<figure><img width="986" height="671" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08ba9c7e80680e0a6034jpeg.jpg" alt=""/><figcaption>Photo: UPASANA KHADKA</figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/nepali-migration-in-the-2020s/" target="_blank" rel="noopener noreferrer">migration sector</a> is a zoom lens through which we can examine up close Nepal's socio-economic and political problems through recent history. To a greater or lesser degree, all Nepalis suffer from the country’s chronic malaise: discrimination, exclusion, <a href="https://www.nepalitimes.com/editorial/hunger-for-governance/" target="_blank" rel="noopener noreferrer">poverty</a>, indebtedness, joblessness, poor health care and education, all a result of an uncaring state. But it is when citizens decide it is too much trouble to remain, or risk it all to leave their families and birthplace for a better shot at life, that the true impact of leadership failure and government neglect is thrown into sharp focus.The government’s mishandling of the Covid-19 pandemic since February 2020 is a case in point: it has cost lives at home, and magnified the <a href="https://www.nepalitimes.com/latest/wage-theft-of-migrants-during-pandemic/" target="_blank" rel="noopener noreferrer">misery of Nepali workers overseas</a>.To be sure, most governments around the world have mismanaged the pandemic. But that is no excuse.There were four labour ministers in the past two years, but they were all AWOL. And the situation now is no different, when there is no labour minister. The government was slow to respond last year to repatriate Nepali workers stuck in the Gulf and Malaysia. The flights did happen, but too little, too late, and too expensive. Compensation schemes were not properly implemented. As r<a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">ecovery from the second wave stalls</a>, and ICUs fill up again, the new government has appointed a private hospital operator as state minister of health. We will give him the benefit of doubt for now: who knows, he may have the mojo to do a better job than his predecessors.But this week, thousands of migrant workers had to wait all night at Teku Hospital just for a rubber stamped piece of paper to certify they have been vaccinated. Some were in line for 28 hours for a letter that may not even be valid for travel because it does not have a QR code.This is just the latest demonstration of the <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">appalling neglect of desperate migrants</a> by the health and labour bureaucracy. Instead of making it as convenient as possible for them, state actors treat them with apathy, flip-flopping rules, and add yet another layer of hardship to an already complex recruitment process with workers victims to cheating, high fees and false promises. The process entails visiting different offices, standing in line, being treated with lack of respect and dignity by the authorities and ripped off by ‘manpower’ agents.  <figure><img width="1246" height="770" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08bd9c7e80680e0a6035jpeg.jpg" alt=""><figcaption></figcaption></figure>There is an added hurdle: testing, quarantine and vaccination rules that are confusing, inconsistent, and costly for workers. There are hidden costs for migrants from remote parts of Nepal who have to make expensive visits to Kathmandu for documents. Meanwhile, the migrant diaspora props up the economy by sending $7 billion home every year even during the Covid-19 crisis (see graph). And overseas Nepalis were the <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer">first to help by raising money for oxygen cylinders</a> and other equipment during the second wave. Migration is important not just for the national economy, but for individual families.The difference between remittance and no remittance for many Nepalis is poverty, inability to send children to good schools, or afford hospital bills. Labour approvals for new migrants dropped to only 75,000 last year — the lowest figure in 20 years. This puts even more families at risk, especially during the pandemic when there is no social safety net, and schemes like the <a href="https://www.nepalitimes.com/banner/missing-the-plot-in-nepals-job-scheme/" target="_blank" rel="noopener noreferrer">Prime Minister’s Employment Progam</a> are a farce. The <a href="https://www.nepalitimes.com/here-now/nepalis-queueing-up-all-night-for-proof-of-jab/" target="_blank" rel="noopener noreferrer">reportage on Teku by Upasana Khadka this week</a> is a deplorable image that showed both the desperation for overseas work, and the lack of empathy from the authorities. The crowded queues risk turning hospitals into hotspots for the virus. The appalling lines this week demonstrated indifference and lack of coordination towards those at the mercy of the state. You know things are not all right and the government has failed its citizenry when a migrant realises that 2AM is too late to stand in line to obtain a simple piece of paper.The ministry finally authorised four hospitals for vaccine certification to thin the crowds. Why didn’t they think of that before? There are other concerns about the one-shot J&amp;J doses running out, and inconsistent vaccine acceptability in destination countries. Give migrants clear information, strengthen coordination between the health and labour bureaucracies, decentralise services with more staff at service delivery points, and stop harassing them every step of the way.

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2AM is too late

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cda029c7e80680e092ed4jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Nepal is seeing the <a href="https://www.nepalitimes.com/latest/thick-haze-adds-to-nepal-covid-19-woes/" target="_blank" rel="noopener noreferrer">first signs of a second Covid-19 surge</a> even as its vaccination drive is suspended, and as survivors live with ‘Long Covid’.Doctors and hospitals are reporting a significant proportion of infected individuals with what is now called ‘<a href="https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173" target="_blank" rel="noopener noreferrer">Long Covid</a>’ or ‘post-acute Covid-19 syndrome’ in which survivors continue to struggle with extended after-effects of the illness.<a href="https://www.nbcnews.com/health/health-news/brain-fog-other-neurologic-symptoms-can-last-months-after-covid-n1261810" target="_blank" rel="noopener noreferrer">Months after testing negative</a>, many of them still suffer from fatigue, shortness of breathing, joint pains, headaches, prolonged cough, chest pain, loss of appetite and brain fog.Long after he recovered from his coronavirus infection last October, 37-year-old Purna Rai says he is still not feeling completely well. After two weeks of isolation and testing negative, he suffered from insomnia, panic attacks and anxiety. Rai was first told he had gastritis, and later sodium deficiency. Then the doctors even referred him to a psychiatric ward to see if he had 'post-Covid' symptoms.“I used to have difficulty breathing, it used to feel like I had stopped breathing. I even thought I might have Covid again,” recalls Rai who finally recovered with proper medication, diet, meditation, yoga and consultation with friends and families.As Nepal’s health authorities come to terms with signs of a second wave, and the<a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer"> vaccination campaign on hold</a> because of the lack of doses due to India’s export ban on Covishield, they also have to deal with patients whose symptoms have never gone away.In addition, there is the worry that even those who have had Covid-19 in the past, the immunity erodes as time goes on and there is a danger of re-infection. It is also not known if the AstraZeneca vaccine is effective against the new strains, and if so how long the immunity lasts.Binu Acharya, 80, was severely sick with Covid-19 along with some members of her family last September. Everyone in her family tested negative and ultimately recovered, but for Acharya, it has been one long convalescence.“Ever since I had Covid, I have never recovered properly, I have never been myself, I have difficulty climbing stairs and breathing and feel weak all the time,” says Acharya, who adds that after she got her first Covishield dose she felt like she had the illness all over again.Deepak Sundar Shrestha of Subekchya Internal Hospital consults patients like Rai and Acharya regularly. Studies have shown that about 20-30% of Covid-19 patients suffer from <a href="https://www.thereporter.com/2021/03/23/long-covid-emerges-in-more-than-one-quarter-of-healthy-people-with-modest-initial-illness-2/" target="_blank" rel="noopener noreferrer">long-term symptoms of the infection</a>.“First of all, it is important to know and understand long Covid and that the symptoms could either be psychosomatic or real,” says Shrestha. “And because a notable portion of patients suffers from this condition, having 50,000 people in Nepal with Long Covid has a huge cost.”A team of doctors at Sukraraj Tropical and Infectious Disease Hospital in Kathmandu has started researching Long Covid in Nepal. Preliminary findings show that <a href="https://www.bbc.com/news/health-56509340" target="_blank" rel="noopener noreferrer">women are more susceptible</a> whereas only 28% of men suffered from long-term after-effects. Researchers are now trying to find out how many of them endured the condition for more than six months.There is no one medication for Long Covid, but the <a href="https://www.nytimes.com/2021/03/17/health/coronavirus-patients-and-vaccine-effects.html" target="_blank" rel="noopener noreferrer">vaccines have been found to be effective</a> in reducing the severity of symptoms, and in some cases even treating them.Western countries are also running <a href="https://www.nbcnews.com/health/health-news/inside-post-covid-clinics-how-specialized-centers-are-trying-treat-n1258879" target="_blank" rel="noopener noreferrer">post-Covid clinics</a> with teams of dedicated physiotherapists, dieticians, lung doctors, physicians and psychiatrists. However, here in Nepal, even health professionals are sometimes unaware of the condition.“I took every test possible to figure out why I had suddenly developed shortness of breath, palpitations, fatigue and discomfort six months after getting Covid-19,” recalls Sirju Agrawal of Vedanta Dental Clinic.“If medical personnel like me felt like this, I can’t imagine what the general public must be experiencing. We need to better communicate and counsel people about Long Covid.”

