Just as Nepal was recovering from the Covid pandemic in 2022, the government with GAVI, the Vaccine Alliance, inoculated almost 8 million school-children against typhoid.&nbsp; What was even more remarkable was that this vaccine was earlier trialled among 20,000 people in Lalitpur, showing a significant reduction in typhoid incidence with efficacy rate of an impressive 80%, and was the subject of a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1905047">research paper in the New England Journal of Medicine in 2019</a>.&nbsp; This kind of <a href="https://nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal">Typhoid Conjugate Vaccine (TCV) </a>has also been used in Malawi and Pakistan where there has been a drop in typhoid cases. The trial was undertaken by the Oxford University Clinical Research Unit (OUCRU) Nepal which was set up in Lalitpur in 2003 to control endemic typhoid fever in Nepal and the region. Besides vaccines, OUCRU-Nepal has also carried out ground breaking randomised controlled trials in the treatment of typhoid fever. Its seminal paper in the journal Lancet Infectious Disease in 2016 influenced WHO to suggest that the fluoroquinolone drugs which was chosen at the time for typhoid fever should not be used in the empirical treatment of typhoid fever in South Asia. Nepal’s successes both in the prevention and treatment of typhoid fever will be showcased at the <a href="https://www.ascodd2024.org">17th Asian Conference on Diarrhoeal Diseases and Nutrition (ASCODD)</a> in Kathmandu 8-11 December titled Emerging Enteric Infections and Impact of Climate Change. Over 300 experts will attend the conference, including Andrew Pollard who helped develop the Oxford AstraZeneca Covid vaccine and Edward Thomas Ryan, immunologist at Harvard University and Massachusetts General Hospital, among others. Buddha Basnyat and Andrew Pollard were the two principal investigators for the typhoid conjugate vaccine trial in Lalitpur. “The conference is a one of a kind platform bringing together researchers, policymakers, and public health professionals from across Asia and beyond to address critical challenges in diarrhoeal diseases, nutrition, and public health,” says Abhilasha Karkey, medical microbiologist and director of OUCRU Nepal. Typhoid fever is prevalent in countries with poor hygiene and is transmitted through the faecal-oral route. If untreated, it can cause complications leading to death. Treatment is straightforward, but antibiotic resistance is a growing problem. “Typhoid, much like tuberculosis, is a biblical disease,” explains Buddha Basnyat, chair at the OUCRU Nepal. “It is hardly heard of in developed countries, except in travelers from our part of the world.” Indeed, South Asia including Nepal has an incidence of about 500 cases per 100,000 population. Anything over 100 per 100,000 is regarded as ‘alarming’. Hotspots include cities like Kathmandu, Karachi, New Delhi, Dhaka and Kolkata. It goes without saying that the best antidote to diseases like typhoid fever and cholera is safe drinking water and better hygiene, which can only be guaranteed with political accountability and education. “Careful study of typhoid burden, and performance of typhoid vaccines in children, led by OUCRU-Nepal based at the time in Patan Hospital in Nepal in collaboration with the Oxford Vaccine Group, has been central to the development of policy by the World Health Organisation,” Andrew Pollard told Nepali Times. He added: “As a result of the contribution of the Nepali investigators, more than 60 million