<figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e29c7e80680e06f117jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Nepal’s oxygen emergency <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/">has eased somewhat as the Covid-19 second wave crests,</a> but the crisis exposed serious gaps in the supply and distribution of medical oxygen with major implications for the future.At the peak of the second wave, many Covid-19 patients died as hospitals ran out of oxygen, but with an<a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/"> overwhelming international response </a>to rush cylinders, concentrators and generators, there is now the risk of over-capacity of medical oxygen post-pandemic. Nepal’s demand for oxygen cylinders shot up to 50,000 per day during the peak of the second wave in May, with the country’s oxygen factories and hospitals <a href="https://www.nepalitimes.com/here-now/its-an-emergency/">only able to fill 19,000 cylinders every day</a>. In contrast, pre-wave calculations had suggested that peak daily demand would only be about 6,000 cylinders.  <img width="640" height="338" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e49c7e80680e06f118jpeg.jpg" alt=""><img width="640" height="319" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91e79c7e80680e06f119jpeg.jpg" alt="">Most of the 29 oxygen factories in Nepal were working at only half capacity pre-pandemic because of low demand. In fact, three of them had closed down. As the second wave hit, the plants went into full-scale production, but a shortage of cylinders meant that the excess production could not be sent to hospitals.Meanwhile, factories relying on liquid oxygen tankers were affected by an Indian ban on export. Empty cylinders from China, Oman and other countries alleviated the shortage somewhat, while oxygen plants grappled with increasing generation capacity. <figure><img width="640" height="361" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ea9c7e80680e06f11ajpeg.jpg" alt=""><figcaption> </figcaption></figure>Too little too lateWhen the inter-ministerial Covid-19 Crisis Management Center (CCMC) finally reacted, it was too late. Its arbitrary quota system for every hospital proved disastrous.“The quota resulted in hard-hit hospitals being undersupplied and safer hospitals being unnecessarily saturated with cylinders,” explains Roop Jyoti, former chairman of Grande City Hospital, suggesting the problems lay in supply chain management rather than oxygen production. Faced with mounting criticism for bungling the oxygen quotas, the Health Ministry resorted to micromanaging, and ordered suppliers to only send filled cylinders to hospitals that had its recommendation letter. The result was catastrophic, many<a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/"> hospitals were either forced to refuse service</a> or they asked families of patients to bring their own full cylinders.In a notice posted in mid-May, Kathmandu’s Om Hospital said: ‘Under the capping made by the government on oxygen supply, we are unable to take admissions despite our willingness to provide service. We have enough manpower such as doctors and nurses to take care of patients but not enough oxygen supply.’ Families with Covid-19 patients hoarded full cylinders at home, and desperate ones rushed to the gates of oxygen factories to buy the life-saving gas. Municipalities, especially in areas with spare capacity, prevented the transport of oxygen beyond district borders.Most of Nepal’s oxygen plants are in central and eastern Nepal. The Morang-Sunsari industrial corridor alone had five large oxygen factories with surplus capacity, but these were prevented from sending supplies to hospitals in Kathmandu and other areas with shortages. Lack of training in oxygen flow management and ventilator use did not help matters. Makeshift local isolation centres with non-medical staff were using full flow to treat patients with mild symptoms. Hoarding and black marketing was rampant, and while large hospitals ran out of oxygen supply, local isolation centres had one cylinder per patient.In Grande International Hospital, there was a 30% drop in oxygen demand when doctors were more judicious in oxygen use. Still, the shortage was serious enough for some doctors to ration oxygen even for their most serious patients. Others had to make the difficult choice between continuing to put patients who had little chance of survival on oxygen, or to give it to those who would immediately recover with oxygen. Even before the pandemic, government oversight on cylinders was non-existent with no standardisation or regulation in place regarding colour coding, pressure, price rates and deposits on oxygen cylinders.  “I used to get desperate calls at 3am from families of patients desperate for oxygen. We were able to call up spare capacity during the second wave, especially in the east of the country, but the shortage of cylinders for refilling did create a temporary shortage,” says Gaurav Sharda of the Nepal Oxygen Industries Association (NOIA). <figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ed9c7e80680e06f11bjpeg.jpg" alt=""><figcaption> </figcaption></figure>After the peak With the first week of June, Nepal’s Covid-19 curve started flattening with hospitals in Kathmandu and major cities seeing fewer patients who needed to be on oxygen or in ICU. “Compared to the devastating shortages in April and May, oxygen availability is relatively stable,” says Anup Bastola, a physician at Teku Hospital. The Ministry of Health also seems to have learnt from its mistakes, and is ensuring a more equitable supply of cylinders. Donated oxygen concentrators are now being flown to district hospitals where they are needed. However, even as demand for oxygen goes down, <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/">overseas Nepalis and international donors</a> are still rushing empty cylinders, concentrators, generators and liquid oxygen tanks on relief flights to Kathmandu. There are more oxygen generator plants arriving from France, the US and China this week. Ventilators from <a href="https://www.nepalitimes.com/latest/international-help-for-nepal-picks-up/">international donors</a> are sitting idle at some district hospitals in western Nepal because no one knows how to operate them. Domestic oxygen production itself is now reaching 100% capacity. Even though there is a challenge of logistics, equitable distribution, and cost, Nepal will soon have more oxygen than it needs. What the government needs to focus on is getting much-needed <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/">oxygen to rural areas</a> where the virus is spreading house-to-house.  The flood of donated oxygen generators now means that there will be domestic over-capacity just as there was before the second wave. Nepal’s oxygen sector therefore needs to balance supply to meet demand surges and periods of low consumption.Explains Jyoti: “Ironically, many new donated oxygen plants are being set up in hospitals in response to the second wave, so when this passes, there will be tremendous over-capacity. Regular factories would probably have to function at less than 25% capacity and will be destroyed financially.”At Teku Hospital, Bastola says <a href="https://www.nepalitimes.com/banner/two-nepals-in-the-death-zone/">repurposing oxygen equipment</a> could help Nepal prepare for future spikes. If there is a third wave this autumn, for example, demand would go up again. Besides Covid-19, there is also the pre-existing need for oxygen to treat the rise in respiratory ailments such as COPD and heart disease caused by worsening air pollution. Says Sharda at NOIA: “One of two scenarios can now play out. The government could either continue its reliance on donated oxygen generation equipment, thereby driving Nepali producers out of existence, or it could encourage sustained domestic production to meet a spike in demand during future outbreaks.” Last month, reports of Pressure Swing Adsorption (PSA) oxygen plants failing in hospitals, and a CCMC finding of 70% oxygen leakage in many hospitals were overlooked. These issues are structural and if resolved can help alleviate future shortages.“The government’s approach to oxygen distribution was myopic,” says Sharda. “Oxygen is a basic product and can easily be bottled here. But they failed to consult with us producers, and now all this oversupply from abroad will jeopardise our ability to respond to future outbreaks. Plant staff should also be <a href="https://www.nepalitimes.com/banner/nepals-life-or-death-o2-quest/">treated as frontline workers</a> and have vaccinations.” The government and CCMC failed to acknowledge that assistance was needed in the oxygen supply chain rather than production, and by allowing import of production equipment but bungling on supply management, they failed to take into account domestic generation capacity, thus increasing vulnerability in the future.  The only solution to prevent another oxygen crisis is to stop the problem at the source, by <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/">stemming the spread of Covid-19.</a> But the lesson from the second wave is that Nepal’s government, hospitals and oxygen plants need to have standby capacity at hand for future waves.

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Pandemic and the political-economy of oxygen supply

<figure><img width="722" height="482" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86609c7e80680e06784ejpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The flood of social media posts of <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNFw4HGIaJzWsPjE6KDbOCN9BO71nA">donated medical supplies</a> being unloaded at Kathmandu airport every day, gives the impression that the outside world cares more about the humanitarian emergency in Nepal than the country’s own leaders.
This week proved that the <a href="https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGnYd3WYcqcWZhTuAO1fDLmr6DWrw">Nepali politicians still do not get it</a>. Except for the chatting classes locked up at home, not many Nepalis follow, or care, about a dissolved Parliament, elections in November, or writs at the Supreme Court. They are preoccupied with trying to prevent relatives from <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG0TkkaP2byuZ7gTldxbjVgjSti9w">breathing their last</a>.
Prime Minister K P Oli has proven that he is not just a shrewd manipulator, but also has elastic ethics. In the past year, he has shown that he will stop at nothing: split the NCP that he himself united, dismantle his own UML, dissolve a Parliament in which he had a two-thirds majority. All is fair, it seems, in love and politics. 
