<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17de9c7e80680e0ac78djpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>A post-graduate student of mechanical engineering Samita Rimal is completing her 14-day quarantine in a hotel in Montreal. Despite being fully vaccinated with VeroCell in Nepal, she now has to take one of the four jabs recognised in Canada.“I wish I had taken J&amp;J before coming here, I just wasted time and money, others like me should really try to find out the exact requirements before leaving Nepal,” says 23-year-old Rimal.Another student preparing to leave for Canada is in a dilemma: should she get a shot of the Johnson &amp; Johnson (J&amp;J) vaccine which is accepted in Canada, or face two weeks of quarantine and further restrictions because the Chinese vaccine VeroCell is not accepted by the Canadian government?“People inoculated with vaccines other than those accepted there are treated as if they are not vaccinated and hence face additional restrictions. I probably won’t be able to attend in-person classes there,” says the 29-year-old.Other students leaving Nepal are also confused because they do not know whether it is safe to mix vaccines accepted in Europe or North America on top of the Covishield or VeroCell vaccines they have taken earlier this year.A year after the first Covid-19 jabs were developed, there are at least 11 different vaccines in use worldwide, and many more are in different phases of trials. Never before has there been as much effort and investment in vaccine development.But this breakthrough in science is not accompanied by a<a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/"> fair distribution of vaccines</a> around the world,  or within countries. It is usually those with access and reach who are fully vaccinated, and some are even getting <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">booster shots</a> already.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e09c7e80680e0ac78ejpeg.jpg" alt="" width="698" height="738">Nepal is currently using three different vaccines: AstraZeneca, VeroCell and J&amp;J. While China is giving Nepal one million doses of its other Covid vaccine Sinovac, the government is set to receive 100,000 doses of Pfizer shots under WHO’s <a href="https://www.who.int/initiatives/act-accelerator/covax" target="_blank" rel="noopener noreferrer">COVAX</a> facility, which requires ultra-cold refrigeration.There are two new jabs under trial in Nepal: a Chinese messenger RNA (mRNA) vaccine, and another developed by Sonafi, a partnership between a French company and UK’s GlaxoSmithKline.Of these only AstraZeneca and J&amp;J are widely accepted in Europe, the US, and the Gulf, which means Nepali students and migrant workers have to bear expensive hotel quarantine costs while missing out on university or work.On the other hand, even as thousands of people get vaccinated each day, the vaccination drive has been <a href="https://www.nepalitimes.com/opinion/giving-all-nepalis-a-shot-at-the-covid-vaccine/" target="_blank" rel="noopener noreferrer">concentrated in the urban centres</a>. This is why it is not surprising that even as half of Kathmandu Valley residents is fully vaccinated, only 22% of Nepal’s total population has been inoculated.Nepalis in the hinterland were already least prioritised by the state, for health, education and basic needs, but extreme climate events due to global warming has <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">added to the pre-existing challenges</a>.“This week in a village in Kailali we met isolated pockets of Tharus and Dalits, most of them unvaccinated,” says epidemiologist Lhamo Yangchen Sherpa. “Because of flash floods, they had no access to healthcare, market or schools, the streets were all flooded and the river had swelled.”Indeed, as Sherpa argues in her <a href="https://www.nepalitimes.com/opinion/giving-all-nepalis-a-shot-at-the-covid-vaccine/" target="_blank" rel="noopener noreferrer">guest editorial</a>, this monsoon rural Nepal was hit by triple disasters: historical state neglect, <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer">international apathy</a> with rich countries stockpiling vaccines, and <a href="https://www.nepalitimes.com/editorial/a-flood-of-recrimination/" target="_blank" rel="noopener noreferrer">climate change</a>.  