children have been protected against typhoid around the world in the past two years and many tens of millions more will be protected in the decade ahead.” Typhoid fever is also often misdiagnosed. Nine years ago in the aftermath of the Nepal earthquake, there were several deaths across the country as they were wrongly diagnosed because of the widespread use of the Widal test that is consistently known to give false results. In reality, these patients had typhus fever which is spread to humans by fleas, lice, and chiggers, and required a different antibiotic, not ceftriaxone, a potent antibiotic for typhoid fever. &nbsp; <h2>ASCODD 2024</h2>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120703124_d067362901ebf9142bfbac6ed2995c9c7efb05b5f98bb6856dab66b66aaea956.jpg" data-media-id="editor_3" data-image-id="2024120703124_d067362901ebf9142bfbac6ed2995c9c7efb05b5f98bb6856dab66b66aaea956" data-rendition-name="original" width="1200" height="500" loading="lazy" alt="ASCODD"> </figure>  The ASCODD 2024 is a platform for Nepal to present its public health research, including in the prevention and treatment of enteric illnesses like typhoid. The conference theme is Emerging Enteric Infections and Impact of Climate Change. Another key highlight is the launch and discussion of Nepal’s National Cholera Control Plan which reflects the country’s commitment to eliminating the disease. The last big cholera outbreak was in Jajarkot in 2009 that killed 111 people, mainly children, and in 2016 in Kathmandu with 169 cases. “At the conference, we will explore the latest scientific advancement in diagnostics, treatment, vaccines while emphasising equitable access to these tools in resource-limited settings and in climate vulnerable countries like Nepal,” says Abhilasha Karkey, director of OUCRU Nepal. Keynote speaker is the former director general of the International Vaccine Institute (IVI) John Clemens and other sessions will look at the latest trends in antimicrobial resistance, the impact of the climate crisis on enteric diseases and community-based interventions.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241211031252_74274eb986c631c2771ea65770c4d0abb8dfcb3548d736fac096ca88656b3e56.jpg" data-media-id="editor_4" data-image-id="20241211031252_74274eb986c631c2771ea65770c4d0abb8dfcb3548d736fac096ca88656b3e56" data-rendition-name="original" width="1904" height="1254" loading="lazy" alt="17th Asian Conference on Diarrhoeal Diseases and Nutrition"> <figcaption>The Asian Conference on Diarrhoeal Diseases and Nutrition (ASCODD) president Firdausi Qadri addressing the crowd in Kathmandu. </figcaption> </figure>  What is the difference between typhoid fever and typhus fever? Typhoid fever is often confused with other illnesses not just because they sound the same, but have common symptoms. Typhoid fever is caused by the bacteria Salmonella typhi or Salmonella paratyphi via water or food contaminated with fecal matter. It leads to high fever, rashes, headache, general weakness, diarrhoea. Typically, these last for a week but are clearly preventable with better hygiene and vaccines. Treatment is a course of antibiotics. There is an alarming increase in antibiotic resistance. Typhus fever is a rickettsial disease mainly transmitted through vectors such as mites, fleas, lice and ticks, and have non-specific symptoms similar to a bad cold, including fever, chills, headache, muscle pains and rash. A common antibiotic called Doxycycline is used in the treatment of the disease, but misdiagnosis has led to deaths in Nepal.

