<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20230112100136/63bfd50f9c7e80680e0d30d0jpeg.jpg" alt="" width="1024" height="576"/><figcaption>Health workers transporting Covid-19 vaccines in rural Nepal. Photo: NARENDRA SHRESTHA/ADB NEPAL</figcaption></figure>It was exactly three years ago that the novel coronavirus first emerged from Wuhan. SARS-COV-2 has now come full circle as cases soar and hospitals are overwhelmed across China.Beijing abandoned its zero-Covid policy, and has stopped registering fatalities from Covid-19. Official case load and death figures are said to be underreported. International health experts believe more than 1 million people may die from the disease this winter.Several countries now require mandatory Covid tests from passengers arriving from China, after Beijing eased travel restrictions in the new year. Countries in the region including Nepal are on high alert.The Health Ministry last week made masks once again mandatory in public places while appealing to people to resume hand washing and social distancing. On 28 December Nepal reported only 8 cases and zero Covid deaths.The Ministry has also urged the public <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">to take booster shots, and second boosters</a> for people above 55 and the immunocompromised. The Drug Advisory Committee on 27 December granted emergency use approval for the Pfizer-BioNtech bivalent vaccine of which Nepal is set to receive 1.5 million doses from the COVAX global initiative by mid-January.Read also: <a href="https://www.nepalitimes.com/here-now/three-years-of-living-dangerously/">Three Years of living dangerously,</a> Sonia Awale“What is of utmost priority now is to protect our elderly and vulnerable populations. We need to fully vaccinate them if they have not or give them a booster, bivalent would be even more effective as it can fight both the original and Omicron strains,” explains Sher Bahadur Pun at the Teku Hospital.Pun likens what is happening in China now to the Omicron surge in Hong Kong earlier this year which also saw a significant rise in hospitalisations and deaths. Nepal also suffered a spike in fatalities among the elderly towards the end of the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron third surge in 2022</a>. In both cases, the unvaccinated were victims.“Omicron might be less severe but in vulnerable groups who have not been vaccinated, even this strain can cause complications,” he warns.More than 80% of Nepal's eligible population (above 5) have been fully vaccinated against Covid-19. But the booster uptake is much lower at only 27%. There is also concern that it has been more than a year since most Nepalis got their last shots, and their immunity might be waning. Officials recommend a booster even though memory cells could provide some residual protection.The WHO has asked China to reveal its true Covid figures, and the nature of the prevalent strain. Experts attribute its surge to vaccination hesitancy among the elderly, stringent zero-Covid strategy which suppressed natural immunity, and Chinese vaccines like Sinovac being less effective than mRNA jabs.Read also: <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/">Why is there vaccine hesitancy in Nepal?</a> Sonia Awale“China did great with lockdowns and restrictions but took it to unnecessary levels, which means the population is Covid naïve compared to other countries. When they reopened, the variants already present multiplied rapidly,” explains Buddha Basnyat, physician at Patan Academy of Health Sciences. “It also seems they did not learn from the rest of the world, did not vaccinate their elderly sufficiently and relied only on their own vaccines.”The efficacy of Chinese-made vaccines has long been debated, but there are no studies to prove their efficacy, or lack thereof. However, experts agree that all the available vaccines recommended by WHO considerably reduce the severity of the disease.Media amplification of the China surge has caused some panic in the neighbourhood. Japan, Malaysia, Taiwan and India are the latest countries to require Chinese passengers to have Covid tests. India has also introduced nasal vaccine this week, those who had taken Covishield and Covaxin can take it as a heterologous booster dose.Read also: <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/">Nepal’s uneven Covid-19 deaths</a>, Ramesh KumarHowever, the BF7 Omicron strain has already spread around the world and it is not virulent, and does not seem to adversely affect vaccinated individuals. Experts also caution that although 1 million deaths sounds like a lot, it is a tiny fraction of China’s population. The Chinese government has accused the West of ‘hypocrisy and hyping the threat’.“The BF7 is not a new variant, it has been around for a while. It has been circulating in Europe, America and parts of Asia. It has been reported in India and chances are high it is in Nepal too, we probably just haven’t detected it yet,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal.He adds: “Nepalis have developed enough resistance through reinfections and vaccinations, especially as subsequent strains have been more contagious but less virulent.”The WHO says it is concerned about further mutations and the emergence of new variants, but mutations do not necessarily mean increased severity. Just like Omicron is more contagious but less severe than Delta.Says Pun: “There are at least 17 sub-variants of Omicron in Nepal. This means we have had enough immunity gained via reinfections. We also have protection from vaccination and the proof of this is how we marked our festivals, and elections without following safety measures and without any resulting surge.”Read also: <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/">Omicron may not be risky, but take care,</a> Sonia AwaleHaving said that, the <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/">pandemic is not yet over.</a> Parts of China including Hong Kong, South Korea, Hong Kong and Japan which have high mobility of Nepalis are also seeing a Covid-19 surge this winter.The health desk at Kathmandu airport is not strictly checking vaccination or PCR tests anymore, and some experts say it should increase surveillance — especially when flights from Chinese cities resume on 8 January. After being locked down for so long, many Chinese are already booking holiday travel to Asian destinations.The Rasuwa border post also reopened this week to resume the cargo transport at Kerung and the trade between the two countries. The checkpoint which has been shut due to the pandemic since early 2020.Says Buddha Basnyat: “There is no harm in continuing to follow safety measures, it is now proven that masks and hand washing saves lives. It also protects us from a host of infections including typhoid and TB and more importantly from air pollution, all non-Covid silent killers.”

Sonia Awale

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China’s surge: should Nepal be worried?