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Had Covid? Beware of Long Covid.

<figure><img width="2048" height="1282" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1af9c7e80680e083e61jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>With the <a href="https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/">pre-winter resurgence of Covid-19</a> around the world and in Nepal, pressure is mounting on governments to procure vaccines to protect their populations.
Last week, the <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government set up a committee</a> of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them. But Nepal is far behind other countries, which have already ‘booked’ their future supplies.
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.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">VAX POPULI</a>, Sonia Awale
However, there is no effective strategy to ensure vaccines for all as distribution in Nepal comes with the challenge of taking it to poor and remote corners of the country. Experts fear that even when the vaccines become available, the campaign will be plagued by the same socio-economic inequities that afflict the medical sector.
“We need to immediately start identifying vulnerable groups like <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a>, <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> or those with comorbidities to prioritise for immunisation,” says Bikash Gauchan, a physician at Bayalpata Hospital in the under-served western district of Achham.
“We also need to set up proper cold chain facilities across the country as soon as possible and have a well thought out distribution plan so that when the vaccine does arrive, we can hit the ground running,” he adds.
The silver lining is that Nepal already has a successful <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">childhood immunisation</a> network that has successfully mobilised <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and they can deliver vaccines to the homes of the elderly who cannot make it to clinics. Monitoring the follow-up second dose for some of the vaccines will be crucial, although Nepal’s health system has experience with maintaining a cold chain for other campaigns.
<a href="https://www.nepalitimes.com/latest/nepali-diaspora-hit-by-covid-surge/">Nepali diaspora hit by Covid surge</a>, Nepali Times
Despite recent breakthroughs in trials (see box) public health experts stress the importance of exploring vaccine supply options closer to home. As of now, 11 vaccines developed in several parts of the world are in the third phase of <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener noreferrer">clinical trials</a> with many of them expected to be as effective.
Neighbouring China and India are at the forefront. And Nepal should have begun its ‘vaccine diplomacy’ much before this to secure its supply of shots.
There is also the uncertainty of vaccine efficacy depending on the strain: the same vaccine could be highly effective against people in the West but not as much in South Asia where people suffer from chronic malnutrition and multiple infections.
“For a working vaccine to be made within a year is an amazing victory for science but we also need to know that these vaccines are designed for their population. So I’d want to know more about the vaccines in India and China,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Particularly China, as it was where the pandemic started but <a href="https://www.nepalitimes.com/latest/what-nepal-can-learn-from-china-about-covid-19/" target="_blank" rel="noopener noreferrer">has since controlled it effectively</a> unlike rest of the world.”
<a href="https://www.nepalitimes.com/opinion/the-truth-about-the-chloroquine-scam/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Buddha Basnyat</a> of the Patan Academy of Health Sciences agrees. He says: “China looks at the reality in our backyard. So a more suitable vaccine for us could come from the Chinese, particularly because they have a track record of having developed better vaccine for this part of the world.”
Indeed, the JEVAX made by the researchers in Chengdu is now the most widely used jab against Japanese Encephalitis because it’s more cost effective compared to its western vaccines.
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.
Similarly, researchers at the Indian Institute of Science have designed a protein-based heat-tolerant vaccine that can stay stable for a month at 37°C, and could endure temperatures as high as 100°C if freeze dried, a feature that could be a game changer for mass vaccination campaigns in lower and middle income countries in Asia and Africa.
The other factor to consider will be the duration of the immunity after each vaccine shot, as well reinfection groups and if antibodies developed in the first episode helps fight the mutated forms of the virus.
With Covid-19 crisis continuing to spread rapidly across Nepal and at 10 fatalities per million population (same as Pakistan and much higher than China’s 3), it is not too early to start dialogue with Gavi, the vaccine alliance, COVAX and agencies like the World Bank and World Health Organisation to help procure the most cost effective approach to vaccines most suitable to Nepal’s conditions.
Alternatively, many pharmaceutical companies will want to play the field in order to boost their profile. In fact, embassies and foreign donors are already hard at work pushing for trails and deals.
“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.”
In all this excitement, Nepal’s health authorities must also keep an eye on the plight of infected people and many more to come as <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">they wait for a vaccine</a>. The results of current treatment regimens ranging from plasma therapy to administering Remdesivir have been patchy. And as scientists study the long-term impact of Covid-19 on patients even after they recover, making an optimal use of resources becomes even more significant.
So far, the government has been faulted for squandering months of lockdown, not carrying out sufficient tests and contact tracing, not increasing hospital capacity and equipment, and letting the people fend for themselves.  
The result is that Nepal is <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">suffering a sustained surge</a>, with more than 1,400 new cases a day, over 60% of them in Kathmandu Valley alone and a quarter of those tested coming out positive. There is also a surge in symptomatic patients, even among those without pre-existing conditions, and those sick enough to require ICU and ventilator.
Even when the government does act, the <a href="https://www.nepalitimes.com/latest/coronavirus-coordination-committee-doesnt-coordinate/" target="_blank" rel="noopener noreferrer">priorities seem to be misplaced</a>. For instance, health experts say the emphasis in the past months should have been on high flow oxygen therapy or High Dependency Units rather than Intensive Care Units in hospitals.
“It would have been cheaper, it does not require highly trained staff or sophisticated equipment, and it would have freed up the ICUs for the really critical patients,” adds Pun, who himself is at the Health Ministry, and this possibly means his advice is not being taken.
Insiders say it will likely take upwards of six months for the first vaccines to arrive in Nepal, and there will be a rush by the rich, the powerful and those with political connections to get their shots. The marginalised, poor, those in remote areas will be the last to get their injections, unless the government has fair and effective rules in place and implements them.
Till then, there is little else to do than <a href="https://www.nepalitimes.com/opinion/silver-linings-in-the-covid-cloud/" target="_blank" rel="noopener noreferrer">keep masking up this winter, avoid large gatherings, keep distance and wash hands regularly</a>.
Says <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a>: “The mask is the best vaccine we have at the moment. These safety measures have largely reduced hospitalisation due to other infections in 2020, masks in particular will also protect us from winter pollution in the coming months.”<h2>The Vaccine Race</h2>The global resurgence of Covid-19 in the northern winter has coincided with breaking news every day of successful new vaccine trials.First the Russians announced a vaccine in September that is 92% potent against SARS-CoV-2.  Last week Pfizer unveiled a 90% effective vaccine, which on Wednesday was upgraded to 95% efficacy without side effects. Moderna was next with an efficacy of 95%, and not needing extreme refrigeration. More companies in China, India and Europe are conducting their own trials.Public health experts have hailed the developments, but warn that vaccines will not be universally available till late 2021 and even so will not provide full protection. They suggest continuing with masking up, keeping distance and avoiding crowded indoor places.Pfizer and its German partner BioNTech’s mRNA-based vaccine came out declaring over 90% effectiveness but only at -70°C ultra cold chain which will be a challenge even for countries with the best health facilities in the world.Massachusetts-based Moderna’s RNA shot has 94.5% efficacy, seems to also prevent severe infections and remains stable in medical and home refrigerators for up to 30 days, in freezers (-20°C) for up to six months, and at room temperature for up to 12 hours.Even so, poorer countries are unlikely to get coronavirus vaccine any time soon. Even the biggest pharmaceutical multinationals can only manufacture a limited quantity of the vaccine over the next year.Pfizer has capped its production at 1.4 billion for 2021, 80% of which has already been booked through advance purchase agreement by the US, UK, EU, Canada and Japan. Moderna expects to manufacture 20 million doses this year and up to one billion in 2021.On the other hand, <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">Russian’s Sputnik V</a> has been overshadowed by new developments, and due to lack of sufficient data to back up its claim of 92% efficacy. Although geopolitical rivalry with the West has given it negative publicity, some health agencies have not ruled it out.

