<figure><img width="1334" height="889" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14189c7e80680e0a995ejpeg.jpg" alt=""/><figcaption>Children aged 12-17 started getting inoculated with the Pfizer BioNTech Covid vaccine in Kathmandu on Monday. Photo: AMIT MACHAMASI</figcaption></figure>Not long ago, <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">to boost or not to boost </a>was the dilemma of rich countries, even as developing nations were struggling to vaccinate their frontline workers and elderly with the first dose.
The argument <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">has now reached our part of the world</a>, with some health experts even in Nepal recommending boosters shots for the immune-compromised and frontline workers. In fact, the government’s Teaching Hospital and a few others in Kathmandu this week administered a third booster shot to some patients suffering pre-existing diseases.
The recommendation has been met with some conflicting opinion at a time when only a little over 30% of Nepal’s target population has been fully inoculated against Covid-19. While over half the people in densely populated urban centres like Kathmandu have been vaccinated, parts of rural Nepal are still largely unable to access jabs.
“Our first and foremost priority must be to vaccine everyone, and if we have plenty more vaccines, which we are more than likely to have, the next step is to provide booster shots to people with co-morbidities and the elderly,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.
Infectious disease specialist at HAMS hospital Anup Subedee agrees: “If the question is what is more advantageous in terms of controlling the pandemic, vaccinating the unvaccinated or offering booster shots, the answer is to vaccinate everyone first.”
Having said that, Subedee adds that Nepal should provide the third dose of VeroCell to individuals who were inoculated with the Chinese vaccine, for higher efficacy, as recommended by the World Health Organisation (WHO).
The concern about boosters is mainly because antibody levels decline significantly after 6-9 months of being inoculated, as proven by studies around the world. And as one of the first countries in South Asia to start its Covid-19 vaccination drive, it has been six months since<a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer"> frontline workers</a> were given jabs.
Some experts, however, say that the human body provides protection also from so-called ‘memory cells’ so that even if vaccine immunity drops, the T and P cells which produce antibodies only when a pathogen attacks. There is no exact estimate of how long the memory cells provide protection, but it is most likely long-term, which means the general population may not need booster shots just yet.  
Those who recover from Covid-19 are even better placed to ward off the infection and its complications, with natural immunity being more effective than that gained by vaccination. And according to the recent seroprevalence survey, over two-third of Nepalis have SARS-CoV-2 antibodies that provide them natural immunity.
“Given that 68% of people in Nepal have some form of protection and a significant chunk of the population is fully vaccinated, we don’t have to worry about boosters yet. Our infection rate, hospitalisations and morbidities have all largely declined,” says Sameer Dixit of the Centre for Molecular Dynamics Nepal, which conducted the seroprevalence survey.
The new surge in Europe has been associated with the Delta variant, which has already swept through every corner of Nepal and India, which means a majority of the people here have developed some immunity against it.
“So, we don’t have to panic about another major surge as of now,” Dixit adds.
This is <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">not to say Nepal is out of the woods</a> yet. With a declining number of daily cases and fatalities, schools have reopened, there are wedding parties, crowded marketplaces and indoor seminars are happening all over the country.
Safety measures must be maintained despite higher vaccination rates and declining hospitalisations. This means, continuing to mask up, avoiding crowds and maintaining distance -- especially with the onset of winter and the seasonal risk of coronavirus, influenza and pneumonia infections. There are already reports of students, parents and teachers in Kathmandu schools testing positive for Covid-19.
The government had <a href="https://www.nepalitimes.com/latest/pfizer-vaccines-arrive-in-nepal/" target="_blank" rel="noopener noreferrer">set aside Pfizer </a>vaccines for the immunocompromised, but a lack of uptake meant that students up to age 12 are now being offered the US-made vaccine that has been certified for children.
Shyam Raj Upreti, Nepal’s focal person for the Covid-19 vaccine maintains that the government will start administering booster shots only after nearly 100% of the targeted population has received its first dose, the figure currently stands at about 40%.
Nepal has so far received 25 million doses of vaccines in <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">donations or purchase</a>, 30 million more are in the pipeline. “We now have more than enough vaccines for our targeted population, and we are now starting with students,” says Upreti. “The new challenge is to increase vaccine acceptance among those who have so far refused to take it.”
Although surveys have shown that 97% of Nepalis trust vaccines, many pregnant women and those with co-morbidities are refusing to get shots, <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">fearing side-effects</a>.
Experts caution that Nepal’s response to the pandemic needs to <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">extend beyond vaccinations</a>. The country has to be prepared for a possible surge, and this means contact tracing including the testing of the children, stringent quarantine and isolation, well-equipped health infrastructure and trained medical staff to operate them.
“Another surge might not be a major one but it could still be on a scale sufficient to significantly impact our economy and lives,” adds Anup Subedee. “So we have to be prepared. But a lot of it boils down to political will, and an efficient bureaucracy that is focused on controlling the pandemic.”
Indeed, Covid-19 is here to stay which means continued vigilance and precautions like <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">masking and physical distancing</a>. Warns physician Buddha Basnyat: “Covid-19 is a wily virus, and it is still a formidable foe. We can’t let down our guards yet.”

