Do Nepalis need Covid booster shots?

Not long ago, to boost or not to boost was the dilemma of rich countries, even as developing nations were struggling to vaccinate their frontline workers and elderly with the first dose.

The argument has now reached our part of the world, with some health experts even in Nepal recommending boosters shots for the immune-compromised and frontline workers. In fact, the government’s Teaching Hospital and a few others in Kathmandu this week administered a third booster shot to some patients suffering pre-existing diseases.

The recommendation has been met with some conflicting opinion at a time when only a little over 30% of Nepal’s target population has been fully inoculated against Covid-19. While over half the people in densely populated urban centres like Kathmandu have been vaccinated, parts of rural Nepal are still largely unable to access jabs.

“Our first and foremost priority must be to vaccine everyone, and if we have plenty more vaccines, which we are more than likely to have, the next step is to provide booster shots to people with co-morbidities and the elderly,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.

Infectious disease specialist at HAMS hospital Anup Subedee agrees: “If the question is what is more advantageous in terms of controlling the pandemic, vaccinating the unvaccinated or offering booster shots, the answer is to vaccinate everyone first.”

Having said that, Subedee adds that Nepal should provide the third dose of VeroCell to individuals who were inoculated with the Chinese vaccine, for higher efficacy, as recommended by the World Health Organisation (WHO).

The concern about boosters is mainly because antibody levels decline significantly after 6-9 months of being inoculated, as proven by studies around the world. And as one of the first countries in South Asia to start its Covid-19 vaccination drive, it has been six months since frontline workers were given jabs.

Some experts, however, say that the human body provides protection also from so-called ‘memory cells’ so that even if vaccine immunity drops, the T and P cells which produce antibodies only when a pathogen attacks. There is no exact estimate of how long the memory cells provide protection, but it is most likely long-term, which means the general population may not need booster shots just yet.  

Those who recover from Covid-19 are even better placed to ward off the infection and its complications, with natural immunity being more effective than that gained by vaccination. And according to the recent seroprevalence survey, over two-third of Nepalis have SARS-CoV-2 antibodies that provide them natural immunity.

“Given that 68% of people in Nepal have some form of protection and a significant chunk of the population is fully vaccinated, we don’t have to worry about boosters yet. Our infection rate, hospitalisations and morbidities have all largely declined,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal, which conducted the seroprevalence survey.

The new surge in Europe has been associated with the Delta variant, which has already swept through every corner of Nepal and India, which means a majority of the people here have developed some immunity against it.

“So, we don’t have to panic about another major surge as of now,” Dixit adds.

This is not to say Nepal is out of the woods yet. With a declining number of daily cases and fatalities, schools have reopened, there are wedding parties, crowded marketplaces and indoor seminars are happening all over the country.

Safety measures must be maintained despite higher vaccination rates and declining hospitalisations. This means, continuing to mask up, avoiding crowds and maintaining distance -- especially with the onset of winter and the seasonal risk of coronavirus, influenza and pneumonia infections. There are already reports of students, parents and teachers in Kathmandu schools testing positive for Covid-19.

The government had set aside Pfizer vaccines for the immunocompromised, but a lack of uptake meant that students up to age 12 are now being offered the US-made vaccine that has been certified for children.

Shyam Raj Upreti, Nepal’s focal person for the Covid-19 vaccine maintains that the government will start administering booster shots only after nearly 100% of the targeted population has received its first dose, the figure currently stands at about 40%.

Nepal has so far received 25 million doses of vaccines in donations or purchase, 30 million more are in the pipeline. “We now have more than enough vaccines for our targeted population, and we are now starting with students,” says Upreti. “The new challenge is to increase vaccine acceptance among those who have so far refused to take it.”

Although surveys have shown that 97% of Nepalis trust vaccines, many pregnant women and those with co-morbidities are refusing to get shots, fearing side-effects.

Experts caution that Nepal’s response to the pandemic needs to extend beyond vaccinations. The country has to be prepared for a possible surge, and this means contact tracing including the testing of the children, stringent quarantine and isolation, well-equipped health infrastructure and trained medical staff to operate them.

“Another surge might not be a major one but it could still be on a scale sufficient to significantly impact our economy and lives,” adds Anup Subedee. “So we have to be prepared. But a lot of it boils down to political will, and an efficient bureaucracy that is focused on controlling the pandemic.”

Indeed, Covid-19 is here to stay which means continued vigilance and precautions like masking and physical distancing. Warns physician Buddha Basnyat: “Covid-19 is a wily virus, and it is still a formidable foe. We can’t let down our guards yet.”