Badri Acharya is currently at the helm of the public health office in Pokhara, but worked in the field leading and delivering essential public health provisions in the isolated Manang district during the Covid-19 pandemic and the extensive devastation triggered by 2021 climate-induced flash floods.&nbsp; “I walked for two days with our medical team to reach the remote village, Naar, up to the mountain, and did Covid-19 vaccinations,” Acharya explains. He described the perilous journey, during which he navigated through active landslides and steep slopes. “We walked that path with courage, relying on tree roots to avoid falling into deep crevasses,” he adds. Manang is known for its Himalayan terrain and the livelihood of locals, which is primarily based on indigenous knowledge. During the Covid-19 pandemic, places like Manang, Mustang, and Humla, became locked and isolated, where access to basic necessities was already nearly out of reach for villages like Naar and Fu. However, these places managed to provide jabs smoothly during the high influx of Covid cases, showcasing the dedication of healthcare workers. “It was because of micro planning and coordinated efforts from every stakeholder,” Acharya adds.&nbsp; The World Health Organization (WHO) recognized it as “<a href="https://www.who.int/about/accountability/results/who-results-report-2020-2021/an-unwavering-voice-for-vaccine-equity">exemplary efforts in ensuring vaccine equity</a>...which helped protect communities that might otherwise have been overlooked.” In 2021, the infection rate was going upward, and there was a limited vaccine supply, Still, places like Manang and Mustang were able to carry out immunsations without disruption, thanks to a well-coordinated implementation plan of vaccination from the federal to provincial to local levels.&nbsp; According to<a href="https://www.linkedin.com/in/abhiyan-gautam-59082a142/"> Dr Abhiyan Gautam</a>, the head of the Child Health and Immunization Service Section at the<a href="http://dohs.gov.np/"> Department of Health Services</a>, it was an uphill battle to combat the pandemic situation, especially for a country like Nepal where resources are limited, and distribution is challenging due to difficult road connectivity.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230828130824_dafff20c8c3076963eeba11e122f447f945339a91054625b01e8a6d0d12eb73f.jpg" data-media-id="editor_3" data-image-id="20230828130824_dafff20c8c3076963eeba11e122f447f945339a91054625b01e8a6d0d12eb73f" data-rendition-name="original" width="630" height="473" loading="lazy" alt="IPS NT"> <figcaption>Dr Abhiyan Gautam, the head of the Child Health and Immunization Service Section at the Department of Health Services. Photo: TANKA DHAKAL</figcaption> </figure>  “Vaccine supply is always a major issue in geographically challenging areas, and with Covid, there was added pressure to vaccinate all eligible individuals,” Gautam says. “Thanks to back-and-forth discussions on policy, continuous guidance from experts, and dedication from healthcare workers on the ground, we were able to overcome challenges.” There were existing challenges, including the lack of a cold chain to safely store vaccines and vaccine carriers to reach villages in the mountain region. In the midst of the pandemic, mountain districts like Manang and Mustang faced <a href="https://kathmandupost.com/gandaki-province/2021/06/15/floods-wreak-havoc-in-several-settlements-in-manang">flash floods in 2021</a> that swept away roads, bridges, and houses. Public health expert Gautam says, “At that time, it was difficult to transport vaccines. Health workers used ropes to transfer vaccines from one place to another.” Acharya, who was the head of the Public Health Office in Manang for two years from November 2020 to March 2022, recalls the distress he experienced and how he and his team navigated that pressured situation. “Already difficult situation worsened due to the flash flood,” he recalls, “There was no electricity for a week, and solar power also didn’t work for an extended period. We sought help to bring ice packs from Pokhara to preserve the vaccine.” Physical distancing and other Covid-related precautions were impossible during the flood, adding the risk of infection spread and other public health concerns. “We didn’t halt the vaccination drive and pursued an equity-based approach to vaccine rollout,” Acharya explains, “The situation in Manang and Kathmandu differed; treatment access was available in Kathmandu but not feasible in Manang, so we emphasised preventive measures, focusing on vaccination for all eligible individuals.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230828130828_71664f8d04032235fde3cce28f715d4f9d18c58cc616808be4249f0f9907ce6e.jpg" data-media-id="editor_5" data-image-id="20230828130828_71664f8d04032235fde3cce28f715d4f9d18c58cc616808be4249f0f9907ce6e" data-rendition-name="original" width="630" height="354" loading="lazy" alt="IPS NT"> <figcaption>Residents of Manang's Meta village with their Covid-19 vaccination card. Photo: BADRI ACHARYA</figcaption> </figure>  Initially, there was no formal authority from the federal level, but the provincial authority provided enough vaccines to cover all eligible individuals. “Only a few thousand individuals were eligible for the vaccine, yet we provided jabs to all village residents,” Acharya recalls, “A later federal-level decision was made to ensure vaccine equity in remote areas, which greatly aided us.” According to the 2020 census, Manang is the least populated district in Nepal, with 5,658 people, while Mustang is the second least populated, with a population of 14,000. In the first week of August 2021, Manang became the first district to vaccinate all individuals aged 18 or above (4,198), followed by Mustang, which administered jabs to 9,300 eligible residents at that time. As of July 2023, the Family Welfare Division of the Department of Health Service states, “The Government of Nepal vaccinated 83.9% with the first dose and 83.4% with the full/second dose for the total population.”