<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221129121128/6385ed659c7e80680e0cc8d3jpeg.jpg" alt="" width="540" height="350"/>This pandemic is a time for clinical research to help humanity out of the crisis, and scientists are scrambling to find a <a href="https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines">COVID-19 vaccine.</a>It is urgent because if they do not do human trials during the pandemic, the infection rate may decline and the vaccine will not be well-tested enough to prevent this disease.This lack of cases and the resulting inability to test a strong candidate vaccine is exactly what happened to the zika virus vaccine. Zika may have run its course even as the vaccine study was getting underway. But there is every likelihood it may return with a vengeance without an effective vaccine in place.Many big pharma including Astra Zenca, Pfizer, Merck, and Johnson and Johnson are involved in the testing and manufacture of the COVID-19 vaccine. Companies in India, China, and Japan are also ramping up their efforts.Unfortunately, no promising drug treatment is on the horizon. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext">Remdesivir,</a> convalescent plasma, interleukin inhibitors like tocilizumab, chloroquin are certainly not the silver bullets they are made out to be. But every bit of hope is useful.Last week, <a href="https://science.sciencemag.org/content/368/6495/1041">a riveting scandal rocked the medical world</a> that involved a team of doctors whose research into choloroquine and the journals that published the result.This antimalarial drug, discovered in 1934 and introduced generally in 1947, is one which humans have been most exposed to. Chloroquine is inexpensive and simple to administer. It remains a first-line treatment for non-falciparum malaria and is on the World Health Organisation (WHO) List of Essential Medicines.It has been used extensively as a continuous prophylaxis <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-guts-of-the-anopheles,548">against malaria</a> for individual periods often exceeding five years, and has been the prophylactic drug of choice in pregnancy in order to avoid non-falciparum malaria. In addition to its antimalarial use both chloroquine, and the closely related hydroxychloroquine, are used in continuous daily dosing for common joint diseases like rheumatoid arthritis and lupus.Cholorquine in viral culture cells in research laboratory has been shown to suppress the novel betacoronavirus SARS-CoV-2, the cause of the <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">COVID-19 infection</a>. This effect occurred when the drug was given either before or immediately after viral inoculation, not after a long lag period.An observational study purporting to use data from a multi-country registry was recently published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31324-6/fulltext">The Lancet</a>, revealing that regardless of any benefit chloroquine may (or may not) have for the treatment of COVID-19, there were unacceptable side-effects on the heart leading to decreased survival of the patients.But there was a problem with the study. Sapan Desai, one of the authors and owner of <a href="https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine">Surgisphere Corporation</a> based in Chicago from where this registry  data was obtained, was, when requested, unable to share the dubious list.Desai’s colleague, Mandeep Mehra, the lead author, and other co-authors including Amit Patel have now <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext">retracted the article from The Lancet</a>. But the story does not end there.This same group of authors, some of whom work in prestigious institutions like Harvard (Mehra), also retracted a recent <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2016638">New England Journal of Medicine (NEJM) article</a> regarding COVID-19 where they had used data from Surgisphere Corporation, and when requested, were unable to share it.These retractions by the same set of authors (one of whom owns the data collection corporation) from two of the highest impact medical journals could suggest possible fraud. In addition, the editors of both the <a href="https://www.nejm.org/doi/full/10.1056/NEJMe2020388">NEJM</a> and <a href="https://www.abc.net.au/radionational/programs/healthreport/major-research-papers-retracted-over-data-controversy/12326900" target="_blank" rel="noopener noreferrer">The Lancet</a> were caught with their pants down in the rush to publish data.Finally, a proper randomised controlled trial named the Recovery Trial from the UK that utilised large numbers of patients who were treated with hydroxychloroquine revealed this week that the drug does not work in the treatment of COVID-19 patients.But whether chloroquin works in prevention (as opposed to treatment) of <a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/">COVID-19</a>, especially in the vulnerable group of health workers, is not known and studies are continuing regarding pre-exposure to the virus. Medical science can be tricky. A drug not useful for treatment can often be useful for prevention.Potentially fraudulent studies notwithstanding, it is beneficial for countries like Nepal, after proper examination, to collaborate in international observational or randomised controlled trials like the <a href="https://www.nepalitimes.com/opinion/countries-cooperating-to-find-covid-19-cure/">WHO’s Solidarity Trials</a> for COVID-19 antidotes -- especially because it will help with capacity building in our region without desperately having to look for funding.The <a href="http://archive.nepalitimes.com/news.php?id=10203#.XuBQOS0w0Wo">Nepal Health Research Council</a> has been doing an excellent job of reviewing manuscripts and usually providing prompt feedback to the researchers in the region. However, what we medical researchers in South Asia lack is an appreciation of equipoise.‘Equipoise’ means curiosity, but it also has an element of humility. A true state of equipoise exists in research when there is no good basis for a choice between two or more options. In fact, the state of equipoise is the reason for doing research using RCTs.Unfortunately, many health care professionals in South Asia do not make room for this quality. For example, some institutions have turned down doing potentially useful, well-written and well-grounded multilateral studies in the mistaken belief that we know better that the drug or treatment in question does not work. How can this be assumed?This narrow belief may shut useful research out which ultimately could inform clinical treatment and help the patient. Helping the patient, at the end of the day, is what we all are trying to do.Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and writes this <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">frequent health column</a> Dhanvantari for Nepali Times.

