"Nepal is a priority for vaccine shipments"

Special interview in Saglo Samaj tv magazine program with Foreign Minister Pradeep Gyawali, who is also a member of the government’s Covid-19 Control and Management Committee (CCMC). Kanak Mani Dixit asks him about the government’s response to the Covid-19 pandemic so far, and its strategy to deal with the crisis now that there is a brief respite from the political stalemate.

Kanak Mani Dixit: We have often heard that both the government and citizens are responsible for the second wave. But was it not the government’s job to warn people of the risks and make sure precautions were taken? 

Pradeep Gyawali: I have just come from a meeting in which the prime minister instructed the new Cabinet that the complete focus of our work henceforth should be to fight against Covid-19 by using every means at the government’s disposal. It is true that there were lapses, we knew the wave was coming but the state was bogged down with party power struggles and that prevented us from concentrating on battling the pandemic. But it is not that the government has stood idly by, since last year we had added testing centres, HDUs, ICUs, ventilators. But this second wave was so aggressive, all this was not enough. For example, last year only the really serious patients needed oxygen, this time there are more patients needing critical care, which means more oxygen flow. Our preparations were not enough to deal with the severity of the second wave.

If the situation is so serious, why does the government not declare a health emergency?

The existing Infectious Disease Act gives the government the power to punish those flouting rules to stop the spread of communicable diseases. But the situation is serious, and many have advised us that we should declare a health emergency which would allow the state to deploy private hospitals to treat patients, and get all agencies of the state to concentrate solely on health. But so far, the existing laws are adequate to deal with the situation.

The CCMC has not been effective as the main state mechanism in tackling the emergency. Are there plans to change that?

We set up the CCMC because the war against Covid needs various ministries of government to work together. The Health Ministry is the frontline agency, but it has to coordinate with the Home, Foreign, Finance, Tourism, Supplies and other ministries. If the CCMC had not been there, there would be chaos. The CCMC is empowered with the authority to take its own decisions. Obviously, its work needs to be more effective and visible. 

Maybe we need more than ‘coordination’? Maybe we need more effective and accountable leadership. 

The Health Ministry gives a good daily briefing. But Covid response is not just a health issue, there are decisions regarding supplies, transport, enforcement that need to be conveyed better to the public. We will activate the CCMC to be more proactive in communicating its decisions and situation reports. 

The prime minister told CNN that Nepal had the pandemic under control, a few days later in an appeal in The Guardian, he asked the international community for urgent help. Why this mixed message?

It also depends on how the question is framed. CNN asked if it was true that the Covid-19 pandemic was out of control in Nepal. Even in the current situation, we cannot say it is out of control, and it is not. It is true that we are overstretched, and there are shortages of hospital beds and oxygen, but that does not mean that it is out of control, and we have surrendered. We have been telling the international community that the country is in difficulty at the moment, and the reason is that we have a 1,800km open border with India and even last year the trend was that what happens in India follows in Nepal within 12-13 days. This has really stretched us to the limits.

What is the reason for the delay in bringing vaccines? Nepalis have not got a clear answer.

There is a huge rich-poor vaccine gap in the world. As soon as vaccines were available last year, we approached manufacturers and international agencies. We had to look at affordability, efficacy, and the logistics for refrigeration. The most suitable was AstraZeneca’s Covishield vaccine. I was in India in January, and we put forward our case. Nepal became the second country in South Asia to start vaccinations. We got 1 million doses as a grant from India, after that we bought 2 million, of which 1 million doses were delivered. Then China gifted us 800,000 VeroCell vaccines, under the COVAX initiative we got 348,000 doses. India separately provided 100,000 doses for the Nepal Army. So we have received more than 3.2 million doses so far, and about 2.2 million so far have been fully or partially vaccinated which is about 8-9% of the total population. This means we rank 80th in the world in vaccinations, which is not bad. We paid for 2 million doses of Covishield at $4 a dose, a price the government set, of which 1 million doses were sent immediately. But then the pandemic suddenly spread in India and the court and government there banned exports. There was no other reason for the non-delivery of the remaining 1 million doses, it was not because of any middlemen or commissions. The allegations are totally false, I am willing to go to any court in the world to debate this. The remaining doses will come to Nepal.

But this issue came up because the Health Minister himself accused middlemen of behind the delay. 

He was not talking about the 2 million. After this we tried to buy another 5 million doses from India and that deal did not happen because there was demand for vaccines within India itself, but it is true that the Serum Institute of India told us to talk to their authorised agent in Nepal. However, we said we sent you advance payment of which half the doses have not even been delivered. It is unfortunate that without even understanding the issues, the opposition parties have turned this humanitarian issue into a political agenda.

We are in talks with Sinopharm to buy 2 million doses of VeroCell for delivery by June. The second is the Russian Sputnik vaccine for which we have already provided permission for emergency use, but the problem is that Russia is not producing enough. Even so, we have said we need 8 million doses, of which 4 million are required right away. We are waiting for their answer. 