Sonia Awale

When will Nepal’s Covid vaccine turn come?

<figure><img width="640" height="311" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1b29c7e80680e083e62jpeg.jpg" alt=""/><figcaption>Nepal Army special funeral team brings home the first fatality from Covid-19 in Bhojpur District. She was a 24-year-old woman. The government's challenge is to bring the Covid-19 vaccine to remote parts of Nepal like these. Photo: RSS</figcaption></figure>Nepal’s <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">surge of Covid-19 continues unabate</a>d  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%.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">When will Nepal's Covid vaccine turn come?</a>, Sonia Awale 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 <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">wait for vaccines to be available</a>, 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 <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/&amp;sa=U&amp;ved=2ahUKEwiSi7fx3pDtAhWlwjgGHWzzCnwQFjAAegQIBBAC&amp;usg=AOvVaw18PYxlijebm6Z8s6c8PcRX" target="_blank" rel="noopener noreferrer">failed all these years to make free health care accessible to all</a>, 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, <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">polio</a> and other childhood killer diseases. It has valuable experience in deploying a nationwide network of <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/&amp;sa=U&amp;ved=2ahUKEwjaqeaY35DtAhUSyzgGHYXhBtoQFjAAegQIAxAC&amp;usg=AOvVaw1_j5Qa_kWIBHLL5EZjqV1b" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, 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 <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/tb/&amp;sa=U&amp;ved=2ahUKEwjxlPay35DtAhWizDgGHd_SDB4QFjAFegQIBRAC&amp;usg=AOvVaw1d367zHYY84fBDOJyCB8HY" target="_blank" rel="noopener noreferrer">DOTS program</a> to deliver anti-tuberculosis therapies, and Nepal’s rural health care workers have experience in maintaining the cold chain from previous <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;sa=U&amp;ved=2ahUKEwj07oLT35DtAhW6yDgGHe6ZCsYQFjAAegQIABAC&amp;usg=AOvVaw2VfJkLuf5k3bEjPG4_59-X" target="_blank" rel="noopener noreferrer">vaccination programs</a>.  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.”

VAX POPULI

<figure><img width="800" height="534" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151116/636bb6a99c7e80680e07bc76jpeg.jpg" alt=""/><figcaption></figcaption></figure>On Tuesday news broke about an agreement between the Russian Direct Investment Fund (RDIF) and Nepal’s Trinity Pharmaceuticals to import 25 million vials of the Sputnik V vaccines against Covid-19. But the deal is shrouded in mystery because the country’s Ministry of Health had no idea about the deal.
At a first glance it could be good news at a time when Nepal is reeling under the pandemic. But it seems no one in the government is aware of the deal. But the fact that announcement of such a massive deal did not come from the government, and doubts about whether the vaccine is safe has raised eyebrows.
What is more, Trinity Pharmaceuticals is not even registered as an importer under Nepal’s Department of Drug Management list of companies.
In a <a href="https://rdif.ru/Eng_fullNews/5852/">statement released on 29 September</a>, RDIF Chief Executive Officer Kirill Dmitriev said that about 90% of Nepalis will be provided with Sputnik V vaccine safely and effectively though clinics in the country.
“Unlike experimental vaccines based on monkey adenovirus or mRNA, Sputnik V vaccine was created on human adenoviral vectors platform, which has been studied over decades and has proven no negative effects in the long-term,” added Dmitriev. “We see a strong interest from other partners in Asia. RDIF is ready to supply Sputnik V vaccine to the countries of the region.”
In the same press release, the director of Trinity Pharmaceuticals in Kathmandu Kishor Adhikari is quoted as saying, ‘Trinity is waiting for results of the final trial of Sputnik V. As soon as the vaccine is approved by Government of Nepal we will make it available for the population of Nepal.’
Nepal saw a total of 1,559 new Covid-19 cases on Wednesday with 902 in Kathmandu Valley alone. With 1,057 people were discharged in the last 24 hours, the recovery rate now stands at 72.5%. Total confirmed cases now stands at 77,817 with 491 fatalities.201 patients are in ICU and 31 in ventilator support.
The Sputnik-V (trade name of<a href="https://sputnikvaccine.com/"> Gam-COVID-Vac</a>) vaccine was developed by Russia's Gamalia National Research Institute of Epidemiology and Microbiology on 11 August and was later registered by the country's health ministry.
Despite having been tested only in 76 people in early-stage clinical trials that lasted two months (June-July), Sputnik V was quickly approved for distribution in Russia, drawing criticism from the international scientific community as a premature decision. It normally takes a year or more to test vaccine safety and efficacy.
Gam-COVID-Vac is administered in two doses and is expected to provide immunity from SARS-CoV-2 for up to two years. The vaccine is based on the human adenovirus, a common cold virus and is fused with the spike protein of SARS-CoV-2 to stimulate an immune response.
So far, RDIF has announced supply agreements with Mexico (32 million doses), Brazil (up to 50 million doses and Uzbekistan (up to 35 million doses). India is importing another 100 million doses of the vaccine.
The results of the first and second rounds of clinical trials of the vaccine which were <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext">published in the Lancet Journal</a> on 4 September showed no serious adverse effects, but stable immune response in all participants, said the statement.
Post-registration phase III clinical trial involving 40,000 people is underway and the first results are expected to be published by October-November. Some mild side-effects have been reported in one of every seven people so far. This phase III trial is a crucial scientific step in order to prove vaccine safety and efficacy.
But back in Nepal, officials are unaware of the agreement. Before importing any new vaccine and drug, permission must be obtained from the Department of Drug Management.
Narayan Dhakal, director of the Department of Drug Management, says he had “no idea” about a Nepali company importing the vaccine against coronavirus from Russia.
The Chief Research Officer of the Nepal Health Research Council Meghnath Dhimal also told us he had no official information about a vaccine being imported from Russia.
Apart from Russia, Chinese pharmaceutical companies and Oxford University have also expressed their interest in conducting phase III <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/">clinical trials in Nepal</a>.
There are currently over 169 Covid-19 vaccines under development, with 26 in the human trial phase. The <a href="https://www.gavi.org/covax-facility">WHO has assured</a> that it will facilitate equitable access and distribution of a safe and effective vaccine in all countries with priority to people at most risk once it is found.