Buddha Basnyat

original

400x266

400x240

400x203

301x200

The truth about the chloroquine scam

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b71809c7e80680e0600d4jpeg.jpg" alt="" width="1440" height="1080"/><figcaption>Peking University campus on the 26th of January. Photo: MADISON PLASTER</figcaption></figure>For the past week, I have been in a voluntary lockdown in Beijing because of the rapid spread of the coronavirus in China. A trip to the supermarket to stock up on supplies felt like being in a post zombie apocalyptic breakout, not waiting for the infected to attack you but actively making a run when someone coughed or sneezed. Relying on homemade noodles, I am looking forward to flying out of Beijing soon with no knowledge on when I will be back as many universities in Beijing have requested students not to return until further notice.As seen in <a href="https://www.ncbi.nlm.nih.gov/books/NBK92479/" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.ncbi.nlm.nih.gov/books/NBK92479/&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNF3tSZYxe_Ww_d6Hv2DoRvSoKHD5Q">China’s 2002 SARS pandemic</a> that infected more than 5,300 people and killed 349 nationwide, the government has yet again relied on putting almost 50 million people in quarantine to contain the crisis. According to <a href="https://www.youtube.com/watch?v=S2VoEvDEuxw" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DS2VoEvDEuxw&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNHxS4nKpuTtjHXhJHlS4zi-tjlDMQ">news</a> from the BBC, as on January 26th, the number of people killed in China has risen to 81 with almost 3,000 confirmed ill.Embassies continue to work for the wellbeing of their citizens, and neighbouring countries such as Mongolia and North Korea are reported to have <a href="https://abcnews.go.com/International/wireStory/report-mongolia-closes-border-china-amid-virus-fears-68557875" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://abcnews.go.com/International/wireStory/report-mongolia-closes-border-china-amid-virus-fears-68557875&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNE4MB58BpGrDibXc8rfZpEgAZtTvw">closed down borders</a> with China. Acknowledging the uniqueness and severity of the situation as people were traveling for Lunar New Year, the Chinese government has extended the Lunar New Year holidays and both public and private sectors are adding buffer time periods before things start moving business as usual.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b71839c7e80680e0600d5jpeg.jpg" alt="" width="1125" height="1500"><figcaption> </figcaption></figure>Like many crises situations, there seems to be more unknowns than knowns. While Wuhan seafood market was initially believed to be the source of the novel virus, a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNF3MXldTizCebbsdGu1o3RPlNtrjw">new study</a> published in <a href="https://www.thelancet.com/journals/lancet/home" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.thelancet.com/journals/lancet/home&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNGSNtrH9F-1Q6aP25WKdl9kI4WfIw">The Lancet</a> of 41 hospitalised patients who had confirmed infections challenges that hypothesis. According to an <a href="https://www.sciencemag.org/news/2020/01/wuhan-seafood-market-may-not-be-source-novel-virus-spreading-globally" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.sciencemag.org/news/2020/01/wuhan-seafood-market-may-not-be-source-novel-virus-spreading-globally&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNFtb1KBIlj4mlVhbjLL_50gOHu5yQ">article published</a> in the <a href="https://science.sciencemag.org/" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://science.sciencemag.org/&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNFc4FOYJSQSQtW3Iv0WItiwgvZqLw">Science</a>, Daniel Lucey, an infectious disease specialist at the University of Georgetown, asserts that “The virus came into that marketplace before it came out of that marketplace.”Transparency from the government in reporting the crisis also continues to be questioned within and beyond China. While state run media channels such as CGTN are showing hundreds of medical personnel <a href="https://www.youtube.com/watch?v=ydphq5uA_Jg" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.youtube.com/watch?v%3Dydphq5uA_Jg&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNFO7K2xW_laJTA2asovWvLK4zJC1Q">voluntarily traveling to Wuhan</a> out of a sense of duty to the nation, and a <a href="https://www.youtube.com/watch?v=VbA2PRYsakA" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DVbA2PRYsakA&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNGV9x-Kx5xOlevsbCmyhYdOFFvrgw">wonderfully staged case</a> of people recovering from the virus and heading back home, people continue to question the legitimacy of the magnitude of the crisis as reported from the Chinese government.While <a href="https://www.ncbi.nlm.nih.gov/books/NBK92479/" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.ncbi.nlm.nih.gov/books/NBK92479/&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNF3tSZYxe_Ww_d6Hv2DoRvSoKHD5Q">previous experiences suggest</a>, be it during the air pollution crisis in 2008 or the 2002 SARS pandemic, that China has not been the most transparent in reporting crisis, the rise in social media and the internet means that complete lack of transparency from the government might not be just impossible but also counterproductive.https://www.youtube.com/watch?time_continue=2&amp;v=ydphq5uA_Jg&amp;feature=emb_logoBut in fleeing China for Nepal, I cannot question but wonder if I am safer in Beijing than I am in Nepal. A day after the first coronavirus case was confirmed in Nepal, two more suspected cases have emerged. While countries around the world are figuring out the best response mechanism to contain the crisis, Nepali authorities appear particularly unprepared.The Epidemiology and Disease Control Division reportedly chose not to speak to the media, in following the orders from the Ministry of Health.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b71869c7e80680e0600d6jpeg.jpg" alt="" width="1080" height="1440"><figcaption> </figcaption></figure>The rudimentary screening mechanisms alongside the lack of human resources and technology at the country’s only international airport needs no mention. And while China is <a href="https://news.sky.com/story/coronavirus-china-to-build-two-wuhan-hospitals-in-under-three-weeks-11917336" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://news.sky.com/story/coronavirus-china-to-build-two-wuhan-hospitals-in-under-three-weeks-11917336&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNHsoNgF7mWsi-yXGbB-mYgF5dsBeQ">building two health facilities</a> with enough space for around 2,300 patients over the next few weeks, the Sukraraj Tropical and Infectious Disease Hospital in Teku lacks even a <a href="https://newsinfo.inquirer.net/1219763/two-more-coronavirus-cases-suspected-in-nepal" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://newsinfo.inquirer.net/1219763/two-more-coronavirus-cases-suspected-in-nepal&amp;source=gmail&amp;ust=1580228862390000&amp;usg=AFQjCNHBbq7QdxT_FH6WsvrO7kZzHAEVOQ">dedicated isolation ward</a>.It is disheartening to see fellow friends at university hear from their respective embassies whilst I was forwarded with a “do and don’t” list issued by the Nepal Embassy from a WeChat group. It is not that Nepali people expect a lot from their governments, but I can’t help but contemplate why I feel safer in the hotspot of a global pandemic than I would at my own home country.https://www.youtube.com/watch?v=VbA2PRYsakA&amp;feature=emb_logoGrappling with this idea has been difficult, but it also serves as a reminder for the very reasons why we must continue to fight to contribute to the development of Nepal in every way possible.Rastraraj Bhandari is currently pursuing a Masters in Economics and China Studies at the Yenching Academy of Peking University in Beijing, China. <img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b71899c7e80680e0600d7jpeg.jpg" alt="" width="175" height="173">

