<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111413118/6372307e9c7e80680e0c256cjpeg.jpg" alt="" width="1641" height="1000"/><figcaption>Photo: NYAYA HEALTH NEPAL</figcaption></figure>Viral hepatitis is a disease of the liver that is preventable, treatable and curable in most cases. It is a disease where elimination can and must be achieved.On this World Hepatitis Day, the World Health Organisation is highlighting the need to bring hepatitis care closer to the people. This means making hepatitis care available, affordable and accessible to one and all who need it without discrimination.This is a crucial component in the quest towards elimination of viral hepatitis as a public health threat by 2030. Elimination would translate to 90% reduction in incidence and 65% reduction in mortality by 2030, compared with the corresponding figures of 2015.The action against hepatitis cannot wait any longer. Firstly, it is the only communicable disease where mortality is showing an increasing trend. Globally, approximately 354 million people are suffering from hepatitis B and C and one person is dying every 30 seconds due to its complications.South-East Asia has 20% of the global morbidity burden of hepatitis. An estimated 218,000 people died due to hepatitis in the Region in 2019. About 95% of all hepatitis-related deaths are due to cirrhosis and liver cancers caused by the hepatitis B and C virus.Second, viral hepatis is a disease that is completely preventable. Clean food and good personal hygiene, along with access to safe water and sanitation, can protect us from hepatitis A and E. Measures to prevent hepatitis B and C need to focus on full coverage with hepatitis B immunisation including a birth dose, as well as access to safe blood, safe sex and safe needle usage.Third, a world free of hepatitis is practical and feasible, and it is one of the few infectious diseases the elimination of which is tangible. We do have the tools to diagnose, treat and prevent chronic viral hepatitis, and thereby eliminate viral hepatitis.Safe and effective vaccines exist to prevent hepatitis B, alongside new and powerful antiviral drugs that can manage chronic hepatitis B and cure most cases of hepatitis C. These interventions together with early diagnosis and awareness campaigns have the potential to prevent 4.5 million premature deaths in low- and middle-income countries by 2030.However, access to these services is often out of reach of communities as they are usually available at centralised/specialised hospitals at a cost which cannot be afforded by all. People continue to die because of late diagnosis or lack of appropriate treatment, if they are being diagnosed or treated at all. Early diagnosis is the gateway for both prevention and successful treatment.Modest testing and treatment coverage is the most important gap to be addressed for an effective response to the hepatitis epidemic. If we look at the treatment cascade of the South-East Asia Region, only about 10% of people with hepatitis know their status. And of those who know their status, only 5% are on treatment. Of the estimated 10.5 million people with hepatitis C, just 7% know their status, of which around 1 in 5 are on treatment.This gap, primarily attributable to general lack of awareness, needs to be patched up. This is what this year’s World Hepatitis Day campaign on 28 July is all about. It highlights the need to accelerate the fight against viral hepatitis by testing and treating the real people who need it, i.e. closing the equity gap by “leaving no one behind”.Even before Covid-19, very few countries were on track to reach the 2030 elimination goals set by WHO. The pandemic has put elimination efforts further behind. Rather, it has potentially jeopardised national elimination programs. Fear of Covid-19 has been a substantial barrier to hepatitis testing and treatment throughout the crisis.Amid all the challenges, the Region has continued to implement key interventions to prevent, detect and treat hepatitis, and to engage and empower at-risk populations. Since 2016, when the Region launched its Action Plan for Viral Hepatitis 2016–2021, nine countries have achieved more than 90% coverage of the third dose of hepatitis B vaccine. Four countries have achieved the hepatitis B control target of less than 1% seroprevalence among children over 5 years of age.En route to the 2030 target of eliminating hepatitis, there are some transitional targets to be achieved. By 2025, together we must reduce new infections of hepatitis B and C by half, reduce deaths from liver cancer by 40%, and ensure that 60% of people living with hepatitis B and C are diagnosed and that half of those eligible receive appropriate treatment. This can only be achieved if hepatitis care reaches to the community. In order to do so, several priorities must be addressed, and these include the need to:<ul><li style="font-weight: 400;" aria-level="1">Enhance political commitment across all countries of the Region and ensure sustained domestic funding for hepatitis.</li> 	<li style="font-weight: 400;" aria-level="1">Improve access to drugs and diagnostics by further reducing prices, including integrating costs in national health and domestic financing.</li> 	<li style="font-weight: 400;" aria-level="1">Develop communication strategies to increase awareness as the vast majority of the people do not know that they are infected, especially among subpopulations that are at higher risk of hepatitis B and C.</li> 	<li style="font-weight: 400;" aria-level="1">Innovate service delivery to maximise the use of differentiated and people-centred service delivery options across HIV, viral hepatitis and STIs to tailor and deliver services according to people’s needs and preferences in line with the primary health care approach. Decentralising hepatitis care to peripheral health facilities, community-based venues and locations beyond hospital sites brings care nearer to patients’ homes. Bringing care closer to the community will also need innovations to strengthen community engagement, community-based service delivery and community-led monitoring.</li></ul>For the first time, an integrated Regional Action Plan for viral hepatitis, HIV and STIs 2022–2026 is being developed by WHO. This integrated regional plan will ensure effective and efficient utilisation of limited resources available for the Region and will guide countries to adopt a person-centred approach rather than a disease-specific one.All countries of South-East Asia must accelerate the coverage of testing and treatment services, including through large scale adoption of innovative technologies, simplified approaches at the primary health care level, and community participation. WHO remains committed to make South-East Asia free from viral hepatitis by 2030.As we observe World Hepatitis Day, we must look forward and act together with communities and all stakeholders for a future free of hepatitis. This will lay a firm foundation for a healthier, more equitable and more prosperous Region and the world.Poonam Khetrapal Singh is the WHO Regional Director for South-East Asia.