&nbsp; “Nepal achieved the milestone of vaccinating 70% of the total population with the full dose on July 20, 2022, thanks to the exemplary work carried out by the unexpected frontrunners, Manang and Mustang,” says Gautam.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230828130828_876dbed04c1abe6d7924db9a2d81e406e03dbb896dafe38a4bb7f2ad08ced1a9.jpg" data-media-id="editor_6" data-image-id="20230828130828_876dbed04c1abe6d7924db9a2d81e406e03dbb896dafe38a4bb7f2ad08ced1a9" data-rendition-name="original" width="630" height="473" loading="lazy" alt="IPS NT"> <figcaption>Badri Acharya (second from right) with his team heading to Meta village at NaarFu, Manang. Photo courtesy: BADRI ACHARYA</figcaption> </figure>  Both Gautam and Acharya, who invested long hours heading vaccination efforts during the pandemic era, emphasise that the battle is not yet over, but they harbour less concern about the situation now and hold hope for the future. “The health institution itself was destroyed by the flood in some villages. However, the health workers did not give up,” Acharya recalls. “We provided encouragement. Health workers take pride in being part of this endeavour and remain prepared to act whenever required.” Detailed micro-planning and the dedication of healthcare workers to serve the public good are the factors that enabled success in hard-to-reach areas of the upper mountains. Adds Gautam: “We are now better equipped to store vaccines, with ultra and supra cold chain facilities. We feel more prepared than ever to confront a pandemic-like situation in the future. The Covid-19 pandemic tested and enhanced our ability to combat widespread infections.” <a href="https://www.ipsnews.net/2023/08/nepals-covid-19-immunization-campaign-unlikely-frontrunner">Republished</a> under an arrangement with Inter Press Service (IPS).This story was supported by the Sabin Vaccine Institute and Internews.

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At the frontlines of Nepal's Covid vaccine drive

As Dipak Subedi was organising a vaccination programme against the human papillomavirus (HPV) in Chitwan’s Bharatpur he was getting phone calls from neighbouring districts asking if he had extra doses available — people were willing to travel for hours to get their girls vaccinated against HPV, which causes cervical cancer, the deadliest form of cancer for women in Nepal. Callers had heard about the campaign, which started in 2022, after the city posted the news on its Facebook page, says Subedi, senior public health officer and chief of the Bharatpur public health promotion section. Unfortunately he had no extra doses to meet the demand. “With such demand if the HPV vaccine was to be included in our regular vaccination programme we could get more than 90% coverage,” he adds in an interview in his office in Bharatpur, a city of 370,000 best known for its location near Chitwan National Park. Most people approached for this article who were connected to the Bharatpur campaign, or to previous small-scale pilot projects in Nepal, noted similar high demand. In recent years the Nepal Government has pledged repeatedly to provide the HPV vaccine for national distribution but has yet to do so.&nbsp; Earlier this month a national campaign moved a step closer when the child health and immunisation section of the health department submitted a request to the global vaccine alliance GAVI for 1.6 million doses. The response should be known by September; if positive, vaccination could start in 2024. Cervical cancer is the fourth most common form of cancer among women globally and the leading cause of cancer-related deaths for women in 36 countries in Africa, Asia and Latin America. The World Health Organisation (WHO) reported recently that 604,000 new cases of cervical cancer were reported globally in 2020 and that 342,000 women died from the disease – a staggering 90% of the new cases and deaths occurred in low and middle-income countries. HPV is the virus that causes most cases of cervical cancer and is responsible for the majority of sexually transmitted infections of the reproductive system. The HPV vaccine has been shown to prevent up to 90% of HPV-related cancers and pre-cancerous injuries. WHO says that eradicating cervical cancer will require vaccinating 90% of all girls worldwide by the age of 15. The burden of the disease in Asia is high. In 2020, China and India alone accounted for 40% of global cervical deaths (17% and 23% respectively), according to <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00501-0/fulltext" target="_blank">The Lancet journal</a>. In Nepal, there were an estimated 14.2 cases per 100,000 women in 2020, versus the WHO target for 2030 of less than 4.0. The disease kills about 1,500 women in the country each year, reports the <a href="https://hpvcentre.net/aboutus.php" target="_blank">HPV Information Centre</a>. In 2020, researchers predicted that without any intervention, a total of 170,600 women in Nepal would die from cervical cancer by 2070 and 318,855 by 2120. But <a href="https://asiapacific.unfpa.org/sites/default/files/pub-pdf/nepal_final_16_12_21.pdf" target="_blank">according