674x448

610x380

500x500

1250x600

1084x550

A Nepali in Beijing during coronavirus scare

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d49c7e80680e06009bjpeg.jpg" alt="" width="1500" height="803"/><figcaption>Photo : UNICEF</figcaption></figure>Last month, the prestigious <a href="https://www.nejm.org/" target="_blank" rel="noopener">New England Journal of Medicine</a> published a study of the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">successful trial of a new typhoid vaccine</a> that could prevent thedeaths of many children around the world. The vaccine research was conducted at Patan Hospital by a Nepali researcher.The randomised control trial of the typhoid conjugate vaccine (TCV) was conducted among more than 20,000 participants in Lalitpur district, and the efficacy of the new vaccine was found to be 81.6% -- a major improvement on previous vaccines. (See box below).The positive news from Nepal came as various parts of the world, including the US, Europe, Samoa and Africa, struggled to cope with the biggest measles outbreak in decades. Most of the cases have now been associated with people forgoing recommended preventive shots because of fears of side-effects fanned by social media.Fear of vaccination started ever since a paper in 1998 in the medical journal <a href="https://www.thelancet.com/" target="_blank" rel="noopener">The Lancet</a> cited a link between autism and the <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/maurice-hilleman-the-vaccine-man,1852" target="_blank" rel="noopener">measles, mumps, rubella (MMR) vaccine</a>. The research was later found to be fraudulent and retracted, but the anti-vaccine movement gained traction again in the past year after the rumours resurfaced on the Internet resulting in families rejecting early childhood immunisation against diseases like polio, rubella and measles.“The good news is that unlike in the rest of the world, people in Nepal demand vaccines. If we miss to vaccinate a child for any reason, parents come knocking, asking for the shots,” says Jhalak Gautam of the Family Welfare Division at Teku.Sameer Mani Dixit of The Centre for Molecular Dynamics Nepal concurs. “Entire communities actively participate in vaccination programs and are well aware of the benefits. Every mother in Nepal knows the immunisation schedule by heart.”The Centre for Molecular Dynamics Nepal has just completed a study on why the country has been so successful with its immunisation program, and the results will be published later this month. This study and similar studies underway in Senegal and Zambia are being conducted with  funding from the Bill and Melinda Gates Foundation, in an effort to analyse the success of vaccination programs in developing nations.Nepal’s national immunisation program started in 1988 and now vaccinates some 620,000 children under 15 months of age every year against 11 infectious diseases such as <a href="https://www.nepalitimes.com/banner/tb/">tuberculosis</a>, <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Bouncing-back-higher-wheelchair-basketball,3802" target="_blank" rel="noopener">polio</a>, pneumonia and measles.The last case of <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener">polio</a> was detected in Rautahat district in 2010, and Nepal was declared polio free four years later. The country also eliminated maternal and neonatal tetanus in 2005. Similarly, Japanese encephalitis, diphtheria, pertussis and pneumonia have all been controlled, and there are regular vaccinations against congenital rubella syndrome and hepatitis B.Despite the high immunisation rate, thousands of Nepali children continue to die due to easily preventable and treatable communicable diseases <a href="https://archive.nepalitimes.com/news.php?id=16988#.XiBL7_4zaUk" target="_blank" rel="noopener">like diarrhoea</a> and according to Nepal Demographic Health Survey 2016, one in a hundred Nepali children have still not been vaccinated against any infectious diseases.Read also: <a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all the change in world health"</a>Immunisation coverage data from last year also shows a worryingly high dropout rate. While 93% of newborns received BCG jabs, the first in the national immunisation schedule, the coverage dropped to 73% by the time children received the last vaccine, an immunisation against measles and rubella, recommended at the age of 15 months.Several cases of <a href="http://archive.nepalitimes.com/news.php?id=186#.XiBGW_4zaUk" target="_blank" rel="noopener">measles</a> have been detected in Kapilvastu, Dang, Makwanpur, Sarlahi and Manang districts recently, and Nepal has not been able to meet its previously set target to eliminate measles and rubella by 2019. The new goal is to eliminate the diseases by 2023.“Dropout rate is a challenge, we have not been able to reach the remotest corners of the country, and children miss their shots because of migration,” says Jhalak Gautam. “We now have a strategy to identify missed pockets and deliver shots at home if required.”The Immunisation Section of the Ministry of Health is now gearing up for a nation-wide measles-rubella vaccination campaign aimed at those who might have missed routine shots. Three million children between the ages 9 months to 5 years are expected to participate in two phases of the campaign later this year.Polio drops will also be administered at the same time to 1.5 million children under five in 19 Tarai districts. The Immunisation Section is also introducing a new vaccine against rotavirus this June to reduce the prevalence of childhood diarrhoea.The new challenge to vaccination comes from an unlikely quarter: federalism. There is confusion about where the vaccines are sourced and who should pay for them. There is concern about the quality of vaccines, many of which need a cold chain with refrigeration to the point of delivery.Warns Patan Hospital physician Buddha Basnyat: “Nepal’s immunisation program is a model of success, but we cannot afford to be complacent.We have to introduce newer and more effective vaccines while also prioritising hygiene and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener">sanitation</a> simultaneously.”<h2>Successful trial of new typhoid vaccine</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101120/636b70d79c7e80680e06009cjpeg.jpg" alt="" width="1500" height="1000">Over 20,000 children between 9 months and 16 years of age in Lalitpur district participated in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047" target="_blank" rel="noopener">first large-scale randomised controlled trial</a> of a new vaccine against <a href="http://archive.nepalitimes.com/news.php?id=17306#.XiBGav4zaUk" target="_blank" rel="noopener">typhoid</a>, a disease that affects millions across South Asia.Half of them received the vaccine and the other half received control shots. The efficacy of Typhoid Conjugate Vaccine (TCV) was found to be 81.6%, and the results were published last month in the prestigious New England Journal of Medicine.Prior to this, a small-scale TCV trial was conducted in Britain, and the World Health Organisation (WHO) has since strongly recommend the use of the vaccine for countries and regions where the water and food-borne infection is most common. "Pakistan has been able to control typhoid with this vaccine and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30320-1/fulltext" target="_blank" rel="noopener">Vietnam</a> has eliminated it," says lead author of the paper, Mila Shakya, "Administration of this new, effective vaccine by our government will help control the most common bacterial disease in Nepal and South Asia."<a href="http://archive.nepalitimes.com/news.php?id=12158#.XiBGbP4zaUk" target="_blank" rel="noopener">Typhoid</a> is a contagious infection caused by the bacteria Salmonella typhi, which is found in contaminated food and water and which causes fever, diarrhoea and vomiting. It can easily be prevented with awareness, safe drinking water and frequent hand-washing.The vaccine is useful because it is a prophylactic in places where preventive measures are taking time to implement. There are some 21 million typhoid cases and 161,000 typhoid-related deaths annually worldwide. South Asia has been often dubbed as the hub of typhoid and there are some 500 cases per 100,000 population in the region.“This study is Nepal taking a lead in preventing typhoid, after never having really prioritised it. It might not kill as many people as other diseases do, but it still affects thousands of school-going children,” says physician Buddha Basnyat at Patan Hospital.TCV is <a href="http://archive.nepalitimes.com/news.php?id=18178#.XiBGdP4zaUk" target="_blank" rel="noopener">not the first typhoid vaccine to be developed</a>. Currently there is an injectable unconjugated polysaccharide vaccine for persons aged two years and above, and an oral capsule for those over six years of age. But they do not work well on young children and they provide protection only for a few years. TCV on the other hand can be given to children below 2 years and the immunisation lasts up to five years.“A single dose of the new vaccine is safe, immunogenic, and effective, and the deployment of the vaccine will reduce the burden of <a href="https://www.nepalitimes.com/opinion/so-far-so-good/infectious-enthusiasm-for-travel/" target="_blank" rel="noopener">typhoid</a> in high-risk populations,” stated the interim analysis. “This new evidence of efficacy is especially timely with the recent spread of extensively drug resistant typhoid fever, which threatens child health in affected regions.”Pakistan, which has been struggling against an outbreak of drug resistant typhoid fever since 2016 is already using TCV with positive results and its Sindh province will become the first region in the world to include TCV in routine childhood immunisations.<a href="https://www.gavi.org/" target="_blank" rel="noopener">Gavi, the Vaccine Alliance</a>, which has earmarked $85 million to fund the introduction of the vaccine in the world’s poorest countries, is supporting the program. Nepal is also eligible for funding from the alliance.Says Basnyat: “We should take action before we are also hit, like Pakistan, by the drug-resistant typhoid. What are we waiting for, when Gavi is ready to fund the vaccination program for free and its benefits are so clear. This is a case of vaccine under-utilisation.”Sonia Awale