Sonia Awale

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Nepal’s success in typhoid vaccine trial

<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

A shot in the arm for vaccines in Nepal

Where will Nepal be in 2050? It is only 25 years away. The country’s population will be peaking at 36 million, the poverty rate will drop to near zero. Maternal and child mortality rates will fall further. Nepal will be generating up to 40,000MW of hydro and solar power, more than half of that for export. Upgraded highways will improve connectivity, railways will make transport cheaper. Pokhara and Birganj will only be two hours away from Kathmandu. Nijgad airport could be Nepal’s new aviation hub, reducing Kathmandu’s congestion. Nepal will hitch its wagon to the engines of economic growth in India and China. Investment and job creation will reduce outmigration, Nepal's data centres will be powered with surplus electricity. Remote areas will prosper with high-value tourists. That is if all goes well. But if Nepal’s politics remains dysfunctional with incompetent leadership, then the country will muddle along as it is doing now. Society will be more unequal, public discontent may boil over as politicians resort to faith to hide failures, the exodus abroad of youth will continue. Climate breakdown will exacerbate these crises. Global average temperature will have risen to 2.7°C above pre-industrial levels (it is 1.1°C now). The remaining Himalayan icecap will shrink by half, glacial lakes will threaten valleys. The hydrology of rivers will change, reducing dry season flow. Severe and prolonged heat waves in the Tarai will force people to migrate back to the mountains. In the final analysis, it all boils down to a political system that is more accountable, and displays more integrity and efficiency. <h2>Mission 2050</h2> · Melamchi Water Supply Project · Pokhrara International Airport · Bhairawa International Airport · Upper Tama Kosi Hydroelectric Project . Kathmandu-Tarai Expressway What do these biggest infrastructure projects in Nepal have in common? All ended up being more expensive than they should, all have been delayed and are not fully operational, two were badly damaged in climate-related disasters that should have been foreseen. The $800 million Melamchi is Nepal’s most expensive infrastructure project to date. It took 30 years to build, but was nearly destroyed by a glacial debris flow in June 2021. The headworks need major repairs. The 456MW Upper Tama Kosi was severely damaged by a rockfall and floods in last September’s floods. It is still not operating at full capacity, and other hydropower plants were damaged in recent glacial floods. Pokhara and Bhairawa airports were supposed to be the new aviation gateways to Nepal to take the pressure off Kathmandu, and become game changers for tourism and pilgrimage. Nearly three years later, both handle domestic flights. Poor and inadequate design, kickbacks on contracts, cost overruns, failure of diplomacy to get India’s nod on air routes, and lack of planning and marketing have made the airports a pair of white elephants. Some of these setbacks can be blamed on natural calamities, but mostly it is political incompetence and greed, lack of accountability and poor implementation. That is no surprise, since these are the hallmarks of doing business in Nepal, often delaying projects, adding to the cost, and even when completed they are already outdated. That is the story of the last 25 years, are the next 25 going to be any different? Not if governance does not improve. “What we really need for the future is vision, idea, and understanding, and then the domestic capacity to implement them,” says infrastructure expert Surya Raj Acharya, who laments the total absence of technical and planning expertise. “None of our national highways meet technical standards, our cities are unplanned. The priority was never on quality. Politicians sold us short-term infrastructure that have now become a barrier to prosperity,” he adds. One silver lining has been private sector involvement in hydropower, and the energy strategy aims to generate 11,769MW by 2030. But hydropower is high-investment, high-risk due to climate breakdown, and ecologically damaging. “Hydropower is a good example of how government incentives and public-private partnership can work wonders, although we now have to take climate change into account,” explains economist Kalpana Khanal of the Policy Research Institute. She adds, “We now have to identify other key infrastructure areas that also enhance the growth of other sectors.” The National Planning Commission’s periodic plans guide overall social and economic strategy for the country into the coming decade. Nepal’s current five-year plan (2024-2029) has set a target of 7.3% annual economic growth against the current 3.9%, $2,351 per capita income up from $1,456 at present, and poverty reduction to 12%. The plan aims to export nearly half the hydropower generated by 2030, earning the country Rs41 billion annually. But there is no real coordination between line agencies, and bureaucratic lethargy leads to constant delays, says former member of the National Planning Commission (NPC) Min Bahadur Shahi. “Development in Nepal is still very much synonymous with building roads and bridges, and infrastructure is rudimentary,” he says. “Elsewhere in the world, digital infrastructure and governance go hand in hand, we are far behind.” The frustration of a man who served in the National Planning Commission is an indication where the problem lies: in actually executing plans and implementing strategies. “We need to prioritise projects based on our geography, climate, societal needs,” Shahi continues. “We want to push Nijgad airport when we can’t even operate Pokhara and Bhairawa. Have we even studied potential air routes and needs of international carriers?”