Poonam Khetrapal Singh

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Bringing hepatitis care closer to you

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d49c7e80680e06009bjpeg.jpg" alt="" width="1500" height="803"/><figcaption>Photo : UNICEF</figcaption></figure>Last month, the prestigious <a href="https://www.nejm.org/" target="_blank" rel="noopener">New England Journal of Medicine</a> published a study of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">successful trial of a new typhoid vaccine</a> that could prevent thedeaths of many children around the world. The vaccine research was conducted at Patan Hospital by a Nepali researcher.The randomised control trial of the typhoid conjugate vaccine (TCV) was conducted among more than 20,000 participants in Lalitpur district, and the efficacy of the new vaccine was found to be 81.6% -- a major improvement on previous vaccines. (See box below).The positive news from Nepal came as various parts of the world, including the US, Europe, Samoa and Africa, struggled to cope with the biggest measles outbreak in decades. Most of the cases have now been associated with people forgoing recommended preventive shots because of fears of side-effects fanned by social media.Fear of vaccination started ever since a paper in 1998 in the medical journal <a href="https://www.thelancet.com/" target="_blank" rel="noopener">The Lancet</a> cited a link between autism and the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/maurice-hilleman-the-vaccine-man,1852" target="_blank" rel="noopener">measles, mumps, rubella (MMR) vaccine</a>. The research was later found to be fraudulent and retracted, but the anti-vaccine movement gained traction again in the past year after the rumours resurfaced on the Internet resulting in families rejecting early childhood immunisation against diseases like polio, rubella and measles.“The good news is that unlike in the rest of the world, people in Nepal demand vaccines. If we miss to vaccinate a child for any reason, parents come knocking, asking for the shots,” says Jhalak Gautam of the Family Welfare Division at Teku.Sameer Mani Dixit of The Centre for Molecular Dynamics Nepal concurs. “Entire communities actively participate in vaccination programs and are well aware of the benefits. Every mother in Nepal knows the immunisation schedule by heart.”The Centre for Molecular Dynamics Nepal has just completed a study on why the country has been so successful with its immunisation program, and the results will be published later this month. This study and similar studies underway in Senegal and Zambia are being conducted with  funding from the Bill and Melinda Gates Foundation, in an effort to analyse the success of vaccination programs in developing nations.Nepal’s national immunisation program started in 1988 and now vaccinates some 620,000 children under 15 months of age every year against 11 infectious diseases such as <a href="https://www.nepalitimes.com/banner/tb/">tuberculosis</a>, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">polio</a>, pneumonia and measles.The last case of <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener">polio</a> was detected in Rautahat district in 2010, and Nepal was declared polio free four years later. The country also eliminated maternal and neonatal tetanus in 2005. Similarly, Japanese encephalitis, diphtheria, pertussis and pneumonia have all been controlled, and there are regular vaccinations against congenital rubella syndrome and hepatitis B.Despite the high immunisation rate, thousands of Nepali children continue to die due to easily preventable and treatable communicable diseases <a href="https://archive.nepalitimes.com/news.php?id=16988#.XiBL7_4zaUk" target="_blank" rel="noopener">like diarrhoea</a> and according to Nepal Demographic Health Survey 2016, one in a hundred Nepali children have still not been vaccinated against any infectious diseases.Read also: <a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all the change in world health"</a>Immunisation coverage data from last year also shows a worryingly high dropout rate. While 93% of newborns received BCG jabs, the first in the national immunisation schedule, the coverage dropped to 73% by the time children received the last vaccine, an immunisation against measles and rubella, recommended at the age of 15 months.Several cases of <a href="http://archive.nepalitimes.com/news.php?id=186#.XiBGW_4zaUk" target="_blank" rel="noopener">measles</a> have been detected in Kapilvastu, Dang, Makwanpur, Sarlahi and Manang districts recently, and Nepal has not been able to meet its previously set target to eliminate measles and rubella by 2019. The new goal is to eliminate the diseases by 2023.