Sputnik V vaccine mystery in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba78d9c7e80680e07378djpeg.jpg" alt="" width="957" height="638"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>The Nepal Health Research Council has decided to allow international researchers to conduct Covid-19 vaccine trials in the country as part of a global effort to stop the virus. However, this is not a panacea, and an exit strategy from this pandemic should not just include vaccines.Vaccines may or may not work, and their immunity rates will vary. Other methods for tackling SARS-CoV-2 need to include diagnostics and therapeutics.DiagnosisAt present the definitive diagnosis is made by a cumbersome and sophisticated RT- PCR (Reverse Transcription Polymerase Chain Reaction) with a sample taken from the back of the mouth or naso-pharynx.More user-friendly tests need to be made available soon if we are to make testing easier and more prevalent. Scientists are trying to see if saliva samples can replace the awkward oral or nasopharyngeal swab samples.Ideal would be a RDT (Rapid Diagnostic Test) like a dip stick test, similar to what is available for pregnancy that does not require well-trained technicians and can be performed at home. This is easier said than done, but scientists are feverishly (pun intended) working on trying to make a much simpler test than PCRs available now.If a diagnosis using RDT is promptly and accurately made available in large quantities, it will be easier to decide who to isolate, and hence inhibit transmission of the virus – the main tenet of Covid-19 control.In addition, the importance of prompt testing is underlined by the fact that as the Nepali winter approaches there will be influenza and other viruses which may be mixed up with SARS-CoV-2, leading to unending confusion about who to isolate if tests are not easily available.In Nepal we know all to well the consequences of a wrong diagnosis, using RDTs such as the Widal Test to diagnose typhoid fever. Post-2015 earthquake in Nepal, many false-positive Widal Tests lead to treatment for typhoid fever when the patient in reality had typhus fever, a totally different disease which required a different antibiotic. As a result, the typhus fever was not controlled, sometimes with fatal consequences.TherapeuticsTreatments make up the other important exit strategy to rid the world of the pandemic. If a single, effective treatment (none exists so far) is found, it will not only help the index patient but also mitigate transmission of SARS-CoV-2.In terms of treatment research, randomised controlled trials (RCTs) are much more reliable and superior to observational studies of patient treatment as bias can lead to incorrect conclusions. In addition a large sample size, RCTs may be able to give a definitive answer.The importance of a proper sample size is illustrated by this example. Chinese doctors in Wuhan did such a good job in controlling Covid-19 that when they performed RCTs on Covid-19 patients using Remdesivir (an expensive antiviral drug, now available in Nepal ) in their hospital, they ran out of patients to study and did not have a large enough sample size to arrive at a definitive conclusion.Subsequently other groups studied Remdesivir and showed that it cut down the days (not mortality) in hospital for the sick patient. It was a spot of good luck that the largest (9,000 patients) randomised trial in for Covid-19 from the UK (the Recovery Trial) showed that the cheap steroid, Dexamethasone, although not a silver bullet, significantly decreased mortality in patients requiring oxygen.In the treatment of Covid-19, cost effectiveness will be an even more important factor for countries like Nepal. Ventilators may be important, but they are the last resort. Worldwide up to 90 % of Covid-19 patients on ventilators succumb to their illness because their condition is already so serious when they are attached to the machines.In this part of the world where a functioning arterial blood gas machine to help with the ventilator settings and other technical issues like availability of adequate oxygen are already potential problems, getting ventilators to work properly may also be an issue.The Covid-19 pandemic is a saga, it is a marathon not a 100 metre sprint. It will be important to be psychologically ready for the long-haul with this virus until at least one of the strategies -- vaccine, diagnostics or therapeutics -- works well.Luck is obviously going to play a big part in all of this, including serendipitous findings of which there is a history in medical research. Remember Alexander Fleming’s accidental discovery of penicillin?The good news is that the best scientific minds in the world are devoting all their time and energy in finding a way out. There is a lot of punditry and advice floating about, but most of it is at best guess work because this is a very wily virus.The <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNH0zvBSZMMLSQvc5kYtRhr_xwj7_Q">Nepal government has got its work cut out</a> with the surge of the past month, it has to monitor the situation closely with the mantra of test, isolate and treat – as well as listen carefully to scientific facts, not rumours.Frequent hand washing is probably as important as distancing and wearing a mask, and adequate soap and water has to be provided including in quarantine areas. The government should not pretend the situation is getting better as it did when it <a href="https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-ends-covid-19-lockdown/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNHvrS-j-Z63qT-h62KmHeFUPcysYg">lifted the lockdown on 21 July</a>. It is better to be over-prepared than under-prepared with periods of on-and-off lockdowns in the coming months.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNGHix4rBrAx8vz_0a47HkcVdlKHWg">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1598421240339000&amp;usg=AFQjCNGHix4rBrAx8vz_0a47HkcVdlKHWg">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

A Covid-19 exit strategy for Nepal

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221129121128/6385ed659c7e80680e0cc8d3jpeg.jpg" alt="" width="540" height="350"/>This pandemic is a time for clinical research to help humanity out of the crisis, and scientists are scrambling to find a <a href="https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines">COVID-19 vaccine.</a>It is urgent because if they do not do human trials during the pandemic, the infection rate may decline and the vaccine will not be well-tested enough to prevent this disease.This lack of cases and the resulting inability to test a strong candidate vaccine is exactly what happened to the zika virus vaccine. Zika may have run its course even as the vaccine study was getting underway. But there is every likelihood it may return with a vengeance without an effective vaccine in place.Many big pharma including Astra Zenca, Pfizer, Merck, and Johnson and Johnson are involved in the testing and manufacture of the COVID-19 vaccine. Companies in India, China, and Japan are also ramping up their efforts.Unfortunately, no promising drug treatment is on the horizon. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext">Remdesivir,</a> convalescent plasma, interleukin inhibitors like tocilizumab, chloroquin are certainly not the silver bullets they are made out to be. But every bit of hope is useful.Last week, <a href="https://science.sciencemag.org/content/368/6495/1041">a riveting scandal rocked the medical world</a> that involved a team of doctors whose research into choloroquine and the journals that published the result.This antimalarial drug, discovered in 1934 and introduced generally in 1947, is one which humans have been most exposed to. Chloroquine is inexpensive and simple to administer. It remains a first-line treatment for non-falciparum malaria and is on the World Health Organisation (WHO) List of Essential Medicines.It has been used extensively as a continuous prophylaxis <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-guts-of-the-anopheles,548">against malaria</a> for individual periods often exceeding five years, and has been the prophylactic drug of choice in pregnancy in order to avoid non-falciparum malaria. In addition to its antimalarial use both chloroquine, and the closely related hydroxychloroquine, are used in continuous daily dosing for common joint diseases like rheumatoid arthritis and lupus.Cholorquine in viral culture cells in research laboratory has been shown to suppress the novel betacoronavirus SARS-CoV-2, the cause of the <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">COVID-19 infection</a>. This effect occurred when the drug was given either before or immediately after viral inoculation, not after a long lag period.An observational study purporting to use data from a multi-country registry was recently published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext">The Lancet</a>, revealing that regardless of any benefit chloroquine may (or may not) have for the treatment of COVID-19, there were unacceptable side-effects on the heart leading to decreased survival of the patients.But there was a problem with the study. Sapan Desai, one of the authors and owner of <a href="https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine">Surgisphere Corporation</a> based in Chicago from where this registry  data was obtained, was, when requested, unable to share the dubious list.Desai’s colleague, Mandeep Mehra, the lead author, and other co-authors including Amit Patel have now <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext">retracted the article from The Lancet</a>. But the story does not end there.This same group of authors, some of whom work in prestigious institutions like Harvard (Mehra), also retracted a recent <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2016638">New England Journal of Medicine (NEJM) article</a> regarding COVID-19 where they had used data from Surgisphere Corporation, and when requested, were unable to share it.These retractions by the same set of authors (one of whom owns the data collection corporation) from two of the highest impact medical journals could suggest possible fraud. In addition, the editors of both the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2020388">NEJM</a> and <a href="https://www.abc.net.au/radionational/programs/healthreport/major-research-papers-retracted-over-data-controversy/12326900" target="_blank" rel="noopener noreferrer">The Lancet</a> were caught with their pants down in the rush to publish data.Finally, a proper randomised controlled trial named the Recovery Trial from the UK that utilised large numbers of patients who were treated with hydroxychloroquine revealed this week that the drug does not work in the treatment of COVID-19 patients.But whether chloroquin works in prevention (as opposed to treatment) of <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/">COVID-19</a>, especially in the vulnerable group of health workers, is not known and studies are continuing regarding pre-exposure to the virus. Medical science can be tricky. A drug not useful for treatment can often be useful for prevention.Potentially fraudulent studies notwithstanding, it is beneficial for countries like Nepal, after proper examination, to collaborate in international observational or randomised controlled trials like the <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/">WHO’s Solidarity Trials</a> for COVID-19 antidotes -- especially because it will help with capacity building in our region without desperately having to look for funding.The <a href="http://archive.nepalitimes.com/news.php?id=10203#.XuBQOS0w0Wo">Nepal Health Research Council</a> has been doing an excellent job of reviewing manuscripts and usually providing prompt feedback to the researchers in the region. However, what we medical researchers in South Asia lack is an appreciation of equipoise.‘Equipoise’ means curiosity, but it also has an element of humility. A true state of equipoise exists in research when there is no good basis for a choice between two or more options. In fact, the state of equipoise is the reason for doing research using RCTs.Unfortunately, many health care professionals in South Asia do not make room for this quality. For example, some institutions have turned down doing potentially useful, well-written and well-grounded multilateral studies in the mistaken belief that we know better that the drug or treatment in question does not work. How can this be assumed?This narrow belief may shut useful research out which ultimately could inform clinical treatment and help the patient. Helping the patient, at the end of the day, is what we all are trying to do.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and writes this <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">frequent health column</a> Dhanvantari for Nepali Times.