to the UN Population Fund</a>, HPV vaccination could prevent nearly 38,737 cervical cancer deaths in Nepal by 2070, and 165,115 by 2120. About 400-500 new cases are diagnosed at the BP Koirala Cancer Hospital in Bharatpur alone every year, says Asmita Rana, the head of the hospital’s department of cancer prevention control and research. Rana is managing the vaccination campaign that includes Bharatpur and two other municipalities, distributing 12,500 doses to girls ages 11-13, two doses each. While the first phase was a big success, the second one has faltered, she says. That’s mainly because phase one was implemented at the community level (schools and health facilities) by municipal staff. Phase two was centred around the hospital, meaning that caregivers (school officials and/or parents) had to take time to transport children to and from the facility. Asked what she has learned from the campaign, Rana says she would do all phases through schools next time to ensure participation. “That would be a more appropriate way to follow up those girls… rather than at the health facilities.” The second learning is raising awareness ahead of time, adds Rana. “From my experience I can say that if we do an awareness programme ahead of time — tell them something about the vaccine, about HPV, and the effectiveness of the vaccine for preventing cancer, then they will be quite positive and participating.” Even if people are initially sceptical, when parents learn that the &nbsp;vaccine prevents their daughters from getting cervical cancer in the future and is free of cost, most are convinced, she adds.&nbsp; The vaccine is available at private health facilities in Nepal but two doses costs around Rs10,000 ($76). The country’s per capita income was about $1,300 in 2022. Neighbouring India started producing its own vaccine, Cervavac, in 2022. Its price is $4.88-$9.76 for two doses. Bhutan, Sri Lanka and the Maldives have also launched national vaccination programmes while Bangladesh has done pilot projects. Vaccine hesitancy hasn’t been much of an issue in the campaign. One school did refuse to participate, says Rana, after they were told that parents had to sign consent forms. They thought it was a new vaccine and was being tested on their girls.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230813210832_3760fa231c5ef4ae92fa6c2768844a624a2caa91c13526cdd93a1d1aadb9db2b.jpg" data-media-id="editor_3" data-image-id="20230813210832_3760fa231c5ef4ae92fa6c2768844a624a2caa91c13526cdd93a1d1aadb9db2b" data-rendition-name="original" width="1123" height="1000" loading="lazy" alt="HPV vaccine"> <figcaption>Staff members at the hospital’s department of cancer prevention control and research discuss vaccination with a girl about to receive her second dose of the HPV vaccine.</figcaption> </figure>  School nurse Sudeepa Poudel also faced some resistance, but says she overcame it after talking to skeptical parents. “They say ‘we were never vaccinated but we are fine till now — why do our kids need to be vaccinated’?… Some parents are easy to convince but others are not because they’re illiterate, so I have to take time to explain carefully to them; sometimes it takes two sessions. After that explanation they easily accept it.” Poudel works at a secondary school in Bharatpur where 25 girls were vaccinated earlier this year. Beforehand she spent one hour explaining the process to students. “I conducted classes for those students who were going to be vaccinated as well as those younger students (9-11) who might receive the vaccine in the future, explaining the purpose of the vaccine, where it comes from, how it is managed, possible side-effects, etc.” Just down the hall from Rana’s office at the hospital is the vaccination room. During one recent morning girls arrived in small groups and took turns sitting in a chair and rolling up their sleeves, while caregivers looked on. Later outside the room, three girls from a high school in Bharatpur shake their heads when asked if their shoulders hurt where they got the injection. They had no hesitation getting the vaccine, they add. “We got information from the school nurse and teachers so we are confident,” says one. "We’re doing this for three reasons,” adds another: "To prevent genital problems, conception issues, and because getting cervical cancer would interfere with menstruation.” The father of one of the girls says he learned about the vaccine from his daughter, via news reports and social media before being contacted by the school. “I talked to the school nurse… Yes, I’m positive — both my wife and I are positive — because there is news about this vaccine being very good. I don’t know much about the technical part,” he adds, “but I feel good doing this for my child.” HPV is spread through sexual contact, but Rana says that most Nepalis don’t interpret that to mean their daughters should be vaccinated before they become sexually active, which might be one reason there is not as much resistance. Nepal’s health department has prepared an awareness module in preparation for HPV vaccination being added to the national vaccination programme, says Abhiyan Gautam, head of the child health and immunisation section. It will be part of what he calls a demonstration campaign ahead of the programme, which will distribute 20,000 doses in various parts of Nepal, still to be identified. A trial phase is needed, adds Gautam, because the health system was reorganised after Nepal enacted federalism in 2017. “We haven’t conducted such a campaign at the local area… so this is a new concept for us,” he says. “The district