“Dropout rate is a challenge, we have not been able to reach the remotest corners of the country, and children miss their shots because of migration,” says Jhalak Gautam. “We now have a strategy to identify missed pockets and deliver shots at home if required.”The Immunisation Section of the Ministry of Health is now gearing up for a nation-wide measles-rubella vaccination campaign aimed at those who might have missed routine shots. Three million children between the ages 9 months to 5 years are expected to participate in two phases of the campaign later this year.Polio drops will also be administered at the same time to 1.5 million children under five in 19 Tarai districts. The Immunisation Section is also introducing a new vaccine against rotavirus this June to reduce the prevalence of childhood diarrhoea.The new challenge to vaccination comes from an unlikely quarter: federalism. There is confusion about where the vaccines are sourced and who should pay for them. There is concern about the quality of vaccines, many of which need a cold chain with refrigeration to the point of delivery.Warns Patan Hospital physician Buddha Basnyat: “Nepal’s immunisation program is a model of success, but we cannot afford to be complacent.We have to introduce newer and more effective vaccines while also prioritising hygiene and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener">sanitation</a> simultaneously.”<h2>Successful trial of new typhoid vaccine</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d79c7e80680e06009cjpeg.jpg" alt="" width="1500" height="1000">Over 20,000 children between 9 months and 16 years of age in Lalitpur district participated in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">first large-scale randomised controlled trial</a> of a new vaccine against <a href="http://archive.nepalitimes.com/news.php?id=17306#.XiBGav4zaUk" target="_blank" rel="noopener">typhoid</a>, a disease that affects millions across South Asia.Half of them received the vaccine and the other half received control shots. The efficacy of Typhoid Conjugate Vaccine (TCV) was found to be 81.6%, and the results were published last month in the prestigious New England Journal of Medicine.Prior to this, a small-scale TCV trial was conducted in Britain, and the World Health Organisation (WHO) has since strongly recommend the use of the vaccine for countries and regions where the water and food-borne infection is most common. "Pakistan has been able to control typhoid with this vaccine and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30320-1/fulltext" target="_blank" rel="noopener">Vietnam</a> has eliminated it," says lead author of the paper, Mila Shakya, "Administration of this new, effective vaccine by our government will help control the most common bacterial disease in Nepal and South Asia."<a href="http://archive.nepalitimes.com/news.php?id=12158#.XiBGbP4zaUk" target="_blank" rel="noopener">Typhoid</a> is a contagious infection caused by the bacteria Salmonella typhi, which is found in contaminated food and water and which causes fever, diarrhoea and vomiting. It can easily be prevented with awareness, safe drinking water and frequent hand-washing.The vaccine is useful because it is a prophylactic in places where preventive measures are taking time to implement. There are some 21 million typhoid cases and 161,000 typhoid-related deaths annually worldwide. South Asia has been often dubbed as the hub of typhoid and there are some 500 cases per 100,000 population in the region.“This study is Nepal taking a lead in preventing typhoid, after never having really prioritised it. It might not kill as many people as other diseases do, but it still affects thousands of school-going children,” says physician Buddha Basnyat at Patan Hospital.TCV is <a href="http://archive.nepalitimes.com/news.php?id=18178#.XiBGdP4zaUk" target="_blank" rel="noopener">not the first typhoid vaccine to be developed</a>. Currently there is an injectable unconjugated polysaccharide vaccine for persons aged two years and above, and an oral capsule for those over six years of age. But they do not work well on young children and they provide protection only for a few years. TCV on the other hand can be given to children below 2 years and the immunisation lasts up to five years.“A single dose of the new vaccine is safe, immunogenic, and effective, and the deployment of the vaccine will reduce the burden of <a href="https://www.nepalitimes.com/opinion/so-far-so-good/infectious-enthusiasm-for-travel/" target="_blank" rel="noopener">typhoid</a> in high-risk populations,” stated the interim analysis. “This new evidence of efficacy is especially timely with the recent spread of extensively drug resistant typhoid fever, which threatens child health in affected regions.”Pakistan, which has been struggling against an outbreak of drug resistant typhoid fever since 2016 is already using TCV with positive results and its Sindh province will become the first region in the world to include TCV in routine childhood immunisations.<a href="https://www.gavi.org/" target="_blank" rel="noopener">Gavi, the Vaccine Alliance</a>, which has earmarked $85 million to fund the introduction of the vaccine in the world’s poorest countries, is supporting the program. Nepal is also eligible for funding from the alliance.Says Basnyat: “We should take action before we are also hit, like Pakistan, by the drug-resistant typhoid. What are we waiting for, when Gavi is ready to fund the vaccination program for free and its benefits are so clear. This is a case of vaccine under-utilisation.”Sonia Awale