Sonia Awale

A shot in the arm for vaccines in Nepal

It was 30 years ago this month that investment into ‘Baby Arun’, the 201MW first phase of the run-of-river Arun III project, was brought to a screeching halt when the World Bank officially withdrew its support. This brought about profound and fundamental changes in the way Nepal’s power sector subsequently developed. Nepalis suffered debilitating power outages between 2008-2016 due to shortages attributable to the cancellation. At the same time, the gap left by Baby Arun was filled by private sector investment in ways that were not obvious in 1995. It took 30 years, but in many ways Nepal’s power sector is more healthy today than it has ever been, and likely better than if the project was built as planned. At a projected budget of $1.08 billion, Baby Arun would have cost the equivalent of Nepal’s entire annual government expenditure in 1995. It was to be funded by concessional grants and loans from multilateral and bilateral funders, including the World Bank, Asian Development Bank (ADB), KfW, and investment by the government itself. At the time, Nepal’s total electricity generation capacity was only 230MW, and the trajectory of the power sector changed dramatically following the cancellation. In the past 30 years, $5.4 billion has been invested in the power sector led by private investors, and much of it from domestic banks and pension funds (table, right).  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150840_c13d6f9f34d7163832b3089eabdad6f20d2d5cef3a53039e0432add2be6c32f0.jpg" data-media-id="editor_0" data-image-id="20250829150840_c13d6f9f34d7163832b3089eabdad6f20d2d5cef3a53039e0432add2be6c32f0" data-rendition-name="original" width="984" height="521" loading="lazy" alt="30 years after Baby Arun"> </figure>  Nearly 70% of the new megawatts generated were by private independent power producers (IPP) in the past 30 years, while the Nepal Electricity Authority (NEA) and its subsidiary companies added 30% of new capacity. Almost 80% of total debt financing came from domestic banks and employee retirement funds. International assistance for power generation dropped dramatically over this time, accounting for only about 15% of investment. Before 1995 new power projects used to be entirely dependent on foreign aid. Since 1995, 63% of new generation came from 171 small hydropower projects with an average capacity of 12MW, while 4% was from 21 solar photovoltaic and biomass projects developed by local IPPs.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150844_5bc299fc78be90b95ce4727b0b3bdaa4542e17e126718cc8725d136630ffc097.jpg" data-media-id="editor_1" data-image-id="20250829150844_5bc299fc78be90b95ce4727b0b3bdaa4542e17e126718cc8725d136630ffc097" data-rendition-name="original" width="988" height="503" loading="lazy" alt="30 years after Baby Arun"> </figure>  Over three decades, investment in Nepal’s power supply came primarily from new actors that had never before been involved in this sector. The rate of electrification rose from 10% to close to 100% -- sufficient to meet domestic needs during most of the year, and in 2024 made Nepal a net exporter of power to India for the first time in its history. As practically all the new investment in this period went into run-of-river hydro and solar projects, rather than into hydropower reservoirs with seasonal storage, Nepal continues to rely on imports from India during the dry winter months. Surplus electricity generation for export during the monsoon is slated to grow rapidly as another 200 solar and hydro projects are nearing completion of construction, with over 5,000MW of power capacity. Private Power The cancellation of Baby Arun inadvertently accelerated the entry of the private sector into Nepal’s power generation. The government enacted the Electricity Act in 1992 to attract private IPPs and diversify away from total dependence from international aid, but had been struggling for several years to conclude the first agreement with the 60MW Khimti Project. There remained a large gap between the tariff that the government thought was reasonable versus what was demanded by the Norwegian investor Statkraft, and the private sector arms of the World Bank and ADB that were financing the project. The shock of World Bank withdrawal from Baby Arun put tremendous pressure on the government, then led by the UML as it is now. The Bank’s decision to terminate its involvement was ostensibly, at least partially, taken in response to a letter critiquing the project sent by the UML while it was in the opposition.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150848_7fb3641d776fe86a09ad60a758f7e16660a409fdb15e541644f13646b0894347.jpg" data-media-id="editor_2" data-image-id="20250829150848_7fb3641d776fe86a09ad60a758f7e16660a409fdb15e541644f13646b0894347" data-rendition-name="original" width="949" height="446" loading="lazy" alt="30 years after Baby Arun"> <figcaption>BAD NEWS: Newspaper clippings from the early 90s on tender announcement ahead of loan approval (left) and secrecy surrounding environmental assessment (centre) of Arun III before its eventual cancellation in August 1995.</figcaption> </figure>  The government was forced to soften its position and agree to the investors’ terms following the cancellation of Baby Arun. It directed NEA to sign a power purchase agreement (PPA) with Khimti. It was concluded in January 1996, and this was followed by a second PPA in July 1996 with Panda Energy, the American developer of the 45MW Upper Bhotekosi project. The expensive USD-denominated agreements to buy power from two international private producers, with price escalation clauses tied to the New York Consumer Price Index, sent alarm bells ringing. There was worry that the country was heading towards unaffordable tariff rates for the consumer and potential bankruptcy for NEA as a result of inevitable future weakening of the Nepali Rupee. The government had strong-armed NEA into signing these agreements, and realised that concessionary financing terms that Nepal was used to receiving for public sector projects such as Baby Arun and Kali Gandaki A, that included below-market interest rates and 40 years repayment period with a 10 year grace period before starting repayment, were not the norm for private sector investors. Nepal’s status as a less than attractive destination for foreign investment meant that the country had few options but to accept expensive dollar PPAs from international developers with the high commercial interest rates and short repayment periods imposed by their banks because of high investment risks. In the end, the government ended up having to additionally provide a sovereign guarantee in order to close the deal at the insistence of the lenders – committing it to repayment in case NEA defaulted on paying the IPPs. It is reasonable to assume that the extraordinarily high political cost of agreeing to the PPA terms would have meant that no government would have willingly agreed to them in 1995 had it not suffered the trauma of the loss of concessionary-financed public sector projects as large as the Baby Arun. It has taken NEA 25 years to consider offering dollar-denominated PPAs again: to cover the foreign exchange portion of the investment in the 216MW Upper Trisuli-1 and 120MW Rasuwa-Bhotekosi Hydropower projects. It seemed unlikely at the time, but it turned out that the dire situation Nepal found itself in 1995 planted the seed to mobilise investment for affordable power from within the country. Double Whammy After the dual shock of first losing investment in Baby Arun and having to sign expensive power purchase agreements with international IPPs, the first proposal for an alternative strategy to mitigate the risk of foreign currency investment into hydropower projects came from a group of engineers within the Arun III team at NEA. Led by <a href="https://archive.nepalitimes.com/news.php?id=4900">Deputy Director Damber Bahadur Nepali,</a> engineers convinced the leadership that NEA needed to invest in a subsidiary company to build a series of locally-designed and domestically-financed projects that would have lower cost with rupee-denominated PPAs. They registered the Chilime Hydropower Company Limited (CHCL) in October 1995 with 51% shares from NEA, 25% from its employees, and 24% available for the general public, 10% of which was prioritised for local residents at the project site. The 22.1MW project is in Rasuwa on a tributary of the Trisuli, and mobilised debt financing from the Employee Provident Fund, which manages retirement savings for employees of the government, public enterprises, and private sector institutions. CHCL’s experience showed that NEA employees themselves believed that individual hydropower projects with operational independence from NEA could be developed profitably in Nepal by its own engineers -- and they were willing to put their own money on the line. Chilime also demonstrated that there was money in the country, particularly with retirement funds, looking for opportunities for long-term investments. Following completion of Chilime in 2003, CHCL led the formation of three other NEA subsidiary companies that completed construction in 2023 and 2024, producing 168.3MW using fully rupee-tied investment. NEA’s largest subsidiary, the Upper Tamakosi Hydropower Limited, completed construction of its 456MW plant in 2021.