<figure><img width="1319" height="1975" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203ae9c7e80680e0b281ejpeg.jpg" alt=""/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>For the first time in four months, Nepal recorded over 1,000 daily new Covid cases on Sunday. Of the 12,632 people tested nationwide, 9% were positive – proving that <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/" target="_blank" rel="noopener noreferrer">Omicron</a> has replaced Delta as the dominant strain.Reacting to the sharp rise in infections, Nepal’s Covid-19 Crisis Management Committee (CCMC) has imposed a ban on gatherings of more than 25 people in public spaces, and made it compulsory to show vaccine certificates before entering them. Schools that had just opened following winter vacation, will also be shut for another three weeks.“It will be foolhardy of us not to expect a surge now. But if the vaccination drive slows, we will pay for it dearly,” warns Buddha Basnyat, a physician at Patan Academy of Medical Sciences.But Nepal’s vaccination drive has hit a speed bump because of a shortage of syringes. Although <a href="https://www.nepalitimes.com/here-now/from-scarce-vaccines-to-storage-shortage-in-nepal/" target="_blank" rel="noopener noreferrer">there is a stockpile</a> of 12 million doses in refrigerated stores across the country, and 6 million more doses on the pipeline, there are a limited number of needles to administer them.Nepal was one of the first countries in the region to start Covid vaccinations in March 2021, and has managed to fully inoculate only 36.8% of its 30 million population. Only half the population has received the first dose. The needle shortage is holding back first jabs, second doses and booster shots for the vulnerable groups including health workers, the elderly and immuno-compromised individuals.“Two doses of vaccines against Omicron is not as effective but a booster is. So we have to provide the third dose not so much to prevent mortality, but to stop Omicron from spreading rapidly and overwhelming our healthcare system,” says epidemiologist Lhamo Yangchen Sherpa.She adds: “Yes, there is a moral dilemma to boosters. Given that a majority of Nepalis haven’t yet been fully vaccinated we have to consider the latest development as the doses are approaching their expiry date.” Nepal is planning to provide boosters only when 40% of the population has been fully inoculated. But studies have shown that the immunity afforded by vaccines wanes over time with a significant decline in the level of antibodies. And while most of the vaccines are not as effective against Omicron, they still <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">largely prevent severity</a>.Says Minister of Health and Population Birodh Khatiwada: “We are trying to sort out some final details and will make an announcement on boosters soon.”Studies have now confirmed that Omicron produces less damaging infections with impacts largely limited to the upper respiratory tract and does not multiply readily in lung tissue, leading many to believe that <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">the new variant is much milder</a> and hence likely to replace Delta.“We must provide boosters for the most vulnerable groups, I have seen many patients at my hospital who are fully inoculated but struggling with complications,” says virologist Sher Bahadur Pun at Kathmandu’s Teku Hospital. “Just because they have already received two doses we can’t leave them to die.” He adds: "In the meantime, we also have to identify groups who can’t access shots and those who are still hesitant to inoculate, and work out strategies that address them best to speed up the vaccination drive.”Most infected people are also experiencing much milder symptoms of Omicron, either because they have been vaccinated or have natural immunity due to previous infections that they were not aware of. Even so, the sheer transmissibility of the new strain will likely <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/" target="_blank" rel="noopener noreferrer">overwhelm Nepal’s understaffed and underfinanced healthcare</a> mechanism. <figure><img width="640" height="296" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203b19c7e80680e0b281fjpeg.jpg" alt=""><figcaption>Daily case load in India and Nepal (below). Source: WORLDOMETERS</figcaption></figure><figure><img width="640" height="327" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410110/637203b49c7e80680e0b2820jpeg.jpg" alt=""><figcaption></figcaption></figure>In neighbouring India, the daily caseload is now nearing 150,000 a day, and it is doubling every 1.5 days in Bihar state across the border. During the Delta surge, Nepal’s cases peaked two weeks after it did in India, but with Omicron it may not even take that long. “We are prepared for hospitalisations if cases are milder and not as serious but we don’t know how the virus will behave. We are also better prepared than the last surge with oxygen, ICUs and other facilities,” says Sangita Kaushal Mishra at the Ministry of Health Health Coordination Division.That may be the case, but across Nepal many rural hospitals are still understaffed and <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">do not have trained personnel</a> to operate ventilators and run ICU wards. Similarly, not all newly installed oxygen plants are functional yet.Then there is virtually no contact tracing, leading experts to believe that figures for Omicron are underreported, and only individuals with symptoms are being tested. “Given how contagious Omicron is, increased testing can go a long way in controlling the surge, so can institutional isolation of active cases,” says Bikash Gauchan of the Gandaki Province Infectious and Communicable Disease Hospital in Pokhara.Children all over the country are still largely unvaccinated, and should be prioritised during the time that schools are closed. There has been a worrying rise in paediatric hospitalisation in the US and Europe among unvaccinated children. And while people below 18 years have been largely spared so far, they are nonetheless an active medium for the virus to spread rapidly to more at-risk groups.The community spread of Omicron in Nepal is blamed on large gatherings of major political parties during their conventions in the past month. Such irresponsibility from top leaders has also led general populations to flout safety measures. Maoist Centre Chair Pushpa Kamal Dahal, his family and many of his close aides have tested positive, and leaders of other political parties, including ministers are in isolation.The once-in-12-year <a href="https://www.nepalitimes.com/banner/creation-to-destruction-then-revival/" target="_blank" rel="noopener noreferrer">Makar Mela</a> is expected to draw 6 million visitors in a month to Panauti starting next week, and can be a hyper-spreader event. So can the lead-up to the local elections slated for April. “The fact that Omicron is much milder can make people more careless, so we must once again reinforce the importance of masks, ventilation and distancing,” says Pun.Besides this, the second line of defence is to vaccinate as many people as soon as possible, and start giving boosters to the rest. Adds Buddha Basnyat: “We were lucky with Omicron that it is mild but we should use it as an opportunity to vaccinate both the unvaccinated and boost the vulnerable groups simultaneously on war footing to prevent stronger variants from arising.”