All of this has further magnified the coronavirus crisis in the region least equipped with healthcare infrastructure, and vaccine inequity.Elsewhere in Kathmandu, there is a false sense of security among people who think they are immune against Covid-19 with increasing vaccine coverage. The declining number of daily news cases and deaths have added to the complacency. However, many Kathmandu hospitals still report full ICUs -- mostly occupied but by referral <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">patients from outside the Valley.</a><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e39c7e80680e0ac78fjpeg.jpg" alt="" width="650" height="327">The misinterpretation of the recent sero-prevalence study conducted by WHO and the Health Ministry has added to the misconception. The sample survey found that 67% of Nepalis have natural immunity against the virus.But virologists say the test used does not reveal the concentration of neutralising antibodies that fend off the virus in an individual. It does not detect memory T-cells either, which provide crucial immunity against foreign organisms in the body.After six months of Nepal’s vaccination drive, about half of those who had been inoculated have started registering a decline in the level of antibodies. However, this does not always translate into individuals getting infected, as they might still have immunity afforded by memory T-cells.“Given our vaccination coverage and natural immunity mostly against the Delta variant, we can say that there might not be an immediate large-scale surge unless there is a new strain,” says pulmonary specialist at Kathmandu’s HAMS hospital Raju Pangeni. “But we also know that even those vaccinated are not fully protected against the Delta variant which transmits much faster in enclosed spaces.”With the Dasain festival starting this week, people are now leaving for their hometowns, and<a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer"> market places are crowded</a>. Parties, meetings and seminars are being held in enclosed spaces, and unvaccinated students are <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">packed into classes</a> for lessons before the holidays begin.During Dasain, children and the elderly are at the most risk of infection. While children are entirely unvaccinated, senior citizens even if fully inoculated have weaker antibody responses. This means the mobile younger population that have been vaccinated and hence are asymptomatic even if infected pose severe risks to the vulnerable groups.“We must perform our rituals this Dasain keeping in mind the consequences of our actions, if we are not careful we will be jeopardising the health of our children and parents,” says Sherpa, who works with IPAS Nepal.Experts have now shifted their focus to the post Dasain-Tihar festival season, and upcoming winter months when coronaviruses thrive. Children, elderly, people with co-morbidities, and immune-compromised individuals are at the higher risk.Says Raju Pangeni: “Our priority now must be to vaccinate children across Nepal after the holidays. At the same time, we must also promote influenza vaccines in order to avoid the double whammy of Covid and flu.”

Sonia Awale

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The jabs and jabnots

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17b19c7e80680e0ac780jpeg.jpg" alt="" width="856" height="571"/><figcaption>Kathmandu's Dasain shopping crowd this week. Photo: AMIT MACHAMASI</figcaption></figure>Nearly half of Kathmandu Valley’s population is fully vaccinated against Covid-19, but the national average is only a little over 20%. In essence, this is a microcosm of <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">vaccine inequity seen globally</a> – but it also reflects Nepal’s in-built socioeconomic inequalities.In Asia and Africa, a majority of the population including health workers and the elderly are yet to receive even their first dose. But the US, France, Germany, and Israel are already <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/" target="_blank" rel="noopener noreferrer">providing booster shots</a> to their vulnerable populations.On one hand, this is a stark reminder that Nepal is not on the priority of wealthy nations. Just as it was not during the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave in May</a> when, despite the prime minister and the president calling on foreign governments for vaccine shipments, <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer">the response