<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b85559c7e80680e0677e9jpeg.jpg" alt="" width="800" height="534"/>While Western countries were busy with their own vaccination campaigns, Russia has filled the leadership vacuum in developing countries. This  trickle of news flies under the media radar.Argentina has become the first country in South America to produce Russia’s Sputnik V vaccine. The first shipment of the shots is promised to Peru by May.Some 11,000 doses of the Russian jab has reached North Macedonia, while Tunisia has begun to administer 30,000 doses, and 1.7 million more are promised to Bolivia by May.The African Union has received an offer of 300 million doses from Russia, which has already signed agreements to produce tens of millions of doses in China, Brazil, Iran and Serbia.While we weren’t looking, Sputnik V has become the cornerstone of pandemic response for the developing world. In doing so, Russia has filled the leadership gap in Asia, Africa and South America left by western countries busy with their own vaccination drives.But at heart, Sputnik V is a calculated campaign to increase the Kremlin’s power and influence through a global scientific, diplomatic, and media influence operation.Far from the authoritarian, bellicose, annexationist Moscow that poisons its domestic political opponents and interferes in its rivals’ elections, the jab casts Russia in the role of scientific superpower and pandemic saviour.Sputnik V is the image of Russia the Kremlin wants to project and indeed offers a unique chance to launder the country’ reputation.Russian capabilities align elegantly with the world’s pandemic needs. As developing countries tried and failed to secure enough vaccine supplies through Western mechanisms, headlines worldwide hail Russia as the partner that really comes through when it counts.Russia’s official mouthpieces minutely cover each new country that approves Sputnik V for use, while the Russian Direct Investment Fund, the Kremlin agency that bankrolled Sputnik V s development, trumpets Russia’s achievement not just in finding a vaccine first, but also in making it widely available.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b85589c7e80680e0677eajpeg.jpg" alt="" width="640" height="578">Sputnik V’s <a href="https://twitter.com/sputnikvaccine" target="_blank" rel="noopener noreferrer">Twitter</a> feed pumps out messages once or twice an hour — ‘A planeload of vaccines lands in Armenia!’ — or retweets good news from partner countries. The Mexican Health Ministry claims that Sputnik V is the only vaccine with a 0% chance of producing serious adverse side effects.What Russia can no longer achieve with its declining military strength, Flemming Splidsboel Hansen at the Danish Institute for International Studies writes, it now seeks through cognitive and digital means.First in line for the Russian jab have been Moscow’s long-time allies. “The vaccines underline the anti-Western bloc’s scientific prowess. Ideology demands it be portrayed as greater than the West’s,” says Félix Arellano, a professor of international relations at the Universidad Central de Venezuela in Caracas.He adds: “Russia’s posture, in offering up highly effective vaccines at a low price for countries like Venezuela, is media-driven. It’s how Russia and its allies seek to show that authoritarian governments can also grow in the scientific realm, that it’s possible to grow without democracy.”Argentina, under a proto-socialist government, was the first to send a team to Moscow to translate Sputnik V’s technical documentation to Spanish and set up its own production facilities.Other countries soon followed suit, including Mexico, Brazil, Bolivia, and even US allies like Peru, Chile, and Colombia. The last three were the final seal of approval on an operation that is succeeding largely thanks to the West’s navel-gazing inaction.“At this point the discussion, at least in Peru, grants the need to negotiate to secure whatever vaccine is on offer,” explains Oscar Vidarte, a professor of international relations at the Pontificia Universidad Católica de Perú in Lima.For Colombia, buying into Sputnik V serves two purposes, immunising a vulnerable population and rebuilding bilateral links with Moscow. “We’re Washington’s key ally in the region,” says Mauricio Jaramillo, who teaches international relations at the Universidad del Rosario in Bogotá, “but the U.S. is not trying to leverage vaccines to project its power or earn prestige.”The West hasn’t so much lost this fight as forfeited it. The World Health Organization (WHO) <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">COVAX initiative</a> amounts to a clearinghouse for the West’s leftovers.The Biden administration has pledged some $4 billion to COVAX, but the WHO’s director-general, Tedros Adhanom Ghebreyesus, acknowledges that ‘when there are no vaccines to buy, money is irrelevant.’It is not just access to ample supply that is tilting the field in Moscow’s favour, it is how the Russians approach supply agreements, making sure to portray deals not as charity, but as partnerships among equals, say experts.Meanwhile, Sputnik V’s successes keep mounting. The European Union’s shambolic vaccine roll-out has brought even some member countries like Slovakia, Hungary, Greece, and the Czech Republic knocking on Moscow’s door. Each has had to negotiate unilaterally for its share.Italy and Spain are now considering doing the same, and the European Medicines Agency has had no choice but to formally consider certifying the Russian vaccine, softening its line in the wake of Crimea and Navalny.To be sure, liberal democracy need not fear for its life from the Russian vaccine. But the West has left a huge leadership vacuum at a moment of acute crisis that Russia is determined to exploit.Western democracies, and particularly the United States, have lost too many opportunities to the pandemic — not least among them the chance to back their allies, firm up their influence and position themselves as the go-to model for how to manage a crisis that, many scientists fear, could be repeated sooner than many realise.Valentine Lares is a journalist and managing editor of Armando.info, an investigative journalism site. This <a href="http://www.ipsnews.net/2021/05/russias-sputnik-diplomacy/" target="_blank" rel="noopener noreferrer">article</a> was originally published in community blog <a href="https://www.persuasion.community/p/sputnik-diplomacy?token=eyJ1c2VyX2lkIjoxMjQ2NTkyNiwicG9zdF9pZCI6MzU0Nzk2NzEsIl8iOiJsQldzViIsImlhdCI6MTYxOTc5MzMxOSwiZXhwIjoxNjE5Nzk2OTE5LCJpc3MiOiJwdWItNjE1NzkiLCJzdWIiOiJwb3N0LXJlYWN0aW9uIn0.GJMrfTqUglKDoYoOsBLqkMKNIkoSVz0PS42EBCmQpSI">Persuasion</a> and <a href="http://www.ipsnews.net/2021/05/russias-sputnik-diplomacy/">Inter Press Service.</a>Nepal is in talks to procure 8 million doses of Sputnik V vaccine. Russia has offered an international competitive price of $19.90 per two shots. The jab received emergency use permit in Nepal back in April and has over 90% efficacy.In the region, India and Philippines have started inoculating its populations with the Russian jab. Bangladesh has also entered an agreement to domestically produce the vaccine.

