VAX POPULI

Nepal’s surge of Covid-19 continues unabated  with new hotspots, and because of inadequate testing, no one really knows how much and how fast the pandemic has spread.

The government has left Nepalis to their own devices, only issuing guidelines on precautions, but stopping free testing and treatment. Meanwhile the daily positivity rate and fatalities have not come down. As of Thursday, out of the 9,805 people tested nationwide 2,103 were positive, which gives a very high positivity rate of 21.4%.

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Nepal’s death rate from the coronavirus of 43 per million is much lower than India (93%), but much higher than China and Sri Lanka (3%). This points to poor prevention measures as well as inadequate or unaffordable hospital treatment. 

The only option for Nepal is to wait for vaccines to be available, but even on this it has moved too late. Many governments around the world have pre-booked vaccines from pharmaceutical companies like Pfizer and Moderna, and most countries will first prioritise their own citizens.

Last week, the Nepal government finally set up a committee of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them.

On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.

Despite this, Nepal will possibly be one of the last countries in the world to get a vaccine, and even when the first vials arrive perhaps by the middle of 2021, the poorest Nepalis living in the remotest areas will be the last in line to get them.

The government, which has failed all these years to make free health care accessible to all, will have to prove that its vaccine distribution is fair, and the poor in remote areas of the country are not left out. 

Says Bikash Gauchan, a physician stationed in remote Achham district: “We need to immediately start identifying vulnerable groups like frontline health workers, the elderly or those with co-morbidities to prioritise for immunisation, and to have an effective distribution plan for remote areas.”

Nepal is internationally recognised as a model low-income country with an effective vaccination programs against measles, polio and other childhood killer diseases. It has valuable experience in deploying a nationwide network of Female Community Health Volunteers, and Nepal’s Covid-19 vaccine delivery will have to re-learn from its own best practices.

Monitoring the follow-up vaccine dose can gain from Nepal’s acclaimed DOTS program to deliver anti-tuberculosis therapies, and Nepal’s rural health care workers have experience in maintaining the cold chain from previous vaccination programs.  

Despite recent breakthroughs in trials, public health experts say Nepal should be looking at neighbouring China and India and belatedly begin ‘vaccine diplomacy’ to secure its supply.

Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.

In India, the Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.

“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”