Nepalis might have followed the political games in Kathmandu more closely if the alternatives to Oli inspired more confidence. But they are all tried, tested and failed ex-prime ministers themselves. The main contender Sher Bahadur Deuba of the Nepali Congress lined himself up to be PM for the fifth time, and has still not given up.
The crises due to the pandemic would have been the opportunity to form a national unity government, and work together to fight the virus. This would be the time for all the parties to skip a generation and bring up some young do-ers. That is what they may have done if this was a war. But <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/this-is-war/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEWgT9G992ZUlwbDLKjh5yVL3iW-A">this is a war</a>.
The needs are great: ensuring <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEbjbLTsFcBFUFjyD0KkohRt6dD0w">adequate oxygen supply</a>, rushing relief for the millions who have lost their income during the lockdowns, ensuring that ICU care is available and affordable to the general public, and negotiating a reliable vaccine pipeline. Preoccupied with politicking, the leaders had little time for any of this. 
Most of Nepal’s politically-appointed ambassadors overseas are more beholden to their patrons back home than to the people. With the exceptions of our female envoys in <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Oman and Spain</a>, other missions have not stepped up to the task of conveying the emergency like we did after the 2015 earthquake.
The oxygen cylinders and medical equipment that have arrived are mostly through donations from the <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Nepali diaspora</a>, citizens groups that have mobilised through social media, and friends of Nepal. 
No wonder the rest of the world does not take us seriously. When a state does not demonstrate accountability towards its own citizens, there is little trust even from governments that genuinely want to help, to provide urgently needed material. 
And there is not much the outside world can do when the malaise is within. Nepal has to resolve its own governance crisis that has messed up its Covid-19 response. 
Having said that, the international community could show more concern for the urgent need for vaccines. There are many flights bearing ventilators, concentrators, PPEs and test kits, but much vacillation on vaccines. 
Nepal is not getting the urgent help it needs to immediately vaccinate 1.4 million people whose default date for the second dose is now. On Monday, the government extended the dose gap to 16 weeks in the hope that someone somewhere will quickly send the <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG_KLW5M52MZ3Y7ijjHYNDTM3xYdQ">AstraZeneca (AZ)</a> vaccines we paid the Serum Institute of India for, but which were never delivered.
This is a major <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGmt0XUUHhxlq6n1BtsGFdw3YfM_w">failure of Nepal’s vaccine diplomacy</a>, but it is also India, Britain, the EU, US, the WHO that have let us down in this hour of need. We get it that vaccines are now a geo-strategic item, and countries are stockpiling it for the third wave. But some countries have enough doses to vaccinate their populations several times over, at a time when their own citizens are refusing to take AZ because of the panic over clots. 
Across France, AZ vaccines are being dumped because they are nearing expiry, the <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHGyEJVpvRxkfBu00MFW-UbFzLJxQ">United States has a cache</a> of 80 million Covid-19 vaccines, and nearly half its population refuses to be vaccinated. <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNF0Zuj2D_3iMclB9cP3qSBYR8nxPQ">Ship the shots </a>to people who want and need the vaccines.
We would like to see fewer Tweets of donated items that Nepal can afford to buy, and more timetables for vaccine deliveries.

