<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1e259c7e80680e0af3f5jpeg.jpg" alt="" width="1524" height="1000"/><figcaption>The 4.1 million doses of Moderna and J&amp;J vaccines sent by Germany via COVAX facility arrived in Kathmandu this week. Photo: UNICEF</figcaption></figure>Till a few months ago, Nepal was struggling with a critical shortage of vaccine doses, and the situation was so dire that the 1.4 million senior citizens were <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">waiting past the due date for their second doses</a>.How the tables have turned. Today, the vaccine stockpile is so large that there is a danger of vials having to be destroyed because of the lack of refrigerated storage — and there are millions more vaccines in the pipeline.“There is no shortage of vaccines anymore, there are millions of doses in stock and we now need to inject them into arms as soon as possible,” says Buddha Basnyat, a physician at the Patan Academy of Medical Sciences.“The best strategy now is to continue inoculating those who haven’t yet been vaccinated while simultaneously also administering boosters, given the decreasing antibody levels and the rise of new variants,” he adds.Health experts are now recommending that the Nepal government also <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">start booster shots for high-risk populations</a> such as the immuno-compromised, senior citizens and frontline workers. They urge better planning and clarity from the government about booster shots, and who should get them to prevent influential people from jumping the queue, or misusing the doses.So far Nepal has got 20 million doses of vaccines, and has used an estimated 10 million. In the next three months, the country will be taking delivery of over 34 million doses of AstraZeneca, Coronavax, VeroCell, J&amp;J, Moderna and Pfizer vaccines. This week alone, Germany sent 4.1 million doses of Moderna and J&amp;J vaccines via the COVAX initiative. It also supported the procurement of ultra-low temperature freezers.But it is not only the lack of storage facility and nearing expiry date that validates the logic behind booster shots. Studies have shown that the antibody levels afforded by vaccines and natural infections wane significantly over time. The memory cells also provide immunity against the infection, but there is uncertainty about how long that lasts.“From the perspective of science, a booster dose is necessary especially with <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">Omicron in the picture</a>, boosters have been shown to significantly reduce hospitalisations” explains Lhamu Yangchen Sherpa, an epidemiologist with IPAS Nepal.She adds, “However, we in Nepal have a moral dilemma because a majority of our population haven’t yet received even a single dose. We need to balance this and come up with protective mechanisms that will save the most lives.”Indeed, despite adequate vaccines in the stock and millions more in the pipeline, only 30% of Nepal’s target population have been fully vaccinated against Covid-19. Some 36% have been partially inoculated.Some of Kathmandu’s hospitals are starting to observe an increase in hospitalisations, severity and deaths among people who had been fully vaccinated six months ago. This makes the case for boosters, starting with those with co-morbidity, or those above 60.“This can be an early warning for what is in store for us, the best way to prevent future surge is proper management and distribution of the vaccines we have,” says Sher Bahadur Pun, a virologist at Kathmandu’s Teku Hospital.“Nepal’s priority remains <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">vaccination for all</a>, but this does not mean we leave those who have taken two doses to die. Individuals above 60 and those more vulnerable to Covid-19 must get boosters on time and that is now,” Pun adds.Going by this week’s figures, Nepal is registering on an average of 260 new Covid a day with the positivity rate at 2.3%. While this figure is not as alarming as <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave in April-May</a>, the arrival of the Omicron variant is of serious concern.The new variant has been credited for a steep increase in the number of infections across the globe. The UK reported over 76,000 cases a day on Wednesday, and the WHO has warned that Omicron is spreading at an unprecedented rate across the world.“The new variant while comparatively less virulent than the Delta is at least two to three times more transmissible, which means it can still cause a significant number of deaths given the higher number of infections and more morbidity, underwhelming our health infrastructure,” warns Anup Subedee, infectious disease specialist at HAMS hospital.“It may not lead to another big surge like the second wave but we have to be on a high alert,” he adds.Nepal’s poor health infrastructure is not <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">fully prepared for another spike</a> in infections. While doctors and nurses may have experience with the pandemic, and city hospitals are mostly well-equipped, ventilators are gathering dust due to the lack of skilled workers to operate them. New oxygen plants have not been monitored properly, and ICUs do not have enough trained nurses.“Everything Covid wise is now under control, we haven’t had a single case in the last two weeks but we are no better prepared,” says Binod Dangal of Charikot Hospital in Dolakha District. “If there is another wave, we are done for. <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">Our equipment is not functional</a> and we don’t have trained staff either.”There is once again a false sense of security, and the public cannot wait to go back to pre-Covid days with marriage parties, political conventions, packed classrooms, and crowded markets. For the foreseeable future, experts say we must continue to mask up and follow safety protocols despite the vaccine rollout, especially with the rise of new variants.Says physician Buddha Basnyat: “The mask is the best vaccine. It is cheap and effective, while we attempt to vaccinate everyone and give boosters.”

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From scarce vaccines, to storage shortage in Nepal

