teku Hospital, virologist Sher Bahadur Pun predicts that the third wave will most likely peak in a few days, or by the end of next week.“For the past week, I have observed that the number of people coming in for tests and consultation every day has decreased by a half,” Pun says. “Of course, not everyone is coming to the hospital, but this is the beginning of the end of this wave.” To be sure, the government’s daily Covid-19 figures are gross under-estimations. Mostly symptomatic patients are testing, thus registering a very high positivity rate. Infected people with flu-like symptoms are isolating at home without a PCR test. There are also people self-testing with kits available at pharmacies, and these infections are not in the official tally.Even so, figures from elsewhere show <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the Omicron surge</a> lasts only for a month or two. South Africa, where the variant was first detected in December, is over the hump. The UK and parts of the US have also passed their peaks. Many countries, including Australia, are now removing restrictions."It is too early to be sure about exactly when the high number of cases will subside completely," Andrew Pollard, of the team that developed the Astra Zeneca vaccine, told Nepali Times in an email interview from Oxford. "The main issue with rapid spread of Omicron is for the unvaccinated who may be at risk of severe disease, particularly if they are older adults and those with other health conditions."The spread of Omicron in Kathmandu Valley is expected to reach an equilibrium soon, with a steep fall in cases, says Bangkok-based public health expert Sushil Koirala. But he warns slower-moving outbreaks may continue outside the valley where the population is thinly spread. “These next 10 days are critical. It will tell us if the Omicron variant is indeed a quiet pass to a pandemic end-game, or we still have a big human cost to pay,” Koirala adds. “There is still little clarity on how severe this variant will be to those who are still unvaccinated and those who had the vaccines many months ago.” <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205569c7e80680e0b28aejpeg.jpg" alt=""><figcaption> </figcaption></figure>The World Health Organisation (WHO) last week issued an <a href="https://news.un.org/en/story/2021/12/1108932" target="_blank" rel="noopener noreferrer">optimistic projection</a> that the pandemic would probably be over during 2022 — provided inequalities in the vaccine coverage and treatment are addressed.  Global health researcher and economist Christopher J L Murray <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext" target="_blank" rel="noopener noreferrer">writing for the journal Lancet</a> also said that after the Omicron wave, ‘Covid-19 will return but the pandemic will not.’ Pollard also explains that once health systems can cope with Covid-19, the pandemic could be considered over, but that doesn’t mean that the virus will be gone. "We have a pandemic because of pressure on health systems and deaths. With growing global immunity as a result of vaccination and previous waves of infection, both severe disease and deaths should decline during 2022," he says. Despite this, health experts in Nepal warn that severe infections needing hospitalisation have a lag of a few weeks after the surge in infections. And despite being a <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder strain</a> that primarily only affects the upper respiratory tract, Omicron can still lead to serious diseases in the elderly and people with co-morbidities. Indeed, ICU admissions and those needing ventilator support in hospital have tripled in one month, although nowhere near the figures in April-May. Also, the seven-day average for daily fatalities have remained below five.  Says infectious disease specialist Anup Subedee: “It will still take some time and a few more variants before the pandemic comes to an end. So our health system should be ever ready with the management and treatment of Covid-19, isolation and contact tracing.” Virologist Pun at Teku agrees: “We are now moving from pandemic to endemic, but this does not mean that we can sound the all clear. We must continue mass vaccinations and safety measures.” The general consensus is that increased vaccine coverage with boosting, more testing, whole genome sequencing to detect variants, and public adherence to safety measures will determine whether there will be a new surge, or if the virus will taper off. Nepal has 20 million doses of vaccines in stock for those waiting for first and second jabs, and has started booster shots for high risk groups. However, communication on location, eligibility and requirements for <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">vaccination</a> centres is confusing and inadequate. With reports from India, Denmark and the Philippines of the even more transmissible ‘stealth Omicron’ sub-variant BA.2 that can evade PCR detection, Nepal needs to continue vigilance. This is also important to determine if the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> is still circuiting and how dominant it is. “Our Covid figures from the last four days strongly suggest that we have passed the peak,” confirms Sameer Mani Dixit of the Centre for Molecular  Dynamics. “But we must keep a close watch on next week’s numbers to know for sure if the cases are just levelling off, still peaking, or if it was just a momentary decline.”

