Fever accompanied by chills, body aches, runny nose, sore throat or cough? You probably have Covid, and are likely over it.
After only recording a handful number of new Covid-19 cases for the last few months, Nepal registered nearly 400 in the last week. But these are only the official figures, doctors say there are flu-like cases recovering in almost every family.
The latest surge is once again in line with the rise of cases in India where the new sub-variant of <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care">Omicron</a> has been found to be responsible. On 4 April, there were 3,637 new reported Covid-19 cases across India and seven deaths in the past 24 hours. Some 60% of the new cases have been attributed to the new variant circulating in the country, XXB.1.16, a subtype of the Omicron variant.
“This is proof that when it comes to Covid-19, we are not out of the woods yet, it is a reminder that we need to continue to be careful, especially with the elderly and populations with comorbidities,” says Buddha Basnyat, physician at Patan Academy of Health Sciences.
However, unlike in India, it is not yet known which strain is driving the new infections in Nepal. A genome sequencing in last 2022 found that there were 17 sub-variants of <a href="https://www.nepalitimes.com/here-now/boosting-booster-jabs-against-omicron">Omicron</a> circulating in Nepal.
At Teku Hospital, virologist Sher Bahadur Pun has been observing a gradual increase in the number of Covid cases and old-age patients being admitted. Most symptoms are mild, but interestingly many are complaining of a lack of smell and taste, which was typical of pre-Omicron cases. Over time, Covid-19 symptoms have also gradually changed.
“What I’m seeing are breakthrough cases, these are people who have taken three shots, including a booster dose. This means we are likely to see a large number of such breakthrough cases in the near future,” explains Pun.
He adds: “This could very well be a new variant, a hybrid of these that were already circulating or XXB.1.16 like in India given there are no restrictions preventing the strain from travelling.”
But public health experts agree that while there has been a noticeable surge in the number of new cases being recorded, there has been no significant increase in hospitalisations and deaths.
In other words, while the newer variants are more infectious, they are less virulent and unlikely to cause complications, further helped by the fact the much of the population has gained some level of immunity due to natural infections as well as vaccinations.
Even so, it is important for <a href="https://www.nepalitimes.com/here-now/protecting-nepal-s-elderly-from-covid-19-c6e60vp6">vulnerable populations</a> to be protected, and the best way to do that is by taking a booster. As of February 2023, 76.5% of Nepalis have taken two doses of the Covid-19 vaccine which is nearly 96% of the target population. But the booster intake is much lower at about 27%, as of December 2022.
“Given that it has been quite some time since the second dose or even a booster was administered, I urge the elderly, immuno-compromised individuals and frontline workers to take a booster shot or a second booster even,” says Pun. “If there is an option, take a bivalent booster, it will protect you against both the original coronavirus strain and the Omicron variant.”
Back in February, Nepal received 345,600 doses of Pfizer-BioNTech’s bivalent vaccine under the <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax">COVAX initiative</a>, the first of the 1.5 million doses promised in four phases. But officials say the uptake has been discouraging, even in Kathmandu and other urban centres.
The new surge is likely to pass before long and without causing much impact on the overall population. But not taking preventive measures may endanger the elderly and people with comorbidities.
Warns Buddha Basnyat: “This surge is a reminder to continue to mask up and maintain hygiene not so much for Covid-19 at this point but to protect ourselves from a wide range of other equally prevalent infections in our part of the world like <a href="https://www.nepalitimes.com/opinion/comment/pandemic-eclipses-nepals-tb-epidemic">TB</a>, typhoid and a host of diseases caused by <a href="https://www.nepalitimes.com/here-now/warning-breathing-is-hazardous-to-health">air pollution</a>.”