<figure><img width="720" height="480" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14819c7e80680e0a997ejpeg.jpg" alt=""/><figcaption>A student being administered the Pfizer BioNtech vaccine last week in Kathmandu. There are questions about the efficacy of current vaccines against the Omicron variant. Photo: AMIT MACHAMASI</figcaption></figure>The new Omicron coronavirus strain that is spreading concern about a new surge of the pandemic has not been detected yet in samples tested this week in Nepal, but virologists urge <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">caution and stricter enforcement of precautions</a>.  The variant B.1.1.529, also known by the Greek alphabet Omicron, is said to have evolved in southern Africa, and has already been detected in Hong Kong, Belgium, the UK, Czech Republic, Italy, Germany and the Netherlands.Israel, in fact, now requires all foreign travelers to quarantine for two weeks. Nepal on Saturday announced restrictions on travelers from six southern African countries as a precaution.  A private lab which had been conducting genetic sequencing tests on about 50 samples every week from Kosi, Bheri and Teku hospitals, so far has found only the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> and not the Omicron strain. Nepali health experts say it is too early to speculate about the <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">new variant</a>, and making a judgment on response. But they advise even stricter adherence to precautions.“Let’s not panic but prepare, Omicron has spread faster in South Africa but it is also the relatively less vaccinated region,” says virologist Sher Bahadur Pun at Teku Hospital. Only 24% of South Africans have fully inoculated against Covid-19, 28.7% are partially vaccinated. Nepal's figures are only slightly better at 27.4% and 31.6% respectively. It is only because of advances in genetic sequencing technology that a new coronavirus strain is identified in South Africa on 24 November and within four days was designated as a variant of concern by the WHO. Already, Omicron has become a household word, synonymous with a new, possibly deadly, <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">phase in the Covid-19 pandemic</a>.South Africa, where daily cases spiked from 200 to three times that number, have called the travel bans unnecessary and hasty, and that the new variant was not making people seriously sick. But preliminary evidence suggests an increased risk of re-infection, immune escape, and lower vaccine efficacy because of multiple mutations in its spike protein.
“The new strain seems to be spreading fast but what we need to look at is what is happening in countries where Delta has established itself as the dominant strain and that data will determine if it is stronger or more lethal in Nepal,” says Sameer Dixit of <a href="https://www.cmdn.org.np/" target="_blank" rel="noopener noreferrer">Centre for Molecular Dynamics Nepal</a>. “We need to wait a couple of weeks to see if Omicron will replace Delta, overspread, co-exist, or do nothing.”
Dixit’s Centre has partnered with the <a href="https://bnmtnepal.org.np/" target="_blank" rel="noopener noreferrer">Birat Nepal Medical Trust</a> in the EPIINTEL Initiative under the supervision of Nepal Health Research Council to monitor the genetic composition of new variants in the country.
The fact that the new variant has over 30 mutations in its spike protein is a cause for concern. Most current Covid vaccines might be rendered ineffective, except for the Chinese VeroCell and <a href="https://www.nepalitimes.com/latest/jabs-and-jab-nots/">Indian Covaxin</a> which are made from the inactivated virus, and do not only target spike proteins. Experts recommend keeping a close eye on countries that primarily administered VeroCell to monitor their response to Omicron.
Similarly, it is yet to be seen how the new variant will affect people with <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">natural immunity</a>. While initial reports point to an increased risk of re-infection, those who have previously recovered from Covid-19 will have antibodies against all proteins, not just spike protein, unlike vaccinated individuals.
Given that most vaccines against Covid-19 including Pfizer, Moderna, J&amp;J and AstraZeneca primarily target the spike protein, chances are that these jabs will be significantly less effective against variant B.1.1.529. 
Even if the re-infection rate is high, it doesn’t mean severe symptoms. The WHO previously designated Gamma and Beta strains as the variants of concern, but these did not spread much and caused only mild symptoms – before the arrival of the deadlier Delta strain.
Nepal has 30 million new doses of different vaccines in the pipeline, and the government is inoculating everyone from 12 years and above with the <a href="https://www.nepalitimes.com/latest/pfizer-vaccines-arrive-in-nepal/" target="_blank" rel="noopener noreferrer">Pfizer jabs</a>. The new challenge is to increase intake among those who have so far refused to be inoculated such as pregnant women, new mothers and those with co-morbidities – and after that to <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">start administering booster shots nationwide</a>. 
Pun adds: “Now that the Omicron strain is here, our priority should be to <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer">vaccinate as many remaining people as possible</a>, especially because people have started becoming complacent due to the declining number of Covid cases. We must be on high alert and follow safety precautions and genetic sequencing of the variants.”
Adds Sameer Dixit: “We are at a very early stage, but a travel ban is not the way to prepare for what might be ahead. The restrictions can only do so much, at best it prevents early transmission but once the virus is in, it won’t take long to overwhelm the health system as we saw during the second wave. So we must up our vaccinations, keep distance and mask up. That is the only way.”

Nepal on high alert for Omicron

<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

Do Nepalis need Covid booster shots?

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d02409c7e80680e0a366fjpeg.jpg" alt=""/><figcaption>High school students sit for exams in Adarsha Azad College in Bhaktapur on Wednesday. Schools in Kathmandu Valley were all set to restart in-person classes from next week before authorities decided to put off the citing that new Covid-19 cases have not dropped as expected. Photo: AMIT MACHAMASI.</figcaption></figure>UPDATE: The Kathmandu District administration on Thursday decided to put off the reopening of in-person classes, citing that new Covid-19 cases have not dropped as expected. On 5 September, for the first time in nearly five months, there were less than a thousand daily new Covid-19 cases. Since then, new infections per day have mostly stayed below 1,500. The rate of infection is also dropping below 9%, and schools in Kathmandu which have remained closed for nearly two years are <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">scheduled to reopen </a> rom next week. Cinema halls, bars and clubs are already up and running as if it is all over. In fact, most Nepalis seem to think the pandemic is over. <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">But it is not</a>. The infection rate is still several times higher than most parts of the world, and with the festival season around the corner there is a danger of a repeat of last year.<a href="https://www.nepalitimes.com/latest/face-to-face-classes-online/">Face-to-face classes online</a>, Dinesh Paudel About this time in 2020, the government also loosened the lockdown and there was an increase in social and economic activities. Millions travelled from Kathmandu to hometowns, or returned from India ahead of Dasain-Tihar, spreading the virus and eventually leading to the first wave. The only difference this time is that we have vaccines. “Given the vaccination drive and natural immunity in the population, there might not be another big spike in near future, which also means fewer hospitalisations,” says virologist at Kathmandu’s Teku hospital Sher Bahadur Pun. “But transmission and breakthrough cases will continue.”Indeed, Pun narrates a case of his colleague who was fully vaccinated but was infected by Covid-19. His symptoms were not serious, but both his parents were infected next and succumbed to the virus.The much more contagious <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a>, which was responsible for the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">devastating second wave</a> in the Subcontinent, is still circulating in the community, and is the dominant strain of the novel coronavirus in Nepal.Studies have shown that even <a href="https://www.nepalitimes.com/opinion/dying-to-get-vaccinated/" target="_blank" rel="noopener noreferrer">vaccinated people can be infected with the Delta variant</a> and spread it. Jabs do not prevent transmission, they just reduce the seriousness of symptoms. And with the vaccinated population still low in many countries, the virus can replicate and mutate further into even more virulent strains.The Health Ministry’s recent sero-prevalence study has revealed that nearly 69% of people have SARS-CoV-2 antibodies, and therefore have natural immunity against the virus. This means quite a large section of the population has been infected in the past, and have developed resistance to the virus. <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/">To boost or not to boost</a>, Buddha BasnyatBut experts say that this is a misinterpretation and can cause people to disregard proven <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/">preventive measures</a>, including masking and vaccination.Sero-prevalence surveys like the recent study were designed to detect antibodies to measure the spread of the virus in the community. It does not mean people are immune to the virus, and even with vaccinations, ‘breakthrough infections’ of the Delta variant are possible. Also, the survey does not show how long after the participants were infected that antibodies were detected in them. This is important because natural immunity lasts up to eight months.“The key is to vaccinate as many people as possible,” adds Pun, and Nepal is catching up with its inoculation drive. Close to 20% of Nepal’s 30 million people have now been fully vaccinated, and this figure will likely reach 30% by Dasain and 40% by December. More vaccines are arriving, including 100,000 doses of BioNTech’s Pfizer through the COVAX initiative for which ultra-cold refrigeration storage is being installed. There are also two new vaccines under trial in Nepal: a Chinese messenger RNA (mRNA) jab, and another developed by Sonafi, a partnership between a French company and UK’s GlaxoSmithKline.Despite this, experts warn that it is not a time to let our guards down. “It is always better to be overprepared than underprepared,” says Buddha Basnyat, a physician at Patan Academy of Medical Sciences. “We must continue wearing masks and practise safety measures. Only when 80-90% of people have vaccinated will we be out of the woods.”In fact, recent studies have shown just how effective masks can be in saving lives. In the <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">largest study of mask-wearing yet</a>, researchers conducted a trial in 600 villages and more than 340,000 people in Bangladesh earlier this year and found that mask-wearing tripled in the community and increased physical distancing by 5 percentage points. ‘When surgical masks were employed, 1 in 3 symptomatic infections were avoided for individuals 60+ years old, the age group that faces the highest risk of death following infection,’ noted Innovation for Poverty Action, one of the partners of the study.With Dasain around the corner, experts say the government should step up its <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">public awareness</a> campaign so that people limit unnecessary travel and mingling, and ensure mask-wearing even indoors for family gatherings if they cannot be avoided. It is the elderly and unvaccinated children who will be most at risk, especially with schools reopening just weeks before the holidays and teachers only getting their first doses recently.  Says epidemiologist Lhamu Yangchen Sherpa: “Now that we know that the Covid-19 is airborne, we should be especially mindful about enclosed spaces during Dasain, something as simple as moving to the terrace rather than crowding a living room can spare the grandparents and children."