The truth about the chloroquine scam

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8c4d9c7e80680e06b2efjpeg.jpg" alt="" width="4096" height="2730"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>With no proven <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">cure or vaccine available yet for COVID-19</a>, various treatments with no proven benefits and potential deadly side-effects are being tried out on patients.One example of a desperate treatment measure is a New York City doctor carelessly declaring on primetime tv recently that COVID-19 pneumonia was similar to <a href="https://www.nepalitimes.com/latest/high-alert/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/high-alert/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGuDq-Ti_uWGlw-rY-q1PpyQQO54g">high altitude pulmonary edema (HAPE)</a>, and he recommended high altitude drugs like Diamox for the treatment of Covid-19.Trekkers in Nepal are familiar with <a href="http://archive.nepalitimes.com/news.php?id=19693#.Xp-oJy8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19693%23.Xp-oJy8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGSLnJg3LMR2gIcZz9LMdKOvruqJA">Diamox</a>, a pill they take to acclimatise better when hiking at higher altitudes. There is no scientific basis that the drug will work, but this idea of very low oxygen (hypoxia) and pneumonia in both afflictions was appealing.To counter this some of us in Nepal and other countries have a forthcoming Opinion in the British Medical Journalcautioning against this rash treatment strategy using high altitude medicines. In medicine, doctors have to remember the maxim, Primum non nocere (‘above all do no harm’).But there are some silver linings <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGtTkAInA3D5xIkzd65kTSfDvYESg">if Nepal escapes the worst of COVID-19</a>. <a href="https://www.nepalitimes.com/banner/tb/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/tb/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNGbOqrkOzN3uP_va7u0F-uhlxipaQ">Tuberculosis</a> rates, which are very high in South Asia (more than 400 per 100,000) could go down if people continue to use the masks since it will also mean that a tuberculosis patient will not spread the bacteria, not to mention other respiratory infections.Similarly, as more people get into the habit of washing hands with soap and water where available, the rates of diseases like typhoid and hepatitis A and E, caused by fecal oral transmission, will certainly be reduced.An average of <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHn0HGje-Tq3pDeekYbQAbhZxJOwg">230 people used to be killed every month</a> on Nepal’s highways and streets. The lockdown has now lasted a month, and that is approximately the number of lives saved due to vehicles being off the roads.The importance of public health for both the rich and poor countries has been highlighted by the pandemic. Industrialised countries had thought they had been done with infectious diseases, except perhaps the odd HIV patient. This pandemic has given great pause to that argument. Developing countries which having tried to come to grips with pre-existing epidemics have used lessons learnt in dealing with coronavirus in prevention.The Indian state of Kerala for example, has done relatively better in dealing with COVID-19 partly because it utilised prior lessons from the Nipah outbreak a year ago. Other South Asian countries with robust public health infrastructure like Sri Lanka also have a better handle on the disease.They strengthened their public health system, and it has paid rich dividends. South Korea too had an outbreak of MERS Coronavirus in 2015 which was brought by a South Korean returning from Kuwait, but they were able to effectively control the spread, and have been dealing successfully (so far) with the novel coronavirus. Singapore had been doing well, but discovered last week that it had a blind spot in the migrant workers’ dormitories. It has now announced a ‘circuit breaker’ lockdown till 1 June.South Asian countries have had more time in preparing for the contagion, while they wait for a vaccine or drugs to treat COVID-19. Treatment trials are happening all over the world even as the patients and doctors await with bated breath (pardon the pun). In all likelihood, we will soon know if chloroquin works or not before we have a vaccine.Vaccines will be a game-changer against Covid-19, and competition is heating up because whoever makes this vaccine first will be the knight-in-shining armour. China, USA, UK are probably a few of the countries engaged in developing a vaccine, and among them are researchers at Oxford University Clinical Research Unit who <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNHKJgZ_d-vQIhZ5sdehQmMT7iWvHQ">collaborated closely with Patan Academy of Health Science</a> in a recent successful typhoid vaccine study.This Oxford University group lead by Professors Sarah Gilbert and Andrew Pollard are optimistic about producing a million doses of the vaccine by autumn. The vaccine will be eventually required not in the millions, but in billions of dosages. It also has to be affordable for countries like ours.For making vaccines promptly for neglected tropical illnesses, it is hard to beat the Chinese. When <a href="http://archive.nepalitimes.com/news.php?id=19220#.Xp-nMS8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D19220%23.Xp-nMS8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEw-YGKhD3XomMEP736r5ileoWJ3g">Japanese Encephalitis (JE)</a> was raging in China and South Asia, it was the Chinese who tested, developed and made available the ‘Chengdu vaccine’ that revolutionised the prevention of the mosquito-borne disease. The earlier vaccine was expensive and only tourists in Nepal could afford it.Similarly, when <a href="http://archive.nepalitimes.com/news.php?id=18079#.Xp-m3S8w0Wo" data-saferedirecturl="https://www.google.com/url?q=http://archive.nepalitimes.com/news.php?id%3D18079%23.Xp-m3S8w0Wo&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNEndZvjwlu6D0uMBXFMGO9OgvSoXg">hepatitis E</a> was a scourge in China, the Xiamen Innovax Biotech came up with a vaccine in 2012 to protect vulnerable populations. Because there is no other commercial vaccine available against hepatitis E, it will be valuable in South Asia if the virus is rampant again and affect pregnant women with a fatal outcome.Nepal clearly needs to have a strong public health infrastructure in collaboration with a prestigious institute abroad to be able to tackle COVID-19 and other infections. Just like earthquakes, there will be more pandemics in future. Humanity needs to up its game in the control of emergent infectious diseases, and Nepal can make a small contribution by helping itself, especially by strengthening public health.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1587612692665000&amp;usg=AFQjCNFhARSUb8HMQP_ZJgsaTmPoQDLWvA">frequent health columnist</a> for Nepali Times.Prevention while searching for a cur