Sonia Awale

A shot in the arm for vaccines in Nepal

Nepali Congress (NC) President Gagan Thapa's candidacy in Sarlahi-4 has thrust this Madhes constituency into rare national focus. If Thapa wins and the NC emerges as the largest party, Sarlahi-4 will send Nepal's next prime minister to Parliament. But if he does not, Nepal’s grand old party will face the next years in the opposition to fight another day. There is a troubling paradox in Sarlahi-4 where the district bordering the Indian state of Bihar has been a battleground for national politicians with fierce electoral competition, all while remaining one of the region's most underserved and underdeveloped constituencies.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_069cbbc11e971a851b444866dee57f760c0cc611ed40bdf96c627e343e3c0485.png" data-media-id="editor_0" data-image-id="20260305140344_069cbbc11e971a851b444866dee57f760c0cc611ed40bdf96c627e343e3c0485" data-rendition-name="original" width="1802" height="1276" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo: MADHES PAHARA MEDIA</figcaption> </figure>  Ever since Mahant Thakur split from NC in 2008 to form the Tarai Madhes Loktantrik Party, the district has seen rotating political alliances and fragmented votes. Yet, despite 18 years of candidates promising change irrigation schemes remain incomplete, market access for farmers has not improved, unemployment is high.&nbsp; On election day, voters here marked their ballots with fingers stained by dye from the Holi festival the day before. The road leading to Barathawa Bazar was deserted for the most part, except for some youth riding in motorcycles. This is where the high-profile contest between Gagan Thapa and RSP nominee Amresh Singh is being staged. Among the other aspirants is 27-year-old UML candidate Amnish Yadav, the son of former MP Shiv Pujan Yadav. The Yadavs are a political family with considerable caste influence in the constituency. In 2022 Yadav’s daughter Madhumala Yadav received over 14,000 votes here, ranking third overall. Yadav was voted MP from the Maoist party, but defected to the UML this time. His other son is the chair of Sarlahi’s Ramnagar Rural Municipality. Sarhali-4 has 121,012 voters, and the Yadav is banking on the 27,000-strong Yadav vote bank. Sarlahi-4 voter Avishek Sah told us he wanted his vote to go to a young nominee and not someone who has been MP thrice already, like Amresh Singh. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_527c5c2f9aa6a6c7e3bbdfbfe79fdafb0a0b56a62427e9ced86b924c6c563b10.jpg" data-media-id="editor_1" data-image-id="20260305140344_527c5c2f9aa6a6c7e3bbdfbfe79fdafb0a0b56a62427e9ced86b924c6c563b10" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo: AYUSHA CHALISE</figcaption> </figure>  To make local loyalties even more complicated, Amnish Yadav’s uncle, Harinder Yadav is an active NC member and walked side by side with Gagan Thapa during his door-to-door campaigns.&nbsp; The NC is betting on Thapa getting over 60% of the total votes. Amresh Singh’s tally could be limited to 10,000 votes — that too because of the nationwide RSP wave, and the popularity of its prime ministerial hopeful Balendra (Balen) Shah. “Amresh Singh lost his appeal when he played victim after he was denied a ticket by the NC in 2022,” Harinder Yadav says. Voters we spoke to here agreed with this assessment that Singh did not do much for the district once he got elected in the past, and being a part of the RSP seems to be his biggest asset. “The only reason I voted for Amresh Singh is because Balen is in RSP,” local voter Mahendra Gupta from Barathawa. &nbsp;“This is his last chance to return the people’s trust.”&nbsp; Gupta is aware of the institutional presence of the NC here. The party received the most votes in 2022 local elections, adding that the candidacy of someone as high-profile as Thapa is a positive sign for Sarlahi-4.&nbsp; Other voters like Ruby Gupta are rooting for both the NC and the RSP. “I will vote for Gagan and for Balen,” she says, adding that her FPTP vote will go to Thapa while her PR ballot would be for the RSP. RSP supporters are confident that their candidate will win big because even though many voters may not have openly voiced their support they still voted for the party and candidate. The Balen Wave was not limited to RSP voters, but also to UML candidate Yadav, who said in a gathering that he will be “the voters Balen” if they elect him. He touted his party’s track record in government, and largely campaigned on administrative efficiency, infrastructural expansion, and local service delivery. Amresh Singh ran on the RSP’s anti-establishment brand, promising to fight corruption, challenge traditional party politics, improve basic services such as education, health, jobs, and infrastructure, while pushing for stronger representation and development for Madhes.