Sonia Awale

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Another Covid wave, but milder

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161144/636d1d159c7e80680e0af392jpeg.jpg" alt="" width="1920" height="1080"/>I nternational tourist arrivals increased by 58% in July-September, compared to the same period of 2020. This is still 64% below average 2019 levels and 76% below pre-pandemic levels, according to the UN World Tourism Organisation. The figure will stay at 70-75% below average 2019 levels for the remainder of 2021. Mobility restrictions, vaccinations, and traveler confidence have meant improvement in parts of Europe and the Americas during the third quarter of 2021, but arrivals in Asia-Pacific were down almost 95%. The tourism sector could lose $2 trillion this year, the same as in 2020.

Tourism picks up

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfd239c7e80680e0a0bcajpeg.jpg" alt="" width="768" height="512"/><figcaption>People lining up for Covid vaccination in Kathmandu this week. Photo: AMIT MACHAMASI</figcaption></figure>The unprecedented speed at which effective Covid-19 vaccines have been discovered is truly inspiring. The problem with acceptance and <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">distribution of those vaccines</a>, however, is another story.Scientists can invent vaccines faster than ever, but political scientists cannot find answers to the problems of <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">vaccine denial and inequity</a>.If this pandemic had happened 50 years ago and an effective and safe vaccine had ultimately been found, in all likelihood the administration of these vaccines would have happened more smoothly, probably with more equity and <a href="https://www.nepalitimes.com/opinion/why-vaccination-should-be-compulsory/" target="_blank" rel="noopener noreferrer">much less fuss</a>.To be sure, there was similar opposition to the smallpox vaccine when it was first developed, but eventually it was mandated by governments and the disease eradicated. And millions of lives are saved annually in low income countries by vaccines against preventable diseases.But the speed with which medical science has come up with effective Covid-19 vaccines has been a game-changer. If this is followed by treatment protocols, it will be even more spectacular.And the best example to showcase efficacious treatment has been the Oxford University-lead Recovery (Randomised Evaluation of Covid-19 Therapy) trial in which Nepal was the first actively participating site outside the UK.In June 2020, the results of this trial showed that an inexpensive and widely-available drug, dexamethasone (a corticosteroid) substantially reduced deaths in <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">hospitalised patients requiring oxygen</a>. As a result, the drug has saved millions of lives.For those of us in the health profession in Nepal, Covid-19 evoked a feeling of déjà vu. Common rampant infectious diseases like typhoid and tuberculosis are ideally controlled by <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">contact tracing</a> and treatment. Implementing these measures against another human-to-human infection like Covid-19 should therefore have been a no-brainer.Unfortunately, in South Asia contact tracing even for biblical diseases like typhoid and <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener noreferrer">tuberculosis</a> is not done. We would have been able to more easily deal with Covid-19 if we already had contact tracing in place for these rampant, but overlooked, diseases mostly afflicting the impoverished.The trajectory of the pandemic has led to revelations. Herd immunity acquired with previous infections seems to be an unreliable and less robust way to seek protection from the virus. This was dramatically illustrated with the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">spread of the Delta virus</a> in India where many people, including doctors, thought they had enough antibody protection.The BCG vaccine (against TB) was <a href="https://www.nepalitimes.com/latest/could-an-anti-tb-vaccine-be-protecting-nepalis/" target="_blank" rel="noopener noreferrer">thought by many to protect them</a>, and that has also turned out to be probably untrue. Protection afforded by prior exposure to other respiratory viruses including coronaviruses (non-Covid 19) also seems non-existent. The fallacious argument that we are hardy people from South Asia who are protected by our spicy diet also took a hammering.The most dramatic observation during this pandemic has been in human behaviour and psychology. Literate