<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

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“All vaccines prevent severe Covid”

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

Sonia Awale

Vaccines too little, too late for Nepal?

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

1.6 million vaccinated, 20 million to go

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“All vaccines prevent severe Covid”

Vaccines too little, too late for Nepal?

1.6 million vaccinated, 20 million to go