Nepal braces for new wave with vaccine drive

Even as Nepal completes the first phase of its Covid vaccine drive to inoculate frontline health workers and other high-risk groups, new hyper-spreading variants of the coronavirus as well as vaccine denial have raised concerns about the efficacy of the campaign.

Public health experts, however, say the government must continue its vaccination to reach as many vulnerable people as possible with a better communication strategy and more aggressive promotion.

Nepal is one of the first countries in the region to start a mass Covid-19 vaccination drive. But the first phase saw a moderate turnout with only half of the doctors, nurses, FCHVs, security personnel and cleaners prioritised by the government inoculating themselves because of the safety concerns and inaccessibility.

This forced the Health Ministry to expand the first phase to also include civil servants, diplomats, bankers and journalists so that it could used up the 1 million doses of Covishield vaccines donated by India last month.

With additional 2.25 million Covishield doses under the WHO’s COVAX initiative arriving in Nepal by early March and another 2 million that the government is in talks to purchase from the Serum Institute of India, officials are gearing up for the second phase of the vaccination for people above 55 years and those with co-morbidities starting from 7 March.

This will be followed by the age group 40-54 and then those below 40 years of age.

“The campaign will now be community-based, unlike the first phase that was facility-based, we will take the vaccine to the people and ensure higher coverage,” assured Shyam Raj Uprety, head of government’s Covid Vaccine Strategy. “And as per the WHO recommendation, our advisory groups will soon finalise their decision to provide the second dose between 8-12 weeks.”

Public health experts say that the emergence of new variants should not dissuade the government from discontinuing or scaling back its vaccine drive.

“An RNA virus will have variants, it is a given, we have to live with them. In fact, we might have our own variant in South Asia, but we should keep on vaccinating and saving lives,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal.

Of the multiple variants circulating globally, the one first identified in the UK called B.1.1.7 is more widespread, and some have been detected in Nepal in travellers arriving from Britain. The good news is that AstraZeneca Covishield vaccine has been found to be effective against the strain.

However, a trial involving 2,000 people in South Africa claimed that Oxford jabs offered only minimal protection against mild and moderate cases (of their variant B.1.351). Experts caution that it may be too soon to declare the vaccine ineffective because the study was conducted in a small population of young people.

In Brazil, a variant called P.1 has been found to contain contains a set of additional mutations that may affect its ability to be recognised by antibodies, adding to the challenge.

“What’s important in this debate is that even if one were to contract Covid, the vaccine will prevent people from getting severely ill and dying,” says Buddha Basnyat of the Patan Academy of Health Sciences. “Trials and emergency use so far has strongly addressed safety concerns regarding Covishield, so we can’t let news of variants put a damper on the vaccination campaign.”

The nationwide vaccination campaign is taking place at a time when Nepal and the rest of the South Asia are reporting much fewer cases and fatalities, much of which has been credited to limited contact tracing and herd immunity in major cities after large chunks of the population developed resistance against SARS-CoV-2 after contracting it.

But the lack of surveillance, seroprevalence studies and antibody tests means that researchers have not been able to confirm localised immunity.

“The government is unwilling to conduct a study despite interest from aid agencies. Results from these studies would have helped us better prepare vaccination strategy at a time when we face great resource constraint,” says Dixit.

Nepal also needs to continue with vaccine diplomacy and look into other shots, in particular, Chinese Sinovac and Bharat Biotech’s Covaxin. Both the vaccines use the whole inactivated (dead) virus, because of which they are unable to infect people or cause pathological effects but deploy the immune system to mount a defensive reaction against the virus.

Sinovac made global headlines when it was found to be only 50.4% effective in a trial in Brazil whereas it performed better in Turkey (91% efficacy). Covaxin is also controversial because of its emergency use among the frontline health workers in India despite not completing its phase three trials.

It will do well for Nepal to keep track of their trials with the government aiming to vaccinate 72% of its eligible population above 18 years. People aged 55 and above make up 11% of Nepal’s population whereas the 40-54 age group account for 13%. People aged 18-39 made up nearly half of Nepal’s 28.8 million population in the 2011 census.

In the meantime, the government needs to enforce the equitable distribution of the vaccine to the remotest parts of the country with the most at-risk groups high in priority. Public health experts say that with cases rising again in India, Nepal could also see a spike as people become complacent and mingle more.

Says Sher Bahadur Pun of the Infectious Disease Hospital in Teku: “We have been given this reprieve with fewer cases and fatalities, we need to utilise this time to vaccinate the elderly so that the most vulnerable in our communities are protected if and when the next wave hits us.”