people (many in high income countries) refusing to <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">wear masks</a> or be vaccinated despite overwhelming scientific evidence, is bewildering.So, while vaccine stockpiles are nearing their expiry dates in the United States and parts of Europe, people in Africa and Asia are literally dying to be vaccinated.Vedic philosophy calls this era the Kali Yug, a time when knowledge does not translate into wisdom. When individualism takes precedence over collective welfare, people are unkind and intolerant to each other.Lack of humility and an excess of human hubris is also clearly in evidence during this pandemic. Leaders of countries who boasted that they were saviours of the world by promising vaccines were brought to their knees with <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">the spread of the Delta variant</a>. Those who extolled their superior public health status have had to eat their words.Hypocrisy is also in full display. Early grandiose talk of vaccine equity in high income countries even before the discovery of the vaccine <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">was soon forgotten</a> as countries stockpiled up to four times what was needed to vaccinate their eligible populations with two doses.Many countries did not put their money where their mouths were, espousing vaccine nationalism. The concept of vaccine distribution equity is now like talk of motherhood and apple pie.The virus clearly showed us that the world needs not only universal health care and universal basic income but just as much universal behavioural therapy. Even in their enlightened self-interest, these countries should ensure universal vaccination because science has shown that the more people remain unvaccinated, the <a href="https://www.nepalitimes.com/opinion/no-country-is-safe-until-we-are-all-safe/" target="_blank" rel="noopener noreferrer">more the danger of variants mutating</a>.Here on, since 70% vaccine coverage will take time, Nepalis need to <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">continue to mask up and wash hands</a>. Those who are vaccinated must remember that it does not always protect them from infection, just severe symptoms, and they can be carriers to spread it to others. Vaccines only reduce mortality and morbidity and hospitalisations.Same with masks. Wearing a mask and going into crowded places defeats the purpose. Those following proper guidelines have noted that they are less sick than usual with respiratory and gastrointestinal ailments. The use of masks and frequent hand washing in Nepal’s unsanitary conditions may lead to a decrease of other common infections besides Covid-19.All presently available vaccines are effective in the prevention of <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">Covid-19</a> infections, especially regarding hospitalisation. The important thing is not to miss the opportunity to get vaccinated with whatever doses are available whenever. All the available vaccines are safe and have very few, if any, contraindications even in pregnancy.There is much less vaccine hesitancy and denial in Nepal now, especially after people saw how unvaccinated people in their families and neighborhood could easily succumb to the virus.We have to psychologically prepare ourselves for the likelihood that the <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">pandemic will continue for many more months</a> unless the vast majority of us in the world are promptly vaccinated. Herd immunity from vaccination is much more reliable than herd immunity from natural infection.Amazingly, no world leader has gone beyond rhetoric to actually start delivering vaccines to all corners of the world. As the pandemic plays out, the best-case scenario is that Covid-19 antibodies will be present even years after vaccination or post-infection, as was noted with SARS (a different but deadly coronavirus infection in 2002) and provide protection for years to come.Or perhaps Covid-19 will peter out and become like the influenza virus requiring a jab every winter. Variants may continue to be a problem, but no one knows for sure as this is indeed 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=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">novel coronavirus</a>, and we are still learning. In all likelihood, vaccines will continue to be effective even against variants.One thing is for sure, all this shall also pass. But we have to learn lessons to be better prepared for the next pandemic.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=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