recording and reporting system is also quite different now… at the operational level we have to be sure that the system will work, so we’ll be piloting first.” The same system will be used for the national programme, if GAVI approves the request. “We are hopeful that we’ll get the vaccines,” says Gautam. “What we do know is that whenever we operate a vaccine programme GAVI provides some vaccines to Nepal. We submitted our application – now the ball is in their court.” In response to a query, GAVI said that it does not comment on current applications. The planned programme will include girls ages 10-14, in classes 6-10, rather than the 9-14 age group recommended by WHO. Gautam says this is to conserve limited resources. “Our national immunisation advisory committee recommended 10-14 based on the country's situation: if we go to 9-14 our operational costs will almost double.” If Nepal launches the national programme, the immunisation chief anticipates the same results as a previous government-run pilot project in 2016. “The vaccination coverage was very good (97%) because people demand the vaccine when they know about it… Poor people may not go to private settings to get vaccinations but even rich people are waiting for the national programme.” <a href="https://www.ipsnews.net/2023/07/nepal-poised-start-hpv-vaccination-prevent-cervical-cancer-awaiting-gavi/" target="_blank">Republished</a> under an arrangement with Inter Press Service (IPS). This feature was supported by the Sabine Vaccine Institute and Internews.

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HPV vaccine in Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2bb9c7e80680e083ec6jpeg.jpg" alt="" width="1656" height="750"/><figcaption>Vaccine trial of a Covid-19 vaccine at Oxford University’s Jenner Institute. Photo: UNIVERSITY OF OXFORD/JOHN CAIRNS</figcaption></figure>Many Nepalis who had felt their government had not done enough <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">‘vaccine diplomacy’</a> to for Covid-19 immunisation could have been assured by visiting Indian Foreign Secretary Harsh Vardhan Shringla’s remarks on Thursday that India would give preference to Nepal when trials are over.Indeed, it may be more practical and cheaper for Nepal to rely on vaccine supplies from research centres in India and China than multinationals, whose supplies of new vaccines are ‘booked’ by the world’s richest countries into next year.Handing over 2,000 vials of the broad-spectrum antiviral drug, Remdesivir, to Foreign Minister Pradeep Gyawali, Shringla said: "We will make the vaccine accessible and affordable, and it goes without saying that first priority will be for our closest neighbours like Nepal. We will put our health ministers and regulators in touch when this vaccine enters the market, Nepal will have the fullest benefit."<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2be9c7e80680e083ec7jpeg.jpg" alt="" width="1920" height="1080"><figcaption> </figcaption></figure>This week, the vaccine made by Oxford University in collaboration with the British-Swedish firm AstraZeneca was said to have 60-90% efficacy against Covid-19. The Oxford Vaccine has relevance for Nepal because the <a href="https://www.seruminstitute.com/" target="_blank" rel="noopener noreferrer">Serum Institute of India had</a> started manufacturing millions of doses of this vaccine long before the preliminary results of the trial came in.The Serum Institute of India is the world’s largest vaccine producer and already well-known in Nepal, especially for its anti-rabies vaccine that is commonly used here. The company had so much faith in the Oxford Vaccine, and it felt there would be such a rush later on, that it just went ahead and started manufacturing the vaccine, glass vials and stainless steel vats.Sure enough, preliminary results of the Oxford Vaccine now show that this gambit may have paid off for all concerned, including the people in India and its neighbouring countries.Adar Poonawallah, CEO of the Serum Institute of India has clearly made it his mission to manufacture the Covid-19 vaccine for the world’s poor. None other than Bill Gates is so impressed with his dedication that his foundation has committed millions of dollars to help with the project.Even as global Big Pharma roll out new vaccines, the difficult part will be to find ways to pay for the poorest people in the world’s poor countries to be immunised against Covid-19. Collaborative efforts like the one by the Serum Institute of India and COVAX appear to be the way to go.There is another interesting connection between the Oxford Vaccine and Nepal. The Chief Investigator of the Oxford Vaccine study, Prof Andrew Pollard has a long history of working in Nepal, especially in the prevention of typhoid fever. In December 2019, a paper on the milestone typhoid conjugate vaccine trial was published in <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener noreferrer">The New England Journal of Medicine</a> by doctors at Patan Hospital in collaboration with Pollard and colleagues. This breakthrough may well lead to policy changes around the world where typhoid is still rampant.The unusual thing about the Oxford Vaccine is that, for some reason, the scientists administered only a half-dose of the vaccine on one group followed by the full second dose, as opposed to administering two full doses. Amazingly, the group that got the half dose followed by the full dose had a 90% vaccine efficacy compared to the group that was administered the full two doses, which registered only a 60% efficacy.It will be intriguing to see if the half dosage was planned, or was an oversight that leads to this welcome finding. The history of medical breakthroughs abounds in such serendipitous discoveries.The Oxford Vaccine announcement was preceded by American companies Pfizer and Moderna unveiling the breathtaking efficacy (&gt;90%) of their own Covid-19 vaccines. However, besides the $60 cost per dose, the cold chain maintenance of -70oC for Pfizer’s vaccine would be impossible for countries like Nepal.The Oxford Vaccine, on the other hand, does not require such extreme cold chain maintenance. The regular vaccine cold chain 2-8oC will suffice. More importantly, the cost is thought to be substantially less.