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

Vaccine geo-politics and Sputnik-V

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636ced6f9c7e80680e09adc6jpeg.jpg" alt="" width="800" height="534"/>While Western countries were busy with their own vaccination campaigns, Russia has filled the leadership vacuum in developing countries. This  trickle of news flies under the media radar.Argentina has become the first country in South America to produce Russia’s Sputnik V vaccine. The first shipment of the shots is promised to Peru by May.Some 11,000 doses of the Russian jab has reached North Macedonia, while Tunisia has begun to administer 30,000 doses, and 1.7 million more are promised to Bolivia by May.The African Union has received an offer of 300 million doses from Russia, which has already signed agreements to produce tens of millions of doses in China, Brazil, Iran and Serbia.While we weren’t looking, Sputnik V has become the cornerstone of pandemic response for the developing world. In doing so, Russia has filled the leadership gap in Asia, Africa and South America left by western countries busy with their own vaccination drives.But at heart, Sputnik V is a calculated campaign to increase the Kremlin’s power and influence through a global scientific, diplomatic, and media influence operation.Far from the authoritarian, bellicose, annexationist Moscow that poisons its domestic political opponents and interferes in its rivals’ elections, the jab casts Russia in the role of scientific superpower and pandemic saviour.Sputnik V is the image of Russia the Kremlin wants to project and indeed offers a unique chance to launder the country’ reputation.Russian capabilities align elegantly with the world’s pandemic needs. As developing countries tried and failed to secure enough vaccine supplies through Western mechanisms, headlines worldwide hail Russia as the partner that really comes through when it counts.Russia’s official mouthpieces minutely cover each new country that approves Sputnik V for use, while the Russian Direct Investment Fund, the Kremlin agency that bankrolled Sputnik V s development, trumpets Russia’s achievement not just in finding a vaccine first, but also in making it widely available.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131124/636ced719c7e80680e09adc7jpeg.jpg" alt="" width="640" height="578">Sputnik V’s <a href="https://twitter.com/sputnikvaccine" target="_blank" rel="noopener noreferrer">Twitter</a> feed pumps out messages once or twice an hour — ‘A planeload of vaccines lands in Armenia!’ — or retweets good news from partner countries. The Mexican Health Ministry claims that Sputnik V is the only vaccine with a 0% chance of producing serious adverse side effects.What Russia can no longer achieve with its declining military strength, Flemming Splidsboel Hansen at the Danish Institute for International Studies writes, it now seeks through cognitive and digital means.First in line for the Russian jab have been Moscow’s long-time allies. “The vaccines underline the anti-Western bloc’s scientific prowess. Ideology demands it be portrayed as greater than the West’s,” says Félix Arellano, a professor of international relations at the Universidad Central de Venezuela in Caracas.He adds: “Russia’s posture, in offering up highly effective vaccines at a low price for countries like Venezuela, is media-driven. It’s how Russia and its allies seek to show that authoritarian governments can also grow in the scientific realm, that it’s possible to grow without democracy.”Argentina, under a proto-socialist government, was the first to send a team to Moscow to translate Sputnik V’s technical documentation to Spanish and set up its own production facilities.Other countries soon followed suit, including Mexico, Brazil, Bolivia, and even US allies like Peru, Chile, and Colombia. The last three were the final seal of approval on an operation that is succeeding largely thanks to the West’s navel-gazing inaction.