Dying to get vaccinated

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd779c7e80680e08bc80jpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>So far, 450,000 Nepalis have received the first dose of Covishield, reaching 85% of the target group in the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first phase of the country’s Covid vaccination drive</a>.Starting 7 March, 3.7 million Nepalis above 55 who make up 12% of the total population will get their shots against SARS-CoV-2. Teachers, students, bus drivers and other groups will also be included in the second phase.On the paper, Nepal looks like it is in a <a href="https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/" target="_blank" rel="noopener noreferrer">better position with vaccination</a>, especially given that more than 100 countries <a href="https://www.nepalitimes.com/latest/90-in-poor-countries-will-miss-covid-vaccinations/" target="_blank" rel="noopener noreferrer">have yet to receive</a> even a single dose.“We have to applaud the government for its effort in bringing the vaccine earlier than expected and for rolling it out efficiently,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Nepal will be among the first countries to take the vaccine to the majority of its population with the second phase in early March.”However, the vaccine campaign has been plagued with <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">hesitancy and denial</a>. Even doctors and nurses were reluctant to inoculate themselves, resulting in a  low uptake. Failure to communicate, allay concerns about side effects, and ensuring access in remote areas were the main roadblocks to better coverage.“The very fact that the vaccines arrived in Nepal <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">much earlier than we anticipated</a> and once it did, we had to use it on the fly with the pandemic still going on, leaving us without a proper communication strategy,” admits Buddha Basnyat of the Patan Academy of Health Sciences.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">Covishield</a>, developed by AstraZeneca Oxford University and manufactured by the Serum Institute of India is being used in the UK, the EU, India with Australia starting their vaccination soon. With the efficacy ranging from 70-80%, 0.5ml of 2 doses 4-12 weeks apart, the jab has been deemed safe with no severe reactions or any death.In the recent past, local governments used to deploy Tole Health Promoters (THP) in neighbourhoods before a vaccination drive for measles, polio and other infections to address the public’s safety concerns.Another effective communication tool would have been the use of social media platforms and mass media to increase awareness about the vaccine as well as promote its use. Elsewhere in the world, prime ministers and presidents being inoculated were being televised live. Celebrities took to the Internet to share their experience of vaccination.“Someone like Nirmal Purja would have been best to promote the campaign and increase the acceptance of the vaccine in the masses with his legions of followers,” says Sher Bahadur Pun, a virologist at the Sukraraj Tropical and Infectious Disease Hospital.Basnyat agrees that Purja with his <a href="https://www.nepalitimes.com/latest/nims-purja-does-it/" target="_blank" rel="noopener noreferrer">international mountaineering fame</a> and Gurkha commando background would have also bolstered Nepal’s vaccine diplomacy. “He could be our brand ambassador to take up our case to aid agencies given the UK’s stand on vaccine equity while also backing India’s interest to promote neighbourhood first policy with vaccines,” he added.The government has approved the second dose to be given anywhere between 8-12 weeks of the first one, prioritising vaccination of as many vulnerable individuals as possible before that.But the availability of the vaccine will be the main concern as we move on to the next stage of the campaign. With the 1 million dose Covishield <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">grant from India</a> in January, another 2 million that Nepal purchased this week from Serum Institute of India, 2.25 million (with the first 300,000 arriving first) under the COVAX initiative, and 500,000 doses of Sinopharm from China, the government has a stock of close to six million doses.  This means 3 million can be vaccinated soon.