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2c19c7e80680e083ec8jpeg.jpg" alt="" width="1214" height="690"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181124/636be2c49c7e80680e083ec9jpeg.jpg" alt="" width="1188" height="754">It is clear that <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">for Nepal, just the discovery of an efficacious vaccine will not be enough</a>. We must be able to have access to it, and also afford it. In addition, whether the vaccine prevents transmission or not is also going to be important -- together with whether or not it prevents severe illness.Their important considerations are all pending, but for now, we need to continue to wear masks, wash hands, and maintain social distancing. We may have to continue that practice even after the vaccination campaigns start.Because the Oxford Vaccine will be distributed by governments (not Oxford University) the Nepal government will need to liaise with the <a href="https://www.who.int/initiatives/act-accelerator/covax" target="_blank" rel="noopener noreferrer">World Health Organization-initiated COVAX</a>, which is the only global inter-governmental initiative working with manufacturers to ensure Covid-19 vaccines are available worldwide to both the rich and the poor.Most industrialised countries have already started placing orders for vaccines from Pfizer, Moderna and AstraZeneca, so there is every likelihood that COVAX will concentrate on ensuring vaccine supply to less-developed countries.Along with the Indian vaccines, results of the Chinese vaccine against Covid-19, which may well be just as effective and affordable, will probably be announced soon.The <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government needs to coordinate closely</a> with groups like COVAX and keep its attention focused on obtaining the vaccine for Nepalis of all socio-economic strata.With Harsh Vardhan Shringla’s assurance this week in Kathmandu, it may also be useful to connect directly with the Serum Institute of India, which can play an instrumental role in supplying this all-important vaccine against Covid-19.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and contributes this <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" target="_blank" rel="noopener noreferrer">health column</a>, Dhanvantari, for Nepali Times.

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Glimmers of hope for Nepal on vaccine

<figure><img width="1500" height="758" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141144/636baf689c7e80680e07804cjpeg.jpg" alt=""/><figcaption>Photo: Marty Logan</figcaption></figure>Children are <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">collateral damage in </a>the flight against the COVID-19 pandemic: some 4 million of them in South Asia under the age of five are at the risk of suffering life-threatening malnutrition as a result of the socio-economic impact of the COVID-19 pandemic.
An analysis in The Lancet recently estimates that 6.7 million children globally could suffer from wasting (low weight for age) and over half (58%) would be from South Asia alone. Prevalence of wasting may increase by 14% in low- and middle-income countries this year. Such an <a href="https://www.nepalitimes.com/latest/eu-unicef-support-child-nutrition-during-lockdown/" target="_blank" rel="noopener noreferrer">increase in child malnutrition</a>  combined with disruptions in vitamin A supplementation and breastfeeding, would mean over 10,000 additional child deaths per month worldwide.
“It’s been seven months since the first COVID-19 cases were reported and it is increasingly clear that the repercussions of the pandemic are causing more harm to children than the disease itself,” says UNICEF Executive Director Henrietta Fore. “Household poverty and food insecurity rates have increased. Essential nutrition services and supply chains have been disrupted. Food prices have soared. As a result, the quality of children’s diets has gone down and <a href="https://www.nepalitimes.com/latest/pre-existing-diseases-may-kill-more-children/" target="_blank" rel="noopener noreferrer">malnutrition rates will go up</a>.”
Wasting makes children too thin and weak, and puts them at greater risk of early childhood death, poor growth, development and learning. In 2019, 47 million children worldwide were already wasted -- over half of them in South Asia. The number of children suffering from wasting could reach 54 million over the course of the year, bringing global wasting to levels not seen in this millennium.
According to Nepal’s own 2016 Demographic and Health Survey (DHS), <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">wasting among Nepali children under 5</a> still hovers at 10% — a mere 1% decrease from 8 years ago. The UN’s Sustainable Development Goals (SDGs) require Nepal to reduce wasting to less than 5% by 2030, a target that looks even more daunting in the face of COVID-19 impacts.