Then there is America which has booked and bought 60 million doses of AstraZeneca, and there is a debate within the United States about whether this vaccine stockpile can be donated to other countries. We have activated diplomatic channels to convince the Americans that they should provide us some of these doses. But the US Food and Drug Administration, the Centre for Disease Control and even the security agencies need to give approval for export. But I am sure that once these requirements are fulfilled, Nepal will be a priority.

In addition, we are also knocking on COVAX’s doors. The problem there is that its most important supplier of vaccines is India’s Serum Institute. It should have already received 90 million doses from there by March, but it has only got a small fraction of that. But they have also put Nepal on a priority to provide enough vaccines for 20% of our population, which is 1.4 million doses.

https://www.youtube.com/watch?v=YsNYIuN2TVw

Watch the complete interview in Nepali here.

What of those 18 and above who should have got the Sinopharm vaccine, the 100,000 above 65 who didn’t get their shots of Covishield, and why were the 59-65 age group left out?

Our plan was to use the next consignment of 1 million doses to inoculate the 800,000 people in the 59-65 age group with the first dose, but when those vaccines did not come, we could not deprive those who had already got their first shots from their second doses. So we decided to give it to the above 65, but even here as you point out, 100,000 were left out. So far, we have administered 1.75 million AstraZeneca Covishield, and for the second dose we need that same amount of Covishield, as well as for those above 65 who were missed out. Our strategy now is to get at least 2.5 million Covishield for this cohort, either from the Serum Institute or other AstraZeneca plants. For those below 65, we are trying the other vaccines, whichever we can get first. We are aware of those who were left out, and are trying to cover them as quickly as we can.   

Isn’t it possible for your ministry to work with Nepali organisations abroad that have been lobbying with the US and British government to rush some of their unused vaccine stockpiles to Nepal?

I thank American Senators and Congressmen who raised Nepal’s needs in the committees last week, as well as Nepali groups that made this happen. We have been in touch with the British government as well, and I can disclose that the UK is soon going to announce a major aid package for Nepal. Similar assistance is also coming from Switzerland. China has also announced a RMB 10 million through which we are acquiring oxygen cylinders, concentrators, ventilators and other medical equipment. The Sichuan and Tibet provincial governments are also sending help, in fact the Tibet government is providing 150 large containers that can hold 200 litres of liquid oxygen each. 

The shortage of oxygen is nothing short of disaster. What can be done to manage oxygen supply equitably within the country, and what is being done to source oxygen from abroad?

We definitely did not do enough to install adequate oxygen generators in the past year. This time, after the oxygen crisis hit, we stopped the non-medical industrial use of oxygen which used to make up about 30% of our production. This meant we could deploy 10,000 cylinders from industries to hospitals. We have also directed all oxygen plants to operate at 100% capacity, and to increase production in others. Despite all this, the demand is so high that we need liquid oxygen, but its import from India was stopped for ten days even as our cases were rising. Due to our diplomatic efforts, India agreed to lift the ban and we are trying to add more tankers. We still need cylinders, but much more urgent is increasing the capacity to generate oxygen, and we are trying to increase the import of liquid oxygen, and bring in medium-sized air-based oxygen plants.

We have an open border with India, what are the plans regarding people travelling across it in both directions?

We have raised this with India, we have said that both sides cannot be infection-free as long as the disease rages on the other side. This is why the question of vaccines and other medical supplies is so important. Because India itself is in crisis right now, it is not in a position to help much, but I think we have managed to get the message across. We have also apprised the international community that they have to help both countries together otherwise the region will not be Covid-free. 

Are you giving too much attention to Kathmandu Valley and forgotten about the rest of the country? 

I don’t think so. Ever since last year, we have tried to increase the capacity of the provinces and municipalities to deal with the crisis. What we were not prepared for was just how contagious and lethal this variant would be. Nepalganj got hit first and the infection rate there is still high, but they are managing. Butwal and Sudur Paschim Province are also under a lot of stress. Other than that, the hospitals and local governments are trying to cope with this crisis. 

How do you see the role of non-profits and civil society in dealing with the crisis?

Last year, we had to conduct an emergency repatriation of Nepali workers from the Gulf and Malaysia, and non-resident Nepalis played a very important role. This year too, Nepalis abroad have been helping, for example like with the cylinders sent from Oman this week. I would also request them to continue lobbying with the governments of the countries they work in to assist Nepal at this time of crisis.

Within the country, it pains me to say this, but it seems that some sections of civil society feel that their sole role is to oppose everything the government does. As if they are not citizens unless they oppose the government. This is not right. Civil society includes media, NGOs, and others and which play an important role in disseminating correct information, to raise public morale at a time of crisis. This is not to say that the media should suppress news about fatalities or the lack of oxygen, but when you say there were 9,000 deaths today why leave out the fact that 5,000 recovered? The government should not be alone in this fight, every citizen needs to be a part. 

We have encouraged non-governmental organisations to help fight the pandemic, but without overlapping with the government, and to coordinate so that it conforms to our priority areas. We are also wondering why some of them are not putting in more effort. On the part of the government we will do our best to facilitate. Let’s just try not to have a case of too much in one place, and too little in others. 

We face difficult days. But however difficult they may be, they will soon pass. So let us keep our hope, beliefs and self-confidence levels up. Let us remember that only if we ourselves are safe can we make society secure.