Too early for Nepal to let its guard down

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d020c9c7e80680e0a365djpeg.jpg" alt="" width="1500" height="1125"/>After nearly <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">two years of disruptions,</a> Nepalis are itching to get back to normal lives. But there are signs society is returning to an old normal.As soon as the daily caseload and infection rate started falling, the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">lockdown was lifted</a> even while more than 10% of those tested are still Covid-positive, there are still nearly 500 people in ICU and ventilators in hospitals, and the Delta variant is infecting even those vaccinated.And now schools are set to open next week. While we understand that there has been a tremendous social cost to students not attending in-person schools for nearly two years, why was there a need to reopen <a href="https://www.nepalitimes.com/latest/learning-during-the-pandemic-in-nepal/" target="_blank" rel="noopener noreferrer">just for a few weeks </a>before the holidays?Some teachers, not all, have only just got their first vaccine doses, and unvaccinated children will now be in crowded classrooms, and then going home for family and festival gatherings for Dasain-Tihar-Chhat.As our report this week warns, we have <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">been at this point before.</a> Last year this time, the government relaxed the lockdown and millions travelled to their hometowns. Cases soared as the first wave peaked during the holidays (see graph).<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d020f9c7e80680e0a365ejpeg.jpg" alt="" width="1494" height="788">Experts have told us that a <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">third wave is not likely</a>, given that 20% of the population are now vaccinated (probably rising to 30% by Dasain), as well as the presence of natural antibodies detected in nearly 70% of the population in a recent sample sero-prevalence survey.However, we <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">cannot let our guard down.</a> Delta is a sly virus, just waiting for an opportunity to pounce, and exploiting every weakness in human behaviour.Experience from Nepal and other countries have shown that fully vaccinated people can be infected, and spread the virus to others, including elderly and unvaccinated children at home. Because of Delta’s high transmissibility, experts warn that labels like ‘herd immunity’ and ‘breakthrough cases’ do not make sense anymore.By the time Nepal reaches 40% vaccinated population by December, it will also be time for the third booster shots. We also do not know how long the natural immunity will last in the 70% of the population with antibodies.Studies in India and elsewhere have shown that lockdowns and a high seropositivity rate did not protect children from being infected with Covid-19 if family members were not careful about mingling and mask-wearing.Research also shows that the risk of infection in the classroom is low if students wear masks properly at all times, and are physically separated in well-ventilated classrooms.Experts predict that there will be a slight increase in Covid-19 cases among students, teachers and family members at home when schools resume in-person classes. But as vaccination rates rise, and in areas with high sero-prevalence, it may not lead to another spike, or even a third wave.What no one can tell us is how ‘slight’ this ‘increase’ in Covid-19 cases will be in Nepal – especially since the <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/?fbclid=IwAR0IGQM5l7WOvlo7nCpubILhVAcvoXeHdI-EUnSHShNKTUlswPNRcyndBfw" target="_blank" rel="noopener noreferrer">vaccination rate is still low </a>and most classrooms, school buses, playgrounds are crowded, and children will be excited to see each other after so many months away from friends.So, while the benefits of resuming physical classes may outweigh the risks, the government <a href="https://www.nepalitimes.com/editorial/ministry-of-education-gets-an-f/" target="_blank" rel="noopener noreferrer">has been ill-advised</a> to restart in person lessons just a few weeks before schools close again for the holidays.Instead, it should have used the coming weeks to launch a saturation awareness campaign with strict criteria for school opening, citing <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">mask-wearing at all times,</a> spacing and limited mingling. Parents, teachers and students must be convinced that the risk has been minimised, and the cost of denying children education now exceeds the risks to them from Covid.Across South Asia, school closures and limited digital learning have deprived children for a prolonged period from education, widening socio-economic inequalities. In Nepal, the <a href="https://www.nepalitimes.com/here-now/digital-divide-exposes-class-divide-in-nepal-schools/">digital divide has created an education divide</a> with most of the 80% of students who attend government schools deprived of learning since March 2020.Most students have missed at least 70 weeks of school since the pandemic. Of the 29% of children in a recent survey who said they had access to distance learning via radio, television or online, only half were actually using it – mostly in cities and private schools. The pandemic has wrecked Nepal’s gains in school enrolment, especially among girl children.While keeping schools closed does not prevent the Delta variant from spreading, they should not reopen <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">without precautions in place</a> – and only after the festivities. Public awareness campaigns are needed before in-person classes resume, and compliance must be monitored. Last but not least, expedite full vaccination of teachers and school staff nationwide.