“At this point the discussion, at least in Peru, grants the need to negotiate to secure whatever vaccine is on offer,” explains Oscar Vidarte, a professor of international relations at the Pontificia Universidad Católica de Perú in Lima.For Colombia, buying into Sputnik V serves two purposes, immunising a vulnerable population and rebuilding bilateral links with Moscow. “We’re Washington’s key ally in the region,” says Mauricio Jaramillo, who teaches international relations at the Universidad del Rosario in Bogotá, “but the U.S. is not trying to leverage vaccines to project its power or earn prestige.”The West hasn’t so much lost this fight as forfeited it. The World Health Organization (WHO) <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">COVAX initiative</a> amounts to a clearinghouse for the West’s leftovers.The Biden administration has pledged some $4 billion to COVAX, but the WHO’s director-general, Tedros Adhanom Ghebreyesus, acknowledges that ‘when there are no vaccines to buy, money is irrelevant.’It is not just access to ample supply that is tilting the field in Moscow’s favour, it is how the Russians approach supply agreements, making sure to portray deals not as charity, but as partnerships among equals, say experts.Meanwhile, Sputnik V’s successes keep mounting. The European Union’s shambolic vaccine roll-out has brought even some member countries like Slovakia, Hungary, Greece, and the Czech Republic knocking on Moscow’s door. Each has had to negotiate unilaterally for its share.Italy and Spain are now considering doing the same, and the European Medicines Agency has had no choice but to formally consider certifying the Russian vaccine, softening its line in the wake of Crimea and Navalny.To be sure, liberal democracy need not fear for its life from the Russian vaccine. But the West has left a huge leadership vacuum at a moment of acute crisis that Russia is determined to exploit.Western democracies, and particularly the United States, have lost too many opportunities to the pandemic — not least among them the chance to back their allies, firm up their influence and position themselves as the go-to model for how to manage a crisis that, many scientists fear, could be repeated sooner than many realise.Valentine Lares is a journalist and managing editor of Armando.info, an investigative journalism site. This <a href="http://www.ipsnews.net/2021/05/russias-sputnik-diplomacy/" target="_blank" rel="noopener noreferrer">article</a> was originally published in community blog <a href="https://www.persuasion.community/p/sputnik-diplomacy?token=eyJ1c2VyX2lkIjoxMjQ2NTkyNiwicG9zdF9pZCI6MzU0Nzk2NzEsIl8iOiJsQldzViIsImlhdCI6MTYxOTc5MzMxOSwiZXhwIjoxNjE5Nzk2OTE5LCJpc3MiOiJwdWItNjE1NzkiLCJzdWIiOiJwb3N0LXJlYWN0aW9uIn0.GJMrfTqUglKDoYoOsBLqkMKNIkoSVz0PS42EBCmQpSI">Persuasion</a> and <a href="http://www.ipsnews.net/2021/05/russias-sputnik-diplomacy/">Inter Press Service.</a>Nepal is in talks to procure 8 million doses of Sputnik V vaccine. Russia has offered an international competitive price of $19.90 per two shots. The jab received emergency use permit in Nepal back in April and has over 90% efficacy.In the region, India and Philippines have started inoculating its populations with the Russian jab. Bangladesh has also entered an agreement to domestically produce the vaccine.