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829160812_ce9ab8b49c598970db3f5bf0a079061ef52f153b28d9f4ead2bb1b26bfd7c2f3.jpg" data-media-id="editor_4" data-image-id="20250829160812_ce9ab8b49c598970db3f5bf0a079061ef52f153b28d9f4ead2bb1b26bfd7c2f3" data-rendition-name="original" width="3000" height="1571" loading="lazy" alt="30 Years after Baby Arun"> <figcaption>DAMNED: The $700 million 456MW Upper Tamakosi built entirely with domestic funds before it was destroyed by the September floods last year. </figcaption> </figure>  There were some delays and cost overruns on this run-of-river project, the largest in the country with a final cost of over $700 million -- all of it sourced domestically. The five subsidiary companies launched by NEA have produced almost two times as much new power as NEA has over the past 30 years. Seven other NEA subsidiaries are currently constructing projects to add another 474MW to the national grid. But even more important than NEA subsidiaries have been local IPPs: Nepali companies which have over the past three decades enthusiastically entered the hydropower sector. From a regulatory perspective, the credit for mobilising domestic private investment to engage in power generation goes to Minister of Water Resources Shailaja Acharya, who in 1998 offered a flat feed-in-tariff of Rs4/kWh for hydropower projects under 10MW. This upfront offer removed a major barrier that early developers had faced of having to spend money to carry out a detailed feasibility study before they could even start tariff negotiations with NEA. She had laid the foundation stone of the Chilime project, and proved to be the champion of opening up the sector for domestic IPPs. The guarantee of a PPA with a fixed tariff, irrespective of project specifications, gave small power developers the confidence to apply for survey licenses and invest in feasibility studies so they could directly approach commercial banks and make a case for their project producing required revenue to repay loans. Domestic IPPs started adding power to the national grid in 2002. Their contribution was initially modest, and first projects were small and commercial lenders who took time to be confident about providing debt financing to a sector which had previously not been considered suitable for private sector investment. While the first 10 years were slow, with less than 10MW being added to the grid each year, this increased twenty fold over the following ten years, resulting in the equivalent of a Baby Arun being added by Nepali IPPs to the grid each year. A total of 84 IPPs added 232MW, 328 MW, 454MW, and 400MW of new generation to the grid in 2021-2024 (graph). There was explosive, exponential growth as domestic developers have surged ahead to account for 76% of the new megawatts added to the grid since 2020, compared to 24% by NEA and its subsidiary companies. The megawatts that IPPs are adding have followed the classic ‘hockey stick curve’ with the ‘breakout point’, signaling the rapid growth phase in 2020. Private producers are expected to accelerate new generation in the coming years with 300 solar and hydropower projects adding 11,000MW. Another 166 hydropower and 96 solar projects are currently in the survey stage, and are in line to add another 11,000MW to the construction pipeline. One major challenge is finding financing required for the projects. Domestic investment will no longer be sufficient to finance this ambitious pipeline of renewable energy projects. Project developers as well as NEA and the Electricity Regulatory Commission will have to leverage their substantial experience accumulated through the construction of over 200 projects to attract regional and international investment and hedge the risks of dollar-denominated PPAs. Following the cancellation of Baby Arun, <a href="https://nepalitimes.com/opinion/people-power/decentralising-power-in-nepal">Nepal developed a highly distributed power sector</a>. The national electricity grid is currently supplied with power from a remarkably decentralised array of hundreds of hydropower and solar photovoltaic projects spread across 43 districts and all seven provinces.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150848_0c3aa66b34bfb08380a624f397bf3ebb4126f4d6b41a26115848b496876f501b.jpg" data-media-id="editor_6" data-image-id="20250829150848_0c3aa66b34bfb08380a624f397bf3ebb4126f4d6b41a26115848b496876f501b" data-rendition-name="original" width="1228" height="867" loading="lazy" alt="30 years after Baby Arun"> </figure>  This presents a sharp contrast to the pathway of a few large public sector hydropower projects with a sprinkling of private sector projects that was envisioned as part of NEA’s investment planning when Baby Arun was being considered the front runner for investment. The strategy then was to allow public sector investment in a few large hydropower projects with thermal plants to fill the gap. Knowing what we know now about acceleration of climate change impacts and increased extreme weather events, following this path would have made Nepal’s power sector highly vulnerable. Decentralised generation greatly improves the resilience of Nepal’s power supply as damage to power plants in one part of the country need not affect other areas that have their own generation. Following the investment plan where over two thirds of the country’s power supply would have come from power plants on the Arun River, would have greatly imperiled Nepal’s energy security. All rivers in Nepal are susceptible to flooding from cloudbursts made more frequent by climate change. The Arun River which is fed by glaciers in Tibet is also at risk to glacial lake outburst floods. Bikash Pandey is Director of Clean Energy and Circular Economy at Winrock International. People Power is his regular column in Nepali Times on global energy issues relevant to Nepal. <h2>Decentralised and Diversified</h2> In the 30 years since the cancellation of ‘Baby Arun’: Hydropower projects constructed cover capacities ranging from less than 1MW to 456MW and developed by IPPs from across the country with strong local involvement in purchasing equity shares. Renewable energy sources contributed to the generation mix through solar IPPs that further contribute to climate resilience, and cover shortfalls during low rainfall. The government is committed to solar contributing 10% of the power on the grid. Increasing solar beyond this target and providing incentives to project developers to invest in utility-scale battery storage would further improve resilience. BIG ARUN: The 900MW Arun III project under construction since 2018 at Num in Sankhuwasabha (pictured, below) is a separate initiative by a different project developer using a different financing modality. The ‘Baby Arun’ version of Arun III was cancelled in 1995.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250829150852_df534df5166eb5a9bb4cbe101627bdec7ac1df2a405a9d3988d1c86fcc8ecdeb.jpg" data-media-id="editor_7" data-image-id="20250829150852_df534df5166eb5a9bb4cbe101627bdec7ac1df2a405a9d3988d1c86fcc8ecdeb" data-rendition-name="original" width="1750" height="1312" loading="lazy" alt="30 Years after Baby Arun"> </figure>