Two schools of thought

<img width="1513" height="1019" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc299c7e80680e0a0b72jpeg.jpg" alt=""/>In recent weeks, Nepal has resumed nationwide vaccinations against the Covid virus in earnest. While this is a crucial step towards ending the pandemic – with only 7.34% of the population fully vaccinated, <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">we are not out of the woods yet</a>, not by a long shot. 
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/" target="_blank" rel="noopener noreferrer">Leaked information from the US Center for Disease Control</a> last week has added renewed complications in this fight against Covid-19. 
The<a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer"> Delta variant</a> was the dominant strain in Nepal, and caused more than 200,000 reported infections across the country within 30 days between May and June 2020. This has now become the main strain of the virus on the planet. 
Evidence now suggests that it is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu, and smallpox. This is one of the most effective virus variants to face modern society, spreading as effectively as the ubiquitous (but mostly harmless) chickenpox. 
When the Delta variant was first isolated, the global public health community understood that it transmitted more effectively, but many questions remained about whether or not it was more deadly or likely to cause serious complications. 
One of the first sources about the severity of Delta included a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNGrOA9yy_1CCG3ZKEzLPdBkRu_zAg">study</a> from Scotland which demonstrated that it was about twice as likely to result in hospitalisation for unvaccinated individuals than the original Alpha variant. 
Another analysis of 38,805 cases in England revealed that the Delta variant posed a 2.61 times higher risk of hospitalisation than Alpha. 
One reason for this faster spread is a mutation on the spike protein, which the virus uses to enter human cells. The Delta variant has <a href="https://covariants.org/variants/21A.Delta" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://covariants.org/variants/21A.Delta&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNFeDyT6pXrRRitXys-T0BmqKODhOg">a particular mutation called ‘D614G’</a>(colloquially referred to as ‘Doug’) <a href="https://pubmed.ncbi.nlm.nih.gov/33243994/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/33243994/&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNFdbibR-uEEpwa7sjZ1qDZKgs9Xxg">that packs the surface of the virus with spike proteins</a> which, in turn, help it avoid the natural antibodies that human cells use for defenseand <a href="https://pubmed.ncbi.nlm.nih.gov/33558493/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/33558493/&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNHAjuQ_dXz0EpZ-6MCfRroVslX3gA">enter our cells more easily. </a>
As if this wasn’t enough, Delta also has<a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNEoIFGa5Um_pxXGHNQwDefBsxQ6Pg"> a spike mutation called P681R</a>, which appears to produce higher viral loads in patients, making it easy to spread to more people, more quickly. A study in China demonstrated that people infected with Delta have <a href="https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724&amp;source=gmail&amp;ust=1628338257263000&amp;usg=AFQjCNEmgWymHmdImGh5su5H_IBjs9607A">1,000 times more viruses in their respiratory tract</a>. 
This means that there is more Covid virus per droplet that we expel. People exposed to the smaller droplets with higher concentrations of virus can be infected more quickly and when standing much further away from one another. 
This makes the virus much more likely to spread between people even with very limited contact: a review of CCTV footage from a shopping mall in Sydney, Australia proved that the virus was transmitted between two persons who were only casually passing by.
Delta has <a href="https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724&amp;source=gmail&amp;ust=1628338257264000&amp;usg=AFQjCNGIeRz4ZJuEq04MfnF6C2FmeOQZzw">an incubation period of only four days</a>, rather than six. This means that people are contagious sooner and end up infecting more people. A patient with the original Alpha variant would infect, on average, two or three other people. With Delta, this number soars to an average of eight. 
The good news is that vaccinations still offer significant protection against the Delta variant. While there is mounting evidence breakthrough infections do occur, and may result in death, the chances of ending up in the hospital or a morgue are vastly reduced once you’ve had a full dose. 
The bad news is that even if you are fully vaccinated, you can still be a major spreader of the virus. A <a href="https://khub.net/documents/135939561/390853656/Impact+of+vaccination+on+household+transmission+of+SARS-COV-2+in+England.pdf/35bf4bb1-6ade-d3eb-a39e-9c9b25a8122a" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://khub.net/documents/135939561/390853656/Impact%2Bof%2Bvaccination%2Bon%2Bhousehold%2Btransmission%2Bof%2BSARS-COV-2%2Bin%2BEngland.pdf/35bf4bb1-6ade-d3eb-a39e-9c9b25a8122a&amp;source=gmail&amp;ust=1628338257264000&amp;usg=AFQjCNHB5XqQ5B6aTBMVodh1VEJCSX1nJQ">Public Health England study</a> of more than 365,000 households found that full vaccination with either Pfizer or AstraZeneca was associated with only a 40 to 50% reduction in household transmission after a vaccinated person tested positive. 
The leaked documents from the CDC go so far as to suggest that the likelihood of further transmitting the virus is nearly the same for vaccinated and non-vaccinated individuals. This is particularly worrying for Nepal given that full vaccines for the majority of the population – including children in particular - <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">are still a long ways away</a>. 
Today, despite an increasing number of people receiving vaccinations, Delta has the upper hand. We cannot expect our government to take adequate and timely steps to avoid a third or fourth deadly wave of infections, and we can expect the virus to continue to mutate and find even more effective ways to continue to circulate through the global population. Ensuring the safety of ourselves and our communities is, once again, left in our own hands.
The standard practice of regular handwashing and wearing face masks is no longer sufficient to prevent the spread of COVID. 
With Delta, the most important prevention behaviour is to avoid crowded public spaces — particularly when there is poor air ventilation. A vaccine is not a passport to resume life as normal.
Indeed, the data shows that we all need to <a href="https://www.nepalitimes.com/latest/keep-wearing-masks-after-the-lockdown/" target="_blank" rel="noopener noreferrer">change our behavior immediately</a> and with a renewed vigour, and to amend our public messaging accordingly. If we fail to do so, the virus will win and more loss of life and prolonged, stricter lockdowns will be the inevitable result.
Sushil Koirala is a public health expert based in Bangkok, Thailand.
Ben Ayers is an American citizen based in Nepal for over 20 years.

Delta variant’s wake-up call for Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f09c7e80680e0a5febjpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>For the first time in weeks, Nepal recorded more than 3,000 new cases on 20 July. There were 25 deaths. The country is on the tail end of what has been a deadly second wave, but the rate of decline in infections and mortality has stalled.Public health officials blame it on <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">sudden reopening following two-months of lockdown</a> in which many mingled without masks, low vaccination rate, and minimal testing and tracing.While some experts say Nepal and India are now safe against another major surge of the Delta variant that was largely responsible for <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave</a>, others warn of a third wave if safety measures are not enforced.The Delta mutant is now ravaging Indonesia, and spreading across Europe and North America. And scientists say it has affected mostly countries and regions with low vaccination rates.“The third wave is a matter of when not if. And if we don’t vaccinate as many people as soon as possible, there will be a continued threat of more dangerous variants, and we will be repeating the whole cycle,” warns Buddha Bansyat, a physician at the Patan Academy of Health Sciences.So far, Nepal has fully vaccinated 1,158,130 people, 3.6% of its total population. Some 10% Nepalis have received the first dose of either AstraZeneca Covishield, Chinese Sinopharm VeroCell or <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">single-shot Johnson &amp; Johnson</a> jabs.Another 8 million doses of various Covid-19 vaccines are expected by September – some purchased from China, more doses from COVAX, as well as a direct grant from Japan. This should take the total fully vaccinated population near 20%, which together with antigen positive population could cushion the impact of a possible third wave.“We have now moved on from vaccinating <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> and frontline workers to groups less at risk of the Covid-19, and we have more vaccines in the  pipeline,” says Shyam Raj Uprety, head of government's Covid Vaccine Strategy. “We have applied to buy 10.5 million more doses of vaccines from the COVAX at a subsidised rate.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f39c7e80680e0a5fecjpeg.jpg" alt="" width="448" height="537"><figcaption> </figcaption></figure>Indian public health experts have projected the third wave to hit that country in late August. What happens in India usually follows in Nepal within 12-13 days, and if that is true this time too, Nepal cannot be  unprepared like in March.“If the vaccination program progresses as smoothly as it is happening now compared to the first two surges, the third wave might not be as significant if it happens at all. By Dasain, a significant chunk of Nepalis should have been vaccinated,” explains Sameer Dixit of Centre for Molecular Dynamics Nepal.Apart from vaccines, in case of a sudden surge, hospitals need to be ready with sufficient beds and ICUs, oxygen, life-saving medical equipment, drugs and <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">functioning oxygen plants</a>. Hospitals must also prepare their paediatric wards since the third wave could affect a younger population.Since the peak of the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">second wave</a> when there were close to 10,000 new cases a day and over 200 daily fatalities, international donors have been supplying essential medical equipment to Nepal.The Health Ministry received 385 ventilators and 970 oxygen concentrators in May June from various donors. District hospitals at local levels have also received direct supplies from aid agencies. These should be in running  condition and on standby instead of being stockpiled in Kathmandu, say doctors interviewed for this report.With the <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">vaccine supply chain less constrained</a>, there is now a debate about reprioritising the doses and a more strategic distribution of supply. Some experts have suggested a ‘firewall strategy’ wherein densely populated cities are fully vaccinated to reduce transmission, and to revive  the economy that will in turn restore jobs.Equitable vaccination is ideal, but in epidemiological terms inoculating a thinly-spread population is not the best use of limited doses. Inoculating  younger adults mean they are less likely to carry the virus and transmit it to <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">children</a>, the largely unvaccinated group. Even within cities, the focus must be on the urban poor in congested areas.“Moving forward, we must now prioritise crowded cities and highly mobile groups for vaccination to help blunt the effect of another wave and save as many lives as possible,” says Sher Bahadur Pun, a virologist at Teku Hospital.However, epidemiologist Lhamo Yangchen Sherpa worries that focusing in cities may mean the underserved are neglected. “While reprioritising, our strategy should be such that the supply isn’t misused and the neediest aren’t missed out.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f59c7e80680e0a5fedjpeg.jpg" alt="" width="2048" height="1366"><figcaption> </figcaption></figure>At present VeroCell and J&amp;J vaccination drives are running in parallel across Nepal. Soon, the Japanese grant of 1.4 million <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AstraZeneca</a> will be used to inoculate the elderly who have been waiting for four months for their second doses.Social media is rife with speculation about the jabs and who should and shouldn’t get it, leading to widespread confusion and vaccine hesitancy. People are also comparing the efficacy level of one vaccine against the other.“Let’s take any vaccine available, they do what they are supposed to do, prevent deaths and hospitalisations in most cases,” says Buddha Basnyat.  “I encourage people with heart conditions, cancer and liver diseases to vaccinate, they are high-risk group, as well as pregnant women.”According to Public Health England, Covid-19 vaccines have so far  prevented 13,200 deaths and 39,700 hospitalisations in the United  Kingdom, even while the country sees a surge in Delta variant cases.As Nepalis inoculate against SARS-CoV-2, people are starting to forgo <a href="https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/" target="_blank" rel="noopener noreferrer">safety measures</a> even if the majority of the population remains unvaccinated. They are back on the streets taking part in political rallies and conducting crowded indoor meetings. Jam-packed and poorly- managed vaccination centres could themselves be super spreaders.Says Sameer Dixit: “In midst of vaccines, variants and new surges, we cannot forget masks and physical distancing, it is still our first line of  defence against the coronavirus.”