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Boosting booster jabs against Omicron

<figure><img width="1902" height="1266" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1ed59c7e80680e0af431jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Following initial lab reports that AstraZeneca and VeroCell boosters afford lower or no protection against <a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">the new Omicron strain</a>, Nepal Times reached out to <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">Andrew Pollard</a>, who helped develop the Oxford AstraZeneca vaccines. Majority of the vaccinated Nepalis have been administered either with the Chinese VeroCell or the AstraZeneca Covishield manufactured in India. At least 12.2 million Nepalis (42% of the population) have got at least one dose of vaccine, and 9.7 million have got both jabs (33% of population).Of these 28.5% got the Covishield and 62.1% got the VeroCell which are vector vaccines made from disabled viruses, as per the government figures last updated 18 November. Another 9.2% got J&amp;J. Less than 4,000 have received Pfizer or Moderna which are genetically engineered mRNA vaccines. Nepal currently has nearly 14 million <a href="https://www.nepalitimes.com/here-now/from-scarce-vaccines-to-storage-shortage-in-nepal/" target="_blank" rel="noopener noreferrer">vaccines in stock</a> and wants to fully vaccinate 40% of the population before offering booster shots by the end of the month.Excerpts of the conversation with Andrew Pollard:Read also: <a href="https://www.nepalitimes.com/latest/nepal-has-all-the-conditions-for-an-omicron-surge/">“Nepal has all the conditions for an Omicron surge”</a>, Nepali TimesNepali Times: Is it true that AstraZeneca boosters are not as effective against Omicron?Andrew Pollard: The new coronavirus is here to stay and it will remain with us for decades to come. To do this is will find ways to continue to infect people in communities even if they are vaccinated. The important role of the vaccines is to prevent severe disease and the evidence so far, even with Omicron, does appear to indicate that vaccines are still holding up in preventing most of the severe outcomes.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">New variants</a> are able to cause asymptomatic or mild disease in vaccinated people with any of the vaccines that are being used around the world, and Omicron is the champion so far in doing this. But vaccines remain highly effective in preventing severe disease from all variants and make us a lot safer than if we are unvaccinated.Is the negative publicity likely to increase <a href="https://www.nepalitimes.com/banner/why-is-there-vaccine-hesitancy-in-nepal/" target="_blank" rel="noopener noreferrer">vaccine hesitancy</a> in Nepal, and fuel the pandemic even more?I think the interpretation of the data is wrong. The evidence is clear, vaccines have already saved millions of lives. A recent analysis showed that AstraZeneca jabs have saved more lives than any other vaccines worldwide.Viral evolution means that Omicron and its children will evade immune responses and allow infections with any of the vaccines. At this moment, Omicron can cause infection whether you have had AstraZeneca or Pfizer with very low protection from both of them. However, the vaccines still prevent severe disease. <img width="400" height="400" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1ed99c7e80680e0af432jpeg.jpg" alt="">Read also: <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/">Living with Covid in 2022</a>, Sonia Awale What options Nepal and India can pursue to stop the spread of Omicron? The impact of first/second doses is huge and these should be prioritised over boosters where there is a short supply of doses. Omicron spreads very easily and so it is more likely that the virus will find the unvaccinated and put them at risk, so we do need to get <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">vaccine coverage</a> high everywhere but especially in older adults and those with health conditions who have not yet been vaccinated as they are at greatest risk. Is it time to administer booster doses, and if so, who should get it first? <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Boosters</a> do seem to increase antibodies and some early evidence from the UK shows that boosters increase protection against these mild infections. Boosters may be important for some of the frailest in our communities to keep them safe if their protection has waned. Some countries have started booster programs focusing on these risk groups first. Read also: <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/">Nepal needs to prepare for new Covid wave</a>, Cilo Bazakas

“All vaccines prevent severe Covid”

<img width="1594" height="986" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1ed09c7e80680e0af42fjpeg.jpg" alt=""/>The rapid spread of the<a href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer"> new coronavirus variant Omicron</a> across the globe has cast serious doubts about the efficacy of different Covid-19 vaccines in use worldwide. In particular, non-mRNA vaccines have been put on the spotlight, with initial lab reports suggesting their decreased protection against the new strain. Nepali Times spoke with regional <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">health expert Sushil Koirala</a> based in Bangkok this week about Omicron setting off a <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">new surge</a> in the Subcontinent, the danger of falling vaccine efficacy, and the best strategy for Nepal moving into 2022. Nepali Times: Initial lab reports suggest that non m-RNA vaccines are largely ineffective against Omicron. Would this be accurate? Sushil Koirala: I am not aware of any specific evidence that says viral vector vaccines are ineffective against the Omicron variant. I have also not seen any evidence of it being effective. The problem is the lack of transparency from manufacturers. That unknown, compared to some evidence we have with the mRNA vaccines, is the problem. Since little is known on the effectiveness of viral vector vaccines particularly VeroCell, the natural tendency is to think that the mRNA vaccines are a better choice as a booster against delta reinfection and Omicron variant. Read also: <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/">“All vaccines prevent severe Covid”</a>, Nepali TimesIn that case, how should our vaccination drive move ahead now?Nepal should swiftly provide booster doses to the vulnerable population, many of whom were vaccinated almost a year ago. Early evidence based on lab studies shows that a recent (booster) jab provides ‘increased’ protection against Omicron. Most importantly, The Imperial College London Covid-19 response team has recently estimated that the risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant. This implies that the protection against reinfection by Omicron afforded by past infection may be as low as 19%.  <figure><img width="126" height="150" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161152/636d1ed49c7e80680e0af430jpeg.jpg" alt=""><figcaption>Sushil Koirala</figcaption></figure>In short, there is some evidence that natural immunity from past infection and or vaccine-induced immunity from prior vaccination may not be sufficient to prevent Omicron infection. However, it’s good to point out that it is too early in the day, and there is insufficient knowledge on how those infections will translate to increased severity and or death at a population level. Good thing is, Nepal has now received sufficient Moderna vaccines to provide booster doses to elderly and vulnerable groups and will have additional 2 million doses to continue vaccinating those of 12-18 years of age.  Read also: <a href="https://www.nepalitimes.com/here-now/living-with-covid-in-2022/">Living with Covid in 2022</a>, Sonia Awale Is there now a clearer picture of Omicron? What can we say about a possible new surge, increased transmissibility and severe diseases? Though it is still quite early to conclude anything, there is a broader general consensus on the following evidence:  1) Due to mutations in the spike protein, Omicron is highly transmissible. Early studies suggest that it is four-fold more infectious than the original coronavirus and two-fold more infectious than <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">Delta</a>.  Lab studies suggest that Omicron was able to replicate 70 times faster in human respiratory tissue than Delta, which may help the variant spread more rapidly between people. There were also higher levels of the Omicron variant in respiratory tissue 48 hours after infection than the Delta variant.  2) There is some evidence that natural immunity from past infection and or vaccine-induced immunity from prior vaccination may not be sufficient to prevent Omicron infection as discussed earlier. 3) There is mixed evidence based on small lab-based studies that suggest that vaccine still provides some level of protection against Omicron and while other studies suggest that there are vaccine escapes. The magnitude of either one is unknown.  4) Early data suggests that Omicron may be milder than previous variants, but most of this anecdotal data comes from young and fully vaccinated patients. It is also important to note that many of these initially confirmed Omicron cases were already fully vaccinated or previously infected, revealing the occurrence of breakthrough reinfection and the immune escape of the Omicron variant. 5) There are not many studies/data that look at the severity of Omicron infections among unvaccinated and elderly/vulnerable people. Some experts believe that Omicron's increased transmissibility could still result in high rates of severe disease and death particularly among vulnerable and unvaccinated people.  Read also: <a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">Masks and vaccines to stop Nepal’s 2nd wave</a>, Sushil Koirala At this point in the pandemic, what should be Nepal's best strategy moving forward? We have three confirmed imported cases of Omicron. Since the first case arrived in Nepal in mid-November, it is safe to assume that there must be small cluster transmission happening in Nepal, particularly in Kathmandu. Recent<a href="https://www.nepalitimes.com/latest/unconventional-party-conventions/" target="_blank" rel="noopener noreferrer"> superspreader political events</a> have exacerbated the risks of the transmissions to other parts of Nepal. All three confirmed cases were detected when they were clinically sick and among vaccinated people. It shows that our active surveillance is not working well.  Despite having multiple cases from fly-in travelers, our real risk of a large-scale outbreak is likely to come from across the southern border. So, yet again, what will happen in Nepal will largely depend on how the Omicron outbreak unfolds in India. Nepal should keep its focus on surveilling border cases and up its vaccination drive, which has flattened in recent months.   As natural immunity seems to be unable to prevent Omicrom infections, it is of outmost importance that<a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer"> Nepal prepare critical care </a>for a large-scale Omicron outbreak.  We have a relatively lower vaccinated coverage, we have not provided <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">booster doses</a>,  the efficacy of the Chinese vaccine against the new variant is unknown, and public health measures at population levels are sketchy and insufficient.  This presents all necessary conditions for a highly contagious variant to spread in Nepal. It is still too early to tell how this increased transmissibility translates to the severity and deaths. We will eventually know that, but we cannot afford to wait. Read also: <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/">Delta variant’s wake-up call for Nepal</a>, Sushil Koirala and Ben Ayers

