Nepal goes viral

One thing we cannot complain about is that, for once, the world is not ignoring a humanitarian disaster in Nepal. They have even named a variant after us.

Worried about the Delta strain spreading in his country, a UK official blamed the ‘Nepal variant’ for spoiling summer holiday plans for many Brits. The tabloid press, but even the BBC, dutifully headlined this, despite a WHO denial about a Nepali strain. But the damage was done. Just google ‘Nepal variant’ now.

What the publicity has done is pushed the world to rush oxygen and medical supplies to Nepal. All help is useful in a crisis like this, but much of the aid being flown in contains items that Nepal is already buying in bulk in China.

While there was a dire shortage of oxygen cylinders three weeks ago that led to loss of lives, the nature of the emergency has changed. Nepal’s 29 oxygen factories are now working at 100% capacity producing only medical oxygen, and soon there will be a surplus. The problem is not supply, but logistics and equitable distribution.

What we really need are vaccines — most urgently for the 1.4 million Nepalis above 65 who got their first dose of Covishield AstraZeneca three months ago, and are now past the default date for their second after India banned its export.

India's total vaccine exports before it was stopped in March.

The lockdown should have bought us time for a mass vaccination drive, but once more we squandered two months shutting people in their homes. The restrictions did bring down the daily caseload, but infections are likely to spike again once mobility increases, just like last year.

Instead of #NepalVariant trending on Twitter, we need #NepalVaccines to go viral. To be sure, the United States has pledged 80 million surplus doses, but only 7 million of that in the first phase is for the whole of South and Southeast Asia with a population of 1.5 billion. Supply bottlenecks mean the first shipments will not include AstraZeneca.

Europe has a stockpile of AstraZeneca and more on order that are not going to be used, either because of slow uptake or because of fears of clots. In France, tens of thousands of doses have gone to waste. Norway and Denmark are not using  AstraZeneca anymore, and some of this may be channeled to Europe’s pledge to donate 100 million doses this year, sell 1.3 billion doses at cost price to low and middle-income countries, and donate another 1.3 billion doses in 2022, mostly through COVAX.

The International Monetary Fund (IMF) last week announced a $50 billion plan to vaccinate 40% of the world population within 2021, and 60% by mid-2022. This is all encouraging news if it happens, but the long and short of it is that for Nepalis, neither the second doses nor vaccines for the larger population are getting here any time soon.

Number of patients in ICU and ventilators in Nepal in May.

Even Andrew Pollard of Oxford University, an old Nepal hand, and one of the developers of the AstraZeneca vaccine says he feels helpless. He wrote in a column in this paper recently: ‘I felt so proud when I saw the first doses of the Oxford vaccine being administered in Kathmandu, and the hope that it brought to Nepalis, but I am now saddened to hear that further supply is delayed.’

On Tuesday, the 60-65 age group in Kathmandu Valley, and 62-65 outside started being vaccinated with the 1 million extra doses of Sinopharm VeroCell donated by China. However, we need to get jabs to at least 19 million Nepali arms in the next few months to reduce the danger of a pre-Dasain surge, not to mention younger cohorts who are likely to be more vulnerable to a predicted third wave. Negotiations with Sinopharm to procure another 2 million doses are bogged down over a confidentiality clause in the contract.

The only ‘Nepali variants’ we should be worried about are the country’s feckless and mutated politicians. Prime Minister Oli has replaced five Health Ministers since 2018, three of them since the pandemic began.

Since vaccines are unlikely soon, public health experts have warned us repeatedly that even after the lockdown is eased, and even if some people are vaccinated, the only way to prevent future surges is through proper masks and physical distancing.

A recent Yale study in Bangladesh involving over 300,000 people showed that four simple actions led to a 10-time increase in mask wearing. Their four-fold path includes: 1. Giving away free masks, 2. Spread information about how to wear them properly, 3. Get celebrities to promote mask-wearing, 4. Enforce mask-wearing through persuasion and punishment.

Official figures grossly underestimate the spread and fatality from Covid-19 in Nepal. A projection by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine in Seattle shows that on 31 May when the government reported 96 deaths from Covid-19, the actual number was closer to 363.

IHME calculations also show that 1,000 fewer Nepalis will die by 1 September if 95% of people wore masks while outdoors. The government is hinting that the lockdown rules will be eased on 14 June. Since vaccines are still a long way off, our only protection is masks and minimising movement.