Vaccines, variants and a third wave

<figure><img width="2048" height="1364" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fb9c7e80680e0a5f3ajpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>There is breaking news every other day: the United States donates 2 million Moderna shots to Bangladesh and Pakistan. Denmark announces 250,000 AstraZeneca doses to Bhutan. Japan pledges surplus AZ vaccines to Sri Lanka and the Pacific Islands.Nepal is never in the news, even though <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">1.4 million people still wait for their second doses</a> of Covishield AZ vaccines and another 20 million people need to be inoculated before a possible third wave this year. So far, Nepal has only been gifted or bought vaccines from India, China or the COVAX initiative. It has not even got 1 million vaccines from Serum Institute India that it paid for, and <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">all other promises from western countries were never kept</a>.  Nepal’s vaccine diplomacy has failed miserably. And the only silver lining is that there are four million doses of the Chinese Sinopharm VeroCell starting next week to immediately inoculate its above 55 population.Nepal is still recording an excess of 2,000 new cases a day and is seeing a slight daily increase following the <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">relaxation in travel restrictions</a>. Everyone, the public and the government, seem to have forgotten that the real peak during the first wave last year took place only after the lockdown was eased.“The third wave is already on its way, our figures are going up and we must assume we will be hit by new variants,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences (PAHS). “We must vaccinate as many people as quickly as possible, if not we will get more difficult variants that are potentially resistant to the vaccines.”In other news, the Oxford Vaccine Group which developed the AstraZeneca (AZ) vaccine has found that administering two doses 44-45 weeks produced the highest antibody boost. This news, announced by <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">Andrew Pollard</a>, one of the developers of the AZ, is glad tidings for countries like Nepal where people above 65 are waiting for their second doses.Pollard said antibody levels remained elevated for close to a year with <a href="https://www.thehindu.com/sci-tech/health/ten-month-gap-between-astrazeneca-doses-sees-highest-antibody-boost-oxford-study/article35019890.ece" target="_blank" rel="noopener noreferrer">a ten-month gap between AZ doses</a>, as well as antibody levels twice that after the second dose among volunteers who were administered a third booster dose, pointing to a long-term, possibly life long immunity, also against variants.“This is great news for the elderly, many of whom are panicking, unable to get their second dose in the recommended time frame. The additional time the study has afforded us shouldn’t lead to complacency in our effort to procure vaccines,” says Sher Bahadur Pun, an epidemiologist at Sukraraj Tropical and Infectious Disease Hospital. <figure><img width="950" height="633" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d05fe9c7e80680e0a5f3bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Norway, Czech Republic and Denmark have unused AZ shots they want to donate to Nepal, but have been forced to go through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">COVAX, which is unlikely to deliver</a> the doses before the end of 2021.On 1 July, Denmark announced that it would donate 250,000 vaccines to Bhutan. However, it is understood that these grants still need to be facilitated by the EU. Also in the news this week is the result of a new modelling study published in the European Centre for Disease Prevention and Control’s medical journal Eurosurveillance that further strengthens the link between <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AZ vaccines and a rare blood clot</a>.The study models four months of a vaccine distribution strategy in France from May 2021 and concludes that using AZ on the entire adult population would avert 10 deaths from Covid among 18-39-year-olds. However, it would be associated with 21 deaths from blood clots in the same age group over the same time period. In other words, <a href="https://www.irishexaminer.com/news/arid-40328123.html?type=amp" target="_blank" rel="noopener noreferrer">clot risk to younger people from the AZ vaccine</a> is twice as high as Covid death risk. But public health experts in Nepal maintain that the benefit of mass vaccination still far outweighs the risk. “Similar studies in the context of the South Asian population are needed but as it is, transmission risk of Covid is much higher than the individual risk of blood clots here,” says epidemiologist Lhamo Yangchen Sherpa.Buddha Basnyat of PAHS concurs: “The UK with over half of its population fully vaccinated is now being hit by the <a href="https://www.nepalitimes.com/latest/covids-regional-threat-needs-regional-response/" target="_blank" rel="noopener noreferrer">delta variant</a>, although it has been largely spared from severity due to the mass inoculation. Nepal being mostly unvaccinated is unprotected both from transmission and severity. This should show us where our priority should lie.”The European Centre for Disease Prevention and Control finding about clot risk therefore could indirectly be a blessing in disguise for countries like Nepal by further freeing up AZ stockpiles in Europe, as well as Korea and Japan.Even so, blood clot risk has prompted leaders including Germany’s Angela Markel to opt for Moderna as a booster shot to her first dose of AZ jab.Several EU nations including Germany have said mix-and-match doses are safe for Covid prevention, which according to new findings also point to <a href="https://www.bbc.com/news/health-57636356" target="_blank" rel="noopener noreferrer">a better immune response</a>. This could also offer much-needed flexibility when vaccine supplies are uneven or limited.“We need to introduce mixing and matching also in Nepal in the face of more virulent delta variants, particularly for the elderly who are at the higher risk of developing severity from an infection, instead of waiting endlessly for Covishield,” says Basnyat.At a time when Nepal is yet to recover from a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second surge</a>, only an equitable vaccination strategy will prevent an even more deadly third wave. But a mere 2.6% of Nepal’s population has been fully vaccinated, and less than 9% has received a single dose of either Covishield or VeroCell shots.  <figure><img width="1594" height="898" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06009c7e80680e0a5f3cjpeg.jpg" alt=""><figcaption> </figcaption></figure>And even the doses are unevenly distributed within the country. More than half the first dose of VeroCell was distributed in Bagmati province, according to the government’s own figures. Moreover, 97% of the booster jabs of VeroCell were used only in Bagmati Province. “We are seeing a similar kind of disparity in vaccination that we saw in testing, concentrated in urban centres and in particular Kathmandu,” notes epidemiologist Lhamo Yanghen Sherpa. “The excuse for using most of the doses in Kathmandu is that people elsewhere refused to inoculate. If that’s the case what is the government and others doing to dispel vaccine myths?” Virologist Sher Bahadur Pun says the government should immediately deploy its 60,000 or so <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">female community volunteers</a> and healthcare workers who have historically done such effective work in non-Covid childhood vaccination drives.He adds, “They are spread across the country and are best placed to communicate the significance of vaccines and increase vaccination uptakes at  local levels.”