Vacillating on vaccines

<figure><img width="1236" height="856" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a09c7e80680e067804jpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure><h2>1. Oxygen</h2> To save lives, Nepal’s most urgent need now is oxygen. Not just cylinders, but oxygen generators, concentrators and liquid oxygen. Most infected people are not succumbing to Covid-19, they are <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">dying because of low oxygen saturation</a> in the blood, and lack of hospital beds -- patients who need not have died of coronavirus. Dire as the situation is in the cities, Nepal’s pandemic has now <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer">infiltrated the remotest villages</a> where there is no hospital care and no oxygen. The virus is preying on people already suffering malnutrition, previous ailments, and decades of structural state neglect. In Rolpa, Humla and other remote districts, between 80-90% of PCR tests are coming back positive, and it takes a week to get results. Patients are either not isolating, or not following precautions.Kathmandu's doctor-to-patient ratio is 1:850, but in rural Nepal it is one doctor for every 15,000 people, and hospitals and medical staff there <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">are already overstretched</a>.Close to 60% of all swabs collected nationwide are from Bagmati Province, with nearly half of them in Kathmandu Valley, says epidemiologist Lhamu Yangchen Sherpa. She adds: “There just aren’t enough tests and contact tracing is minimal, official total cases and fatalities are grossly underestimated.” <figure><img width="1497" height="746" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a39c7e80680e067805jpeg.jpg" alt=""><figcaption> </figcaption></figure><figure><img width="984" height="519" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a69c7e80680e067806jpeg.jpg" alt=""><figcaption> </figcaption></figure>Hospitals in Kathmandu Valley with roof helipads have multiple daily rescue flights, but even these facilities are <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">at breaking point</a> with patients being turned away. Understaffed and under-equipped hospitals in the districts do not stand a chance. Even where hospitals exist, many families avoid them for fear of being infected and take wrong medication from pharmacies.Case in point are recent deaths due to misdiagnosis across the country. <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/" target="_blank" rel="noopener noreferrer">Typhoid disease</a> simulates Covid-19 with similar symptoms, and the widespread Widal test is known to give false positives.“Covid patients are being prescribed antibiotics to fight typhoid, only to turn critically ill in a few days’ time,” says Buddha Basnyat of Patan Academy of Health Sciences. “This is the reason behind some of the latest Covid fatalities.” <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85a89c7e80680e067807jpeg.jpg" alt=""><figcaption> </figcaption></figure>As in India, Nepal is beginning to see a slight bending of the curve for new infections, but health experts expect the fatality rate to remain high for some more time.  There were 190 Covid deaths in the past 24 hours and 6,543 recoveries. Of the total 8,305 new cases on Thursday, Kathmandu Valley accounts for 3,232 infections. 7,814 people are undergoing treatment in hospitals with 1,748 in ICU and 492 in ventilator support. “After the relentless patient pressure of the past month, we have seen a decline in those requiring admissions,” says virologist at Teku hospital Sher Bahadur Pun. “The virus has now infected a majority of people in the cities, and this combined with the lockdown means we may be getting to the halfway mark of the second wave.” <h2>2. Vaccines</h2> A prolonged lockdown is not the answer. If it was, the <a href="https://www.nepalitimes.com/latest/covid-19-numbers-slightly-down-in-nepal/" target="_blank" rel="noopener noreferrer">reduction in the number of cases and the positivity rate</a> this week would have been steeper. Even while the government tries to increase oxygen supply to hospitals, the only long-term strategy is to vaccinate at least 70% of Nepal’s eligible population.Doctors report a marked difference between the recovery of people who are vaccinated against those who are not. Says virologist Pun at Teku Hospital: “Except for a few rare cases, all patients in critical condition and those dying are the ones who for one reason or another had not been vaccinated.”But Nepal has run out of its vaccine stock, leaving 1.4 million people still waiting for their second dose of AstraZeneca Covishield in a lurch, after India banned its export, and the COVAX Facility could not supply its remaining 1.8 million vaccines to Nepal because of the global supply bottleneck.  <figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ac9c7e80680e067808jpeg.jpg" alt=""><figcaption> </figcaption></figure>The Nepal government and pressure groups in Nepal and the United States <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer">have strongly urged the Biden administration</a> to immediately rush some of its AstraZeneca doses to Nepal.Meanwhile, the UK, the US and Canada have authorised vaccines for use in children and adolescents, sparking outrage in the global public health community for prioritising an age group that is rarely critically affected by Covid-19. The World Health Organisation’s director-general Tedros Adhanom Ghebreyesus has urged rich countries to instead donate doses to the <a href="https://www.nepalitimes.com/latest/unicef-urges-g7-to-dispatch-vaccines/" target="_blank" rel="noopener noreferrer">COVAX Facility</a> for poorer states that have barely covered health workers and the most vulnerable groups. Speaking at the British Parliament last week, noted vaccinologist and the principal researcher of Oxford University’s AstraZeneca vaccine, Andrew Pollard, called the decision to inoculate children in wealthy nations ahead of high-risk groups in poorer countries “morally wrong.” Pollard has worked extensively in the region, leading research into the burden and transmission of typhoid in Nepal, Bangladesh and Malawi, and the impact of typhoid vaccine in these areas. He also runs surveillance for invasive bacterial diseases, and studies the impact of pneumococcal vaccines in children in Nepal.In Nepal, vaccination will grind to a halt this week after the current campaign to inoculate 300,000 people in the 18-59 age group with their second dose of the Chinese VeroCell ends.  <figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85af9c7e80680e067809jpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b29c7e80680e06780ajpeg.jpg" alt=""><img width="960" height="639" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b49c7e80680e06780bjpeg.jpg" alt="">Although <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer">Foreign Minister Pradeep Gyawali says</a> the government is in “final negotiations” for 2 million doses of Sinopharm VeroCell vaccines by June, there is no movement at the Ministry of Health. Ongoing talks to procure 8 million doses of <a href="https://www.nepalitimes.com/opinion/vaccine-geo-politics-and-sputnik-v/" target="_blank" rel="noopener noreferrer">the Sputnik V</a> have hit a production capacity snag in Russia. “We can implement lockdowns only for so long, the only exit strategy is vaccines. Science delivered, now our politicians must do the same,” says Buddha Basnyat, a physical at the Patan Academy of Health Sciences. “The Nepal government must procure vaccines using every diplomatic channel possible, and rich countries must realise that they are not safe until countries like Nepal are also vaccinated.” Activists have been trying to convince <a href="https://www.nepalitimes.com/latest/leading-public-figures-call-on-uk-government-for-oxygen-for-nepal/" target="_blank" rel="noopener noreferrer">the US government and Europeans</a> that Nepal has a lot of experience in successful vaccination campaigns against polio, smallpox, measles. It has over 50,000 female community health volunteers (FCHVs) reaching children with vaccines every year.  <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85b79c7e80680e06780cjpeg.jpg" alt=""><figcaption> </figcaption></figure><img width="2048" height="943" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85ba9c7e80680e06780djpeg.jpg" alt=""><img width="1920" height="864" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85bd9c7e80680e06780ejpeg.jpg" alt="">Similarly, Nepal’s health system has amassed vast experience in maintaining the vaccine cold chain even in the remote mountains. It also has trained human resource overseeing DOTS (Directly Observed Therapy, Short-course) for tuberculosis management all over the country who can lend a hand in equitable distribution of vaccines in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">rural Nepal</a>.Says epidemiologist Lhamo Yangchen Sherpa: “It’s not too late, we can still use existing resources like FCHVs to better mobilise vaccination, conduct contact tracing, dispel any remaining vaccine hesitancy, and use public health professionals in prevention.”

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It’s an Emergency

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636cedad9c7e80680e09adddjpeg.jpg" alt="" width="768" height="512"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Leading figures including Joanna Lumley, Sir Michael Palin and Sir Chris Bonington today called upon the British government to urgently send lifesaving oxygen equipment and medical supplies to Nepal. The Nepali health system has collapsed due to a massive surge in Covid-19 infections. For over a week hospitals have been turning away patients due to lack of beds, and people have died for lack of oxygen.Sir Chris Bonington said, “I have seen for myself how much the hill people from Nepal have done to help Britain over the years and how much we owe them. I do hope that our government can help them in their desperate plight.”Among those signing the open letter to the foreign secretary Dominic Raab are leading British public health specialists and vaccine researchers including Sir Jeremy Farrar, Sarah Gilbert, Andrew Pollard, Nicholas White, Adrian Hill, Peter Horby, Philippe Guérin, Alain Townsend, and Sandy Douglas.<a href="https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%20Nepal%20SitRep%20C19.pdf" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%2520Nepal%2520SitRep%2520C19.pdf&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNHGoTVKycRtzWTcsv6xd8s0ntxOZQ">According to the United Nations</a> this week, “COVID-19 infections are surging at an unprecedented rate in Nepal. The country of roughly 29 million people . . . has the highest effective rate of reproduction in the world . . . With a much weaker health system than neighbouring India’s, Nepal is now at a critical juncture. Hospitals in major cities are at capacity and have had to turn patients away. . .  [there are] also by critical shortages in human resources and essential commodities such as oxygen.”Captain Ram Bahadur Limbu, one of only five living recipients of the Victoria Cross, signed the letter from his home in Kathmandu. He was awarded Britain’s highest military decoration while serving with the 10th Gurkha Rifles in Indonesia in 1965.General The Lord Richards of Herstmonceux, a former Chief of Defence Staff,  joined the appeal. General Sir Sam Cowan, former Colonel Commandant of the Brigade of Gurkhas and Chairman of the Gurkha Welfare Trust, said, “The people of Nepal are suffering badly, and the poorest the most. Our historic links with the country through Gurkha recruitment go back over 200 years.  It’s time for the UK to step up to the mark to make a major contribution to ease the suffering. We cannot do less. Time is of the essence and we need significant action now. We are already behind what other countries with less historic ties are doing.”Fifty-six leading UK figures including writers, actors, mountaineers and soldiers signed the open letter calling on the British government to act now. The letter, which is open for public signatures on <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">Change.org</a>, calls upon “the UK government to urgently respond to the Covid-19 crisis in Nepal by airlifting critical medical supplies including oxygen plants and equipment.”“Acting now will make the difference of life or death for thousands of people. Nepal is one of Britain’s oldest friends in the world, a friendship represented by generations of Gurkha soldiers and mountaineers,” the letter reads. “We must come to Nepal’s aid now.”Sir Michael Palin wrote, “I am very happy to lend my support for the letter. They are very special people facing, once again, an extreme test of survival, and I hope we can do our best for them.”People who want to lend their support to the campaign can do so by signing the <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">Change.org</a> petition letter and by contacting their MP to call for medical aid to Nepal.Rory Bremmer, the impressionist and comedian, said, “Whilst the devastating crisis in India has rightly caught the attention of the world, its neighbour Nepal is similarly overwhelmed, its healthcare system unable to cope on its own. Britain should stand by its long standing friend and ally in its hour of need and provide urgent support.”The Nepali government and health officials say physical supplies including oxygen plants, cylinders, oxygen concentrators and related equipment, as well as life saving vaccines and therapeutic drugs, are desperately needed. Due to the Covid emergency in neighbouring India, Nepal has not been able to buy and import equipment, medicines and vaccines needed to combat Covid-19 as it did earlier in the pandemic. The government of Nepal has shared details of the most urgent priorities with other governments, including Britain.The open letter reads: “The Nepali Health Ministry predicts that by 15 July the number of active cases will reach 800,000, resulting in ten critically ill patients for every ICU bed. Only 7% of Nepal’s population has received a dose of vaccine. The potential loss of life and economic devastation over the coming months is staggering, and preventable.”Other signatories include the actor Nickolas Grace, production designer James Acheson, and Joanna Lumley, who successfully campaigned for ex-Gurkhas to settle in the UK. The Everest summiteer and TV personality Ben Fogle, said, “I am deeply saddened and worried about the worsening health crisis in Nepal, a country and people I know and love. A special, kind people who need our help.”Rebecca Stevens, the first British woman to climb Mt. Everest, said, "In a very long relationship between Nepal and Britain, Gurkhas and British army, Sherpas and mountaineers, the Nepalese have alway given with full heart, often with their lives. It is absolutely our turn and our duty to do what we can to help in their hour of need . . . We must act decisively, immediately.”Kenton Cool, a mountaineer and Everest guide who was participating in the current climbing season, said, "Being in Nepal myself at the present time I have seen first hand the extent of this second wave. People are desperate. Any and all help would make an impact. Having experienced the generosity of the Nepali people over many decades it pains me to see this nation struggle once again."Other signatories include the DJ Paul Oakenfold, who was recently at Everest base camp, and the chefs Asma Khan and Santosh Shah - the recent Master Chef finalist. Jeremy Jack Thomas, producer of The Last Emperor, said “Nepal is reeling from a second wave. This magical landlocked country needs all the support it can get from our government, as it has been a friend to Britain not only in our armies but culturally.”Numerous UK-based scholars joined the campaign, including Michael Hutt, emeritus professor of Himalayan studies at SOAS, David Gellner, professor of social anthropology at Oxford University, Mike Searle, professor of earth sciences at Oxford