“Nepal has all the conditions for an Omicron surge”

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

Nepal on high alert for Omicron

This week at the National Population Policy launch Prime Minister K P Oli exhorted Nepalis to get married by age 20 and have three babies by the time they are 30. This was the first indication that the highest office in the land has understood the need to address Nepal’s dramatically <a href="https://nepalitimes.com/news/nepals-demographic-window-is-closing">falling birth rate</a>, but Oli’s statement was greeted with ridicule on<a href="https://nepalitimes.com/banner/avoiding-the-quicksand-of-social-media"> social media</a> — especially by women. Most urban young are already grappling with economic pressures and shifting life priorities. Even with a university degree,<a href="https://nepalitimes.com/here-now/workers-return-to-jobless-nepal?%2F"> many cannot find jobs</a>, and are taking the first flight out for overseas employment. Having a child is now a fraught decision shaped by income, individual autonomy, and family pressure. The <a href="https://www.unfpa.org/swp2025">UNFPA’s State of the World Population report </a>released last month, highlighted a significant <a href="https://nepalitimes.com/here-now/migrating-males-and-population-decline">decline in fertility rates </a>around the world. The global average fertility rate is 2.25 children per woman, and 18% of the reproductive adults said they will not be able to have the number of children they desire. The total fertility rate in Nepal has plummeted to 2.1 births per woman — down from 5 just 30 years ago. This is considered replacement level, meaning the newborns will replace their parents.&nbsp; However, birth rates are not declining as rapidly everywhere. The Tarai in has a total fertility rate of 2.20, and northwestern mountains is still 2.24.&nbsp; There are multiple factors in play, and the report broadly divides them into four categories: health issues, economic concerns, fears about the future, and lack of a supportive partner or their absence. More than half of the respondents said finance, which includes unemployment and increased cost of housing, as well as parenthood, was a barrier to having children. “More and more people prefer one or two children at maximum. Many women also decide to have children at a much later age,” says Kamala Devi Lamichhane of Tribhuvan University. “The opportunity cost is far higher for women.” But there is also a cost for the country, as the National Population Policy notes. At the rate the total fertility rate is falling it will soon be below replacement level — meaning that in the next three decades Nepal will be confronted with an <a href="https://nepalitimes.com/opinion/the-future-is-older">ageing population</a>.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291.png" data-media-id="editor_6" data-image-id="20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291" data-rendition-name="original" width="1302" height="501" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b.png" data-media-id="editor_7" data-image-id="20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b" data-rendition-name="original" width="1125" height="500" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>  Besides income, there are also cultural factors at play in women having fewer babies — they are expected to do all the childcare duties, even putting their careers on hold. In general, there is little help from spouses, and with more nuclear families there is less support from relatives. “Women today are well educated, career-oriented, and economically independent, allowing them to delay marriage as well as being conscious about their body and <a href="https://nepalitimes.com/multimedia/nepal-far-from-hitting-contraceptive-target?%2F">reproductive rights</a>,” says Laxmi Tamang of the International Confederation of Midwives (ICM). Also present at the policy launch was demographer Yagya Bahadur Karki, who said that women are more educated and hence, empowered to take their own informed decisions regarding having children.&nbsp; He adds, “But the fertility rates have reached replacement rate, and that stands as a warning for the future.”&nbsp; Fertility rates have fallen in inverse proportion to the rise in female literacy. The regions of Nepal where couples have more babies is where women are less educated. Couples in Madhes and Sudur Paschim provinces, where child marriage, gender-based discrimination, menstrual huts and dowry are still widespread are where the fertility rate is still high.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39.jpg" data-media-id="editor_9" data-image-id="20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39" data-rendition-name="original" width="994" height="682" loading="lazy" alt="TFR Map"> </figure>  And because female literacy also has a direct correlation with <a href="https://nepalitimes.com/news/fatal-discrimination">infant and child mortality</a>, couples in those regions tend to have more babies so some of them survive.&nbsp; But it is Nepal’s urban centres among the educated where the increased choices in reproductive health, including alternative methods of conception like IVF and treatment for infertility, as well as <a href="https://nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor">contraceptives</a> offer more options for family planning. “There are more choices regarding reproductive health, and there is more awareness as well, which is why people decide carefully on whether or not to bear a child,” says population expert Yogendra Gurung. <a href="https://nepalitimes.com/here-now/migrants-returning-from-the-gulf-with-infertility">Migration is another factor</a> adding to the decline in fertility rates. Many young Nepalis of reproductive age leave every day in pursuit of better jobs overseas. Spousal separation means fewer children.&nbsp; “Once away, even if not educated, they realise that child-rearing costs are high, and try to have fewer and even no children in some cases,” Gurung adds. Recent studies have also shown that men returning after their stint in the Gulf and Malaysia, where they are <a href="https://nepalitimes.com/news/gulf-workers-need-protection-from-heat">exposed to extreme heat </a>for extended periods as well as various chemicals and toxins in their work environment &nbsp;have a range of health problems, including infertility. To increase the birth rate, Nepal will have to reverse its family planning strategy of the past 40 years. Complicating this is that some regions of Nepal will need measures to control the birth rate, while urban areas will need a strategy to help parents have more babies. One way to help families have more children is to develop more <a href="https://nepalitimes.com/here-now/future-proofing-nepal-s-population-strategy?s=04&amp;fbclid=IwY2xjawFQf-NleHRuA2FlbQIxMQABHRxSwwGPfm7_2cBhDVAowPxEmFXP0Os-KRs1DXqIW_84wDhciExtZuNi1g_aem_jzRqN2cEVAppfwr5qedxRg">family-friendly policies</a> that favour women and youth as the Nordic countries, which also have falling birth rates, have done. They have introduced flexible parental leaves for both parents, including financial and health incentives. China, also concerned about its declining birth rate and an ageing population, now has a three-child policy as well as tax deductions, expanded childcare services, and leave policies to encourage couples to have more children. “We must work towards childbirth and childcare policies and plans that are suitable for Nepal, so that couples planning for children do not have to think twice about it because of finances or other reasons,” adds Gurung. Tamang of the International Confederation of Midwives says a gender transformative approach is needed to address the issues of the gender gap which is adding to the decline in childbirth. Husbands need to play a more important role in child-rearing. Instead of increasing fertility for the sake of it, the objective should be to assist young people to start the families they desire, at a point and time of their choice. Respect for everyone’s rights and dignity lays a foundation for a more balanced demographic trend. Lamichhane sums it up: “If fertility rates are to be sustained, it requires changes in the gender roles and behaviour, keeping the youth’s aspirations in mind.”