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250726070744_0547e5a7fd4424b5de8c279cab637ee7ebd9e65f2673b15e6dbd4eb2aa2524f2.jpg" data-media-id="editor_0" data-image-id="20250726070744_0547e5a7fd4424b5de8c279cab637ee7ebd9e65f2673b15e6dbd4eb2aa2524f2" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Pokhara airport"><figcaption>NO FLY ZONE: Pokhara airport was supposed to be the new aviation gateway to Nepal but nearly three years after its inaguration, it mostly handles domestic flights. Photo: RADHIKA KANDEL </figcaption></figure>  TARGET PRACTICE Export of hydropower, manpower and lately information technology are the mainstays of Nepal’s economy, and will carry the country to its graduation from Least Developed Country status to a developing country in November 2026, and hopefully to middle-income by 2030. Nepal has an installed capacity of about 3,800MW, most of it from hydropower, and increased adoption of electric cars has reduced the import of petroleum products, decreasing the trade deficit with India. Meanwhile, Nepalis abroad sent home $11 billion in remittances last year, and at least $900 million in backend IT exports. But demographer Yogendra B Gurung is not impressed: “Despite the reduction in the poverty rate, and our improving income status, life expectancy, income, even maternal and infant mortality are not on par with countries with similar economic status.” He says relying on remittances is an unsustainable economic model, vulnerable to external factors and remittances are mostly spent on day-to-day needs, and not invested in productive sectors. Remittance is credited with reducing poverty in Nepal which is down to 20.27% from 42% in 1990. Money sent home by workers abroad has allowed families to afford basic healthcare and education, in turn helping to reduce childhood malnutrition and maternal mortality while improving female literacy. But the progress has stalled in recent years, and many doubt Nepal will meet its Sustainable Development Goals (SDGs) targets. The National Planning Commission has said Nepal is likely to achieve just 60% of the targets by 2030. Sex ratio at birth, which is 112 boys to 100 girls in Nepal in particular, is worrying, as it is much higher than the biological ratio of 105 to 100. This is much more pronounced in Karnali, Sudurpaschim and Madhes Provinces which suffer from historical neglect. Despite a rise in female literacy, patriarchy is still deeply entrenched and the provinces are behind the rest of the country for gender equality, education, healthcare, nutrition and economic opportunities. “Karnali is resource-rich, especially hydropower and the recent discovery of the methane gas, but inequality is much greater,” says Shahi, who is with the Karnali Integrated Rural Development and Research Centre (KIRDARC). “Federalism in Nepal is only on paper, we need a total structural reform to devolve political power to really bring about change.”  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250726070744_fd4a218656e1fbf6f13f5f87a47bfe624516c6a0232481b6be77875ae866deb9.jpg" data-media-id="editor_1" data-image-id="20250726070744_fd4a218656e1fbf6f13f5f87a47bfe624516c6a0232481b6be77875ae866deb9" data-rendition-name="original" width="3600" height="2400" loading="lazy" alt="Butwal-Narayangadh "><figcaption>The Daunne section of the Butwal-Narayangadh road notorious for traffic jams and accidents, it has been in never-ending construction for three years. Photo: BISHNU PRASAD GAUDEL / RSS </figcaption></figure>  Despite limited resources, Nepal also suffers from wasteful investment as a result of politically (mis)guided decision-making, instead of people-centric plans and policies, says demographer Gurung. “People are overwhelmingly moving to the cities but our leaders are hell bent on building roads to every village and now there are empty schools in the mountains,” he adds. Nepal needs data-driven planning but its long-term economic vision 2020-44 seems more of a wish-list than realistic goals, including average annual GDP growth of 10.5%, $12,000 per capita income and population under the absolute poverty line at 0. Other goals include raising electricity generation capacity to 40,000MW, access to motor transport to 99%, life expectancy at birth to 80, maternal mortality down to 20% and literacy to 99% and 100% access to the internet, among others. Meanwhile, Nepal is committed to net-zero by 2045 and 100% renewable energy by 2050. “Our planners have no idea what kind of infrastructure we need 20, 30 years down the line to sustain and accelerate growth. We need a big structural change in the political leadership, in technocratic planning, and for policy implementation,” says infrastructure expert Surya Raj Acharya. Meeting such targets would require large investment, and it would be unwise to rely on remittances for the longer run, especially as Nepal’s demographic dividend will diminish as it turns into an aged society by 2065. Reversing out migration requires a favourable investment climate so jobs are created. Good governance marked by accountability and transparency are the basic prerequisite for ease of doing business. But lack of rule of law and illicit funds put Nepal in the grey list of the Financial Action Task Force (FATF), the global money-laundering watchdog. “Everything comes down to a political will. The established parties must realise that if they don’t perform, they will be replaced by alternatives,” says Kalpana Khanal. “In the meantime, we must engage the youth and find ways to retain them as well as attract the diaspora to invest in Nepal.”