University, and Diwakar Acharya, professor of Eastern religions and ethics at Oxford University.Surya Subedi QC, professor of international law at the University of Leeds, said, “"Nepal is a traditional ally of the UK. I hope the UK Government will provide every assistance possible for the people of Nepal in this hour of need."David Lascelles, the film producer and 8th Earl of Harwood, said, “I’m distressed to hear of the devastation being caused by the second deadly wave of Covid-19 in Nepal. Nepal is home to some of the toughest and most resilient people in the world but this will test even their endurance to the limit. We must do everything we can to help our many friends there in their time of need.”The mountaineers, broadcasters, film makers, soldiers  and authors who have signed the open letter, are now joined by many others at <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">change.org</a>. They are united in calling upon the British government to send urgently needed oxygen equipment and other supplies to Nepal. “The UK and Nepal have a unique, centuries-old relationship. We must stand by one of our oldest friends,” the letter reads. “Time is of the essence.”LINK TO <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">CHANGE.ORG</a>: <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard</a>Social media:Twitter <a href="https://twitter.com/alliance4nepuk" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://twitter.com/alliance4nepuk&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNESynB_A9T1PItHuIa8W1ytl9ZfAQ">@alliance4nepuk</a>

Leading Public Figures Call on UK Government for Oxygen for Nepal

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111148/636b85979c7e80680e067800jpeg.jpg" alt="" width="768" height="512"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>Leading figures including Joanna Lumley, Sir Michael Palin and Sir Chris Bonington today called upon the British government to urgently send lifesaving oxygen equipment and medical supplies to Nepal. The Nepali health system has collapsed due to a massive surge in Covid-19 infections. For over a week hospitals have been turning away patients due to lack of beds, and people have died for lack of oxygen.Sir Chris Bonington said, “I have seen for myself how much the hill people from Nepal have done to help Britain over the years and how much we owe them. I do hope that our government can help them in their desperate plight.”Among those signing the open letter to the foreign secretary Dominic Raab are leading British public health specialists and vaccine researchers including Sir Jeremy Farrar, Sarah Gilbert, Andrew Pollard, Nicholas White, Adrian Hill, Peter Horby, Philippe Guérin, Alain Townsend, and Sandy Douglas.<a href="https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%20Nepal%20SitRep%20C19.pdf" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://reliefweb.int/sites/reliefweb.int/files/resources/05142021%2520Nepal%2520SitRep%2520C19.pdf&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNHGoTVKycRtzWTcsv6xd8s0ntxOZQ">According to the United Nations</a> this week, “COVID-19 infections are surging at an unprecedented rate in Nepal. The country of roughly 29 million people . . . has the highest effective rate of reproduction in the world . . . With a much weaker health system than neighbouring India’s, Nepal is now at a critical juncture. Hospitals in major cities are at capacity and have had to turn patients away. . .  [there are] also by critical shortages in human resources and essential commodities such as oxygen.”Captain Ram Bahadur Limbu, one of only five living recipients of the Victoria Cross, signed the letter from his home in Kathmandu. He was awarded Britain’s highest military decoration while serving with the 10th Gurkha Rifles in Indonesia in 1965.General The Lord Richards of Herstmonceux, a former Chief of Defence Staff,  joined the appeal. General Sir Sam Cowan, former Colonel Commandant of the Brigade of Gurkhas and Chairman of the Gurkha Welfare Trust, said, “The people of Nepal are suffering badly, and the poorest the most. Our historic links with the country through Gurkha recruitment go back over 200 years.  It’s time for the UK to step up to the mark to make a major contribution to ease the suffering. We cannot do less. Time is of the essence and we need significant action now. We are already behind what other countries with less historic ties are doing.”Fifty-six leading UK figures including writers, actors, mountaineers and soldiers signed the open letter calling on the British government to act now. The letter, which is open for public signatures on <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">Change.org</a>, calls upon “the UK government to urgently respond to the Covid-19 crisis in Nepal by airlifting critical medical supplies including oxygen plants and equipment.”