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260305140344_982df01801fa7d3532ca0555ecb8a0756e3223be3d93650e08ca82a312dc2ebd.jpg" data-media-id="editor_2" data-image-id="20260305140344_982df01801fa7d3532ca0555ecb8a0756e3223be3d93650e08ca82a312dc2ebd" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Sarlahi-4 voting"> <figcaption>Photo:AYUSHA CHALISE</figcaption> </figure>  Singh’s rivalry with his NC competitor goes beyond the ballot— he allegedly blames Thapa for being denied the NC ticket in 2022, which led him to win the election from Sarlahi-4 as an independent. &nbsp; For his part, Gagan Thapa focused on a more pragmatic development agenda that includes upgrading roads and irrigation, improving schools and hospitals, supporting farmers, and creating employment opportunities with improved governance at the centre. He also promised to build an engineering college in the constituency.&nbsp; Thapa also promoted his own anti-establishment image within the NC, repeatedly reminding voters on the campaign trail that he represents the aspirations of the youth.&nbsp; On Thursday, as voting progressed, there were violent disruptions in two centres where voting was briefly halted. But Sarlahi district police spokesperson Saroj Rai told Nepali Times that there were no major problems. Police in collaboration with the Nepal Army sent the ballot papers to the district’s counting stations, where the votes are expected to be tallied through the night and the winner announced Friday morning.

Sarlahi-4 nervously watches ballot count

As this report is uploaded, the latest results in Nepal’s election show that the Rastriya Swatantra Party (RSP) is headed for an even bigger sweep than most had predicted.
The RSP was leading by large margins in 49 of 165 constituencies, &nbsp;with the UML, NC and NCP trailing far behind. Prominent political figures from the old parties like K P Oli, Minwndra Prasad Rijal, Ishwar Pokhrel, Bishnu Prasad Poudel, Bimalendra Nidhi all seem headed for defeat.
It does look like the RSP’s bell election symbol is ringing right across Nepal — from cities to the remotest districts in the mountains and plains. The party’s blue colour is sweeping the land.
The Nepali people seem to have sent a clear message that they were throughly dissatisfied with the chronic failure of the three main parties to work in the national interest to create jobs and deliver development. It was also an expression of lingering outrage over the the 8 September massacre outside Parliament. &nbsp;
It now looks almost certain that Balendra Shah will get to be Nepal’s next, and youngest, prime minister. Hopefully he will be leading a cabinet of competent and honest technocrats. It remains to seen how the power equation between Shah and the RSP’s leader, Rabi Lamichhane will play out.
Lamichhane is out of jail on bail for fraud cases which he has called political vendetta by the previous regime. Both he and Shah are charismatic and ambitious. Their working relationship will determine Nepal's political stability and whether it can avoid the political cronyism of the past.
This election was not just about casting votes. It was about standing up to principles and a value system, and respecting the hopes and aspirations of Nepal’s youth. It to push for transparent government and against impunity — including for the gunning down of young Nepalis in cold blood.
<div class="embed-block"><iframe src="https://election-geo-dashboard.pages.dev/" width="100%" height="600" frameborder="0"> </iframe>Live election results as winners of candidates are announced.</div>
CAN DO MAN
Shah got mixed reviews as mayor. He was impulsive and ad hoc, but most people inKathmandu and beyond liked his can-do attitude and unconventional style which stood in sharp contract to the legacy leaders. Over his three year mayorship he showed more maturity and planning capacity.&nbsp;
But he always ran headlong into opposition from the federal government over his urban planning and other initiatives to make Kathmandu more liveable. Coming from a civil and structural engineering background, he was involved in building low-cost housing after the 2015 earthquake.
But his public persona is more tied to his irreverent rap lyrics that stood up for the marginalised underprivileged in society, while exposing the high-handedness and apathy of the state. But this also exposed contradictions because he also used his own municipal guards to beat and chase away street vendors and squatters.
But there is no doubt that a combination of the sharp messaging in his rap videos amplified by the algorithms of social media ignited Nepal’s youth to rise up. It was more about optics and emotion than policy and strategy.