Nepal in 2050

MetLife Nepal has signed Rohit Paudel and Indu Barma, the captains of the national men’s and women’s cricket teams, to promote the importance of life insurance.

Metlife signs Nepal cricket captains

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

How the Peace Corps changed a volunteer’s life

· On the night of 15 May, two glacial lakes burst in Tharka in Humla and the debris flow washed away homes and bridges.&nbsp; · Last week, a slurry surge on the Kali Gandaki in Upper Mustang caused at least Rs15 million in damage, and was traced to a melting glacier. · Dozens are feared dead after <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">an expanding glacial lake in Tibet overflowed</a>, sweeping down into Nepal and damaging four hydropower plants generating 230MW, nearly 8% of the country’s total grid supply.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060748_45225dc707c1e9c2968ca8dbf6e564e01e4eb6e2ff254fb8eb940cf62cdd910b.jpg" data-media-id="editor_1" data-image-id="20250718060748_45225dc707c1e9c2968ca8dbf6e564e01e4eb6e2ff254fb8eb940cf62cdd910b" data-rendition-name="original" width="2667" height="1500" loading="lazy" alt="Rasuwa flood"> <figcaption>Miteri friendship bridge connecting Nepal and China was swept away in the Rasuwa flood. Photo: PRAKASH CHANDRA TIMILSENA / NPL</figcaption> </figure>  And those are just in the past month. Climate scientists say Himalayan glacial lake outbursts are becoming more frequent and destructive, and a warning for Nepal not to put all its eggs in the hydropower basket.&nbsp; <a href="https://nepalitimes.com/editorial/when-it-rains-it-pours-ksqprbu3">Record precipitation last September</a> unleashed floods that killed 200 people, and temporarily slashed Nepal’s total generation capacity of 3,000MW by nearly half. The <a href="https://nepalitimes.com/banner/nepal-valley-suffers-quadruple-disaster">Melamchi flood of 2021</a> caused by <a href="https://nepalitimes.com/multimedia/the-not-so-permanent-frost">permafrost melting</a> on a glacier upstream nearly destroyed a $800 million water supply scheme, Nepal’s largest infrastructure project which four years later still has not resumed full operation. The <a href="https://nepalitimes.com/news/sikkim-flood-is-warning-to-nepal">glacial lake overflow in Sikkim</a> caused by record rainfall in September 2023 that destroyed the $1.2 billion Chungthung Dam and caused catastrophic damage to infrastructure on the Teesta River. This was a warning to the cascade of hydropower plants on the Arun and Marsyangdi river basins.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060736_6f61797a6be308321e3bae26e55d2f64cba4b9e5eb262adacb9e92fb5f3c6152.jpg" data-media-id="editor_6" data-image-id="20250718060736_6f61797a6be308321e3bae26e55d2f64cba4b9e5eb262adacb9e92fb5f3c6152" data-rendition-name="original" width="919" height="549" loading="lazy" alt="hydro disasters and hydropower plants"> </figure>  Nepal has set a target of generating an additional 28,500MW by 2035 -- out of the feasible 48,000MW -- but how viable is an energy strategy that is exposed to heightened risk due to climate breakdown? &nbsp; “As extreme weather events increase, we must design and build infrastructures respecting river flow and topography,” says former Energy Secretary Dwarika Nath Dhungel. “We must make the best use of our water resources, but not by letting excavators loose everywhere mining riverbeds and building haphazardly where we shouldn’t.”&nbsp; Although no project can be disaster-proof, <a href="https://nepalitimes.com/banner/climate-smarter-himalayan-infrastructure">climate smart design</a> can minimise damage from flash floods and landslides. Recent disasters have driven up insurance premiums for energy projects in Nepal, and smaller ones cannot even afford them. The 456MW Upper Tamakosi hydroelectric project which is still not fully functional after the September floods has claimed insurance worth Rs1.8 billion. The alternative to high risk high investment hydropower projects is <a href="https://nepalitimes.com/here-now/what-s-cooking-in-nepal-besides-politics">energy diversification</a> to other renewables such as solar, wind or biogas. Nepal gets annual sunlight of 300 days with 6-7 hours on average to total 50,000 terawatt-hours (TWh) per year.