<figure><img width="1280" height="854" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9ef9c7e80680e092ecejpeg.jpg" alt=""/><figcaption>Thousands of revellers thronged to Kathmandu's Darbar Square on Sunday to celebrate Phau Purnima ignoring warnings of a possible second Covid-19 wave and despite hazardous smoke haze that has shrouded the country for days. Photos: MONIKA DEUPALA and AMIT MACHAMASI</figcaption></figure>After a year of living in the shadow of the Covid-19 pandemic, Nepalis were bracing themselves for a second wave from India, when they were hit by an unexpected disaster: <a href="https://www.nepalitimes.com/latest/wildfires-in-nepal-cause-air-quality-to-plummet/" target="_blank" rel="noopener noreferrer">wildfires that have shrouded the country</a> in a pall of smoke for days.The two crises have converged with the suspension of Nepal’s Covid-19 vaccination drive after India <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">banned the export of the AstraZeneca Covishield doses</a>. Two days after the Ministry of Health warned citizens about wearing masks, washing hands and avoiding crowds to defend themselves against a coronavirus surge, it issued another statement on Saturday telling people to stay indoors to avoid the <a href="https://www.nepalitimes.com/banner/nepal-is-going-up-in-smoke/" target="_blank" rel="noopener noreferrer">hazardous haze</a>, and not to venture out unless urgent.It did not look like people in Kathmandu were paying attention to either warning. Thousands of revellers thronged to Kathmandu’s Darbar Square on Sunday dancing and singing, spraying water and smearing colour on each other to celebrate the festival of colours, Phau Purnima. “It depends on us whether there will be another lockdown. Do we continue to mask up and maintain physical distance or start crowding and ignore safety measures?” warns Buddha Basnyat of the Patan Academy of Health Sciences. “Nepal usually tracks India in health trends, so we have to be prepared.” <figure><img width="1280" height="852" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f29c7e80680e092ecfjpeg.jpg" alt=""><figcaption></figcaption></figure><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f59c7e80680e092ed0jpeg.jpg" alt=""><img width="640" height="427" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9f99c7e80680e092ed1jpeg.jpg" alt=""><figure><img width="1280" height="854" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9fc9c7e80680e092ed2jpeg.jpg" alt=""><figcaption>Public gatherings in light of vaccine shortage can have disastrous results.</figcaption></figure>Despite the government ban on public gatherings following the <a href="https://www.nepalitimes.com/editorial/its-not-over-yet/" target="_blank" rel="noopener noreferrer">second wave in neighbouring India</a>, there have been political rallies and public gathering with people behaving as if the pandemic is over. Kathmandu’s bars, restaurants and malls are packed to the brim. Offices and schools have reopened, and there is little physical distancing.On Saturday, with 62,714 new Covid-19 cases, India registered the highest daily rise in 2021 with Maharashtra, Chandigarh, Punjab, Goa, Puducherry, Chhattisgarh, Madhya Pradesh and Haryana recording the highest positivity rates. Bihar state neighbouring India is also seeing a surge as workers travel back.Anticipating another lockdown like last year, <a href="https://www.nepalitimes.com/latest/nepalis-still-stuck-in-no-mans-land/" target="_blank" rel="noopener noreferrer">Nepali migrants from India</a> have also started returning home. Checkpoints in Karnali, Far-West and Province 2 are overwhelmed with a steady rise in positive cases among returnees, who are being asked to self-isolate at homes.“We now have a year-long experience of managing Covid-19 and it is time to learn from our previous mistakes and limitations,” says Sher Bahadur Pun, a virologist at Teku Hospital.Sameer Dixit of Centre for Molecular Dynamics Nepal agrees. “While the second wave in India has been limited to fewer states so far and hasn’t resulted in as high a mortality rate as the first time, local governments here must take charge: monitor returnees, their tests and quarantines,” he says.Despite being <a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/" target="_blank" rel="noopener noreferrer">one of the first Asian countries to start a Covid-19 vaccination drive</a> in late January, Nepal now has only about 500,000 doses of AstraZeneca Covishield vaccine in stock, just sufficient for second doses starting 20 April for those who had inoculated in the first phase.Following the Indian ban on the export of Covishield vaccine before domestic demand is met, Nepal is yet to receive another million doses it purchased from Serum Institute of India. The ban has also delayed the next batch of Covishield shots under <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/" target="_blank" rel="noopener noreferrer">the COVAX initiative</a>, which is not expected until May.A Nepal Airlines plane is finally flying to Beijing on Monday to bring back 800,000 doses of the Sinopharm vaccine gifted by China, but it will not be sufficient to begin the next phase of vaccination targeted at the age group 55-64.But if it comes down to it, experts are recommending vaccinating as many individuals in the risk group as possible, even if that means bypassing the second dose for those already inoculated with the first. <figure><img width="3200" height="1970" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111012110/636cd9ff9c7e80680e092ed3jpeg.jpg" alt=""><figcaption>Tourists take part in Phau Purnima revelry at lakeside in Pokhara despite fears of a second wave, and even though Pokhara has been shrouded in smoke for the past three days. Photo: KRISHNA MANI BARAL</figcaption></figure>So far, <a href="https://www.nepalitimes.com/latest/1-6-million-vaccinated-20-million-to-go/" target="_blank" rel="noopener noreferrer">Nepal has inoculated 1.6 million people</a> and needs to vaccinate 20 million more under its target to immunise 70% of its population. For this alone, the government needs to look into other certified vaccines in the market such as Russian Sputnik V, Bharat Biotech’s Covaxin and Chinese vaccines.With governments failing to ensure supply, it has become crucial to get the private sector involved to meet demand. The Ministry of Health earlier this month approved letting private companies import vaccines so that those with the resource and willingness can immunise themselves, this is said to involve India’s Covaxin and <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">the Russian Sputnik</a>.