He studied Kathmandu district for five years, visiting experts in every field before announcing his independent candidacy for mayor in 2022. Many like me in his own constitunecy did not know who he was and where he came from.
He is a year younger than my architect son, and I saw in him a reflection of my own son’s commitment to serving the nation. I voted for him to be mayor despite his sometimes erratic behaviour, which could be attributed to his youth.
The best sign of his strategic planning, which unsettled septuagenarian and octogenarian politicians, is the he did not grab the first easy option of becoming prime minister in September when GenZ activists offered him the post.&nbsp;
Joining RSP was a masterstroke, as was his challenge to Oli in Jhapa to project national branding. He needed a party platform and Lamichhane needed a popular prime ministerial persona since he himself could not hold the post.
Shah has shown the capacity to take risks when he believes the value justifies the action for the country. Now, he will have to show more strategic thinking on a national scale, as well as understand the delicate geopolitics of Nepal.&nbsp;
He must rise above the kind of crude social media posts that earned him followers on X, but did nothing to erase his erratic and impulsive image.&nbsp;
Some assume that behind his trademark RayBan shades is a closet dictator, and his past remarks about Hitler are still up on social media. He has in the past shown impatience with criticism, unleashing supporters on social media to troll detractors.&nbsp;
Even so, the public seems willing to place their hope on an educated young man with integrity and a proven record for planning at the helm. By tomorrow it will be clear whether the hope Nepalis have held has been fulfilled, and the coming years will show if the RSP will lead Nepalis to a better future.
The voters seem to have shown the door even to the NC despite the fact that under Gagan Thapa, the party had turned a new leaf. A strong government under Prime Minister Balendra Shah heading a carefully selected cabinet and a strong opposition of the NC, UML and other parties for check and balance may be just what we need for a stable Nepal.&nbsp;
Nepalis have collectively always shown maturity in elections. This time they have given a resounding endorsement for integrity and for good governance.

Bells ring all over Nepal

After Thursday’s election, Nepalis are in a wait-and-watch mode. The Election Commission says counting ballot papers will be expedited this time, and the results for the First-Past-The-Post (FPTP) will start being declared within days. In 2022, it took three weeks for the final results to be tallied.&nbsp;
But winning an election is only half the challenge for the parties, forming a government under parliamentary politics is like a complicated mathematical equation.&nbsp;
In 2022, the Nepali Congress (NC) emerged as the biggest party, winning 89 seats. But the UML with 78 seats and the Maoists with 32 formed a minority government. In fact, Sher Bahadur Deuba did not become PM then despite leading the biggest party in Parliament.
This time, there is an unmistakeable Rastriya Swatantra Party (RSP) wave led by its prime ministerial candidate, Balendra Shah. Besides his own popularity, Shah represents change which most Nepalis are clamouring for after decades of corrupt and feckless coalitions that did not deliver.&nbsp;
The past months of campaigning has seen massive youth engagement on social media through memes, AI clips, and viral images. Digital content that appeals to emotion rather than policy debate between candidates shape electoral outcomes in Nepal and elsewhere. &nbsp;
Shah represents GenZ aspirations, and was their candidate for prime minister. It was only when he declined that Sushila Karki was nominated. None of the political parties in the recent past -- new, old, or revolutionary — have won enough seats to go it alone.&nbsp;
The most recent majority government was formed by the short-lived Communist Party of Nepal after the UML-Maoist merger in 2022. But that rare two-thirds majority collapsed after a power struggle between K P Oli and Pushpa Kamal Dahal. The only party to have won a majority was the NC in the 1991 and 1999 elections. But it is near impossible for it to repeat this success now, even with Gagan Thapa's rebranding of the party.&nbsp;
We have compiled these possible scenarios for election outcome in order of likelihood:
RSP gets a majority
RSP hits the magic 138 to form a government entirely on its own. Balendra Shah wins Jhapa-5, and becomes the new prime minister at 35, the youngest ever to hold the office in Nepal. But danger lurks: there could be a personality clash between Shah and Lamichhane who are both equally ambitious. History could repeat itself.&nbsp;
RSP wins but does not get a majority
RSP is likely to sweep the most votes, but what if it does not secure enough seats for a majority? It would need a coalition partner and Nepali Communist Party (NCP) under Pushpa Kamal Dahal could fit the bill, but only if it has the numbers. The RSP is not likely to team up with the UML or NC.