Sonia Awale

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Do Nepalis need Covid booster shots?

How Nepal must prepare for 3rd Covid wave

<figure><img width="1500" height="970" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110111156/636cd8d39c7e80680e092e63jpeg.jpg" alt=""/><figcaption>Photo: UNICEF</figcaption></figure>After immunising over 1.6 million Nepalis against Covid-19, the government now plans to administer the rest of the 600,000 jabs that it has in stock for second doses starting 20 April. But it needs at least another million shots to cover all those who inoculated in the first and second phases, as well as to complete the inoculation of those 55 years and above.The Health Ministry is banking on the remaining 1 million doses of the AstraZeneca Covidshield that it purchased from the Serum Institute of India. That consignment was not delivered on 15 March as promised after an Indian court banned export of vaccines before demand at home is met. The next batch of Covishield vaccine under the COVAX initiative is also not expected before May. However, the current suspension of vaccinations in Europe, Thailand and other countries may ease the worldwide shortage somewhat. “We will go ahead with second doses as planned, but the third phase aimed at the age group 55-64 will depend on vaccine availability and as of now we don’t have dates on when they are arriving,” admits Shyam Raj Upreti, head of the Government Covid Vaccine Strategy told Nepali Times.The Chinese government, on the other hand, has increased its gift of Sinopharm vaccines to Nepal from 500,000 to 800,000, but China has insisted that Nepal send a plane to collect it from Beijing.The shortfall in supply and procurement challenges forced the Health Ministry to allow private companies to import vaccines, including the Covaxin manufactured by Bharat Biotech in India. “The private sector can help bridge the gap in procurement limitation as well as allow people with the means and the interest to get vaccinated, but all this must be monitored and regulated,” says Sher Bahadur Pun, a virologist at the Teku Hospital.Average coverage was 73% of the eligible population in the first two phases, all of them with the Covishield AstraZeneca vaccine. However, media reports of the suspension of that vaccine in European countries this week due to fears of blood clot among some recipients may increase vaccine hesitancy in Nepal. The suspensions have baffled public health experts who warn that there is neither enough data to justify the decision, nor adequate evidence to blame blood clots on the vaccine. The fact that there have been no serious side effects in Nepal had increased the acceptance level of the vaccine in the public and among frontline health workers in Nepal. “The EU might have different standards from ours but it might be a good idea to monitor serious side effects,” says epidemiologist Lhamo Yangchen Sherpa. “However, the vaccine has been safe in this part of the world, so its benefits far outweigh the risk.”Some experts think the suspension of the vaccine campaigns in Europe may actually be a blessing in disguise for Nepal, which is facing delays in shipments of Covishield it ordered as well as remaining doses under the COVAX initiative from the Serum Institute. That delay and the heftier price tag was blamed on a rise in global demand. So far, the government has only administered Covidshield in Nepal and health authorities here see no reason to discontinue the vaccine without a real causal link between AstraZeneca and the blood clots.“The EU decision to suspend AstraZeneca is very random and counterproductive, it was probably influenced by politics,” says Buddha Basnyat of the Patan Academy of Medical Sciences. “There is evidence this vaccine is safe and protects us specifically from severe symptoms of Covid-19.”Meanwhile, reassured by the vaccination drive and a dramatic drop in infections, Nepalis have gone back to normal, and many have forgotten about precautions. With parts of India hit by a second wave with over 37,000 new cases and 171 additional deaths on Wednesday, experts have advised the Nepal government not to let up on communicating the need to mask up and avoid crowds. “Officials here have stopped testing and are focusing only on vaccinating but even those who have been inoculated must remember that they can still be carriers,” Lhamo Yangchen Sherpa told Nepali Times from Achham. “We have to continue to take safety precaution as if the pandemic is not over, which it is not.”