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060744_4acd452b4117180ca9bb5d3be839ff46dfd5464e4d507f5ad3704cef6253bc48.jpg" data-media-id="editor_9" data-image-id="20250718060744_4acd452b4117180ca9bb5d3be839ff46dfd5464e4d507f5ad3704cef6253bc48" data-rendition-name="original" width="1080" height="720" loading="lazy" alt="solar power"> <figcaption>Farmers in Tarai using solar powered water pump. Photo: GHAMPOWER</figcaption> </figure>  The Solar and Wind Energy Resource Assessment (SWERA) calculates that Nepal could source 3,000MW from wind energy alone, considering 10% of the area with more than 300W/m2 wind power density. <a href="https://nepalitimes.com/opinion/people-power/decentralising-power-in-nepal">Solar energy</a> stations are cheaper and quicker to build, and would be an ideal alternative to reliance on hydropower.&nbsp; “There has been some investment in solar power, especially from the state sector,” says water expert Madhukar Upadhyay. “But there is an issue of land acquisition since the arrays need a lot of space. It is comparatively easier to get a permit to put up a hydropower plant on a river.” As for biogas, there is simply no incentive to build on past success with household level plants to <a href="https://nepalitimes.com/here-now/more-bullshit">promote industrial-scale production</a>. Scaling up biogas by integrating it with urban biodegradable waste would still be a viable alternative to LPG.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250718060744_715d44afd5eb4ba8dafa209b0ad0f19400665797b5f078f5636821e600f96684.jpg" data-media-id="editor_12" data-image-id="20250718060744_715d44afd5eb4ba8dafa209b0ad0f19400665797b5f078f5636821e600f96684" data-rendition-name="original" width="1419" height="954" loading="lazy" alt="windmill"> <figcaption>A wind mill in Hapsikot in Nawalpur. Photo: WINPOWER NEPAL</figcaption> </figure>  Nepal’s public sphere is buzzing with excitement over the discovery of potentially 430 billion cubic metres of methane gas beneath Dailekh district that, if properly harnessed, would meet the country’s energy demand for the next 50 years. Even though a feasibility study is awaited, politicians from the prime minister down see this as a petro bonanza that will make Nepal rich. But drilling, storage and distribution of CNG in the country’s current kleptocratic state make that unlikely. If Nepal was to get rich solely on its hydro-energy potential, it could have done so in the past 50 years. Says Dhungel: “This is not exactly a new discovery, but it is premature to celebrate until its extraction is proven to be cost effective. And let us hope it does not get <a href="https://nepalitimes.com/news/balance-of-power">tangled in geopolitics</a>, since China is involved in the prospecting and drilling, which could make India uneasy.”&nbsp; The country suffers from the Dutch Disease curse even before its resource is fully exploited. And the same cronyism, corruption and rent-seeking structure cannot deliver the riches we expect from Dailekh’s methane discovery. Now, <a href="https://nepalitimes.com/here-now/right-climate-for-nepal-s-energy-transition">with hydropower in jeopardy</a>, Nepal’s planners will have to evolve a new strategy for energy security into the future. But first, governance needs to be cleaned up with long-term strategic planning that takes climate risk into account. For example, do we need to mine fossil gas when there are renewable options? Will Dailekh take Nepal away from its climate commitments? Says Madhukar Upadhyay: “Nepal has always been resource rich and management poor. And the larger the resource, the bigger our management incapacity. It is a societal malaise.”&nbsp;

typhoid-conjugate-vaccine

Nepal’s success in typhoid vaccine trial

A shot in the arm for vaccines in Nepal

Nepal in 2050

Metlife signs Nepal cricket captains

How the Peace Corps changed a volunteer’s life

Nepal’s Resource Curse