Omnipresent Omicron starts to lose its edge

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/6372030d9c7e80680e0b27e9jpeg.jpg" alt="" width="1378" height="919"/><figcaption>Photos: AMIT MACHAMASI</figcaption></figure>Be it by naïveté, misplaced optimism, or a great faith in the healing powers of Himalayan air and turmeric, no one in Nepal had expected that we would be in the global epicentre of the Covid-19 surge fuelled by the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant in the spring of 2021</a>.Our miscalculation and gross lack of preparation cost thousands of lives and left so many Nepalis bereaved during this Dasain and Tihar. Shortly after <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">the Indian wave began in March</a>, Nepal recorded the highest number of Covid cases per capita, and the worst viral transmission rates on the planet. While the world focused on India, Nepal's health system was overwhelmed in a matter of days.Remember how we <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">desperately searched for oxygen cylinders</a>, when every ICU bed was occupied and ventilators were in short supply? Remember rural communities where the situation was even worse, and so many Nepalis died without any medical attention? And there was the black market that forced many to pay exorbitant rates for life-saving oxygen, masks, and even paracetamol.We cannot afford to forget these terrible and deadly months. If we do, and do not prepare for the next wave, we will be bound to repeat them. With <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the Omicron variant </a>now spreading like wildfire across the globe, let us remind ourselves that Nepal experiences a surge in Covid cases a few months after the rest of the world. The Delta variant (which has been proven to be less transmissible than Omicron) took more lives in just a few months than the 2015 earthquakes.The current low case numbers in Nepal are not going to last. Repeating our mistakes of under-preparedness and apathy has the potential to kill thousands of more Nepalis in the coming months.While preliminary data shows that the Omicron variant is <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">less likely to hospitalise infected individuals</a> than Delta did, we need to take into account that this new variant spreads at a much faster rate. The relief we may feel from a smaller percentage of Covid patients needing life-saving care is cancelled out by there being an exponentially higher number of total infections.Our medical facilities will still be overwhelmed, leading to unnecessary loss of life on a large scale. In short, Omicron is <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">not to be underestimated</a>, especially for densely populated communities in Nepal.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203109c7e80680e0b27eajpeg.jpg" alt="" width="1221" height="814">We still have some time to prepare. Policy makers and individuals alike have important roles to play in the critical next weeks and months. We cannot squander this opportunity to save lives. National and local governments need time to act now on these critical areas:<ol><li><a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">Vaccinate Aggressively</a>: There are varying statistics on the percentage of Nepalis vaccinated, but no more than 40% of the population have been fully vaccinated. Booster shots are now necessary to adequately protect a population, so we still have a very long way to go.</li></ol>The good news is that even if we cannot fully vaccinate and provide boosters for the entire population, clinical experience shows that <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">vaccinated individuals</a> have less need for Covid-19 hospitalisations and are much less likely to die from the Omicron variant. Decision makers can make our limited vaccine supply go further by prioritising vaccines for densely populated cities and in areas where Delta infection was low, as people in these areas are less likely to have natural immunity.<ol start="2"><li>Border Control: The devastating wave of the Delta variant in Nepal began a few weeks after it had taken hold in India. This was largely attributed to a spillage of the virus through the open southern border. We can support municipalities along the border to help contain the Omicron by strict health desks to screen individuals crossing the border. This will require increased funding and other resources.</li></ol><ol start="3"><li>Isolation and Quarantine Centres: Delta spread from India and urban areas into the countryside because we could not properly accommodate and care for infected patients in quarantine and isolation centres. There is time to re-establish these facilities before the next wave hits, and train frontline health workers and local governments based on guidelines that already exist. Again, as the variants (and our knowledge about them) evolve, we need to remain agile and empower our managers and healthcare workers to address the changing ground situation.