1.6 million vaccinated, 20 million to go

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd779c7e80680e08bc80jpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>So far, 450,000 Nepalis have received the first dose of Covishield, reaching 85% of the target group in the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first phase of the country’s Covid vaccination drive</a>.Starting 7 March, 3.7 million Nepalis above 55 who make up 12% of the total population will get their shots against SARS-CoV-2. Teachers, students, bus drivers and other groups will also be included in the second phase.On the paper, Nepal looks like it is in a <a href="https://www.nepalitimes.com/latest/nepal-braces-for-new-wave-with-vaccine-drive/" target="_blank" rel="noopener noreferrer">better position with vaccination</a>, especially given that more than 100 countries <a href="https://www.nepalitimes.com/latest/90-in-poor-countries-will-miss-covid-vaccinations/" target="_blank" rel="noopener noreferrer">have yet to receive</a> even a single dose.“We have to applaud the government for its effort in bringing the vaccine earlier than expected and for rolling it out efficiently,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Nepal will be among the first countries to take the vaccine to the majority of its population with the second phase in early March.”However, the vaccine campaign has been plagued with <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">hesitancy and denial</a>. Even doctors and nurses were reluctant to inoculate themselves, resulting in a  low uptake. Failure to communicate, allay concerns about side effects, and ensuring access in remote areas were the main roadblocks to better coverage.“The very fact that the vaccines arrived in Nepal <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">much earlier than we anticipated</a> and once it did, we had to use it on the fly with the pandemic still going on, leaving us without a proper communication strategy,” admits Buddha Basnyat of the Patan Academy of Health Sciences.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">Covishield</a>, developed by AstraZeneca Oxford University and manufactured by the Serum Institute of India is being used in the UK, the EU, India with Australia starting their vaccination soon. With the efficacy ranging from 70-80%, 0.5ml of 2 doses 4-12 weeks apart, the jab has been deemed safe with no severe reactions or any death.In the recent past, local governments used to deploy Tole Health Promoters (THP) in neighbourhoods before a vaccination drive for measles, polio and other infections to address the public’s safety concerns.Another effective communication tool would have been the use of social media platforms and mass media to increase awareness about the vaccine as well as promote its use. Elsewhere in the world, prime ministers and presidents being inoculated were being televised live. Celebrities took to the Internet to share their experience of vaccination.“Someone like Nirmal Purja would have been best to promote the campaign and increase the acceptance of the vaccine in the masses with his legions of followers,” says Sher Bahadur Pun, a virologist at the Sukraraj Tropical and Infectious Disease Hospital.Basnyat agrees that Purja with his <a href="https://www.nepalitimes.com/latest/nims-purja-does-it/" target="_blank" rel="noopener noreferrer">international mountaineering fame</a> and Gurkha commando background would have also bolstered Nepal’s vaccine diplomacy. “He could be our brand ambassador to take up our case to aid agencies given the UK’s stand on vaccine equity while also backing India’s interest to promote neighbourhood first policy with vaccines,” he added.The government has approved the second dose to be given anywhere between 8-12 weeks of the first one, prioritising vaccination of as many vulnerable individuals as possible before that.But the availability of the vaccine will be the main concern as we move on to the next stage of the campaign. With the 1 million dose Covishield <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/" target="_blank" rel="noopener noreferrer">grant from India</a> in January, another 2 million that Nepal purchased this week from Serum Institute of India, 2.25 million (with the first 300,000 arriving first) under the COVAX initiative, and 500,000 doses of Sinopharm from China, the government has a stock of close to six million doses.  This means 3 million can be vaccinated soon.