But the estimated increase in child wasting is only the tip of the iceberg. Poor diet and the disruption of nutrition services due to the COVID-19 lockdown means other forms of malnutrition in children and women are also on the rise, including stunting, anemia, and problems associated with obesity.
To make matters worse, anaemia among Nepali women has always been very high. Instead of declining, it will now actually increase from 35% to 41% between 2011 and 2016. Anaemia in children below 5 rose dangerously in that period: from 46% to 53%.
UNICEF reports from the early months of the pandemic suggested a 30% overall reduction in the coverage of essential – and often life-saving – nutrition services. In South Asia, these disruptions have been more severe. During the initial weeks of lockdown, the treatment of severe wasting ground to a halt in India and Nepal. 
Fear of infection and lack of protective equipment for health workers led to an estimated 40% and 75% decline in admissions to treat severe wasting in children in Afghanistan and Bangladesh respectively.
Most countries in the region had to postpone vitamin A supplementation and other regular immunisation programs against common childhood infectious diseases, while means millions of children under five years are missing life saving shots during a time of the greatest need. Nepal saw an <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">outbreak of measles in Dhading and Gorkha districts</a> during the prolonged lockdown.
“We are also deeply concerned about the potential impact on breastfeeding practices. It is essential that mothers are encouraged and supported to continue breastfeeding, even if they have COVID-19 infection”, said Jean Gough, UNICEF Regional Director for South Asia. “Breastmilk provides the best nutrition for babies as well as protection from a range of life-threatening infections.”
Breastfeeding trends in the region has been decreasing over the years. In Nepal, <a href="https://www.nepalitimes.com/banner/back-to-the-nipple-in-nepal/" target="_blank" rel="noopener noreferrer">exclusive breastfeeding in the first 6 months has declined significantly</a> at 65% against SDG target of greater than 90%. 
Humanitarian agencies immediately need $2.4 billion to protect maternal and child nutrition in the most vulnerable countries from now until the end of the year. The heads of the United Nation agencies have appealed to governments, aid agencies and the private sector to safeguard access to nutrition and to invest on maternal and child health.
Says Jean Gough: “We are encouraged by the efforts being taken across South Asia to resume nutrition services. It is essential that we combine efforts across health and social protection to prevent more children from becoming wasted, and to identify and treat those that do.”

COVID-19 leaves millions of South Asian children hungry

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141136/636badaf9c7e80680e077fabjpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: GOPEN RAI</figcaption></figure>On Friday, it will be four months since Nepal closed the country down to prevent the spread of  SARS-CoV-2, the virus strain that causes COVID-19. Of the 40 who have died of the infection in Nepal, two are children below 5.But many more children have died during the four months of lockdown compared to the same period last year because of lack of access to health care due to the restriction on mobility, interrupted vaccination campaigns and the lack of medicines.However, the coronavirus grabs all the headlines. Mortality due to non-COVID-19 causes does not make the news – even though it is clear that a lockdown enforced to control one disease has caused far more deaths from other prevalent diseases, and threatens to undermine Nepal’s progress in infant and child survival over the past four decades.“The COVID-19 crisis and lockdown have pushed many families into poverty, many have lost their sources of income, l<a href="https://www.nepalitimes.com/latest/eu-unicef-support-child-nutrition-during-lockdown/" target="_blank" rel="noopener noreferrer">eading to malnourishment among children</a>,” says Jhalak Gautam of the Child Health Division at the Health Ministry. “Increased malnutrition means children are more susceptible not only to COVID-19 but to many other infectious diseases such as measles and diphtheria.”Under-5 child mortality rate in Nepal had declined substantially from 271 deaths per 1,000 live births in 1969 to 32 in 2018. Government figures show that since 17 July 2018-16 July 2019, a total of 1,357 children under 5 died of various infectious diseases all over the country. Preliminary figures for the same period 2019-2020 is 1,263 – even though only 78% of the data has been collected.Initial government figures also show that a total of 204 children under 5 have died across the country during the lockdown between 14 March-14 June. This number was at a much lower 151 during the same period last year.This data clearly show that the total child death numbers collected by Female Health Care Volunteers is higher this year — meaning they died at home. The number of those who have died at hospital in the same three months this year is lower than last year probably because parents are not taking children to hospital when they are sick during the lockdown.