“Acting now will make the difference of life or death for thousands of people. Nepal is one of Britain’s oldest friends in the world, a friendship represented by generations of Gurkha soldiers and mountaineers,” the letter reads. “We must come to Nepal’s aid now.”Sir Michael Palin wrote, “I am very happy to lend my support for the letter. They are very special people facing, once again, an extreme test of survival, and I hope we can do our best for them.”People who want to lend their support to the campaign can do so by signing the <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">Change.org</a> petition letter and by contacting their MP to call for medical aid to Nepal.Rory Bremmer, the impressionist and comedian, said, “Whilst the devastating crisis in India has rightly caught the attention of the world, its neighbour Nepal is similarly overwhelmed, its healthcare system unable to cope on its own. Britain should stand by its long standing friend and ally in its hour of need and provide urgent support.”The Nepali government and health officials say physical supplies including oxygen plants, cylinders, oxygen concentrators and related equipment, as well as life saving vaccines and therapeutic drugs, are desperately needed. Due to the Covid emergency in neighbouring India, Nepal has not been able to buy and import equipment, medicines and vaccines needed to combat Covid-19 as it did earlier in the pandemic. The government of Nepal has shared details of the most urgent priorities with other governments, including Britain.The open letter reads: “The Nepali Health Ministry predicts that by 15 July the number of active cases will reach 800,000, resulting in ten critically ill patients for every ICU bed. Only 7% of Nepal’s population has received a dose of vaccine. The potential loss of life and economic devastation over the coming months is staggering, and preventable.”Other signatories include the actor Nickolas Grace, production designer James Acheson, and Joanna Lumley, who successfully campaigned for ex-Gurkhas to settle in the UK. The Everest summiteer and TV personality Ben Fogle, said, “I am deeply saddened and worried about the worsening health crisis in Nepal, a country and people I know and love. A special, kind people who need our help.”Rebecca Stevens, the first British woman to climb Mt. Everest, said, "In a very long relationship between Nepal and Britain, Gurkhas and British army, Sherpas and mountaineers, the Nepalese have alway given with full heart, often with their lives. It is absolutely our turn and our duty to do what we can to help in their hour of need . . . We must act decisively, immediately.”Kenton Cool, a mountaineer and Everest guide who was participating in the current climbing season, said, "Being in Nepal myself at the present time I have seen first hand the extent of this second wave. People are desperate. Any and all help would make an impact. Having experienced the generosity of the Nepali people over many decades it pains me to see this nation struggle once again."Other signatories include the DJ Paul Oakenfold, who was recently at Everest base camp, and the chefs Asma Khan and Santosh Shah - the recent Master Chef finalist. Jeremy Jack Thomas, producer of The Last Emperor, said “Nepal is reeling from a second wave. This magical landlocked country needs all the support it can get from our government, as it has been a friend to Britain not only in our armies but culturally.”Numerous UK-based scholars joined the campaign, including Michael Hutt, emeritus professor of Himalayan studies at SOAS, David Gellner, professor of social anthropology at Oxford University, Mike Searle, professor of earth sciences at Oxford University, and Diwakar Acharya, professor of Eastern religions and ethics at Oxford University.Surya Subedi QC, professor of international law at the University of Leeds, said, “"Nepal is a traditional ally of the UK. I hope the UK Government will provide every assistance possible for the people of Nepal in this hour of need."David Lascelles, the film producer and 8th Earl of Harwood, said, “I’m distressed to hear of the devastation being caused by the second deadly wave of Covid-19 in Nepal. Nepal is home to some of the toughest and most resilient people in the world but this will test even their endurance to the limit. We must do everything we can to help our many friends there in their time of need.”The mountaineers, broadcasters, film makers, soldiers  and authors who have signed the open letter, are now joined by many others at <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">change.org</a>. They are united in calling upon the British government to send urgently needed oxygen equipment and other supplies to Nepal. “The UK and Nepal have a unique, centuries-old relationship. We must stand by one of our oldest friends,” the letter reads. “Time is of the essence.”LINK TO <a href="http://change.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=http://change.org/&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNGj60AEY7yPdJulF3DOI6UPbLBfaw">CHANGE.ORG</a>: <a href="https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter%3D1205004619%26recruited_by_id%3D14e94300-b7bf-11eb-b788-f53b463e0386%26utm_source%3Dshare_petition%26utm_medium%3Dcopylink%26utm_campaign%3Dpetition_dashboard&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNFvFd1fau2SkCn3BMxm7up7V0_dNQ">https://www.change.org/p/the-rt-hon-dominic-raab-mp-uk-send-oxygen-to-nepal-now?recruiter=1205004619&amp;recruited_by_id=14e94300-b7bf-11eb-b788-f53b463e0386&amp;utm_source=share_petition&amp;utm_medium=copylink&amp;utm_campaign=petition_dashboard</a>Social media:Twitter <a href="https://twitter.com/alliance4nepuk" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://twitter.com/alliance4nepuk&amp;source=gmail&amp;ust=1621443857422000&amp;usg=AFQjCNESynB_A9T1PItHuIa8W1ytl9ZfAQ">@alliance4nepuk</a>