was tepid</a>.On the other hand, the imbalance in vaccine distribution within Nepal is a reflection of long-standing inequities in healthcare services, education, drinking water, and food that predate Covid-19.Despite a federal Constitution that has devolved decisions and delivery of basic services to local governments, it is still Kathmandu that holds the purse strings and power. Isolated and beyond the state’s reach even at the best of times, Nepal’s hinterland this year has been cut off by <a href="https://www.nepalitimes.com/banner/still-chasing-the-melamchi-mirage/" target="_blank" rel="noopener noreferrer">destructive floods blamed on the climate crisis</a>.A village in Kailali with 200 Tharu and Dalit families has been marooned by floods for the past month, where the submerged roads block access to even the rudimentary healthcare available.It is not surprising, therefore, that very few in this village are inoculated. In fact, those who need to be vaccinated the most now face a triple whammy: historical state neglect, international apathy, and now <a href="https://www.nepalitimes.com/opinion/mountainous-regions-face-catastrophic-impacts-without-urgent-climate-action/" target="_blank" rel="noopener noreferrer">climate-induced extreme weather</a>.This in turn has set off a vicious cycle, and the poor are getting poorer. The official death toll from Covid-19 in Nepal is nearly 12,000, but the ‘excess deaths’ that were not counted in remote villages across the country is probably several times higher.An estimated <a href="https://www.nepalitimes.com/banner/helping-nepals-covid-orphans/" target="_blank" rel="noopener noreferrer">1,200 children have become orphans</a> because of the death of one or both parents due to Covid-19. Many of them do not have support for food, healthcare, and education – setting a stage for intergenerational inequity.In Kathmandu and urban centres, on the other hand, there is complacency and false sense of security as <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/" target="_blank" rel="noopener noreferrer">the festive season approaches</a>. Unvaccinated children have also started <a href="https://www.nepalitimes.com/editorial/two-schools-of-thought/" target="_blank" rel="noopener noreferrer">attending in-person schools</a>. The Health Ministry’s recent seroprevalence study has revealed that 67% of people have SARS-CoV-2 antibodies, and therefore have natural immunity against the virus. This, combined with half of the valley’s targeted demography being vaccinated on paper, makes a case for a fully immune population.But that is not the case. There is now growing proof that antibodies provided by vaccines wane over time, which means many of us who were vaccinated earlier this year have weaker protection than we think. Only those newly infected with the virus might have sufficient antibodies to fight off the next infection.It is not as important to know what portion of the population has antibodies as to how much of it they have. Vaccinated individuals are less susceptible to hospitalisation, severe symptoms, and death, but they can still be contagious, especially as the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">more virulent Delta variant</a> continues to circulate in the region.The Dasain shopping spree has started, and there are throngs of <a href="https://www.nepalitimes.com/latest/dasain-crowd-unmasked/" target="_blank" rel="noopener noreferrer">shoppers in Asan and other bazar streets</a>. Many have stopped wearing masks, or use them inappropriately. The situation will be worse when Kathmandu residents travel to their hometowns this week. They will be visiting elderly parents and grandparents, exposing vulnerable elderly relatives with lower immunity to the virus.The government is bringing in 100,000 doses of Pfizer vaccines after the festivals, with plans for 10 million more by March. But provincial and district hospitals must have deep refrigeration equipment in place, and make necessary collaboration with private hospitals.To make sure that each Nepali child, even those in remote Karnali, gets <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">a shot at the Covid-19 vaccine</a>, our expansive network of community healthcare workers must be mobilised and, where required, administer vaccines at the household level.Lhamo Yangchen Sherpa is an epidemiologist and a senior research monitoring and evaluation advisor at IPAS Nepal.

