From scarce vaccines, to storage shortage in Nepal

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 waiting past the due date for their second doses.

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 start booster shots for high-risk populations 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&J, Moderna and Pfizer vaccines. This week alone, Germany sent 4.1 million doses of Moderna and J&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 Omicron in the picture, 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 vaccination for all, 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 the second wave in April-May, 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 fully prepared for another spike 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. Our equipment is not functional 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.”