</li></ol><ol start="4"><li>Oxygen Supply: During and after the Delta wave last year, the Ministry of Health and Population made commendable efforts to expand oxygen plant availability in the country, with support from international aid groups. These new plants need to be brought online and tested in the coming months, and MoHP must accelerate its efforts to meet its own requirement of having an oxygen plant at every 100 bed-hospital in the country.</li></ol><ol start="5"><li>Using Female Community Health Volunteers: FCHVs have been a key for many of Nepal’s remarkable gains in public health, including reducing maternal mortality rates. This network of local health workers was not fully deployed during the last Covid wave. We can use FCHVs to disseminate public health information, vaccine knowledge, and to play a frontline role in enforcing community guidelines to reduce local transmission of the virus, and to care for the infected. These volunteers and other community-based health workers need to be adequately compensated, and equipped with materials, protective equipment, and training.</li></ol>Properly mobilising and empowering FCHVs is the fastest and most efficient way to support rural communities that lack other options for advanced care. This will have a ripple effect across the national health system, and may be a key factor in avoiding another total collapse. All of these steps depend on implementation by the government and private healthcare system. We commend recent steps taken by the health department to test Nepalis returning from India, and to establish quarantine centres along the border.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203139c7e80680e0b27ebjpeg.jpg" alt="" width="856" height="571">As individuals, we must <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">continue to take responsibility</a> for protecting our loved ones by following public health guidelines for another few months at least. History shows we will not know for certain that Omicron has arrived in Nepal until after the variant is endemic in the population. These proactive measures can slow the spread, starting now:<ol><li>Mask up in all public places and when in close contact with members of at-risk populations. Doubling up on masks is a good idea, given the extremely contagious nature of Omicron.</li></ol><ol start="2"><li>Avoid touching the face with fingers, and frequently wash hands - at least 20 seconds with soap and water.</li></ol><ol start="3"><li>Avoid all public gatherings. If not, maintain social distance of at least 1m.</li></ol><ol start="4"><li>Support the local government by following protocols and encouraging elected officials to take proactive measures to protect the community. Volunteer to spread awareness or set up facilities if you can, and be ready to support your community when the next wave arrives. We Nepali are great at using ‘source-force’ to get things done - now is a great time to use your connections and networks to encourage people in positions of influence to take proactive steps to prepare for Omicron.</li></ol>In the age of Covid, it’ is every country and every community for itself. Delta taught us in Nepal not to trust promises of international aid to save us from the pandemic. We are on our own, and we only have each other to get through this.The Delta wave, like <a href="https://www.nepalitimes.com/banner/rebuilding-five-years-after-2015-quake/" target="_blank" rel="noopener noreferrer">the 2015 earthquakes</a>, also taught us that when the going gets tough, Nepalis come together and achieve miracles. Remember the community groups that blossomed across the country to create isolation centres, distribute food and supplies, and invented improvised oxygen concentrators.Remember the FCHVs and community members who risked their lives to travel into every corner of the country to deliver vaccines to the most vulnerable citizens.  This time, we have an opportunity to harness this grit and compassion when it is needed most - before the disaster strikes.Ramu Kharel is an emergency medicine physician at Brown University and has worked extensively in the frontlines of Covid-19. He runs a non-profit organisation HAPSA in Nepal that is working on Covid response.Ben Ayers is an American citizen based in Nepal for over 20 years.

Omicron is coming to Nepal, be prepared

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637202fc9c7e80680e0b27e3jpeg.jpg" alt="" width="2048" height="1366"/><figcaption>Vehicles are one of the biggest emitters of PM2.5 and other pollutants in Kathmandu. Photos: AMIT MACHAMASI</figcaption></figure>It is that time of the year again when smog makes <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener noreferrer">Kathmandu’s air hazardous to health</a>. Hospitals are swamped not with Covid, but COPD (Chronic Obstructive Pulmonary Disease).Once more, there is a flurry of media headlines about the dangerous concentration of suspended particles smaller than 2.5 microns from diesel exhaust.Read also: <a href="https://www.nepalitimes.com/banner/happy-new-air/" target="_blank" rel="noopener noreferrer">Happy New Air</a>, Sonia AwalePublic awareness about air pollution is at an all-time high, the average life expectancy of Kathmandu’s residents is reduced by at least four years. Yet, nothing happens. Why?