Vaccines too little, too late for Nepal?

Nepal’s only international aviation gateway, at Kathmandu airport, will cut night-time operation hours to allow construction of taxiways, and airlines have been told to curtail flights. This is expected to lead to more than normal chaos during the height of peak autumn and spring tourist seasons at an airport that is congested even at the best of times. The airport will close from 10PM to 8AM from 8 November-31 March 2025. The taxiways will now connect to the thresholds at both ends of the runway, making the airport more efficient in handling higher frequencies of landings and takeoffs. The parallel taxiway extension will allow international flights to land every 4 minutes instead of the current every 7 minutes. At present planes have to wait to land until a plane taking off backtracks along the runway.&nbsp; Kathmandu is Nepal’s only airport with international operations, and it has only one runway that is only one way in from the south over the mountains. With the taxiway improvement, the airport will be able to handle 42 aircraft landings and takeoffs per hour — double the current capacity.&nbsp; The Civil Aviation Authority of Nepal (CAAN) has been trying to entice international airlines to also start flying to and from the other two international airports at Pokhara and Bhairawa (Lumbini) by slashing landing and handling charges. But so far only Nepal Airlines operates a weekly flight to Bhairawa from Kuala Lumpur.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32.jpg" data-media-id="editor_0" data-image-id="20241018161016_046569e53d1d66cd445cc66c697c0ef724810aec9f54bdf827481e3cd6b80c32" data-rendition-name="original" width="2356" height="1134" loading="lazy" alt="Kathmandu airport expansion"> <figcaption>Kathmandu Airport Expansion plan with extension of taxiways to the thresholds of runways 02 and 20 that will limit airport operations from 8 November 2024 - 31 March 2025. Areas in blue are existing structures, including the international terminal which in future will be the domestic airport, and the new international terminal near the north end of the runway,</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a.jpg" data-media-id="editor_1" data-image-id="20241018121028_6e17cc2ee87c1b02d78cb54905825b7aa15299b7a00f5eddb01a59579ab85c1a" data-rendition-name="original" width="1353" height="1328" loading="lazy" alt="Kathmandu airport NT"> </figure>  CAAN has reportedly told international airlines to cut their flight frequency to Kathmandu citing the shorter operation hours and has told budget airlines to shift some of their flights to Pokhara or Bhairawa, or face cuts. Many airlines currently operate regular flights to and from Kathmandu between 10PM and 8AM: Air Arabia to Sharjah, Fly Dubai to Dubai, Jazeera Airways to Kuwait, Cathay Pacific to Hong Kong, Singapore Airlines, several Nepal Airlines flights, and one of four daily flights by Qatar Airways to Doha. Jazeera Airways, FlyDubai, and Thai AirAsia have applied and got permission from CAAN to begin regular flights to Bhairawa’s Gautam Buddha International Airport. Starting 9 November, FlyDubai will start making a stopover in Bhairawa before flying on to Kathmandu. Immigration, customs and security are all fully functional in Bhairawa. In Kathmandu, the next phase of the airport upgrade includes converting the current international terminal for domestic operations, the construction of a new international terminal where the domestic departure area is now, as well as moving the hangars and the Nepal Army Air Wing to the eastern side of the runway. The apron area will also double its parking space for widebody jets. This is part of a Airport Capacity Enhancement Project that was initially funded through a $80 million loan from the Asian Development Bank (ADB), and the entire masterplan is expected to cost $800 million. This project is the latest upgrade to Nepal’s only international airport since it saw its first flight in 1949. The current international and domestic terminals are too small to handle the current annual traffic volume of 8.5 million passengers a year that is growing at 20% a year.

Kathmandu airport to cut flight hours

As Kathmandu becomes more congested and polluted, and with remote online work becoming the norm, many professional Nepalis are planning to retire in Pokhara, or move there.&nbsp; With its stunning mountain panorama, balmy winters and proximity to a profusion of wilderness areas, builders are responding to this demand with new townhouses, housing development and apartments. One such block of flats is the 10-storey <a href="https://sungavaapartment.com/">Sungava Apartment</a> located at Phulbari above the Seti River, near the point where it flows into and under Pokhara. The imposing structure near Manipal Hospital is almost complete, and on a recent visit the site was strewn with huge boulders unearthed while digging the foundation.&nbsp; The Seti brought down these boulders during a gigantic flood that geologists estimate happened 800 years ago when a chunk of Annapurna IV broke off and ploughed into the glacier below. Today, Sungava (means ‘orchid’) sits safely on a high terrace, 100m above the blue-green Seti and commands a view of Dhaulagiri, Annapurna South, Machapuchre, Annapurna III and IV.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9.jpg" data-media-id="editor_1" data-image-id="2024102411104_5f8fc736c86ea3c08d7bef43bb727081d3cc1a2caa55ae2b441717e6044de7e9" data-rendition-name="original" width="2016" height="1512" loading="lazy" alt="High living below the Himalaya NT"> </figure>  The soil here is conglomerate that has solidified like concrete, and the boulders were extracted by heavy earthmovers. It is intriguing to think that these metamorphic rocks as big as cars, rounded by glacial grinding, were once a part of a much higher Annapurna IV. Even for those with little interest in geology, Sungava is an ideal place to contemplate the tectonic forces that pushed these peaks into the sky to be sculpted into delicate shapes by wind, snow, earthquake and avalanche over millions of years. The view of the Himalayan panorama from Sungava’s many balconies are breathtaking when not obscured by clouds, or the haze that drifts in from across the southern border. On most days, just watching the towering pyramid of Machapuchre (Tamu name: कतासुँ क्लिको) play hide and seek with the clouds is mesmerising. There are rocks aplenty at Phulbari, and it is probably the flowers that grew along the flat terraces e that gave the place its flowery name. The boulders will hopefully be turned into a rock garden while landscaping. An nearby restaurant complex is making the best use of the stones in its design, using flat rocks as outdoor benches and tables. Sungava was designed by the husband-wife architect team of Deepak Sherchan and Jyoti Joshi of <a href="https://thedarkmermaidamarbshrestha.blogspot.com/2013/12/creative-builders-collaborative-cbc.html">Creative Builders Collaborative (CBC)</a>, which also built Heritage Plaza, Indreni Apartment and numerous other projects in Nepal. Sadbhavana retains CBC’s trademark Newari-style masonry and here it borrows from the orange brickwork of the old town of Pokhara, integrating it with modern design elements. A few of those heritage houses are still standing in Ganesh Tole and Ram Krishna Tole in Pokhara’s old quarter.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab.jpg" data-media-id="editor_3" data-image-id="2024102411108_5eb64a4885961b6d30781cefeb1e8a313da313ac5227c7a66b60f0c7d48d6fab" data-rendition-name="original" width="1362" height="595" loading="lazy" alt="High living below the Himalaya NT"> </figure>  About 400m from the apartment past a bend on the river, and down below three tiers of terraces in the canyon is a suspension bridge. Below it, the Seti is still swollen with post-monsoon flow as it tumbles away in a hurry to head down south.&nbsp; Back at the apartment, it is quiet, far away from the hubbub of Lakeside a 15 minute drive away, and in the lap of greenery. There are 52 units at Sungava and it already has a close-knit prospective community of professionals, including doctors, publishers, engineers, and businesspeople from the renewable energy and IT sectors.&nbsp; Some residents say they opted for a second home in Pokhara to make it a ‘base camp’ to explore the Annapurnas with its many hiking trails made newly accessible with new roads. With the NRN citizenship law, overseas Nepalis can now also buy the flats. &nbsp; The floor plans include options for north and south-facing 3-bedroom apartments with verandas, and the facility has underground parking has EV charging, heated pool, sauna and gym. There are still some unsold apartments with panoramic views of the mountains and one can imagine oneself at the kitchen with its huge window, humming a ditty while preparing breakfast: “खाना पकाउँ हिमाल हेरेर...”