1250x600

1084x550

Thick haze adds to Nepal Covid-19 woes

<figure><img width="2048" height="1282" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1af9c7e80680e083e61jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>With the <a href="https://www.nepalitimes.com/latest/double-whammy-air-pollution-and-covid-19/">pre-winter resurgence of Covid-19</a> around the world and in Nepal, pressure is mounting on governments to procure vaccines to protect their populations.
Last week, the <a href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">Nepal government set up a committee</a> of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them. But Nepal is far behind other countries, which have already ‘booked’ their future supplies.
On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/vax-populi/" target="_blank" rel="noopener noreferrer">VAX POPULI</a>, Sonia Awale
However, there is no effective strategy to ensure vaccines for all as distribution in Nepal comes with the challenge of taking it to poor and remote corners of the country. Experts fear that even when the vaccines become available, the campaign will be plagued by the same socio-economic inequities that afflict the medical sector.
“We need to immediately start identifying vulnerable groups like <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">frontline health workers</a>, <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> or those with comorbidities to prioritise for immunisation,” says Bikash Gauchan, a physician at Bayalpata Hospital in the under-served western district of Achham.
“We also need to set up proper cold chain facilities across the country as soon as possible and have a well thought out distribution plan so that when the vaccine does arrive, we can hit the ground running,” he adds.
The silver lining is that Nepal already has a successful <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">childhood immunisation</a> network that has successfully mobilised <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and they can deliver vaccines to the homes of the elderly who cannot make it to clinics. Monitoring the follow-up second dose for some of the vaccines will be crucial, although Nepal’s health system has experience with maintaining a cold chain for other campaigns.
<a href="https://www.nepalitimes.com/latest/nepali-diaspora-hit-by-covid-surge/">Nepali diaspora hit by Covid surge</a>, Nepali Times
Despite recent breakthroughs in trials (see box) public health experts stress the importance of exploring vaccine supply options closer to home. As of now, 11 vaccines developed in several parts of the world are in the third phase of <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/" target="_blank" rel="noopener noreferrer">clinical trials</a> with many of them expected to be as effective.
Neighbouring China and India are at the forefront. And Nepal should have begun its ‘vaccine diplomacy’ much before this to secure its supply of shots.
There is also the uncertainty of vaccine efficacy depending on the strain: the same vaccine could be highly effective against people in the West but not as much in South Asia where people suffer from chronic malnutrition and multiple infections.
“For a working vaccine to be made within a year is an amazing victory for science but we also need to know that these vaccines are designed for their population. So I’d want to know more about the vaccines in India and China,” says Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “Particularly China, as it was where the pandemic started but <a href="https://www.nepalitimes.com/latest/what-nepal-can-learn-from-china-about-covid-19/" target="_blank" rel="noopener noreferrer">has since controlled it effectively</a> unlike rest of the world.”
<a href="https://www.nepalitimes.com/opinion/the-truth-about-the-chloroquine-scam/" target="_blank" style="font-size: 15px; letter-spacing: 0.01em;" rel="noopener noreferrer">Buddha Basnyat</a> of the Patan Academy of Health Sciences agrees. He says: “China looks at the reality in our backyard. So a more suitable vaccine for us could come from the Chinese, particularly because they have a track record of having developed better vaccine for this part of the world.”
Indeed, the JEVAX made by the researchers in Chengdu is now the most widely used jab against Japanese Encephalitis because it’s more cost effective compared to its western vaccines.
Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.
In India, The Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.
Similarly, researchers at the Indian Institute of Science have designed a protein-based heat-tolerant vaccine that can stay stable for a month at 37°C, and could endure temperatures as high as 100°C if freeze dried, a feature that could be a game changer for mass vaccination campaigns in lower and middle income countries in Asia and Africa.
The other factor to consider will be the duration of the immunity after each vaccine shot, as well reinfection groups and if antibodies developed in the first episode helps fight the mutated forms of the virus.
With Covid-19 crisis continuing to spread rapidly across Nepal and at 10 fatalities per million population (same as Pakistan and much higher than China’s 3), it is not too early to start dialogue with Gavi, the vaccine alliance, COVAX and agencies like the World Bank and World Health Organisation to help procure the most cost effective approach to vaccines most suitable to Nepal’s conditions.