Nepalis are having fewer babies. Why?

Does anyone know that 2023-33 was declared the <a href="https://nepalitimes.com/banner/visit-nepal-again">Visit Nepal</a> Decade? Or that Pokhara announced that 2025 is a Special Tourism Year? The fuselage of Nepal Airlines jets still carry the Visit Nepal Year 2020 logos. Such ad hoc and unnoticed promotion is emblematic of the way Nepal has tried to increase visitor arrivals <a href="https://nepalitimes.com/news/nepal-hopes-for-tourism-rebound-in-2021-rk4dlo9t">post-Covid</a> — and of the country’s wider political disarray. Deepak Raj Joshi of the Nepal Tourism Board (NTB) has his work cut out to coordinate various agencies of the government to boost arrivals.&nbsp; He says, “We have been working on marketing strategies to revive the tourism sector, and are hopeful that this year will mark a 8-10% increase in arrivals compared to the pre-pandemic times.” On paper, tourist numbers have rebounded to pre-Covid numbers with over 1 million last year, but official figures do not give a true picture of duration of stay, average spending, and the fact every visitor is counted as a ‘tourist’, even repeat visitors who come on business. The few bright spots are largely a result of private sector promotion of niche tourism products, individual social media posts of <a href="https://archive.nepalitimes.com/page/top-10-treks">adventurous treks in Nepal</a>, or the fact that Indians are allowed to enter China again to visit Lake Mansarovar and Mt Kailash via Nepal. Indeed, Simkot airport has up to 15 flights a day from Nepalganj bringing in <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims</a> who are then ferried by helicopter to the border in Hilsa, or Lapcha Pass from where the holy sites in Tibet are visible. The rudimentary hotels and rest houses along the route in Humla have been bursting at the seams for the past month, to the point that some establishments are no longer able to provide patrons basic amenities.&nbsp; Last year, 1.14 million tourists visited Nepal, and the government has projected up to 10% increase in tourist arrivals this year. International tourist arrivals to Nepal have been steadily increasing, especially from the US, Europe, and India. Domestic and regional travel has also increased after the <a href="https://nepalitimes.com/news/lockdown-5-utlzqtvs">Covid lockdowns</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505.jpg" data-media-id="editor_5" data-image-id="20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505" data-rendition-name="original" width="1145" height="668" loading="lazy" alt="Tourist numbers"> </figure>  The tourism industry employs at least 1 million people, trekking injects money directly into the <a href="https://nepalitimes.com/editorial/not-rising-nepal">rural economy </a>and sustains ancillary sectors like handicrafts and domestic aviation. In the last fiscal year, tourism brought in Rs82.33 billion, according to Nepal Rastra Bank. But the industry has been affected by negative publicity about poor infrastructure, air pollution in Kathmandu, travel safety and news of disasters like the <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">China-Nepal flood last week</a> that made international headlines. Growing worries about the climate crisis is also affecting youth travel, especially from Europe. Read also: <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">Missing out on Nepal’s tourism potential</a> “The limitations of airport and road infrastructure has hindered the development of the tourism sector,” admits Joshi. “And many are put off by the appalling state of our road network, especially during <a href="https://nepalitimes.com/opinion/managing-the-monsoon">the monsoon season</a>.” Nepal is home to 20 protected areas, 10 heritage sites, and eight out of the world’s 10 highest mountains, and despite all the obstacles it is still the perfect destination for the modern social media savvy traveller, who are experience-driven and inclined to look for itineraries that emphasise wellness and cultural immersion.&nbsp; Some hotels around Kathmandu, Pokhara, Jomsom and the Khumbu have strived to adapt to this new tourism landscape, expanding facilities with significant international investment. <a href="https://nepalitimes.com/business/a-thamel-within-thamel">Luxury hotels like Aloft Kathmandu</a> in Thamel were inaugurated just before the pandemic lockdowns, survived the crisis and thrived as it. Says General Manager Vikram Singh (pictured, below): “Our prime location in Thamel enhances the guest experience, especially for those seeking convenience and immersion in the local scene and travellers who want to be in the centre of it all.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d.jpg" data-media-id="editor_11" data-image-id="2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d" data-rendition-name="original" width="1066" height="1600" loading="lazy" alt="Aloft GM"> </figure>  <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">Sustainability </a>and environmental consciousness has also become an integral part of the hospitality industry. ISO certifications as well as sustainability initiatives like the Travelife sustainability certification for eco-friendly resorts validate credibility of hotels. Aloft is the first five-star hotel in Nepal to have earned the Waste Smart Certificate, and it has also been awarded the ISO 14001:2015 certification, which is the internationally recognised standard for environmental management systems (EMS). But such investments will not amount to much unless Nepal makes serious efforts to promote itself as a<a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz?utm="> tourism destination</a>, especially to its two giant neighbours. More importantly, the country needs to increase activities in which tourists can spend the money they want to. “While <a href="https://nepalitimes.com/here-now/nepal-pushes-mountain-bike-tourism?fbclid=IwAR1MNH0iFGv1vRz5G9uZ4AzUlKxB6nY7JKq0qT6je_FV4_SuxPZqviwKGn0">mountaineering and adventure tourism</a> are extensively promoted, we have fallen short of marketing other elements such as wildlife, pilgrimage and cultural heritage,” says Joshi. “There is a need to diversify promotion to increase income from the tourism sector.” Meanwhile, making Nepal more accessible to international and domestic visitors, must also be a priority. Kathmandu remains the sole aerial gateway despite new airports in Pokhara and Bhairawa. “International airlines have shown interest, and if access and flights are increased these airports can be fully functional,” says Joshi. But Sichuan Airlines has stopped flying to Pokhara, and there does not seem to be much interest from Thai, Vietnamese and Cambodian carriers to fly directly to Lumbini. Says Singh: “There’s tremendous opportunity to strengthen Nepal’s destination marketing by telling richer, more compelling stories that <a href="https://nepalitimes.com/opinion/comment/culture-cannot-be-an-afterthought">connect travellers with our culture</a>, nature, and people.”