“The second phase is as challenging as it is important. But this is also the group likely to have a higher chance of reaction, so we need to be prepared locally to manage them,” says Shyam Raj Uprety, head of the government’s Covid vaccine strategy. “It is crucial to communicate different types of side-effects and explain that they signify that the vaccine is working.”Around the world, the total number of new coronavirus cases and fatalities is dropping. Although India has reported spikes in some states and Nepal will have to keep a close watch on New Delhi, Uttar Pradesh and Bihar, Nepalis have most likely developed localised immunity.A Nepal Health Research Council study has revealed that over 45% of hospital staff had developed antibodies by December, adding to the view that we are nearing herd immunity.“Once we have vaccinated a larger risk population, even if there is a second wave, it is unlikely to impact much because the group who were getting seriously sick will be protected,” adds Dixit.But even with the vaccine, Nepalis will still have to continue precautions. There is still uncertainty about duration of immunity, and whether vaccinated people can spread the virus.Says Basnyat: “This has been a pandemic of misinformation, we have to negate that with public engagement. Good thing is that Nepal can draw inspiration from past successful vaccination drives and can become a model for others.”<h2>Everything you wanted to know about vaccines</h2>Recently Nepali Times spoke with three experts with frequently asked questions from readers regarding the Covid-19 vaccination drive in Nepal.Excerpts of interviews with Virologist Sher Bahadur Pun at the Sukraraj Tropical and Infectious Disease Hospital, Shyam Raj Uprety, head of the Government Covid Vaccine Strategy and Sameer Mani Dixit of the Centre for Molecular Dynamic Nepal:<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd7b9c7e80680e08bc81jpeg.jpg" alt="" width="1160" height="350">What are the precautions one should take before and after the vaccine?Sameer Mani Dixit: Covishield, the Covid vaccine we are using, is an intramuscular injection, 0.5ml in two doses 4-12 weeks apart. It is administered by a professional and after the jab, one will feel mild pain in the region.What’s the efficacy rate of the vaccine and how long does it work?Covishield has been used in the UK, EU, India and many other countries, Australia is getting ready to use it. It has passed phase 3 clinical trials with over 12,000 volunteers without any severe reactions or any death. The efficacy ranges from 70-80%.Once a person is vaccinated, there are antibodies that the body produces and then there are memory T and B cells. The lifespan of antibodies is about 3-6 months but we don’t know about the duration of the memory cells since the vaccine has just been developed. The assumption is that it will work from anywhere between 9-12 months but we will know for sure once people who have been vaccinated pass that stage.Do we have to get the same vaccine for the second dose?Ideally, the manufacturers of the vaccine suggest we take the same for both doses. But there are instances you may be able to take a second dose from a different company.Do people who have recovered from Covid-19 need to vaccinate?Sher Bahadur Pun: We don’t know exactly how long does the natural infection protect the body. The rough estimation is between 3-6 months. But it varies from one individual to another so it is recommended that people take the shot. Also, two doses provide longer protection.Can breastfeeding mothers take the vaccine?Manufacturers of Covishield have suggested pregnant women and breastfeeding mothers against taking this vaccine. But Nepal government recently said that those breastfeeding for six months or more could take it, but we don’t have concrete data yet so we don’t recommend it.How can people with vulnerable family members get them vaccinated?Shyam Raj Uprety: We identified health workers as the most vulnerable. We vaccinated them at their nearest convenient place. We will do the same for the next vulnerable group, take the vaccine to the communities.If someone is not on the priority list but still wants to get vaccinated, how can they get it? Can it be bought?It is unlikely for people who are not listed as the priority to get the shot. It is being administered for free for the priority group individuals and cannot be bought in the market. But after the most vulnerable are covered, the vaccine could be made available by the private sector.