“The awareness and knowledge have not translated into corrective action,” explains environmentalist Bhushan Tuladhar. “We know about vehicle emission tests but we ignore it, open burning is bad but we don’t stop, we have the opportunity to reduce air pollution with electric mass transport but we don’t invest in it.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203009c7e80680e0b27e4jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Air pollution was directly linked to at least 42,100 deaths in Nepal in 2019. Almost half of that was due to breathing in particles smaller than 2.5 microns in diameter which can cross the air blood barrier in the lung capillaries. Most of those particles come from <a href="https://www.nepalitimes.com/here-now/green-sticker-green-light-to-pollute/" target="_blank" rel="noopener noreferrer">vehicle emission</a>.From 1990 to 2015, the number of vehicless in Nepal grew by 1,995,404 — most of them in Kathmandu Valley. In five years, that figure doubled to 3,987,267.This figure doesn’t include the exploding demand for cars and motorcycles after the end of the Covid second wave in mid-2021. Nepal spent Rs543 billion in importing vehicles, transport equipment and spare parts in four months from mid-July to mid-October, against Rs357 billion and Rs418 billion for the same periods in 2020 and 2019.“There has been an unexpectedly high demand for private vehicles in Nepal after the pandemic, especially two wheelers given the public’s hesitancy to use buses due to coronavirus fears,” says Dhruba Thapa of the National Automotive Dealers Association.<iframe style="border: none;" title="Total vehicles in Nepal" src="https://e.infogram.com/e0cdbfd0-0b3c-4f57-851e-7aced6e69116?src=embed" width="700" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe><a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com/e0cdbfd0-0b3c-4f57-851e-7aced6e69116" target="_blank" rel="noopener noreferrer">Total vehicles in Nepal</a><a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com" target="_blank" rel="nofollow noopener noreferrer">Infogram</a>Raju Chettri, CEO of the MAW Enterprises that imports Yamaha bikes in Nepal has a similar observation. He saw a decline in the annual sales of two wheelers from about 250,000 units to 190,000 right after the pandemic. But this year, the sales went up to 350,000 units.“There are two reasons behind this: pent-up demand and reduced use of public transport because of Covid fears,” Chettri says.There are <a href="https://www.nepalitimes.com/banner/poisoning-the-air-we-breathe/" target="_blank" rel="noopener noreferrer">more than 3.1 million two-wheeers in Nepal</a>, over one million of them in Kathmandu. They are adding to the capital’s foul air, as they are up to 10 times more polluting per passenger kilometre than buses and cars.<iframe style="border: none;" title="Total Motorbikes in Nepal" src="https://e.infogram.com/ea449cd7-2598-4cd4-8ae2-cd91858f9553?src=embed" width="700" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe><a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com/ea449cd7-2598-4cd4-8ae2-cd91858f9553" target="_blank" rel="noopener noreferrer">Total Motorbikes in Nepal</a><a style="color: #989898!important; text-decoration: none!important;" href="https://infogram.com" target="_blank" rel="nofollow noopener noreferrer">Infogram</a>Two-wheelers also emit invisible toxic gases like carbon monoxide, benzene and nitrous oxides, and increase the concentration of street-level ozone. Motorcycle exhaust may not be as visible as diesel exhaust, but they are highly poisonous — especially when there are so many of them. Besides exacerbating respiratory diseases, the gases are carcinogenic, causing cardiovascular diseases and Alzheimer’s.The solution is to shift rapidly to <a href="https://www.nepalitimes.com/banner/nepals-electric-transport-future-is-here/" target="_blank" rel="noopener noreferrer">cleaner electric vehicles</a>, not just for healthier air but also to meet Nepal’s net-zero pledge in Glasgow and to reduce the country’s burgeoning petroleum import bill.“The priority has to be on electric public transport and supporting infrastructure,” says environmentalist Tuladhar. “Electric buses are more expensive than diesel ones, so the government has to help with capital, and better manage Kathmandu’s public transport.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203039c7e80680e0b27e5jpeg.jpg" alt="" width="720" height="480"><figcaption> </figcaption></figure>This week, Nepal opened its first electric charging station powered by solar panels for the Lumbini Development Trust. Similar charging stations can be set up for public and private vehicles in existing bus parks across Nepal and along highways. Sajha Yatayat which is procuring 40 electric buses is also trying to turn the former trolley bus terminal into a charging station.Shilshila Acharya of the Avni Center for Sustainability agrees that the priority should be on <a href="https://www.nepalitimes.com/banner/from-a-fossil-past-to-an-electric-future/" target="_blank" rel="noopener noreferrer">electrifying public transport</a> and encouraging bicycle lanes. She says, “Replacing cars with more cars even if electric only promotes consumerism. We have to give people reliable alternatives.”Kathmandu Valley Air Quality Management Action Plan held its first implementation committee meeting this week, during which it discussed lunching of a USAID-funded project for air pollution and a forecasting system with technical support from ICIMOD.