Tourism needs a new push

Local residents of Mustang, including a sitting MP and several politicians, submitted a petition to Prime Minister KP Oli in Kathmandu this week urging the government to lift the region’s ‘restricted’ status. This is not the first time such a demand has been raised, and as infrastructure the region’s accessibility improved over the years, calls to remove the long-standing restriction have grown louder.&nbsp; Upper Mustang is no longer weeks away <a href="https://nepalitimes.com/here-now/postcards-from-kathmandu">from Kathmandu.</a> Nearly 85% of the road from Beni to Kagbeni has been blacktopped, and one can drive from Kathmandu to Lo Manthang with an overnight stop in Pokhara. Between April 2024 and April 2025, Lower Mustang received 144,745 international tourists, a near 50% increase compared to the previous year. Most of these were <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims </a>travelling to Muktinath. <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a> is also gaining popularity among Nepali visitors, with 700,000 visiting the region in 2024. A hotel operator in Kagbeni estimated that about 20% of Nepali visitors to Muktinath also travel to Korala, the trade and transit checkpoint on the <a href="https://nepalitimes.com/latest/north-of-the-border">China border</a>. That would mean that nearly 100,000 domestic tourists visit Upper Mustang annually. In stark contrast, international tourist numbers to Upper Mustang (north of Kagbeni) have remained stagnant, hovering around 4,000 visitors per year. The primary reason is the continued enforcement of the region’s restricted status. Foreign visitors must pay a steep permit fee: a minimum of $500 for 10 days, with an additional $50 per day thereafter. Tourism some entrepreneurs, politicians, and residents want these fees to be abolished so Upper Mustang can attract a broader range of international travellers. The success of Lower Mustang, where relaxed restrictions have led to a<a href="https://nepalitimes.com/here-now/boom-time-in-central-tarai"> tourism boom</a>, is often cited as proof of what lifting restrictions could achieve. Upper Mustang is not the only region in Nepal with a restricted status. Several northern areas prefixed with ‘Upper’ (Upper Manaslu, Upper Dolpo, Upper Kanchenjunga, and Upper Arun) also need similar permits and fees. Although no clear official explanation exists, these areas were primarily restricted due to historical inaccessibility, ecological and cultural fragility and security concerns. Read also: <a href="https://nepalitimes.com/news/upper-mustang-opposes-prohibited-areas">Call to scrap Upper Mustang tourist fee</a> In the 1960s and 1970s, these remote regions served as shelters for Khampa guerrilla fighters who launched cross border ambushes on the <a href="https://nepalitimes.com/here-now/the-last-days-of-the-khampa">Chinese military </a>across the border.&nbsp; Though the Khampa have long gone, security concerns rooted in that era seem to persist. The government in Kathmandu is seemingly unaware of the changed political and security landscape. If concerns do remain, they are not made public. One of the main reasons for maintaining the restricted designation is to limit visitor numbers. But with <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">improved road access and services</a>, as Upper Mustang has seen, this justification no longer holds. When Upper Mustang first opened to international tourists in 1992, it had no formal lodges or hotels, and it took four to five days of trekking from Jomsom to Lo Manthang.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f.jpg" data-media-id="editor_8" data-image-id="20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f" data-rendition-name="original" width="2000" height="509" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: SHRIJAN PANDEY / NT ARCHIVE</figcaption> </figure>  Without a nechyang (a household with traditional friendship), it was difficult to find a place to stay or get a proper meal. Only a few elite households offered accommodation. Today, there are now more than 80 lodges and hotels above Kagbeni, spread across nearly every village. Several upmarket hotels now struggle to stay afloat during the off-season, relying on low-spending domestic visitors to survive. Lo Manthang, once a remote destination, is now just a few hours’ drive from Jomsom, easily reachable by lunchtime for early starters. Once the remaining road sections are blacktopped, travel time will be further reduced. Yet, the government still charges a flat $500 fee for a 10-day permit based on outdated &nbsp;assumptions from a bygone era. There has been no serious review of the permit structure to align with current realities, nor any response to local aspirations to attract more international tourists and <a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz">harness tourism for economic development</a>. Concerns about over tourism are valid. There is a risk that increasing visitor numbers could erode Upper Mustang’s <a href="https://nepalitimes.com/here-now/a-million-mantras-in-mustang">cultural heritage</a>, social fabric, and fragile natural environment, precisely the features that make it special. However, the region’s 33 years of tourism experience have been largely positive.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a.jpg" data-media-id="editor_11" data-image-id="20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a" data-rendition-name="original" width="1400" height="1050" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: MUKESH POKHREL / NT ARCHIVE</figcaption> </figure>  Tourism has contributed significantly to the restoration and <a href="https://nepalitimes.com/here-now/the-history-of-heritage?%2F">preservation of religious and historical sites</a> like the Thubchen and Jampa monasteries in Lo Manthang, the ongoing conversion of the old palace in Ghami into a premium hotel, and the rehabilitation of many monasteries and chortens.&nbsp; These efforts, supported by international donors and heritage experts, demonstrate that tourism—when well managed—can be a powerful driver of <a href="https://nepalitimes.com/here-now/shrinking-tourism-s-ecological-footprint">conservation</a>. The high permit fees have been somewhat effective in limiting international visitors, but they have no influence on the growing number of domestic tourists, particularly during the Dasain and Tihar holidays. The most pressing need now is for all levels of government—federal, provincial, and local—to<a href="https://nepalitimes.com/news/why-invest-in-nepal"> invest in </a>managing tourist flows and maintaining tourist sites. These efforts are essential not only to enhance visitor experience but also to build long-term resilience and sustainability for the destination. Read also: <a href="https://nepalitimes.com/news/greening-nepal-s-tourism">Greening Nepal’s tourism</a>, Hanna Wells Visitor numbers are central to any tourism development strategy that aims to balance economic, social, and environmental goals. Clinging to obsolete policies and concerns to justify Upper Mustang’s restricted status is not only unfair, it also suggests an undemocratic and discriminatory attitude toward a remote district.&nbsp; Shailendra Thakali, PhD, is from Jomsom and is a freelance consultant on protected areas, tourism, conservation, and sustainable livelihoods.