Nepal fights infodemic to push vaccine

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3c9c7e80680e08bc10jpeg.jpg" alt="" width="2048" height="1550"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Even as Nepal completes the first phase of its Covid vaccine drive to inoculate <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a> and other high-risk groups, new hyper-spreading variants of the coronavirus as well as vaccine denial have raised concerns about the efficacy of the campaign.Public health experts, however, say the government must continue its vaccination to reach as many vulnerable people as possible with a better communication strategy and more aggressive promotion.Nepal is one of the first countries in the region to start a mass Covid-19 vaccination drive. But the first phase <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">saw a moderate turnout</a> with only half of the doctors, nurses, FCHVs, security personnel and cleaners prioritised by the government inoculating themselves because of the safety concerns and inaccessibility.This forced the Health Ministry to expand the first phase to also include civil servants, diplomats, bankers and journalists so that it could used up the <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">1 million doses of Covishield vaccines donated by India</a> last month.With additional 2.25 million Covishield doses under the WHO’s COVAX initiative arriving in Nepal by early March and another 2 million that the government is in talks to purchase from the Serum Institute of India, officials are gearing up for the <a href="https://www.nepalitimes.com/banner/next-up-for-vaccines-elderly-nepalis/" target="_blank" rel="noopener noreferrer">second phase of the vaccination</a> for people above 55 years and those with co-morbidities starting from 7 March.This will be followed by the age group 40-54 and then those below 40 years of age.“The campaign will now be community-based, unlike the first phase that was facility-based, we will take the vaccine to the people and ensure higher coverage,” assured Shyam Raj Uprety, head of government’s Covid Vaccine Strategy. “And as per the WHO recommendation, our advisory groups will soon finalise their decision to provide the second dose between 8-12 weeks.”Public health experts say that the emergence of new variants should not dissuade the government from discontinuing or scaling back its vaccine drive.“An RNA virus will have variants, it is a given, we have to live with them. In fact, we might have our own variant in South Asia, but we should keep on vaccinating and saving lives,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal.Of the multiple variants circulating globally, the one first identified in the UK called B.1.1.7 is more widespread, and some have been detected in Nepal in travellers arriving from Britain. The good news is that AstraZeneca Covishield vaccine has been found to be effective against the strain.However, a trial involving 2,000 people in South Africa claimed that Oxford jabs offered only <a href="https://thewire.in/health/south-africa-asks-serum-institute-to-take-back-1-million-covid-19-vaccine-doses" target="_blank" rel="noopener noreferrer">minimal protection against mild and moderate cases</a> (of their variant B.1.351). Experts caution that it may be too soon to declare the vaccine ineffective because the study was conducted in a small population of young people.In Brazil, a variant called P.1 has been found to contain contains a set of additional mutations that may affect its ability to be recognised by antibodies, adding to the challenge.“What’s important in this debate is that even if one were to contract Covid, the vaccine will prevent people from getting severely ill and dying,” says Buddha Basnyat of the Patan Academy of Health Sciences. “Trials and emergency use so far has strongly addressed safety concerns regarding Covishield, so we can’t let news of variants put a damper on the vaccination campaign.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011110/636ccc3f9c7e80680e08bc11jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>The <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">nationwide vaccination campaign</a> is taking place at a time when Nepal and the rest of the South Asia are reporting much fewer cases and fatalities, much of which has been credited to limited contact tracing and herd immunity in major cities after large chunks of the population developed resistance against SARS-CoV-2 after contracting it.But the lack of surveillance, seroprevalence studies and antibody tests means that researchers have not been able to confirm localised immunity.“The government is unwilling to conduct a study despite interest from aid agencies. Results from these studies would have helped us better prepare vaccination strategy at a time when we face great resource constraint,” says Dixit.Nepal also needs to continue with <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">vaccine diplomacy</a> and look into other shots, in particular, Chinese Sinovac and Bharat Biotech’s Covaxin. Both the vaccines use the whole inactivated (dead) virus, because of which they are unable to infect people or cause pathological effects but deploy the immune system to mount a defensive reaction against the virus.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nytimes.com/2021/02/05/opinion/covid-vaccines-china-russia.html" target="_blank" rel="noopener noreferrer">Sinovac made global headlines</a> when it was found to be only 50.4% effective in a trial in Brazil whereas it performed better in Turkey (91% efficacy). <a href="https://www.newindianexpress.com/cities/thiruvananthapuram/2021/feb/16/the-covaxin-conundrum-2264436.html" target="_blank" rel="noopener noreferrer">Covaxin</a> is also controversial because of its emergency use among the frontline health workers in India despite not completing its phase three trials.It will do well for Nepal to keep track of their trials with the government aiming to vaccinate 72% of its eligible population above 18 years. People aged 55 and above make up 11% of Nepal’s population whereas the 40-54 age group account for 13%. People aged 18-39 made up nearly half of Nepal’s 28.8 million population in the 2011 census.In the meantime, the government needs to enforce the equitable distribution of the vaccine to the remotest parts of the country with the most at-risk groups high in priority. Public health experts say that with cases rising again in India, Nepal could also see a spike as people become complacent and mingle more.Says Sher Bahadur Pun of the Infectious Disease Hospital in Teku: “We have been given this reprieve with fewer cases and fatalities, we need to utilise this time to vaccinate the elderly so that the most vulnerable in our communities are protected if and when the next wave hits us.”