The NCP is relatively untainted by the 8 September events, and also has former UML defectors like Madhav Kumar Nepal and Bhim Rawal who could bag their rural vote banks. After all, there are no permanent foes in politics. If the royalist RPP and Tarai-based Janata Samajwadi have enough seats, those could be options for the RSP. &nbsp;
NC is second
The NC under the new leadership of Gagan Thapa could become the second biggest force and form a government with RSP in a power-sharing deal with Shah. This would be the most stable scenario since the RSP and NC have competent and idealistic young technocrats. Thapa himself embodies a strong combination of both old and new politics to navigate the system for more efficient government. But then Thapa and the RSP's Rabi Lamichhane do not get along.
NC and NCP form a majority
If the NC becomes the largest party but not by a big margin, it could join up with the NCP and Ujyalo. Teaming up with the UML would likely face backlash with the party and outside. If Gagan Thapa becomes prime minister he will face internal pressure from both Deuba loyalists. Same old story.
Minority coalition of NC, UML and NCP
RSP becomes the first party but does not get a majority, paving the way for the three legacy parties to cobble together a minority government. While this is possible in Nepal’s parliamentary system, such a scenario is likely to lead to more instability and dissatisfaction among young Nepalis demanding change, and even trigger street unrest. &nbsp;

The magic 138

Nepal conducted its post-GenZ movement early election on Thursday in a peaceful and orderly manner, although turnout was below average in most districts. In fact, some constituencies saw voters reject the election, including in Arghakhanchi and Mustang.&nbsp; Preparation for the polls had to be done hurriedly after the September protests, with little time for political parties to work on their manifestos and campaign. But the election did push most parties to field younger, fresher and untainted candidates. This was more a <a href="https://nepalitimes.com/news/old-vs-new-vs-new">personality-driven election for the next prime minister</a> than a traditional parliamentary poll. The three main parties had pre-emptively announced their prime ministerial candidates although the chief executive is supposed to be decided by the largest party in the House.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_00809e41288d8dd46d1c8915e8e39fba09892049cfda37ba347e4b23989e94c0.jpg" data-media-id="editor_1" data-image-id="2026030514034_00809e41288d8dd46d1c8915e8e39fba09892049cfda37ba347e4b23989e94c0" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="Nepal elections"> <figcaption>Balendra Shah</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_d288f2cbe05c9c1376e315ea4f24528c5ee63766c978657aee8848eb9f87f4ea.jpg" data-media-id="editor_2" data-image-id="2026030514034_d288f2cbe05c9c1376e315ea4f24528c5ee63766c978657aee8848eb9f87f4ea" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Nepal elections"> <figcaption>Gagan Thapa</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_3e2c1c4595b3aa3a4b0c6ca80aa6243e7c5c6e5d232c9295a380c565f85bd233.jpg" data-media-id="editor_3" data-image-id="2026030514034_3e2c1c4595b3aa3a4b0c6ca80aa6243e7c5c6e5d232c9295a380c565f85bd233" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Nepal elections"> <figcaption>K P Oli</figcaption> </figure>  Going by the noise on social media sites, there seemed to be overwhelming support for the Rastriya Swatantra Party (RSP) and its prime ministerial hopeful, former Kathmandu mayor <a href="https://nepalitimes.com/here-now/political-rap">Balendra Shah</a>. Standing against him in his home turf was K P Oli, of the UML who was forced to resign after the 9 September protests. Although the UML was fielding a tried and tested leader, the Nepali Congress (NC) has tried to carry forward the GenZ aspiration for change by putting forward its new party leader Gagan Thapa as its prime ministerial candidate. The lower-than-average turnout appears to have been driven by several factors: a public that is apathetic towards the older parties but is not yet convinced by the capability of the new. Limited time campaigning, and the over-idealistic manifestos of the parties does not seem to have fired up the electorate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_50394032b053d433ed039aeb6d2c00a491d2a56b48a67e55e27fbffe7e4c7fe4.jpg" data-media-id="editor_5" data-image-id="2026030514038_50394032b053d433ed039aeb6d2c00a491d2a56b48a67e55e27fbffe7e4c7fe4" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="Nepal elections"> <figcaption>Photos: ADITYA KHARE</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_84677be963084003c9a3d3fec0b8f95ab9b9db08c160f08c82aa03b02cb81260.jpg" data-media-id="editor_6" data-image-id="2026030514038_84677be963084003c9a3d3fec0b8f95ab9b9db08c160f08c82aa03b02cb81260" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="Nepal