High living below the Himalaya

When the United Nations held its Summit of the Future at its headquarters in New York in September, many world leaders, including Nepal’s Prime Minister K P Oli, highlighted the effect of climate breakdown in increasing the frequency and intensity of natural disasters. What did not get as much attention was the long term impact of the climate crisis on food production. In fact, heat stress, weather extremes and the consequences on rain-fed agriculture is already being felt worldwide, undermining the chances of the <a href="https://unstats.un.org/sdgs/">UN’s Sustainable Development Goals (SDGs)</a> being met by 2030.&nbsp; The SDG’s 17 targets commit countries like Nepal to reduce poverty and inequality, end malnutrition, protect the natural environment, and ensure that citizens all enjoy health, justice and prosperity without leaving anyone behind.&nbsp; However, besides the impact of climate breakdown on agricultural production, in Nepal the area under cultivation is impacted by urban expansion, falling productivity and the need for expensive inputs like fertiliser and pesticides.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62.jpg" data-media-id="editor_1" data-image-id="20241019041052_626413c5baf4dae407ac9579231b41daeb51510aa636b75aeb7489d94cca6a62" data-rendition-name="original" width="999" height="1500" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Kathmandu's urban sprawl is eating into its fertile cultivable lands. Photo: TAYLOR MASON</figcaption> </figure>  Now, a new study led by Nepali researcher Prajal Pradhan at the University of Groningen in The Netherlands looks at how urban agriculture may offer a solution to falling food production and meeting SDG targets. The researchers evaluated 1,450 publications exploring the contributions of urban agriculture with both positive and negative effects, and published their findings in the journal Cells Report Sustainability. Urban agriculture can help achieve 17 SDGs, positively influencing 81 targets. However, it could also undermine 51 goals.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/the-vanishing-land">The vanishing land</a>, Taylor Mason “Urban agriculture offers immense potential for sustainable development, but realising this potential depends crucially on adopting practices that minimise its adverse effects while maximising its benefits,” Pradhan explains. Urban agriculture can substantially enhance urban food security, provide employment to the urban poor, serve as ground water recharge in built-up areas, and preserve open spaces that can serve as safe havens during disasters like earthquakes. However, it also presents problems like the potential health risks from contamination and the need for expensive inputs. &nbsp; “Urban agriculture plays a definitive role in advancing the SDGs, but achieving this requires tailored, context-specific solutions that address the unique challenges of different regions,” says Yuanchao Hu of Wuhan University in China and who is a researcher at the Potsdam Institute for Climate Impact Research. “But it needs equitable access and rigorous management of environmental risks.”&nbsp; Rapid urbanisation is eating into Nepal’s most fertile agricultural land, which means farming in remaining open spaces inside cities can be a viable alternative, especially as food prices rise.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8.jpg" data-media-id="editor_3" data-image-id="20241019041052_7b7c9413086226fbdc630d45acf772cfa1ced77a8970b9056ec5ec7e5226fdf8" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>A vegetable patch in between new houses in Thimi. Photo: TAYLOR MASON</figcaption> </figure>  “The conversion of Nepal’s most fertile land into cities is a severe problem,” Pradhan told Nepali Times. “Crop cultivation, horticulture, agroforestry, beekeeping, livestock rearing, or aquaculture can all be farming activities within and around cities.”&nbsp; The study makes recommendations for sustainable practices that build on the positive aspects of urban agriculture while mitigating the downsides, thereby promoting more resilient cities in future. Research shows that urban agriculture has been helping many countries attain SDG targets by enhancing food security and biodiversity while helping education and preservation of open spaces.&nbsp; Indeed, many farmers from the hinterland who have settled in Kathmandu Valley or other urban areas of the country have been practicing urban agriculture, leasing neighbourhood patches or cultivating roof gardens both out of necessity because of inflation and falling income to grow their own food, and also as a fulfilling hobby. Saurav Dhakal, a sustainability advocate with Story Cycle and now research fellow at the Asian Institute of Technology in Thailand, says there are socio-economic and environmental benefits of urban agriculture. “It provides benefits to all urban dwellers, regardless of their income status,” says Dhakal, “families get fresh food, and there are many other benefits like water retention, heat regulation and biodiversity. These are all public goods, so special government incentives may be needed.” It is not unusual to see vegetable patches and even paddy fields within inner city Kathmandu where an older generation of farmers are using available fertile land and <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415">roof gardens to produce fresh, nutritious food </a>to reduce their dependence on food items that have to be bought after being trucked in from large distances.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77.jpg" data-media-id="editor_5" data-image-id="2024101905100_1291ce98dbbb8caed8702ac4b1d469b3e13016d7ecaaf3bfd5f91c974d3c0c77" data-rendition-name="original" width="1500" height="999" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>An older generation of farmers are using any available fertile land to continue farming but it is getting more and more difficult. Photo: TAYLOR MASON </figcaption> </figure>  Nepal’s urban population grew rapidly from only 3.6% in 1991 to 25% today. There is large outmigration from the mountains to peri-urban areas of the Tarai, to Kathmandu Valley and Pokhara, with many young men then moving abroad for work. Kathmandu Valley’s population has swelled to nearly 3 million, and is growing at 6.5% a year. Dilip Shrestha, 71, used to work for Nepal Food Corporation, so he knew firsthand about inflation, shortages and vegetables with pesticide residue. So, when he designed his new house in Kathmandu, he built a spacious roof where he grows cucumber, ginger, garlic, coriander, onions, tomatoes, chili, beans, okra, pumpkin and lettuce. His family eats healthier, and he has reduced dependence on the market.&nbsp; The co-author of the Cell Reports Sustainability journal article, Daya Raj Subedi who is a PhD candidate at Beijing Forestry University, says urban agriculture also promotes inclusion and psycho-social wellbeing.&nbsp; He says, “A crucial finding of the study is the identification of opportunities and challenges associated with urban agriculture, it can promote sustainable transformation of society.” In Banepa, 55-year-old Bijaya Manandhar in her lifetime has watched the fertile farms of her neighbourhood that used to supply vegetables to Kathmandu, now completely built up with no open space left. The pandemic lockdown prompted her to turn to the family’s <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world">ancestral livelihood by growing food</a> not on terrace farms, but on the roof terrace. Manandhar is now a part of <a href="https://nepalitimes.com/banner/rooftop-agriculture-on-the-roof-of-the-world%5C%5C">कौसी खेती र करेसाबारी क्रान्ती</a> (Rooftop Farming and Garden Revolution) which has an online membership of 52,000, and awards annual prizes to women who excel in urban agriculture.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d.jpg" data-media-id="editor_8" data-image-id="20241019041052_7257f5def8f823f35a799fa6f6825e153f2ffa406ac11325d4fe74049b79e96d" data-rendition-name="original" width="1600" height="736" loading="lazy" alt="urban agriculture in Kathmandu"> <figcaption>Rooftop farming is gaining popularity as a form of urban agriculture. </figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed.jpg" data-media-id="editor_9" data-image-id="20241019041052_beff1a4494ce896dd8fd383ee1f518e5448bcf7ea8bb138255391c7bcb9769ed" data-rendition-name="original" width="4000" height="3000" loading="lazy" alt="urban agriculture in Kathmandu"> </figure>  Pradhan says the challenge now is to upscale such examples of successful urban agricultural practices so they support Neal’s efforts to meet SDG targets. He adds, “Crop cultivation around cities can be protected by land use plans and regulations. Promoting community-based agriculture, including rooftop gardens, requires community engagement and public-private partnerships across the food value chain.”&nbsp; Such support would accelerate the popularity of existing rooftop farming and community gardens in Kathmandu Valley, or kitchen garden initiatives in Pokhara, and building on traditional farming practices that are preserved and integrated into urban settings like in Bhaktapur and Banepa. In Lalitpur, the Women Entrepreneurship Facilitation Center promotes urban farming enhancing both sustainability and empowerment.&nbsp; Another co-author of the report, Yuanchao Hu from China says followup research of the team will aim to identify good practices in local urban agriculture practices. He adds, “There are examples of urban agriculture that optimise sustainability, ensuring that it remains a viable solution for cities globally while countries try to meet SDG targets.” Prajal Pradhan, Daya Raj Subedi, Kshitij Dahal, Yuanchao Hu, Prakriti Gurung, Sijal Pokharel, Sagar Kafle, Biplav Khatri, Sudeeksha Basyal, Monika Gurung, and Aruna Joshi. Urban Agriculture matters for sustainable development. Cell Reports Sustainability, 1:100217, 2024. [DOI: 10.1016/j.crsus.2024.100217] Prajal Pradhan (<a href="mailto:p.pradhan@rug.nl">p.pradhan@rug.nl</a>) 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_14" data-image-id="20240630110640_30c3782f9c09219bf1c249b51483a3cfb7a53a06d117d2aebd23ca7080d12758" data-rendition-name="original" width="680" height="103" loading="lazy" alt="SDG logo"> </figure>