Lift restrictions on Upper Mustang

Many of us former Nepal Peace Corps volunteers (PCVs) would agree that our time in Nepal changed in significant but very different ways our perspectives on life if not the future paths we chose to follow. Of no one was this truer than Dorothy Mierow. Dorothy was born in 1920, in Colorado Springs. Her father Charles C Mierow was a classics scholar and Latin professor, who served for ten years as president of Colorado College.&nbsp; Dorothy developed an interest in animals as a child, graduated with a BA degree in natural history from Carlton College in 1942, a Master’s in biology from the University of Pittsburgh, and another Master’s in geography from the University of Minnesota.&nbsp; As a young woman, Dorothy traveled with her father throughout Europe, including a visit to ancient Greek ruins, and took a Magellan Tour by cruise ship around the world in 1958.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262.jpg" data-media-id="editor_0" data-image-id="2025071901074_0bad133ab22aada319e74bbad95d563e191371db291c08f373839fbd15440262" data-rendition-name="original" width="903" height="1178" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>HOME AWAY FROM HOME: Dorothy Mierow as a college student in her native Colorado.</figcaption> </figure>  She was a college teacher during much of the 1940s, also teaching at a girls’ school in Hawaii. Then back to her native Colorado in 1953, where she became a curator and later director of the Colorado College Natural History Museum. She taught geography classes, and in her free time, Dorothy climbed 22 of Colorado’s 14,000-foot peaks. Traveling in India in 1960, Dorothy decided to spend two weeks in Nepal. In late 1961, she filled out an application to join the Peace Corps and specified that she wanted to go to Nepal, ‘because I admired the people so much when my father and I were there on our trip’.&nbsp; Dorothy reached Kathmandu in September 1962 as the first group of American Peace Corps volunteers in Nepal. She stood out from the others: one of the few women in that group, surely the oldest at age 41, a world traveler, and a woman who already had established a professional career.&nbsp; One doubts if Dorothy had had a husband and children whether she would ever have gone to work and spend much of the rest of her life in Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515.jpg" data-media-id="editor_1" data-image-id="2025071901078_68e84ade1ffb0f6c83c7f8fa5c1e7315b5f6c543217f96cde012e4d86f171515" data-rendition-name="original" width="1259" height="910" loading="lazy" alt="How th Peace Corps changed a volunteer's life NT"> <figcaption>Pokhara Bazar in 1962.</figcaption> </figure>  The Peace Corps assigned Dorothy to teach geography at Tri-Chandra College. After the school closed in the winter due to lack of heating, USAID and the College of Education asked Dorothy to help train general science teachers.&nbsp; She taught for two months and became involved in a textbook-writing project, commenting: ‘I would like the children to know something about public health, conservation (the trees are going fast and so is the soil), and learn the names of some of their common birds, trees, and flowers. They are more impressed with electricity, airplanes, and cell structure.’ When a new college opened in Pokhara in 1963, Dorothy was transferred there and lived with a Nepali family. The college boasted 30 students and no permanent buildings.&nbsp; In October 1963, Dorothy wrote: ‘Pokhara is a town of almost 5,000 people … We are in a fertile valley surrounded by foothills … There is a small Mission Hospital … a Leper Hospital and Tibetan Refugee Camp started by the Red Cross and now run by the Swiss. With winter approaching, more Tibetans are appearing in town, often with pack horses or donkeys. Some have been carrying large boxes of powdered milk,donated (by USAID) to the camp from the airport … There is no electricity, and the transportation problems make many items scarce and expensive. I am really a sort of a museum. The landlord brings all kinds of people in to see how I live and count my shoes and dresses. They express amazement at my books, pictures, tin oven, Nepali dolls from Kathmandu, screened food shelves and curtained closet.’ The standard term for Peace Corps volunteers was two years, but Dorothy extended her term and was still at Prithvi Narayan College at the end of 1965, when she wrote that she had 20 Geography students in the first-year class and 6 in the second year preparing for the IA Examination. The college enrollment was 125 students, and the foundation for a new science building was being excavated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29.jpg" data-media-id="editor_2" data-image-id="2025071901074_c6a80e5e0db0c705b2f8733c6d30dc0386fe3abbd2238ea9d947b7d746f94a29" data-rendition-name="original" width="902" height="605" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow and friends at Phewa Lake.