Prevention while searching for a cure

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110911110/636b7a719c7e80680e06475fjpeg.jpg" alt="" width="4096" height="2730"/><figcaption>Photo: BIKRAM RAI</figcaption></figure>We are in for the long-haul with <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">COVID-19</a>, as the rotating apex of the pandemic now jumps across the Atlantic to North America.Regardless of how this disease continues to play out this northern hemisphere summer, <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNGsF9kCG9HdHTkbHnhJCph-YXvjyg">we in Nepal</a> and elsewhere will still be dealing with it for the rest of 2020. All models predict there will be ‘hill and valley’ outbreaks as the epidemic peaks and falls.Widespread testing, <a href="https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/covid-19-revives-nepals-wash-drive/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNHYGCrEzyig3O9ciAuasBRIgLs7UA">hand washing</a>, physical distancing and masks in certain situations will certainly make a difference together with lockdowns of the kind we are going through.An effective vaccine will be the game-changer, but it is still at least a year away if we are lucky. In the meantime a potent  drug therapy antidote against this disease would be most welcome.Labs in China, Italy, France, USA, the UK and other countries are doing drug trials even as they deal with the onslaught of the disease. Once the disease is established, there is no other way but to do proper drug trials to treat the disease.The <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---27-march-2020" data-saferedirecturl="https://www.google.com/url?q=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---27-march-2020&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNGcLzzT197xKt0zj3Z9v_q9ITSVtg">World Health Organization (WHO)</a> has come up with an  innovative idea of carrying out what it calls a public health emergency ‘Solidarity’ trial – an international, randomised trial of hospitalised patients with COVID-19.This is ground-breaking because rich and poor countries will be involved in the study, and crucially, it is being carried out in the midst of the pandemic. There was a time when studies like these would be considered after the dust settled.Difficult as it may be, the pandemic is the best time to find a treatment so that more people can benefit. Large sample sizes are needed for conclusions from such a study to be robust and reliable. Findings from a trial using 100 patients will be less certain than a study which employs 1,000.Norway, South Africa, Argentina, and Iran among others have already signed up for the study which has just begun. The WHO is inviting many countries to participate in Solidarity trials so that the results can be generalised and trustworthy.Because the study is being carried out ‘in the heat of the battle’ WHO has kept the study very simple. The trial procedures are greatly simplified, and no paperwork is required. Once the institution has obtained national approval and informed consent from the patient, electronic data entry takes a few minutes.These modern studies using electronic data entry versus paperwork are really not new in countries in South Asia including Nepal which have taken part in state-of–the art collaborative studies before.This WHO COVID-19 trial has four drug arms: Remdesivir, Kaletra (2 anti-HIV drugs), Interferon and Kaletra, and Chloroquin or hydroxychloroquin. All patients will receive the standard of care in their country, and in addition will be randomised to  one of the arms.These drugs are not new and have been used against various viral and parasitical diseases in the past. For example, chloroquin has been used for many decades against malaria. Doctors will be familiar with these repurposed drugs and their side-effects which sometimes can  be worse than the treatment. Hence the importance of a robust drug trial.The final outcomes to determine which is the best choice, if any, among these four arms have also been kept clear-cut: number of deaths, ventilator use, and number of days in hospital.Because this is a WHO-lead practical study focusing on helping resource-limited settings, it is important that countries in South Asia including Nepal be involved. Funding may not necessarily be a problem.  Many countries in South Asia can at least be randomised to chlorquin or hydroxycholorquin which are not expensive to see if this drug works against COVID-19 or not.President Trump said he “felt good” about hydoxychloroquin, but this needs scientific backing which does not exist yet. The published French study that concluded usefulness of chloroquin had a very small sample size, did not report clinical outcomes and was not randomised to be scientifically sound.Similarly the Chinese study using Kaletra and recently reported in the <a href="https://www.nejm.org/" data-saferedirecturl="https://www.google.com/url?q=https://www.nejm.org/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNHGStErHdTfc8Gm40_rBDqZh_c9Mg">New England Journal of Medicine</a> also had shortcomings. Hence the need for a larger sample size which the WHO’s Solidarity trial is poised to do.In Nepal, the best-placed institution to help carry out such an important study with potentially multiple hospitals involved is the Nepal Health Research Council ( NHRC), a revered 30-year-old institution.True, Nepal has only three COVID-19 patients in hospitals right now, but the possibility of this number growing exponentially soon cannot easily be dismissed. It is best to get the practical research system in place, especially because the WHO will welcome the move, and may help with the process so that we may be better able to help our patients with useful, and not harmful, drugs.It will also give NHRC a chance to help nurture the talent of a young Nepali researcher to help drive this study in Nepal, coordinating with the different hospitals. This is an opportunity that should not be missed.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1585631034431000&amp;usg=AFQjCNE0aoyspsOeHIBjtexE2rB8xE3KOw">frequent health columnist</a> for Nepali Times.

Countries cooperating to find COVID-19 cure

Earlier this month, Nepal received Rs1.6 billion from the World Bank as part of its <a href="https://nepalitimes.com/news/will-nepal-ever-be-paid-for-saving-trees">Forest Carbon Partnership Facility (FCPF)</a>, rewarding the country for increasing its carbon sink capacity. Nepal is the first in South Asia to benefit from this facility, and it is specifically to recompense the country for increasing forest cover in 13 Tarai districts between 2018-2024. “We are also trying to get another Rs13 billion from the facility while also preparing for free market-based carbon trading in the international market,” says Nabaraj Pudasaini of the REDD (Reducing Emissions from Deforestation and Forest Degradation in Developing Countries) Implementation Centre. Big emitters of greenhouse gases are under pressure to reduce their carbon emissions, and many have signed agreements to do so by investing in decarbonisation projects in developing countries. Countries that emit more than a specified amount of carbon would be able to buy emission rights from countries that emit less. Nepal is internationally known for its community forestry program which has been largely credited for <a href="https://nepalitimes.com/banner/tree-mendous">increasing tree cover to over 45%</a> in less than three decades. But this achievement had not been adequately recognised or rewarded internationally before. Forests, especially in the tropics, absorb and store large amounts of carbon while releasing oxygen in a process known as photosynthesis. <a href="https://www.fao.org/forest-resources-assessment/en/">Preventing deforestation</a> and increasing canopy cover is considered a much more achievable goal than reducing emission in the scale necessary to limit global average temperature to 1.5°C above pre-industrial levels. COP11 in Montreal in 2005 first proposed reducing carbon emissions by improving forest quality by halting degradation. By 2015, a new mechanism of financial assistance was created to help less developed countries with sustainable management of forests <a href="https://www.un-redd.org/">(called REDD+)</a>. Under this new mechanism, countries receive aid based on their efforts to prevent forest degradation and increase carbon sink, and in 2021 the World Bank was entrusted with implementing it. Nepal’s FCPF receipt this month was calculated on the basis of 2.4 million tons of carbon stored at a rate of $5 per ton. In the second phase, Nepal will receive more than Rs4 billion within the next year for storing an additional 7 million tons of carbon. Eighty per cent of this amount obtained from carbon trading needs to be spent on local beneficiaries and indigenous communities.&nbsp; But carbon trading is not easy, Nepal needs to prove that protected forests will not be destroyed in future.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16.jpg" data-media-id="editor_4" data-image-id="20241121091132_c8a381c9a95aa86fec558951650d97bb87914741f01766982ba2b086af001f16" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="Greenbacks for greenery NT "> <figcaption>Photo: KUNDA DIXIT</figcaption> </figure>  Explains carbon trading expert Yugan Manandhar. “Forests should be handed over to the community and shown that they are managed sustainably. Proving this will be particularly challenging; forest encroachment and degradation is rife in the Tarai.” <a href="https://nepalitimes.com/multimedia/nepal-is-going-up-in-smoke">Deliberate forest fires</a> have also added to the challenge because they increase carbon emissions and reduce the sink capacity of forests. The basis for the amount that Nepal received was set five years ago by calculating the carbon reserves of forests in the 13 Tarai districts. In the meantime, sustainable forest management, tree plantation, forest destruction and erosion control were prioritised to increase carbon reserves in those forests. Nepal is signing another carbon trading agreement during the ongoing Baku climate conference. The <a href="https://www.leafcoalition.org/">Lowering Emissions by Accelerating Forest finance (LEAF Coalition) </a>proposes to sell the carbon stored in the forests of Bagmati, Gandaki and Lumbini provinces. For this, Nepal signed the letter of intent three years ago at COP26 in Glasgow. The target is to store 70 million tons of carbon in 32 million hectares of forest in the three provinces per which Nepal will receive Rs13 billion in four years at $10 per ton with provisions to increase the rate if various conditions are met. However, the agreement in itself doesn’t guarantee the amount. According to the targets set by Nepal, forest degradation should be stopped and carbon reserves increased by protecting tree cover. Preparations are also underway for clean air carbon trade because it has offset fossil fuel use by introducing 30,000 electric vehicles. Nepal has been selected for the first round to receive $40 million within one and a half years through the Clean Air System of the World Bank. Given that most of Nepal’s energy mix is from biomass, replacing them with electric stoves can significantly improve health by reducing indoor pollution as well as strengthen the country’s capacity for carbon trade. “Nepal's goal now is to sell carbon in the free market where carbon credits are bought and sold based on supply and demand in an open and transparent manner,” adds Pudasaini of the REDD Implementation Centre. “Nepal can now set its own price and bargain with interested buyer countries and organisations.” Lately, India has been discussing setting up a carbon market. Nepal has exported Rs12.72 billion worth of electricity to India so far this fiscal year, which can be traded under Nepal’s carbon market. “Carbon trading can create significant economic benefits for Nepal, which will help reinvest in development and environmental protection projects,” says Manandhar. “But we must prioritise sustainable management of forests, cutting older trees and allowing regrowth as well as promoting electric stoves and electric vehicles.”