30 years after Baby Arun

It cannot be a coincidence that after pushing bills to constrict freedom of expression and allow greater <a href="https://nepalitimes.com/news/security-or-espionage">surveillance of citizens</a>, Nepal’s government is now tightening controls on civil society.
In a <a href="https://nepalitimes.com/opinion/guest-editorial/command-and-control">series of recent moves</a> journalists have been sued for contempt of court, imprisoned for YouTube videos, or ordered by courts to desist from investigating corrupt officials.
An amendment to the Print and Publications Act that would hand the power to shut online media to the Chief District Officer (CDO). Another draft Bill would allow a political appointee to head a new Media Council with the power to revoke a journalist’s license. The draft counter-intelligence Bill would let random officials to arbitrarily tap phones, read emails and trail citizens.
Now comes yet another draft Bill that would replace the <a href="https://archive.nepalitimes.com/news.php?id=10675">Social Welfare Council (SWC)</a> with direct government control over registration, regulation, and management of non-governmental organisations, nonprofits and charities. There are more than 54,000 NGOs, 200 international NGOs registered with the SWC.
The draft makes civil society organisations needlessly jump through hoops to carry out work that complements the government in the social sector. Critics say the Bill was drafted without any consultation with <a href="https://nepalitimes.com/opinion/comment/nepal-s-rights-groups-must-step-up-4r4z6ck4">civic groups</a>.
“This Bill’s content is questionable whether it intends to allow for civil society organisations in Nepal a free space to operate,” concludes Dr SP Kalaunee, Country Representative of BlinkNow Foundation and Chair of the Association of International NGOs in Nepal (AIN). “The draft seems oriented towards controling rather than facilitating the work of civil society organisations.”
The Bill will be open for feedback from the public, and integrates the National Directives Act (1961), Association Registration Act (1977), and the Social Welfare Act (1992) and proposes dissolving the SWC and replacing it with a new Social Welfare Department under the Ministry of Women, Children and Senior Citizens.
Non-government groups will now be required to get approval from the Registrar Office, the CDO or the provincial government depending on their area of operation. Those working across provinces will have to get permission from the federal government. &nbsp;
The government says the Bill is intended to vet organisations to see if they are engaged in espionage, violate national security, assist a foreign state, commit treason, cause strife between federal units, or incite communal violence.&nbsp;
CSOs working in Nepal have long called for legislation to better facilitate their work, minimise administrative and bureaucratic red tape which have posed operational challenges. But they are opposed to such drastic control.&nbsp;
Read also: <a href="https://nepalitimes.com/banner/the-crow-and-the-scarecrow">The crow and the scarecrow</a>, Om Astha Rai
The NGO Federation of Nepal also issued a statement this week calling the Bill ‘retrograde and cumbersome’. It added: ‘Most of its provisions are intended to further constrain and control civil society organisations rather than facilitate and strengthen them, and reduce the role of citizen participation … it is an attack on our civil liberties, inclusivity, and transparency, and curtails our <a href="https://archive.nepalitimes.com/news.php?id=5156">democratic values and constitutional rights</a>.’ &nbsp;
<a href="about:blank">Nepal’s graduation</a> from least-developed country status next year may mean less aid for Nepal, and higher interest rates on loans from multilateral creditors. The <a href="https://nepalitimes.com/news/how-usaid-cut-affects-nepal">closure of USAID </a>and reduction in bilateral grants means the work of INGOs will be even more vital – especially to meet its <a href="https://nepalitimes.com/here-now/target-2030-for-maternal-and-newborn-health">SDG targets by 2030</a>.&nbsp;
“We are competing with other countries at a time when the global aid environment is shrinking, so the support we receive is directly dependent on a conducive environment for INGOs to operate and function,” says Kalaunee. “INGOs follow regulations of the nations they operate in, they will not protest or wait around for governments to change their minds or policies.”
Social safety net
Since 1977, the work of non-governmental actors in Nepal has been regulated by the Social Service National Coordination Council (SSNCC) chaired by Queen Aishwarya.
After the <a href="https://nepalitimes.com/banner/one-moment-30-years-ago-today">1990 People’s Movement</a>, King Birendra set up the Social Welfare Council (SWC) as an autonomous body in 1992 through the Social Welfare Act. But since then the SWC has been dogged by controversy and allegations of corruption and extortion.
In 2018, the Commission for the Investigation of Abuse of Authority (CIAA) filed a Rs315 million corruption case against 14 individuals, including the Minister of Women, Children and Social Welfare and SWC chair Badri Prasad Neupane and other officials for violating public procurement laws to rent out three hectares of its property around Bhrikuti Mandap.
Civil society groups have for years called for reforms in the SWC, and a report was drawn up to restructure it before this Bill proposed its dissolution. INGOs in particular will now have to go through the Social Welfare Department and multiple ministries for permissions.
A particularly objectionable provision in the draft stipulates that NGOs must have a Board of Director made up almost entirely of secretaries of various ministries. The NGO Federation has urged the government to take a civil society-friendly approach and not tangle its work in red tape and control. It says the government has no option but to revise the bill in its current form.
“Civil society organisations need an open space to operate, and an autonomous body to oversee them,” says Kalaunee. “Non-government organisations support in the areas prioritised by the government but by definition they cannot be a part of government.”