Back to the land in the cities

The 700-year-old Lakshmi Narasingha temple in Bhaktapur houses a rare half-lion and half-human incarnation of Lord Vishnu carrying the Goddess Lakshmi. The temple was destroyed in the 1934 mega earthquake that killed 10,000 people and destroyed many monuments in Kathmandu Valley. It was rebuilt by a German project in the 1980s, but as a single-storey structure instead of its original two-tier pagoda design.&nbsp; With new findings from in-depth research, Bhaktapur municipality began re-restoring the temple in 2021, preserving its original architecture.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18.jpg" data-media-id="editor_0" data-image-id="20241017131016_2fae38cce543ad7b1f6de632feb3e212e08ed1acedd747830e949d7b8e878f18" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “Our temples and heritage sites hold deep meaning. It is disheartening to witness how often they lose their original elements, whether by design or accident,” explains Kumar Chawal of the Consumer Committee of Bhaktapur. “There is a need to preserve our architecture and protect its historical value for future generations. Otherwise, we risk losing a vital part of our identity.” The Laksmi Narsingha restoration is similar to the Bhai Dega temple in Patan Darbar Square which also collapsed in 1934, but was rebuilt with a Moghul-style dome by the Rana government at the time. Only two months before the 2015 earthquake, heritage conservationists had started to rebuild Bhai Dega as the original three-tier based on early photographs. But priorities shifted when four other temples in the square were brought down by the 7.8M earthquake on 25 April 2015.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130.jpg" data-media-id="editor_1" data-image-id="20241017131016_697ea707d9ad163be5de5f2efbf5b70d3cab771adcc22f0fae6bf937c6cb0130" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  This showed how damage to monuments in Kathmandu Valley spanned from one earthquake to the next. Bhai Dega restoration remains half-complete to this day because money for its restoration ran out.&nbsp; Whereas Bhai Dega restoration was done by the Kathmandu Valley Preservation Trust with grants from western embassies and international foundations, in Bhaktapur it is the municipality itself that allocated the Rs30.7 million needed to restore the Lakshmi Narasingha temple. The expected date of completion is early 2025. The municipality and local communities are focusing on two main aspects: preserving the past and promoting localisation. The restoration team has designed a blueprint for the temple by using historical photographs and insights from older generations.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30.jpg" data-media-id="editor_2" data-image-id="20241017131016_182882fdc393c99e70d1d0490319e415229563666c4934e3a582426ebf00ca30" data-rendition-name="original" width="1200" height="560" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “At first, the Lakshmi Narasingha temple had only one entrance, but during the demolition process, we uncovered the foundations of four doors. Now, we are restoring all of them. This is an example of how our ancient structures have changed over time, often without our knowledge,” says Chawal. “Constructing temples is not like building houses. They carry historical and spiritual values, which is why they hold a special place in our hearts,” he adds. By replicating ancient design elements and rebuilding the temple as accurately as possible to its original form, the team has stayed true to Bhaktapur’s soul. But the restoration also revived ancient techniques that were in danger of being forgotten, generating employment for woodcarvers, masons, and contractors. The community of Bhaktapur’s Gahiti neighbourhood near the famous Nyatapola Temple has also set aside specific days for locals to volunteer in the reconstruction work. This has encouraged young people to take pride in ownership of their heritage. Families have also supported the effort by donating funds for bells, the temple pinnacle, and other structural features to the temple.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6.jpg" data-media-id="editor_3" data-image-id="20241017131016_db850ec0c084cdbe54f65bee92dad2ad8122d20fd60ec87ec086fbb9d2f72bd6" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="In with the old in Nepal NT"> </figure>  “I feel at peace knowing I have contributed my sweat to restoring this temple,” said one volunteer. “It is our duty to preserve our temples and heritage. The Nyatapola area will look magical once this temple is completed.” Community mobilisation is a long-standing tradition in Bhaktapur. In the past, locals have actively participated in the restoration of other temples in the city, such as Bhairav and Nyatapola fostering a strong sense of ownership. This collective engagement has not only been crucial in preserving the city's historical monuments but also in strengthening the bond between local communities and their heritage, says officials at the municipality. While securing funding is essential, and the municipality showed it values heritage conservation, the Lakshmi Narasingha restoration is proof that active involvement and sense of responsibility of the local community is as important, if not more. Local involvement also means that the monuments will be cared for into the future, When locals take ownership of these efforts, the restored monuments are not only protected in the present but are also cared for in the future.