Greenbacks for greenery

Khukri Rum is <a href="http://archive.nepalitimes.com/news.php?id=3719#.WurBk6SFPIU">one of Nepal’s most iconic brands</a>, and is now launching a new Cask Series premium product to sell in Nepal and abroad. The Cask Series Smoked Finish Khukri Rum is a limited edition with only about 7,000 bottles, most of it for export and rest to be sold to rum connoisseurs in Nepal itself. Each bottle is numbered and will mention the cask from which it is derived. “We are working on taking a classic Nepali rum to a new luxury premium brand category, the Cask Series will only be produced this year with new product ranges in future,” explains Subash Lamichhane, managing director of Nepal Distilleries that first started making Khukri rum in 1959 in Balaju and has never stopped. Fermented from molasses in Bara district in the Tarai after the annual sugarcane harvest, the rum is matured for at least eight months during distillation. The distillery bottles the classic Khukri XXX, Coronation Khukri XXX, Khukri White Rum and Khukri Spiced Rum.&nbsp; The distillery is now adding this limited edition of its ‘Cask Series’. While the original rum is stored in huge wooden vats, the rum used for this more exclusive line is in smaller casks made either from oak or sal, with charred insides to give the rum a smoky flavour. The Cask Series rum is indeed smokier than the classic, while the spiced rum tastes toasty and mostly of cardamom. The company has a tasting suite with a master blender and tasters who have to approve the palate test.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241122131124_10b8ddca93b37b0348bf964b4f09e7fac6ef4e754cca6231368850539cd558e2.jpg" data-media-id="editor_1" data-image-id="20241122131124_10b8ddca93b37b0348bf964b4f09e7fac6ef4e754cca6231368850539cd558e2" data-rendition-name="original" width="1498" height="1000" loading="lazy" alt="Khukri Rum"> </figure>  The packaging for the Cask Series is as special as the process. A sturdy patterned box that opens up to a black glass bottle with gold lettering, and an indication of which cask the rum is from. These are then shipped to premium customers around the world One of the reasons this is the more expensive premium line is because the casks are smaller than the vats and the blenders reject more than half of the rum in the casks when the aging period is complete. The trick for the blender is also to decide when to take the run out of the cask.&nbsp; Says Lamichhane: “If we have 25 casks, we expect to throw away about fifteen.”Over the decades, Nepal Distilleries have created and maintained a brand that feels quintessentially Nepali, and has served as Nepal’s ‘ambassador’ with exports to Germany, Korea, Belgium, Finland, the Czech Republic, besides the existing markets among Nepalis in the US, UK, Hong Kong and Australia. &nbsp;Its unique <a href="https://nepalitimes.com/here-now/khukri-rum-sharpens-its-act">khukri shaped bottle</a> first introduced for King Birendra’s coronation in 1975 has been a collector’s item. The bottle and rum have been a staple for Nepalis and visitors to take as gifts when they leave the country, and is used as decoration on bar tables around the world. Now, nearly 40 years later, even that bottle will soon be getting a makeover with a sharper design and sleeker handle. “Our bottle design has always been instantly recognisable, and it is,” says Lamichhane. The Himalayan restaurant at The Hague, for example, has a Khukri Coronation bottle adorning its bar (page 6-7). In Washington DC Himalayan Heritage Restaurant &amp; Bar offers ‘Nepalese Khukri Rum’ mojito in its drinks menu with fresh mint, soda water, lime juice and sugar syrup, for $12.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241122131124_b9474db3fc83c85845348dddc30c49652ee1f17229531867fa241de50849cedc.jpg" data-media-id="editor_3" data-image-id="20241122131124_b9474db3fc83c85845348dddc30c49652ee1f17229531867fa241de50849cedc" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Khukri Rum NT"> <figcaption>Christopher Armes, master blender of the Cask Series.</figcaption> </figure>  A distinct element of the award-winning <a href="https://nepalitimes.com/business/khukri-rum-gets-award">classic Khukri rum</a> is its burgundy colour from caramel sourced from cooking sugar and blended with the raw rum. The spirits are then stored in a warehouse with floor-to-ceiling vats. The vats are not just for storage, the wood in the vats imparts flavour into the rum, and removes a lot of the harshness. &nbsp; On a visit this week, the bottling room was just about to begin for the day and the production line was churning out different shapes and sizes of Khukri Rum bottles. Most of the process is automated, including screwing bottle caps, sticking labels, placing the government seal, and packaging. The only manual intervention is the quality control where bottles are held against the light to check for sediment and colour. A mural on the wall of the distillery in Balaju depicts the rum-making process. A lady slings sugarcane on her shoulder, the molasses is churned in a pot, water is channelled into the distillation process, cinnamon, cloves and cardamom are added to a container, and finally there is a bottle of the classic Khukri Rum against a Kathmandu backdrop.

Khukri goes premium with new rum

Turkish Airlines has introduced a new amenity kit collection designed in collaboration with French fashion house Lanvin for international business class passengers on flights more than five hours. It consists of five pieces designed for sustainability and elegance. Bags are reusable and will consist of Lanvin cosmetic products like hand and body lotions and lip balm. Eye masks and socks are made from recycled materials, earplugs are packaged in paper and the toothbrush is bamboo.