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb39c7e80680e077facjpeg.jpg" alt="" width="1714" height="1210"><figcaption> </figcaption></figure>An expert at the Health Information Management System says when all the data for this year comes in, it is bound to be much higher than last year. This means the lockdown has pushed Nepal back in meeting its health targets under the United Nations’ SDGs (Sustainable Development Goals).Under the SDG target, Nepal is supposed to bring child mortality down further to 25 deaths per 1,000 live births by 2030. Persistent childhood malnutrition is a major reason for infant and child mortality remaining high despite dramatic progress in the 1990s. <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">Figures for stunting, wasting and anaemia in Nepal have plateaued in the last decade</a>  Now, the lockdown has added to the challenge.Says Elke Wisch, UNICEF Representative to Nepal: “Progress made on children’s nutrition in the last decade is at risk of being reversed as rising numbers of children are facing malnutrition due to loss of household income and resulting food insecurity. The social and economic loss for Nepal resulting from the deterioration in children’s nutrition status will be felt long after the COVID 19 crisis is over.”The lockdown has also disrupted <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">vaccination campaigns</a> across the country, leading to <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">measles outbreaks in Dhading and Gorkha</a> in April. Although regular immunisation services have now been restored in health facilities in all 77 districts, parents have been unable to take their children for shots because of restrictions on transportation and also because of the fear of COVID-19 transmission in health posts.In fact, the WHO and UNICEF earlier this week stated that preliminary data for the first four months of 2020 points to a <a href="https://www.who.int/news-room/detail/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19" target="_blank" rel="noopener noreferrer">substantial drop in the number of children completing three doses of the vaccine</a> against diphtheria, tetanus and pertussis (DTP3), first time in 28 years. Moreover, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond.“Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunised than ever before,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself.”With schools closed for the past four months, children in many schools are also not getting their lunches. Domestic violence has also seen a spike during the lockdown, with many of the victims children. There is also evidence of a <a href="https://www.nepalitimes.com/latest/child-marriages-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">rise in child marriage</a>  anxiety, stress and <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental disorder</a>Nepal appears to be on track to proving correct the grim prediction in May by the Johns Hopkins Bloomberg School of Public Health that 1.2 million children worldwide could die from pre-existing diseases like malaria, pneumonia or diarrhoea in the next six months due to the disruption to health services and food supplies due to the lockdown. That makes <a href="https://www.nepalitimes.com/latest/pre-existing-diseases-may-kill-more-children/" target="_blank" rel="noopener noreferrer">6,000 fatalities a day</a> – a whopping 45% rise in child mortality.“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” UNICEF Executive Director Henrietta Fore warned. “We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141140/636badb69c7e80680e077fadjpeg.jpg" alt="" width="3600" height="2400"><figcaption> </figcaption></figure>Another aspect of the pandemic that Nepal has to be careful about is that while worldwide data show that children are relatively safe from contracting SARC CoV-2 which has mainly affected people above 70 years, in Nepal children also seem vulnerable.Health Ministry data show that the rate of infection among children below 5 is 2.2% and increasing – much higher than the global average. The infection rate among young children was at just 1% a month and a half ago.Many of the infected children belong to families who returned from India in the past three months, but children have also been infected by people who flouted lockdown rules and safety measures. This is why Far-west Province has the highest coronavirus infection rate among children at 5%.Nepal has also seen a <a href="https://www.nepalitimes.com/latest/why-are-younger-people-in-poor-countries-dying-of-covid-19/" target="_blank" rel="noopener noreferrer">disproportionate number of COVID-19 infections and mortality among a younger population</a>  Experts say this is mainly due to young returnee migrant workers from India, Malaysia and the Gulf, who make for the majority of the coronavirus cases in the country. Moreover, testing across the country so far has focused on returnees.“Unlike elsewhere, in Nepal people with co-morbidity have a higher risk of dying regardless of the age group, and this is worrying,” says epidemiologist Sher Bahadur Pun of the Health Ministry. “But we must widen our testing to come to a concrete conclusion about this. So, <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">until we have a vaccine</a> we must wear masks, maintain physical distance and follow hand hygiene. This includes children.”