Nepal braces for new wave with vaccine drive

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0914b0ad905ca02f01bjpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0944b0ad905ca02f01cjpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0964b0ad905ca02f01djpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0984b0ad905ca02f01ejpeg.jpg" alt="" width="859" height="915"><figcaption> </figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09b4b0ad905ca02f01fjpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09e4b0ad905ca02f020jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

Upasana Khadka

Nepalis overseas get first vaccinations

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9aa9c7e80680e0878d2jpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9ae9c7e80680e0878d3jpeg.jpg" alt="" width="686" height="915"><figcaption>Binaya Raman Dahal, a hospitalist in North Carolina, getting his vaccination. He says it is a “big relief” for health workers like him as the pandemic rages across the US.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b09c7e80680e0878d4jpeg.jpg" alt="" width="686" height="915"><figcaption>Srijana Panta Rokka has been a nurse in the UK for 15 years, and says she is fortunate as a frontline worker to be one of the first in the UK to be vaccinated against Covid-19.</figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b39c7e80680e0878d5jpeg.jpg" alt="" width="859" height="915"><figcaption>Khagendra Dahal, a clinician in Nebraska, was overwhelmed when he got an email regarding his first vaccination dose.</figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b69c7e80680e0878d6jpeg.jpg" alt="" width="720" height="960"><figcaption>Notice in a UAE newspaper announcing free Covid-19 vaccinations for citizens and residents.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b89c7e80680e0878d7jpeg.jpg" alt="" width="720" height="960"><figcaption>And a UAE Covid-19 vaccination card.</figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

<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.”

90% in poor countries will miss Covid vaccinations

<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.”