Alternatively, many pharmaceutical companies will want to play the field in order to boost their profile. In fact, embassies and foreign donors are already hard at work pushing for trails and deals.
“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”
In all this excitement, Nepal’s health authorities must also keep an eye on the plight of infected people and many more to come as <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">they wait for a vaccine</a>. The results of current treatment regimens ranging from plasma therapy to administering Remdesivir have been patchy. And as scientists study the long-term impact of Covid-19 on patients even after they recover, making an optimal use of resources becomes even more significant.
So far, the government has been faulted for squandering months of lockdown, not carrying out sufficient tests and contact tracing, not increasing hospital capacity and equipment, and letting the people fend for themselves.  
The result is that Nepal is <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">suffering a sustained surge</a>, with more than 1,400 new cases a day, over 60% of them in Kathmandu Valley alone and a quarter of those tested coming out positive. There is also a surge in symptomatic patients, even among those without pre-existing conditions, and those sick enough to require ICU and ventilator.
Even when the government does act, the <a href="https://www.nepalitimes.com/latest/coronavirus-coordination-committee-doesnt-coordinate/" target="_blank" rel="noopener noreferrer">priorities seem to be misplaced</a>. For instance, health experts say the emphasis in the past months should have been on high flow oxygen therapy or High Dependency Units rather than Intensive Care Units in hospitals.
“It would have been cheaper, it does not require highly trained staff or sophisticated equipment, and it would have freed up the ICUs for the really critical patients,” adds Pun, who himself is at the Health Ministry, and this possibly means his advice is not being taken.
Insiders say it will likely take upwards of six months for the first vaccines to arrive in Nepal, and there will be a rush by the rich, the powerful and those with political connections to get their shots. The marginalised, poor, those in remote areas will be the last to get their injections, unless the government has fair and effective rules in place and implements them.
Till then, there is little else to do than <a href="https://www.nepalitimes.com/opinion/silver-linings-in-the-covid-cloud/" target="_blank" rel="noopener noreferrer">keep masking up this winter, avoid large gatherings, keep distance and wash hands regularly</a>.
Says <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/" target="_blank" rel="noopener noreferrer">Buddha Basnyat</a>: “The mask is the best vaccine we have at the moment. These safety measures have largely reduced hospitalisation due to other infections in 2020, masks in particular will also protect us from winter pollution in the coming months.”<h2>The Vaccine Race</h2>The global resurgence of Covid-19 in the northern winter has coincided with breaking news every day of successful new vaccine trials.First the Russians announced a vaccine in September that is 92% potent against SARS-CoV-2.  Last week Pfizer unveiled a 90% effective vaccine, which on Wednesday was upgraded to 95% efficacy without side effects. Moderna was next with an efficacy of 95%, and not needing extreme refrigeration. More companies in China, India and Europe are conducting their own trials.Public health experts have hailed the developments, but warn that vaccines will not be universally available till late 2021 and even so will not provide full protection. They suggest continuing with masking up, keeping distance and avoiding crowded indoor places.Pfizer and its German partner BioNTech’s mRNA-based vaccine came out declaring over 90% effectiveness but only at -70°C ultra cold chain which will be a challenge even for countries with the best health facilities in the world.Massachusetts-based Moderna’s RNA shot has 94.5% efficacy, seems to also prevent severe infections and remains stable in medical and home refrigerators for up to 30 days, in freezers (-20°C) for up to six months, and at room temperature for up to 12 hours.Even so, poorer countries are unlikely to get coronavirus vaccine any time soon. Even the biggest pharmaceutical multinationals can only manufacture a limited quantity of the vaccine over the next year.Pfizer has capped its production at 1.4 billion for 2021, 80% of which has already been booked through advance purchase agreement by the US, UK, EU, Canada and Japan. Moderna expects to manufacture 20 million doses this year and up to one billion in 2021.On the other hand, <a href="https://www.nepalitimes.com/latest/sputnik-v-vaccine-mystery-in-nepal/" target="_blank" rel="noopener noreferrer">Russian’s Sputnik V</a> has been overshadowed by new developments, and due to lack of sufficient data to back up its claim of 92% efficacy. Although geopolitical rivalry with the West has given it negative publicity, some health agencies have not ruled it out.