</figcaption> </figure>  Dorothy noted that she ate one meal a day at the (Shining Mission) Hospital but otherwise lived on dal-bhat, momo, and potato curry at local shops. However, she had developed a new passion: to build what she initially called the Pokhara Museum of the Himalaya. In commendable Peace Corps fashion, Dorothy always worked with Nepalis and respected the culture. ‘The greatest joy and satisfaction I have had has been from the building of a Museum-Library in memory of my parents … It has been possible to feel like a wealthy benefactor with the money saved by father for the family’s education and now available for the education of others… (Father) would have loved to be in on the founding of a new college and be able to plan a library. Several hundred of the books to be in the museum-library came from his collection and were carefully selected to be of use for students in Nepal…’&nbsp; ‘The museum part is to satisfy my own inclinations and was thought of when I found how little diversion there was for the people of Pokhara… It is part of the University requirements for the college that it should have a geography and biology museum. The museum building is small but adequate.&nbsp; I have tried to design it in harmony with Nepalese architecture and decorate it with some of the art of the best artists or woodcarvers… Posts holding up the porch roof are carved by Cottage Industries to represent different peoples of Nepal in typical costumes. The door was carved by a local wood carver and has typical birds of Nepal around it. Inside are 10 roof-support carvings designed by the retired Director of the National Museum in Kathmandu, Mr. C.M. Maskey.&nbsp; They were carved by the best wood carvers in Patan very skilfully. The building has three rooms: the library, the exhibition room, and a smaller workroom which can be used by our newly formed Woman’s Club as well as other groups or classes.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8.jpg" data-media-id="editor_3" data-image-id="2025071901074_03d3359c65389d30a0134e9a4862778994121e7e833b7d28b18e06e36fc76ff8" data-rendition-name="original" width="629" height="599" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow with local women in Pokhara in 1969.</figcaption> </figure>  Dorothy promoted her project to influential Nepalis connected with organisations whose support she solicited: The Department of Archaeology, the Department of Agriculture, the Godavari Botanical Gardens; Tribhuvan University’s Science and Education Department, Nature Conservation Society.&nbsp; The museum was opened officially in early 1967. The Annapurna Natural History Museum, the building Dorothy designed and had constructed, is still open and features some exhibits which she created many years ago.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26.jpg" data-media-id="editor_4" data-image-id="2025071901074_54326a8a0685e980e782378076de2f5cd02d2426e9b0d94eed972d3dbe83af26" data-rendition-name="original" width="1333" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>The Annapurna Natural History Museum.</figcaption> </figure>  Dorothy returned to America in 1967, but she longed for Nepal. In the spring of 1969, she again tried to enroll as a Peace Corps volunteer but was told that as she had spent more than four years, she would not be eligible for another assignment. Undeterred, she persuaded the college in Pokhara to invite her to return as a teacher.&nbsp; UNICEF and the Forestry Department sponsored Dorothy to prepare charts on trees, birds, animals and flowers in colour for distribution to the schools of Nepal. Dorothy, back in the Peace Corps, returned to Pokhara and the Museum in 1972. She formed a friendship with her former geography student from Sikles, Chandra Prasad Gurung, and in 1974, she brought Chandra to America, where he enrolled in Colorado College and studied cultural anthropology.&nbsp; Chandra subsequently earned his PhD in geography from the University of Hawaii and returned to Pokhara to become director of the Annapurna Conservation Area Project. Gurung actively promoted ecotourism, landscape conservation, and biodiversity conservation in Nepal. His life was cut short along with those of 23 other Nepalis and foreigners who perished in a helicopter crash near Taplejung in September 2006.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314.jpg" data-media-id="editor_5" data-image-id="2025071901074_322d3c3ac6f1b08ffa07c44a19998b937a7db9eb43527f7539cf6481e1546314" data-rendition-name="original" width="2500" height="1000" loading="lazy" alt="How the Peace Corps changed a volunteer's life"> <figcaption>Mierow's four books on Nepal and its biodiversity. </figcaption> </figure>  Dorothy worked with several well-known Nepalis to publish her paintings and photos in beautifully illustrated books. She and Hemanta Mishra of the National Parks and Wildlife Service wrote Wild Animals of Nepal (Ratna Pustak Bhandar, 1976). More than 400 photos Dorothy took on treks to the Everest region, Gosaikunda, Muktinath, Jumla and Rara Lake, as well as travels in the Tarai, appeared in Himalayan Flowers and Trees (Sahayogi Prakashan, 1978).&nbsp; The botanist Tirtha Bahadur Shrestha identified the species. Dorothy and Kesar Lall published This Beautiful Nepal (Sahayogi Press, 1981). Birds of the Central Himalayas (1988) contained Dorothy’s paintings of 250 species of birds found along the areas of the Kali Gandaki River, Pokhara, Chitwan and the central Tarai. Dorothy summed up her life and work in Nepal in Thirty Years in Pokhara (Pilgrims Book House, 1997). Dorothy returned to Pokhara and her adopted Gurung family several times during the 1980s and 1990s to celebrate festivals and meet old friends. Her final years were spent at her mountain cottage in Green Mountain Falls north of Colorado Springs. She died at the age of 79 in August, 2000. Nepal gave new meaning and purpose to Dorothy Mierow’s life. Daniel W Edwards was a Peace Corps volunteer in 1966 and is the author of several books on Nepal. The author thanks Special Collections, Tutt Library, Colorado College.

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