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b39c7e80680e07367fjpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Children in Gai Jatra procession in Kathmandu on Tuesday even as the risk of COVID-19 looms over the capital. Participants have however taken to wearing masks as mandated by the government while partaking in festivals. Photo: MONIKA DEUPALA</figcaption></figure>Prime Minister K P Oli held a meeting with 20 public health experts on Tuesday to discuss steps to deal with COVID-19, especially in <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">cities bordering India</a> – a sign that his government is taking a recent surge in cases seriously.The meeting came as Nepal reported 259 new cases on Tuesday, taking the total number so far to 21,009 and the number of fatalities up by one to 58. Kathmandu Valley detected 62 new cases and now has 727 confirmed cases (481 active) with 5 deaths.The government this week put six districts with over 200 cases (Kathmandu, Rautahat, Kailali, Mahottari, Parsa and Doti) in the Red Zone. (see map) In Kathmandu, 72 staff at Nepal Police Headquarters have tested positive and the premises are sealed off.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">Lockdown may</a>be over, but pandemic is not, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b69c7e80680e073680jpeg.jpg" alt="" width="1275" height="1650"><figcaption> </figcaption></figure>Speaking at the interaction, Prime Minister Oli said: “We must lower the infection rate to zero, and treat those who are sick. But as long as we keep the border open, there will be more cases ... so we have to test them before allowing them to travel to home districts.”Experts present noted that although the numbers are rising, the World Health Organisation (WHO) still puts Nepal in the ‘cluster spread’ stage, <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">where the virus is not showing community transmission</a>. They advise the government against re-imposing a lockdown, saying it was not a long-term solution.Most public health experts favour a ‘smart lockdown’ where localities with cluster outbreaks are sealed off, and tested – while strictly enforcing masks in public places and preventing crowds.Since the lockdown was lifted on 21 July, the rate of infection has increased to 3.37%, indicating rapid spread in districts bordering India where all major cities like Birganj, Bitartnagar, Dhandagi, Nepalganj, Janakpur and Rajbiraj are under curfew.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b99c7e80680e073681jpeg.jpg" alt="" width="1265" height="822"><figcaption> </figcaption></figure>Officials in Kathmandu Valley are also said to be considering lockdown, but experts say it is more advisable to seal off neighbourhoods rather than a strict blanket closure.Medical experts fear that another shutdown is likely to kill more people than the disease it seeks to control, as people with non-coronavirus ailments cannot get to hospital for treatment, and the economy suffers even more, <a href="https://www.nepalitimes.com/latest/covid-19-leaves-millions-of-south-asian-children-hungry/" target="_blank" rel="noopener noreferrer">lowering nutrition levels</a> of people.Government figures show that there were <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">30% more child deaths in April-May</a> this year compared to last year. <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">Maternal mortality has also gone up</a> because many more mothers gave birth at home instead of going to hospital. There has been a <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">spike in measles</a> and other infections because of delays in vaccination campaigns.“A lockdown is not the solution to the coronavirus crisis. We must first analyse why we did not do the previous four months to take measures to control the spread,” says Sher Bahadur Pun of the Ministry of Health, “another lockdown will not make a difference.”Pun adds that uncontrolled movement of people across districts during the lockdown with thousands crossing the Indian border to reach their homes, led to the flare-up in the infection.“It is only going to get worse from here, especially as winter approaches,” predicts Buddha Basnyat of Patan Academy of Health Sciences. “We have to accept this and prepare for it, but another lockdown is only the last resort.”Basnyat says the government has to get on a war-footing to <a href="https://www.nepalitimes.com/editorial/open-and-shut-case/" target="_blank" rel="noopener noreferrer">increase testing in the Tarai districts</a> enforce mask-wearing and physical distancing, and as the number of severe cases rise, develop a treatment taskforce.Hospitals should be better equipped to handle the increase in symptomatic and severe coronavirus cases being seen now, with clear treatment guidelines identifying the most effective drugs and therapies for Nepalis, so there is no expensive over-prescription.As the ICUs get filled up, there is an urgent need for ventilators and oxygen concentrators, Basnyat adds. There are now 36 patients with COVID-19 across the country, with 23 in Bagmati Province, which includes Kathmandu Valley. Birganj is said to have reached saturation in ICU capacity, and hospitals in other Tarai cities are also filling up.Health experts say that while Nepal may not be able to build hospitals in a week like Wuhan did, the government can start mass testing in the high-risk zones, set up tents and ICU beds and stockpile life-saving drugs and medical equipment.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4bd9c7e80680e073682jpeg.jpg" alt="" width="858" height="671"><figcaption> </figcaption></figure>Experts are also advocating for regular mass testing in cities with more movement of people. And if there is indeed another lockdown, they say testing in densely populated urban centres is a must.A recent surveillance based on swab samples of 10,000 of the people who entered Kathmandu Valley last week found that 0.7% of them tested positive for SARS-CoV-2. Despite this seemingly low positivity rate, health officials say that the finding is significant because those individuals would have been carriers in their families and communities.More worryingly, there is now a rise in cases with serious symptoms across Tarai districts, unlike in the past when most were asymptomatic or had co-morbidity. Hospitals in the Tarai are seeing a surge of typical COVID-19 symptoms with advanced pneumonia.“Most hospitals and doctors in Nepal are now starting to feel the devastation this virus can cause, as it did in Lombardy, New York and parts of India,” says Buddha Basnyat. “Which is why despite low fatality rate in this part of the world and the concept of herd immunity, there is no time to be complacent.”A rise in influenza in the rainy season could also be a reason for misdiagnosis because flu and COVID-19 have similar symptoms. Experts suggest flu to be tested with COVID-19, especially as winter approaches.But even with all the planning in the world, strategies, drugs and medical infrastructure, the most effective tools against the virus are the three <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">simple safety measures</a>: physical distance, masks and hand hygiene.Says Sher Bahadur Pun: “Testing, tracing and treating are important. Government action is crucial. But how strictly Nepalis follow safety guidelines and adapt it into their everyday lives will make the most difference.”

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