“The problem of air pollution will take some time to be solved but we have started our homework,” says Indu Joshi of the Department of Environment. “At the moment, our biggest challenge is controlling open burning.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114091156/637203069c7e80680e0b27e6jpeg.jpg" alt="" width="2000" height="2625"><figcaption> </figcaption></figure>Apart from transport, garbage burning and biomass fuel for household heating and cooking are also contributors to Kathmandu’s dirty air. The problem is made worse in winter due to the <a href="https://www.nepalitimes.com/banner/how-weather-elevates-air-pollution-in-kathmandu/" target="_blank" rel="noopener noreferrer">Valley’s topography that traps surface pollution</a> in an inversion layer.Improper <a href="https://archive.nepalitimes.com/article/nation/a-load-of-rubbish-kathmandus-garbage-problem,4039" target="_blank" rel="noopener noreferrer">solid waste management in Kathmandu</a> means locals burn garbage by the riverbanks near residential areas — while, as studies show, segregation of waste at homes can reduce the city’s garbage volume by up to 80%.There is no other problem that is so directly linked with the health and economy of the country as urban air pollution. The <a href="https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/" target="_blank" rel="noopener noreferrer">Covid-19 lockdown in 2020</a> is proof that Kathmandu can be cleaned up, it just needs <a href="https://www.nepalitimes.com/banner/dirty-politics-dirty-air/" target="_blank" rel="noopener noreferrer">the right leadership and the political will</a> to back it up.Says Shilashila Acharya: “Our policies on mobility and air pollution have to be people- and culture-centric, instead of focusing only on technology. We must build public pressure to force the politicians into action.”A public opinion poll in this paper just before the 2017 elections showed that a majority of Nepalis were concerned about the health impact of pollution. Since 2022 will be dominated by campaigning for the next election, this could be turned into the main criteria for candidates to win votes.

Breathing can kill you

<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.”

From scarce vaccines, to storage shortage in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19159c7e80680e0ac7fcjpeg.jpg" alt="" width="1149" height="640"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The <a href="https://www.nepalitimes.com/latest/who-wants-early-elections-and-why/">first 100 days of Sher Bahadur Deuba</a> as fifth-time prime minister is not a huge disappointment to Nepalis -- most did not expect much from it.To be sure, it is not all Deuba’s fault, but as prime minister the buck stops with him. He has taken the blame for infighting between and within coalition partners that <a href="https://www.nepalitimes.com/latest/what-is-delaying-nepal-cabinet-expansion/">delayed government formation</a>, for riding roughshod over the <a href="https://www.nepalitimes.com/latest/political-expediency-trumps-nepal-constitution/" target="_blank" rel="noopener noreferrer">Constitution</a>, <a href="https://www.nepalitimes.com/latest/nepal-govt-fills-cabinet-after-3-months/">making controversial appointments</a>. But most of all, the government is seen to be uncaring about citizens ravaged by <a href="https://www.nepalitimes.com/latest/monsoon-hits-nepal-with-a-bang/">floods</a> and the <a href="https://www.nepalitimes.com/banner/helping-nepals-covid-orphans/" target="_blank" rel="noopener noreferrer">pandemic</a>, as well as dismissive about the demand from long-excluded Nepalis for<a href="https://www.nepalitimes.com/banner/four-fold-increase-in-reported-rape-in-10-years/"> social justice</a>.Perhaps nothing has driven home government indifference and neglect for the marginalised more than the treatment meted out to activists like Ruby Khan who walked for 20 days from Nepalganj to Kathmandu to highlight their demand for a fair investigation into the death of two women in Banke district for which they were given the runaround by local police and administration.Nakunni Dhobi, 38, was found dead in her home in July, and foul play was suspected because she had previously faced dowry-related violence. Nirmala Kurmi, 52, has been missing following the passing of her husband and the suspicious deaths of her two sons soon after. Khan had filed a case of kidnapping and murder against 12 people, including NC leader Badshah Kurmi, as part of a plan to take over her property.When the <a href="https://www.nepalitimes.com/latest/protesting-to-protect-the-right-to-protest/" target="_blank" rel="noopener noreferrer">activists</a> finally arrived in Kathmandu, tired, hungry and with blistered feet, the government arrested the activists. The Supreme Court later freed them, but Ruby Khan went on a hunger strike, until the government finally agreed to investigate the two cases.Few believe this will result in justice being delivered, as has been the case of previous high-profile cases of violence against women.