Turkish amenity kit

Nepal now generates a surplus of electricity and it is all from renewable hydropower. Nearly half the country is under forest cover. Despite meeting these decarbonisation goals, Nepal’s hydropower plants are threatened by increased risk due to climate impact.&nbsp; Till <a href="https://nepalitimes.com/editorial/when-it-rains-it-pours-ksqprbu3">28 September</a>, Nepal was <a href="https://nepalitimes.com/news/india-nepal-sign-power-exchange-deal">exporting just over 1,000MW</a> of electricity to power-hungry India, when flash floods and landslides unleashed by historically heavy rains damaged over 30 hydropower plants across the country, temporarily <a href="https://nepalitimes.com/news/power-to-the-people">slashing nearly half the power generation.</a> The 456MW Upper Tamakosi in Dolakha was the hardest hit and it will take six months and Rs2 billion to repair. This has significantly reduced exports as well as domestic generation. Two months later, Nepal has still not been unable to fully keep its export commitment, and is actually paying Rs100 million in fines to India. Thirty-seven existing and under construction projects under the Independent Power Producers' Association Nepal (IPPAN) suffered Rs2.5 billion in damage. One of them is the 22MW Bagmati project in Makwanpur which was almost completely buried in flood debris. Even before <a href="https://nepalitimes.com/news/60-dead-64-missing-in-nepal-floods">record-breaking rain in September</a>, 15 other hydropower projects had been damaged by floods. Last year, floods caused by heavy localised rain damaged 28 hydropower plants. World governments met in Baku for COP29 to discuss the Loss &amp; Damage Fund and the Adaptation Fund, but for countries like Nepal the commas and brackets are meaningless until they are turned into $ and €. And likelihood of adequate compensation for climate-related damage is a long way off, if ever. Nepal’s national strategy is to use its vast hydropower resource as clean energy to spur economic growth, job creation, and boost export revenue. But the plants are located in narrow Himalayan valleys prone to landslides and floods even at the best of times. Now, those <a href="https://nepalitimes.com/opinion/comment/changing-climate-for-investment-in-nepal">risks have been heightened by weather extremes</a> due to climate breakdown. At present, Nepal generates over 3,300MW of clean hydropower, and the target is to reach 12,700MW in the next five years. Projects equivalent to 6,000MW are under construction or ready to start. The Ministry of Energy, Water Resources and Irrigation has an Energy Development Roadmap and Action Plan with the target of producing 28,500MW by 2035 by when more than half of it will be exported.&nbsp; “The climate crisis will further change the rainfall patterns making hydropower generation a big question mark in the future,” Manjeet Dhakal in Baku, who is also the Nepali adviser to the LDC Chair at the United Nations Framework Convention on Climate Change (UNFCCC). “We are building hydropower projects on rivers without evaluating risk. This whole process needs to be reviewed and reconsidered.” The report of the National Adaptation Plan published by the Ministry of Forest and Environment last year mentions that hydropower production, transmission and distribution will be at risk from flash floods, debris flows, glacial lake outbursts and rising temperatures.&nbsp; This risk is not confined to Nepal. Average global temperatures have increased by 1.3°C compared to the pre-industrial era. Worse, the Himalayan mountains are warming faster than the global average by 0.7°C because of elevation-dependent warming. A study conducted by our own Department of Hydrology and Meteorology in 2017 showed that the average temperature in Nepal has increased in the last four decades. Scientists say this is leading to extreme weather unleashing floods and landslides on slopes already destabilized by seismicity.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241124071128_d22901a360e8958f606d80ffa21defba05a671f65afec65539dc21a6885d8345.jpg" data-media-id="editor_5" data-image-id="20241124071128_d22901a360e8958f606d80ffa21defba05a671f65afec65539dc21a6885d8345" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="Right climate for Nepal’s energy transition NT"> <figcaption>BIBLICAL RAIN: Photo taken during catastrophic rain on 27-28 September at the Upper Tamakosi project site that destroyed the control room, killing four staff and burying the sedimentation tanks. Photo: RSS</figcaption> </figure>  Increased atmospheric temperatures has made the monsoon rains more erratic. It does not rain when it is supposed to, and it comes down in torrents when it is not supposed to. The September floods happened two weeks after the monsoon was supposed to retreat from central Nepal. Kathmandu Valley received half its annual precipitation in just over a day. &nbsp; Winter precipitation has also failed, especially in the high mountains and trans-Himalayan valleys. Thirteen of the past 19 years experienced winter drought. This impacts on dry season flows of the rivers, reducing hydropower generation. Nepal’s power capacity normally goes down by one-fourth during winter, but the gap is widening. The Kabeli corridor could only generate 20MW November-March even though plants there have an installed capacity of 200MW. Similarly, Upper Tamakosi only produced 65MW at most against its 456MW capacity last winter. The Nepal Electricity Authority (NEA) pays producers double the price for winter electricity, Rs8.40 per unit. Even though winter operation is highly profitable the rivers run low and NEA has to import from India to meet the winter demand. “This is not just a weather problem but a serious challenge also for the country's energy future, good climate-friendly design should be combined with policy and effective implementation,” says Subarna Das Shrestha, a hydropower investor and CEO of Sanima Mai Hydropower. “Insurance premiums have gone up as well, and settlement for damage is not timely.” <a href="https://nepalitimes.com/opinion/climate-risk-to-hydropower-investment">Hydropower investment</a> at one time was regarded as having a high rate of return. Now, some investors have become <a href="https://nepalitimes.com/banner/climate-smarter-himalayan-infrastructure">wary of the risks involved</a>. Says IPPAN’s Uttam Blon Lama: “Hydropower projects expected to give stable returns are now looking risky. Not only is climate adaptation design and planning expensive, but future repair and maintenance costs will also skyrocket.” Nepal has only one storage type dam <a href="https://nepalitimes.com/multimedia/rivers-be-dammed">in Kulekhani</a> and another one is being built in <a href="https://nepalitimes.com/multimedia/missing-pieces-of-the-hydropower-jigsaw">Tanahu</a>, but they are also at risk. In September, the sluice gates of Kulekhani Dam had to be opened causing loss of life and destruction downstream. Nepal has to learn lessons from the deadly collapse of the $1 billion <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">Chungthang Dam in Sikkim</a> in October 2023 cause by a glacial lake burst. Glacial Lake Outburst Floods (GLOFs) in Nepal pose potentially catastrophic risk to infrastructure. The <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">Thame flood in August</a> was a relatively minor debris flow that damaged half of this village in the Everest region when <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">two glacial lakes at 4,760m burst</a>. Luckily there was no loss of life. Of the <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">47 high-risk glacial lakes</a> in the eastern Nepal Himalaya, 21 are in Nepal and the rest are in rivers in China that are tributaries of the Arun and Bhote Kosi where Nepal has major hydropower plants under construction, or planned.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241123021128_b596cd8520c57a6c5476031e7a3ea6510f26b464c4d5351d2bc10f6f7d6b70d8.jpg" data-media-id="editor_14" data-image-id="20241123021128_b596cd8520c57a6c5476031e7a3ea6510f26b464c4d5351d2bc10f6f7d6b70d8" data-rendition-name="original" width="871" height="648" loading="lazy" alt="Page 10-11 map #1236 NT"> </figure>  Global temperature rise is accelerating the melting of Himalayan snow and ice, increasing the <a href="https://nepalitimes.com/here-now/living-below-nepal-s-melting-mountains">number and size of glacial lakes</a> so that we do not even have names for them. Imja Tso did not even exist in the old trekking maps until 25 years ago, but is now a 2km long lake. “Natural moraine dams in the mountains are weak, and the projects downstream can face major destruction if they burst, and the risk will only increase in future,” warns climatologist Arun Bhakta Shrestha at the <a href="https://www.icimod.org/">International Centre for Integrated Mountain Development (ICIMOD)</a>. <a href="https://nepalitimes.com/here-now/terrifying-assessment-of-a-himalayan-melting">An ICIMOD assessment in 2019</a> projected that if present heating trends continue, as they probably will, the Himalaya will lose two-thirds of our glaciers by the end of this century. “Generally speaking, hydropower developers hand over the project to the government after 30 years but by that time given the climate risks, they may not be an asset anymore,” says Manjeet Dhakal. Indeed, the cascade of expensive projects India is building on the Arun River are supposed to be handed back to Nepal in 25 years, but there is a big ‘if’ about whether they will survive that long. &nbsp;&nbsp; Planning of hydropower projects is still based on historical hydrological data, and does not take into account future temperature rise and its consequences. Investors, on the other hand, say that planning hydropower projects with climate components would make them even more expensive.&nbsp; “It’s not that we aren’t preparing for climate risk, we design keeping in mind the once-in-100-year flood,” says Blon of IPPAN. “But if we start designing based on once in 1,000 years flood, the cost would be so high that we won’t be able to build them at all.” Nonetheless, Subarna Das Shrestha of Sanima Mai Hydropower says that there is no option but to go for climate smart infrastructure despite the higher cost. Sanima Mai's powerhouse, for example, is completely underground. The strategy could also be to spread the risk by building less expensive plants located on rivers all over the country. Nepal is also diversifying away from its sole reliance on hydroelectricity, which at present supplies 92% of the power in the grid. Most of the rest comes from solar plants, where the total potential has not even been scratched. &nbsp; This article is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758.jpg" data-media-id="editor_21" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>  &nbsp;

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