Big, beautiful Bills

An average Nepali could live 3.3 years longer if air pollution is reduced to meet the World Health Organization (WHO) guideline, according the annual <a href="https://aqli.epic.uchicago.edu/">Air Quality Life Index</a> 2025 published this week. The annual average concentration of tiny suspended particles in the air (PM2.5) in Nepal in 2023 was 38.3 μg/m3, nearly eight times the WHO standard, and 10% higher than 2022. Thirty years ago, air pollution in Nepal was half the current levels. WHO says particulate concentration above 5μg/m3 &nbsp;is<a href="https://nepalitimes.com/here-now/what-is-invisible-is-more-dangerous"> hazardous to health</a>.&nbsp; The most <a href="https://nepalitimes.com/banner/why-is-the-air-in-bhaktapur-so-bad">polluted parts of Nepal</a> are along the Indian border in Rutahat, Mahottari, Dhanusha, Parsa and Bara districts in Madhes Povince where average life expectancy is reduced by as much as 5.3 years.&nbsp; People in Sarlahi, Siraha, Saptari, Morang, Sunsari, Rupandehi and Jhapa are also dying at least 4 years earlier. The Air Quality Index 2025 report which is published annually by the Energy Policy Institute at the University of Chicago, says the figure is relatively lower for Kathmandu and Lalitpur at 2.6 and 2.4 years. After the Madhes, Kosi and Lumbini Provinces are the most polluted — especially in towns along industrial corridors and near the border. Karnali Province was by far the cleanest, followed by Sudurpaschim. Read also: <a href="https://nepalitimes.com/here-now/epicentre-of-pollution">Epicentre of pollution</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250828060856_136770cc84e114e8993af82e6a682c45d9458060e4ecf45f18e9f210673e1279.jpg" data-media-id="editor_4" data-image-id="20250828060856_136770cc84e114e8993af82e6a682c45d9458060e4ecf45f18e9f210673e1279" data-rendition-name="original" width="753" height="584" loading="lazy" alt="AQLI map"> <figcaption>Potential gain in life expectancy from permanently reducing PM2.5 from 2023 concentration to the WHO guideline.</figcaption> </figure>  Air pollution is now the leading external<a href="https://nepalitimes.com/editorial/cleaner-air-longer-lives-0z0okfeu"> threat to life expectancy in Nepal</a>, exceeding both tobacco and diet-related risks, which reduced average lifespans of Nepalis by 1.9 years and 1.3 years respectively. The Air Quality Management Action Plan for Kathmandu Valley introduced in 2017 had identified vehicular emissions, brick kilns, and construction as the most polluting. It adopted measures to strengthen air quality monitoring, develop emissions inventory, and conduct impact assessments. Other major sources of emissions in Nepal include <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">forest fires</a>, crop residue and garbage burning as well as transboundary pollution from India and Pakistan. The report says India is the world’s most polluted country with the particulate concentration in 2023 at 41 μg/m3, an average resident in India could live 3.5 years longer if pollution levels were brought down to meet the WHO guideline. Residents of New Delhi on average would live 8.2 years longer if they breathed clean air. South Asia has some of the world’s most polluted cities. On some winter days, Kathmandu records the worst air quality in the world. In 2023, PM2.5 concentrations in South Asia declined by 9.6% between 2021 and 2022 due to lockdowns during the peak of the Covid-19 pandemic. ‘After a dip in 2022, particulate pollution in South Asia increased by 2.8% in 2023 — though it remained 7% lower than in 2021,’ <a href="https://aqli.epic.uchicago.edu/report/annual-update-2025">states the report</a>. ‘In the region’s most polluted countries, particulate pollution’s impact on life expectancy is nearly twice that of childhood, and maternal malnutrition and more than five times that of unsafe water, sanitation and handwashing.’ Elsewhere, unprecedented wildfires caused particulate concentrations to rise to levels not seen since 2011 in the United States and since 1998 in Canada. China also registered a decline in air quality, an increase of 2.8% in particulate pollution in 2023 relative to 2022, the first in a decade since the start of its ‘War on Pollution’ in 2014.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250828060856_94860b929d0fb161220ad72ecb76fcd29ba8e306bd6b844485a4171dadb6bb47.jpg" data-media-id="editor_8" data-image-id="20250828060856_94860b929d0fb161220ad72ecb76fcd29ba8e306bd6b844485a4171dadb6bb47" data-rendition-name="original" width="754" height="501" loading="lazy" alt="AQLI line graph"> <figcaption>Annual average PM2.5 concentration in Nepal from 1998-2023.</figcaption> </figure>  Globally, the PM2.5 concentration in 2023 was 1.5% higher than in 2022, and nearly 5 times the WHO guideline. If global particulate pollution were permanently reduced to meet this guideline, an average person around the world would gain 1.9 years of life, adding 15.1 billion total life years to the <a href="https://nepalitimes.com/opinion/the-future-is-older">global population</a>, the report adds. ‘Particulate pollution remained the greatest external threat to human life expectancy in 2023, with <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">its impact comparable to smoking</a> and surpassing other major health risks,’ the report says. ‘Its toll on life expectancy is more than 4 times that of alcohol use, 5 times that of transport injuries or unsafe water, sanitation, and handwashing, and more than 6 times that of HIV/AIDS.’ The report also highlights the need for open data, and says that accessible air quality information has translated into reduced particulate concentrations and gains in life expectancy in the United States, China, and Poland. Besides data, the report says, investment in monitoring and other air quality management infrastructure must be matched by political will, ambitious policies, capacity building, and sustained enforcement.