elections"> </figure>  The low turnout is also a reflection of massive outmigration from rural districts, and the requirement that voters had to go to their own home constituencies to vote. And since the Election Commission could not organised ballot by mail or online voting, most of the estimated 4 million voters abroad also could not cast their ballots. To be sure, Nepalis abroad do represent an anti-incumbent vote bloc, and they have influenced families and friends back home through social media. The trend towards RSP and younger candidates is therefore a rejection of the old, and a protest vote against the legacy parties rather than full support for the new ones. Many migrants who were coming back to vote were also stuck in West Asia after the war broke out between Iran and Israel-US. Airlines have had to make drastic rerouting plans, and at least 21,000 flights have been cancelled. The conflict will affect petroleum imports including LPG and aviation fuel, if it continues any longer. Although our reliance on fossil fuels is declining, thanks to the increased electrification of transport and cooking, the shortage might be the first crisis for the new government of Nepal to tackle.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_986438337f2af271ab33d267560b8a25691a72292aae074488dc8e77f27cf9c1.jpg" data-media-id="editor_7" data-image-id="2026030514038_986438337f2af271ab33d267560b8a25691a72292aae074488dc8e77f27cf9c1" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepal elections"> <figcaption>Polling in Sangjya. Photo: SHRISTI KARKI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_dd2624707dae59f3b32fdebb402a3edfbfe99a4031f4f43dd4522ef7c58bfab0.jpg" data-media-id="editor_8" data-image-id="2026030514038_dd2624707dae59f3b32fdebb402a3edfbfe99a4031f4f43dd4522ef7c58bfab0" data-rendition-name="original" width="1523" height="2030" loading="lazy" alt="Nepal elections"> <figcaption>Photo: SUDIKSHA TULADHAR</figcaption> </figure>  There were 18.9 million registered voters nationwide, and the 60% turnout this time follows a declining trend, possibly making it the lowest in Nepal's polling history. In the first federal election in 2017, the turnout was an impressive 67%, which dipped to 61% in the 2022 election, although it was slightly higher in the municipal election. The EC has started counting the votes on Thursday evening and hopes to have the winners of the FPTP candidates out within 24 hours, however the tallies of the Proportional Representation ballots for the parties may take up to a week.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_8ff38b016d3cb75f27343ebe5d826f9201bfefffb6147dcbb0c415071ceb472d.jpg" data-media-id="editor_9" data-image-id="2026030514034_8ff38b016d3cb75f27343ebe5d826f9201bfefffb6147dcbb0c415071ceb472d" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> <figcaption>Ballot boxes being collected. Photos: AMIT MACHAMASI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_6e6f6a792db2790533b7ef261e51dbdc07745ee96b80eaa8edc5abab4c7cfd21.jpg" data-media-id="editor_10" data-image-id="2026030514034_6e6f6a792db2790533b7ef261e51dbdc07745ee96b80eaa8edc5abab4c7cfd21" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_75951a6583c17a741e3f9bd1abb796bbefed335cb6e694e5cddf519bfd0b9ed4.jpg" data-media-id="editor_11" data-image-id="2026030514034_75951a6583c17a741e3f9bd1abb796bbefed335cb6e694e5cddf519bfd0b9ed4" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> </figure>  Many have praised the interim prime minister installed six months ago by the GenZ movement, former chief justice <a href="https://nepalitimes.com/news/mission-nearly-accomplished">Sushila Karki</a> for conducting the polls on time as promised—a task that looked impossible until a few months ago, especially considering how Sri Lanka and Bangladesh suspended their electoral processes for a long time following their own youth uprisings. Balen Shah also took to his social media to commend Karki. He wrote: 'हजुरको नेतृत्वमा आज लोकतन्त्रले जितेको छ । <a href="https://www.facebook.com/hashtag/%E0%A4%86%E0%A4%AE%E0%A4%BE?__eep__=6&amp;__cft__[0]=AZYlGAeGzdXOS93cs8uOYTfW2l5YtXypnOpQOwFwdzWQQ2X_sLcqe_tqk518ULo-ftJnT5sCeT83L5zqMhzL09YgqxYLxDTzkHRSXiEtegetmKjz0ZbMz54cS2KFOKvPtqdHCZn4J6N0i4IvRDSXgHcCdLLd3kQYflb-Popks3zpA3O9Pqd4_Yh9efVCtMUPumJdN0l-y32bQLREPIMYm_mnJDYHbgoUy9iRUGMu1IOGHQ&amp;__tn__=*NK-y-R" target="_blank">#आमा</a>' (Democracy has won under your leadership. #mother). After casting her vote from Kathmandu on Thursday, Karki said: “I have fulfilled my responsibility towards the nation, let us hope the people’s wish for stability and prosperity will be fulfilled by the new elected government.”

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The magic 138

Nepal votes with below average turnout