Sonia Awale

When will Nepal’s Covid vaccine turn come?

<figure><img width="640" height="311" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1b29c7e80680e083e62jpeg.jpg" alt=""/><figcaption>Nepal Army special funeral team brings home the first fatality from Covid-19 in Bhojpur District. She was a 24-year-old woman. The government's challenge is to bring the Covid-19 vaccine to remote parts of Nepal like these. Photo: RSS</figcaption></figure>Nepal’s <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">surge of Covid-19 continues unabate</a>d  with new hotspots, and because of inadequate testing, no one really knows how much and how fast the pandemic has spread.The government has left Nepalis to their own devices, only issuing guidelines on precautions, but stopping free testing and treatment. Meanwhile the daily positivity rate and fatalities have not come down. As of Thursday, out of the 9,805 people tested nationwide 2,103 were positive, which gives a very high positivity rate of 21.4%.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">When will Nepal's Covid vaccine turn come?</a>, Sonia Awale Nepal’s death rate from the coronavirus of 43 per million is much lower than India (93%), but much higher than China and Sri Lanka (3%). This points to poor prevention measures as well as inadequate or unaffordable hospital treatment. The only option for Nepal is to <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">wait for vaccines to be available</a>, but even on this it has moved too late. Many governments around the world have pre-booked vaccines from pharmaceutical companies like Pfizer and Moderna, and most countries will first prioritise their own citizens.Last week, the Nepal government finally set up a committee of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them.On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.Despite this, Nepal will possibly be one of the last countries in the world to get a vaccine, and even when the first vials arrive perhaps by the middle of 2021, the poorest Nepalis living in the remotest areas will be the last in line to get them.The government, which has <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/&amp;sa=U&amp;ved=2ahUKEwiSi7fx3pDtAhWlwjgGHWzzCnwQFjAAegQIBBAC&amp;usg=AOvVaw18PYxlijebm6Z8s6c8PcRX" target="_blank" rel="noopener noreferrer">failed all these years to make free health care accessible to all</a>, will have to prove that its vaccine distribution is fair, and the poor in remote areas of the country are not left out. Says Bikash Gauchan, a physician stationed in remote Achham district: “We need to immediately start identifying vulnerable groups like frontline health workers, the elderly or those with co-morbidities to prioritise for immunisation, and to have an effective distribution plan for remote areas.”Nepal is internationally recognised as a model low-income country with an effective vaccination programs against measles, <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">polio</a> and other childhood killer diseases. It has valuable experience in deploying a nationwide network of <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/&amp;sa=U&amp;ved=2ahUKEwjaqeaY35DtAhUSyzgGHYXhBtoQFjAAegQIAxAC&amp;usg=AOvVaw1_j5Qa_kWIBHLL5EZjqV1b" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and Nepal’s Covid-19 vaccine delivery will have to re-learn from its own best practices.Monitoring the follow-up vaccine dose can gain from Nepal’s acclaimed <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/tb/&amp;sa=U&amp;ved=2ahUKEwjxlPay35DtAhWizDgGHd_SDB4QFjAFegQIBRAC&amp;usg=AOvVaw1d367zHYY84fBDOJyCB8HY" target="_blank" rel="noopener noreferrer">DOTS program</a> to deliver anti-tuberculosis therapies, and Nepal’s rural health care workers have experience in maintaining the cold chain from previous <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;sa=U&amp;ved=2ahUKEwj07oLT35DtAhW6yDgGHe6ZCsYQFjAAegQIABAC&amp;usg=AOvVaw2VfJkLuf5k3bEjPG4_59-X" target="_blank" rel="noopener noreferrer">vaccination programs</a>.  Despite recent breakthroughs in trials, public health experts say Nepal should be looking at neighbouring China and India and belatedly begin ‘vaccine diplomacy’ to secure its supply.Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.In India, the Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”