Warning: breathing is hazardous to health

This is the 72nd episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working and studying abroad. My father ran a store and that is where I spent all my time till Grade 6. Doing my homework. Serving customers. I then moved to my maternal grandparents’ house because I used to get along with my cousin who was a year older than me. We did everything together, and were best friends. We took turns studying: I was a night owl, and he was an early riser. Before I went to bed after studying all night, I woke him up. My mother was 44 when I was born, the same year my eldest brother got married. My sister-in-law becoming a part of our family was how my mother referenced my age. I liked making money, and was always a hustler. In Grade 7, I learnt to handle a tractor and helped my brother-in-law to plough, earning Rs10 a day. As I got better, he paid me more. By Grade 9, I was already making Rs500 per day, but had to slow down to prepare for my exams. From an early age I knew I did not want a 9-5 job. There just wasn’t enough money in it. I wanted to get into business, and compared my brother who worked in the post office and what businessmen made. It did not help that my brother was honest, and never took bribes. A friend and I made money selling cheap Chinese phones at a premium to our friends. We blasted music on the phones and pretended that we were giving them a discount. After SLC, I started teaching math and other subjects. I was soon a shareholder in the same school and in the evening I was involved in our family’s floriculture business, growing amaranth and marigold for garlands.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020844_1b54b999d67122a50c4c7e6204cc737bcc99bf2a68db6499a4566a7f61a880b4.jpg" data-media-id="editor_0" data-image-id="20250831020844_1b54b999d67122a50c4c7e6204cc737bcc99bf2a68db6499a4566a7f61a880b4" data-rendition-name="original" width="955" height="1314" loading="lazy" alt="Diaspora Diaries 72"> </figure>  It was then that a friend suggested we learn the Korean language. We could be earning significantly higher in Korea for similar efforts. I had no plans to go abroad but he convinced me. I did not know anything about Korea, and was scolded at the language institute when I asked someone to point Korea on the map.&nbsp; It was only there that I learnt you had to pass an exam for the Korean Employment Permit System (EPS), and pay for language classes. After a week, I decided it was not for me and dropped out. But my friend convinced me to give it one more try. I did not prepare much for the exam, and it was no surprise that I failed. But it was just by one mark, and people would pity me for failing “just by one mark”. It was a brand of failure. It hurt my ego. I had to turn things around by taking the exams seriously, and locked myself up to study hard.&nbsp; Even when we had visitors, my wife told them I was not home. If I was not in my room learning Korean, I would be with a group of ten of us test-takers comparing notes and practicing late into the night. The exam was difficult, but this time I passed, the only one in my group who did.&nbsp; As someone who never liked the idea of doing a job, I still had my doubts about going to Korea. It did not help that one of my acquaintances had returned a month after he had left, and he discouraged me from migrating given that I was already making good money in Nepal.&nbsp; But my wife suggested that I give it a shot since I had worked so hard for it. And if it really turned out not to be my cup of tea, I could always return. What did I have to lose, I thought, at least I would get to visit Korea. My job there was in an electrical company that made circuit boards. I worked all day, earned good money. In the evenings, I kept myself busy with my real estate business back in Nepal. I had learnt the tricks of the trade from fellow real estate agents back home, but at the time did not have the capital to invest.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020848_941e961e2045058f255ad89884b51faa7d2365c68236e5cbe573d63d769ac6c5.jpg" data-media-id="editor_1" data-image-id="20250831020848_941e961e2045058f255ad89884b51faa7d2365c68236e5cbe573d63d769ac6c5" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Diaspora Diaries 72"> </figure>  In Korea, it helped that I had salary records that allowed me to get loans from financial institutions both in Korea and in Nepal. Ultimately, I started earning more from my real estate deals in Nepal than from my job in Korea. This was all thanks to my ability to take loans because of the EPS scheme. My wife has been managing the flower business while I was away. My finances grew stronger over the eight years I was in Korea. I paid off the loans that I had borrowed to buy land. But real estate did not satisfy me entirely. I wondered: what is my brand? What will I be known for? What is my contribution to society? Real estate is for wealth, but that is about it. I needed to sell one piece of land and use the revenue to start a venture. I took classes in business, and returned to Nepal six months ago and got back to my family’s ancestral roots in floriculture. In Nepal too, I am continuing the entrepreneurship training I had started in Korea with the Bridge International. Such exposure helps us reflect on our business such as our branding, vision, and proactive aspects like the importance of strong recordkeeping.&nbsp; I am now working to upgrade and expand my floriculture business. With a friend who is still in Korea I am building a cooling room to increase the shelf-life of flowers and other produce and set up a market in my village where others can sell their produce. Floriculture is our primary business, but it is seasonal and earns good money only during festivals like Tihar.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250831020848_a008ffeba13896e6918f68ff6e687c8fe11140d86a96f1ec11690547f2bcd415.jpg" data-media-id="editor_2" data-image-id="20250831020848_a008ffeba13896e6918f68ff6e687c8fe11140d86a96f1ec11690547f2bcd415" data-rendition-name="original" width="1280" height="720" loading="lazy" alt="Diaspora Diaries 72"> </figure>  So, I grow tomatoes to ensure year-round earnings. I also am engaged in other businesses like real estate and online shopping. I work round the clock in Nepal — a strong work ethic is something I picked up in Korea.&nbsp; My Korean bosses would work alongside us, that motivated us. I work just as hard in Nepal as I did in Korea. People here often ask me why I am pushing myself so hard. But making garlands comes easy to me, it is work my forebears were involved in. My childhood memories are about plucking flowers with my sister. I have a comparative advantage in this work. It comes naturally to me, it is easy and I enjoy it. And sometimes, if there are too many garlands to make, I can multitask while holding meetings. My fingers just fly. I am good at this job, but my wife is even better and faster.&nbsp; When there is too much load, we can also outsource the work. To be known as the flower guy would be great personal branding. The मखमली guy. Or the सयपत्री guy. I decided to come home for just this with a one-way ticket. “अब पासा: जाँदैन ल्हासा!” &nbsp;