“On one hand it is a great achievement that women from a minority community dared to come all the way to Kathmandu for justice and turn this into a national issue,” says journalist Namrata Sharma. “But that they had to resort to this, and were not able to get justice in Banke is a failure of our governance.”Indeed, the <a href="https://www.nepalitimes.com/latest/deubas-long-and-winding-road/" target="_blank" rel="noopener noreferrer">Deuba-led coalition government</a> for the most part in the last three months has been embroiled in a power struggle ahead of the elections in 2023 and the concerns of the public get little importance. Commentators have gone as far as to say that Deuba has committed as many mistakes in three months as that made by K P Oli in three years.For Deuba’s faction-ridden party and coalition, the Ruby Khan case was just an inconvenient distraction in trying to keep his government intact, and to show the public that it is different than the K P Oli government it replaced in June. But 100 days later, he does not have much to show for it.In fact, commentators have said Deuba has violated the constitution more often in the past three months than <a href="https://www.nepalitimes.com/latest/nepal-pm-oli-goes-it-alone/" target="_blank" rel="noopener noreferrer">Oli did in the three years</a> he was prime minister. Members of Deuba’s own NC have been most critical of his dissolution of Parliament to <a href="https://www.nepalitimes.com/latest/old-wine-in-old-bottle-in-nepal-politics/" target="_blank" rel="noopener noreferrer">pass an ordinance to help Madhav Kumar Nepal split from the UML</a>, and then repeal it after the deed was done.“Making laws to serve a particular political party or individual violates the Constitution,” said political analyst Shyam Shrestha. “This makes a mockery of the rule of law, and is unimaginable in a democracy.”And if that was not enough, Deuba allegedly had a pact with Chief Justice Cholendra SJB Rana to nominate two ministers. One of them, Rana’s brother-in-law, Gajendra Bahadur Hamal, was appointed to the Cabinet, but resigned three days later following a public uproar.Even when the coalition has acted decisively, it is for the wrong reason. The Finance Minister amended the Financial Act scrapping the requirement that investors needed to show source of income. This preceded revelations in the <a href="https://www.icij.org/investigations/pandora-papers/global-investigation-tax-havens-offshore/" target="_blank" rel="noopener noreferrer">Pandora Papers</a> about <a href="https://www.nepalitimes.com/here-now/nepals-richest-man-in-the-pandora-papers/" target="_blank" rel="noopener noreferrer">Nepali tycoons maintaining offshore shell companies </a>for money laundering.This week, Human Rights Watch slammed Nepal Police for using excessive force that killed four squatters protesting eviction in Butwal.All of this while the country is still reeling from what has been a disastrous monsoon season. Moreover, this week parts of <a href="https://www.nepalitimes.com/latest/post-monsoon-rain-ruins-nepals-crops/" target="_blank" rel="noopener noreferrer">western Nepal were hit with unseasonal downpours </a> that dumped 500mm of rain in 24 hours in some places, killing at least 100 people, destroying roads, and wiping out 20% of the country’s ready to harvest rice.Meanwhile, health experts across the country are on alert for a possible <a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer">post-Dasain surge in Covid</a> cases as families mingle during the festivals while the contagious Delta variant is still circulating.Half of Kathmandu’s target population <a href="https://www.nepalitimes.com/banner/the-jabs-and-jabnots/" target="_blank" rel="noopener noreferrer">has been vaccinated</a> but the rest of the country is far behind, and as such hospitals and limited medical professionals must be on standby, especially with the onset of the winter season. More than 1,000 ventilators donated during the second wave are just sitting on store-rooms in hospitals across the country.The coalition government, however, has already set its sight on the 2023 elections but not on the fact that district hospitals have<a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/"> ventilators but no doctor or nurse to operate it</a>, or that Nepal is yet to build a proper storage facility for vaccine for the inoculation of children against Covid-19.Says pulmonary specialist Raju Pangeni at HAMS Hospital: “Our priority now must be to vaccinate children across Nepal after the holidays, and with only Pfizer and Moderna certified for the younger population, we should already be preparing for the required storage facility.”

Non-government of Nepal

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

public-health