VAX POPULI

<figure><img width="800" height="534" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109151116/636bb6a99c7e80680e07bc76jpeg.jpg" alt=""/><figcaption></figcaption></figure>On Tuesday news broke about an agreement between the Russian Direct Investment Fund (RDIF) and Nepal’s Trinity Pharmaceuticals to import 25 million vials of the Sputnik V vaccines against Covid-19. But the deal is shrouded in mystery because the country’s Ministry of Health had no idea about the deal.
At a first glance it could be good news at a time when Nepal is reeling under the pandemic. But it seems no one in the government is aware of the deal. But the fact that announcement of such a massive deal did not come from the government, and doubts about whether the vaccine is safe has raised eyebrows.
What is more, Trinity Pharmaceuticals is not even registered as an importer under Nepal’s Department of Drug Management list of companies.
In a <a href="https://rdif.ru/Eng_fullNews/5852/">statement released on 29 September</a>, RDIF Chief Executive Officer Kirill Dmitriev said that about 90% of Nepalis will be provided with Sputnik V vaccine safely and effectively though clinics in the country.
“Unlike experimental vaccines based on monkey adenovirus or mRNA, Sputnik V vaccine was created on human adenoviral vectors platform, which has been studied over decades and has proven no negative effects in the long-term,” added Dmitriev. “We see a strong interest from other partners in Asia. RDIF is ready to supply Sputnik V vaccine to the countries of the region.”
In the same press release, the director of Trinity Pharmaceuticals in Kathmandu Kishor Adhikari is quoted as saying, ‘Trinity is waiting for results of the final trial of Sputnik V. As soon as the vaccine is approved by Government of Nepal we will make it available for the population of Nepal.’
Nepal saw a total of 1,559 new Covid-19 cases on Wednesday with 902 in Kathmandu Valley alone. With 1,057 people were discharged in the last 24 hours, the recovery rate now stands at 72.5%. Total confirmed cases now stands at 77,817 with 491 fatalities.201 patients are in ICU and 31 in ventilator support.
The Sputnik-V (trade name of<a href="https://sputnikvaccine.com/"> Gam-COVID-Vac</a>) vaccine was developed by Russia's Gamalia National Research Institute of Epidemiology and Microbiology on 11 August and was later registered by the country's health ministry.
Despite having been tested only in 76 people in early-stage clinical trials that lasted two months (June-July), Sputnik V was quickly approved for distribution in Russia, drawing criticism from the international scientific community as a premature decision. It normally takes a year or more to test vaccine safety and efficacy.
Gam-COVID-Vac is administered in two doses and is expected to provide immunity from SARS-CoV-2 for up to two years. The vaccine is based on the human adenovirus, a common cold virus and is fused with the spike protein of SARS-CoV-2 to stimulate an immune response.
So far, RDIF has announced supply agreements with Mexico (32 million doses), Brazil (up to 50 million doses and Uzbekistan (up to 35 million doses). India is importing another 100 million doses of the vaccine.
The results of the first and second rounds of clinical trials of the vaccine which were <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext">published in the Lancet Journal</a> on 4 September showed no serious adverse effects, but stable immune response in all participants, said the statement.
Post-registration phase III clinical trial involving 40,000 people is underway and the first results are expected to be published by October-November. Some mild side-effects have been reported in one of every seven people so far. This phase III trial is a crucial scientific step in order to prove vaccine safety and efficacy.
But back in Nepal, officials are unaware of the agreement. Before importing any new vaccine and drug, permission must be obtained from the Department of Drug Management.
Narayan Dhakal, director of the Department of Drug Management, says he had “no idea” about a Nepali company importing the vaccine against coronavirus from Russia.
The Chief Research Officer of the Nepal Health Research Council Meghnath Dhimal also told us he had no official information about a vaccine being imported from Russia.
Apart from Russia, Chinese pharmaceutical companies and Oxford University have also expressed their interest in conducting phase III <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/">clinical trials in Nepal</a>.
There are currently over 169 Covid-19 vaccines under development, with 26 in the human trial phase. The <a href="https://www.gavi.org/covax-facility">WHO has assured</a> that it will facilitate equitable access and distribution of a safe and effective vaccine in all countries with priority to people at most risk once it is found.

sputnik-v

Vaccine geo-politics and Sputnik-V

Vaccine geo-politics and Sputnik-V

Thick haze adds to Nepal Covid-19 woes

When will Nepal’s Covid vaccine turn come?

VAX POPULI

Sputnik V vaccine mystery in Nepal