“The second phase is as challenging as it is important. But this is also the group likely to have a higher chance of reaction, so we need to be prepared locally to manage them,” says Shyam Raj Uprety, head of the government’s Covid vaccine strategy. “It is crucial to communicate different types of side-effects and explain that they signify that the vaccine is working.”Around the world, the total number of new coronavirus cases and fatalities is dropping. Although India has reported spikes in some states and Nepal will have to keep a close watch on New Delhi, Uttar Pradesh and Bihar, Nepalis have most likely developed localised immunity.A Nepal Health Research Council study has revealed that over 45% of hospital staff had developed antibodies by December, adding to the view that we are nearing herd immunity.“Once we have vaccinated a larger risk population, even if there is a second wave, it is unlikely to impact much because the group who were getting seriously sick will be protected,” adds Dixit.But even with the vaccine, Nepalis will still have to continue precautions. There is still uncertainty about duration of immunity, and whether vaccinated people can spread the virus.Says Basnyat: “This has been a pandemic of misinformation, we have to negate that with public engagement. Good thing is that Nepal can draw inspiration from past successful vaccination drives and can become a model for others.”<h2>Everything you wanted to know about vaccines</h2>Recently Nepali Times spoke with three experts with frequently asked questions from readers regarding the Covid-19 vaccination drive in Nepal.Excerpts of interviews with Virologist Sher Bahadur Pun at the Sukraraj Tropical and Infectious Disease Hospital, Shyam Raj Uprety, head of the Government Covid Vaccine Strategy and Sameer Mani Dixit of the Centre for Molecular Dynamic Nepal:<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636ccd7b9c7e80680e08bc81jpeg.jpg" alt="" width="1160" height="350">What are the precautions one should take before and after the vaccine?Sameer Mani Dixit: Covishield, the Covid vaccine we are using, is an intramuscular injection, 0.5ml in two doses 4-12 weeks apart. It is administered by a professional and after the jab, one will feel mild pain in the region.What’s the efficacy rate of the vaccine and how long does it work?Covishield has been used in the UK, EU, India and many other countries, Australia is getting ready to use it. It has passed phase 3 clinical trials with over 12,000 volunteers without any severe reactions or any death. The efficacy ranges from 70-80%.Once a person is vaccinated, there are antibodies that the body produces and then there are memory T and B cells. The lifespan of antibodies is about 3-6 months but we don’t know about the duration of the memory cells since the vaccine has just been developed. The assumption is that it will work from anywhere between 9-12 months but we will know for sure once people who have been vaccinated pass that stage.Do we have to get the same vaccine for the second dose?Ideally, the manufacturers of the vaccine suggest we take the same for both doses. But there are instances you may be able to take a second dose from a different company.Do people who have recovered from Covid-19 need to vaccinate?Sher Bahadur Pun: We don’t know exactly how long does the natural infection protect the body. The rough estimation is between 3-6 months. But it varies from one individual to another so it is recommended that people take the shot. Also, two doses provide longer protection.Can breastfeeding mothers take the vaccine?Manufacturers of Covishield have suggested pregnant women and breastfeeding mothers against taking this vaccine. But Nepal government recently said that those breastfeeding for six months or more could take it, but we don’t have concrete data yet so we don’t recommend it.How can people with vulnerable family members get them vaccinated?Shyam Raj Uprety: We identified health workers as the most vulnerable. We vaccinated them at their nearest convenient place. We will do the same for the next vulnerable group, take the vaccine to the communities.If someone is not on the priority list but still wants to get vaccinated, how can they get it? Can it be bought?It is unlikely for people who are not listed as the priority to get the shot. It is being administered for free for the priority group individuals and cannot be bought in the market. But after the most vulnerable are covered, the vaccine could be made available by the private sector.

Nepal fights infodemic to push vaccine

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Do Nepalis need Covid booster shots?

How Nepal must prepare for 3rd Covid wave

1.6 million vaccinated, 20 million to go

Nepal fights infodemic to push vaccine