Sonia Awale

Children are collateral damage in Nepal lockdown

<img width="1994" height="1148" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8a469c7e80680e06b231jpeg.jpg" alt=""/>Researchers have been puzzled about why while the COVID-19 pandemic ravages China, Europe and now North America, low-income countries in South Asia have so far recorded fewer cases. Public health experts say one reason is that the poorer countries just do not have enough kits to screen populations at risk for the virus. But others maintain that even there were a lot of infected people around, the coronavirus is not spreading in the subcontinent as aggressively as elsewhere.There are many theories floating around to explain this, including the <a href="https://www.nepalitimes.com/opinion/covid-19-nepal-and-the-hygiene-hypothesis/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/covid-19-nepal-and-the-hygiene-hypothesis/&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNHMIJtTKliqHJjv7vV7GHlhjE3ohg">‘hygiene hypothesis’</a> which seems to show that South Asians have developed a resistance to new viruses because the environment is not as sterile as in industrialised countries. Other scientists have speculated that countries with a high incidence of malaria seem to be relatively less affected, and have even proposed chloroquine as a cure.One theory that appears more plausible is that people in countries that administer the anti-tuberculosis vaccine <a href="https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1" data-saferedirecturl="https://www.google.com/url?q=https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNEUPJmIOGkDiDb32usfECN5O5_UaA">BCG (Bacillus Calmette-Guerin)</a> seem to be less susceptible to COVID-19. Even before this pandemic, there had been <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-8-9" data-saferedirecturl="https://www.google.com/url?q=https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-8-9&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNE_gUjRAn9c8XHl_Rqv_VoQo19hRA">epidemiological studies</a> that indicated higher immune levels in people with BCG against communicable diseases, including viral infections.Could Nepal’s surprisingly low caseload of novel coronavirus be attributed to the BCG vaccine which has been widely used in the population for the past five decades? The BCG vaccine campaign started in Nepal in 1979 under Expanded Program on Immunisation of the World Health Organization (WHO), and since then millions of Nepalis have been inoculated with it. The rates of morbidity and mortality from COVID-19 vary greatly in different parts of the world, and scientists have been trying to understand why. For example countries like Italy, the Netherlands and the United States that never had a comprehensive BCG vaccination program appear to be disproportionately imapcted. There are now tests going on in several laboratories in Europe to see if this is indeed true. <img width="640" height="307" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912118/636b8a499c7e80680e06b232jpeg.jpg" alt="">"If you superimpose a map of the world with coronavirus over countries that had a BCG vaccine program, there appears to be less virulent spread of COVID-19 in countries that inoculated children against tuberculosis. The number of cases may still be high, but the fatality rate is lower in BCG countries," explains Sameer Mani Dixit, a researcher at the Centre for Molecular Dynamics in Kathmandu. He adds that the BCG is not an anti-virus vaccine, but seems to build the body's immunity not just against tuberculosis, but also from viral infections. Recent research suggests that live attenuated vaccine like BCG stimulates the immune system and protects against wide range of diseases. It is also important to note that <a href="https://vk.ovg.ox.ac.uk/vk/bcg-vaccine" data-saferedirecturl="https://www.google.com/url?q=https://vk.ovg.ox.ac.uk/vk/bcg-vaccine&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNEcafAVwGzCsVHRNLMdSpScrW-GRA">the vaccine is no means perfect</a>, as it prevents about 60% of TB cases among children. In addition, the vaccine is less effective in preventing TB that affects the lungs and works better against severe forms of TB, such as tuberculosis meningitis. BCG vaccine’s effectiveness against COVID-19 is a hypothesis that is yet to be tested, researchers are starting <a href="https://www.sciencemag.org/news/2020/03/can-century-old-tb-vaccine-steel-immune-system-against-new-coronavirus" data-saferedirecturl="https://www.google.com/url?q=https://www.sciencemag.org/news/2020/03/can-century-old-tb-vaccine-steel-immune-system-against-new-coronavirus&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNEpNA4XHY0U7sEf-Gnj-_7j3mg2KA">clinical trials</a> in Australia, the Netherlands and Germany that should answer the questions surrounding BCG in the near future. The trials are being conducted on people at high risk of exposure, primarily health care personnel. Buddha Basnyat, a physician at Patan Hospital believes that without randomised control trials the efficacy of BCG against COVID-19 is “just a conjecture”, and the tests need to prove beyond doubt that there is a correlation. “The link is unknown and it would require a lot of scientific studies to find the truth. Only, when the results of clinical trials are out can we be absolutely certain. In medicine, association is not enough, we need to show causal linkages, especially when there are so many confounding variable. Until then nothing is concrete,” adds Basnyat. Furthermore, it is also necessary to know for how long does the positive effects induced by BCG lasts in the immune system. Nepalis were vaccinated with BCG as infants, would that protect them as adults? Keeping a vigilant eye on the number of novel coronavirus cases in the BCG vaccinated countries is important. An exponential spread of COVID-19 <a href="https://corona.health-check.in/" data-saferedirecturl="https://www.google.com/url?q=https://corona.health-check.in/&amp;source=gmail&amp;ust=1586251460053000&amp;usg=AFQjCNFfhZXZJiT1qTJnAcpbVZ_MOp5i6g">cases in India</a> could knock out the hypothesis completely, and there is also no explanation why China which has near universal BCG coverage was so badly hit. We could be clinging to straws, hoping that the BCG vaccine will save the day, but the authenticity of the hypothesis cannot be established till it is explored through rigorous clinical trials. Till then, public health experts warn, Nepal needs to maintain its lockdown, test and isolate groups around the country, especially western Nepal where tens of thousands of Nepali workers have come in from India in recent weeks. Read also: <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener">Countries cooperating to find COVID-19 cure</a>, Buddha Basnyat

Could an anti-TB vaccine be protecting Nepalis?

<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

A shot in the arm for vaccines in 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.