Giving all Nepalis a shot at the Covid vaccine

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01119c7e80680e0a360ejpeg.jpg" alt="" width="1313" height="882"/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>In terms of <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">global vaccine equity</a>, the answer to the question of whether it is ethical for rich countries to boost with a third dose of  Covid-19 vaccine, seems like a no brainer.But ethics aside, it has been pointed out that no one is safe until everyone is safe. It is in the public health interest of rich countries to ensure that as many people around the world are vaccinated to <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">prevent new variants and spikes</a>.The graph below starkly illustrates the big gap between the jab and jab-nots – showing the wide chasm between rich and poor countries in terms of the proportion of the population which has got even the first dose.Booster vaccination is a moot point for low-income countries because at the moment the option is limited to high- income countries, where some research has shown waning antibody presence and the authorities in the US are advising a third dose eight months after the second one.As of now there is only scant data to show that boosting will help real-life protection in the general population. Clearly the vast majority of the people who received the full dose of approved  vaccines, including the Chinese VeroCell here in Nepal, already have adequate <a href="https://www.nepalitimes.com/banner/behind-the-masks/" target="_blank" rel="noopener noreferrer">protection against severe</a> (as opposed to mild or moderate infections) Covid-19 disease with the present vaccine schedule.Crucially, a strong international drive to vaccinate the unvaccinated could potentially save many more lives than would boost the already vaccinated.But this is a very wily virus which almost overnight changed the rules of the game by mutating into the <a style="letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">highly infectious Delta variant</a>. We need look no further than what happened in neighbouring India earlier this year as this variant ripped through the unvaccinated population regardless of herd immunity that was thought to be widespread.Delta surged across the open border into Nepal, where it overwhelmed the country’s inadequate and inequitable health care system. There is credible data to suggest that there might have been 3-5 million excess deaths in India during the second wave.<a href="https://covid19.healthdata.org/nepal?view=cumulative-deaths&amp;tab=trend" data-saferedirecturl="https://www.google.com/url?q=https://covid19.healthdata.org/nepal?view%3Dcumulative-deaths%26tab%3Dtrend&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNGVkeZeMBLFWPxAOLd86V8RWL22gQ">Estimates for Nepal</a> by the <a href="http://www.healthdata.org/covid" data-saferedirecturl="https://www.google.com/url?q=http://www.healthdata.org/covid&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNG9rCQIZqojh5um31-iM7GlGaMZPA">Institute of Health Metrics and Evaluation</a> of the University of Washington in Seattle show that although the official cumulative deaths due to Covid-19 as of this week was nearing 11,000, the real figure with excess mortality is closer to 40,000.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141148/636d01159c7e80680e0a360fjpeg.jpg" alt="" width="1774" height="1118"><figcaption> </figcaption></figure>It is among the vast number of the unvaccinated that the virus has a greater chance of randomly mutating and becoming a variant (from alpha to omega and now the mu variant in South America) and potentially spreading worldwide.Every time the virus replicates, its likelihood of mutation increases. The novel coronavirus, unlike the other SARS-CoV-1 from 2003 may not be as keen on killing people as it is in perpetuating infections by replicating as much as possible .After India, the Delta virus affected the UK population in a widespread manner, but there was one huge difference -- in Britain it infected many who had already been vaccinated, even though the severity of the illness was significantly lower in this subset.Hence, as these variants generally develop in the unvaccinated population and some (there are 15 variants at present) turn out like the Delta variant, it would be in the enlightened self-interest of the richer countries to have as much of the world vaccinated as possible so that random mutations and variants will be substantially limited, and will not reach their shores.But such enlightened self-interest seems to be lacking in high-income countries, especially because there are <a href="https://www.nepalitimes.com/editorial/no-vax-ask-for-mask/" target="_blank" rel="noopener noreferrer">not enough vaccines to go around</a>, and rich nations perceive an immediate benefit from boosting.Israel is already giving third jabs and France, UK and the US are strongly considering boosters. Boosting may be a good idea if the Covid-19 vaccine supply was plentiful. But currently the supply is limited and more than half the world’s population has not received even a single dose of the vaccine.Sadly, many in low and middle income countries are waiting for doses through the COVAX facility and drug manufacturers like Serum Institute of India scramble to fulfill previous contracts while grappling with the Delta virus at home.What is even more unconscionable is that many rich countries are throwing away expiring vaccines. And now with new orders for booster vaccination programs from high income countries, the developing world will have to wait even longer to have their contracts filled.With booster doses planned for the rich world, it may indeed be a zero sum game for the world if the supply of the approved Covid-19 vaccines is not dramatically increased. The good news is that Serum Institute of India, where Nepal sourced its first lot of Astra Zeneca Covishield vaccine until the pandemic took a turn for the worse in India, has greatly increased its production capacity.Given the experience of the past nearly two years, most high income countries are likely to ignore ethical considerations regarding vaccine equity and booster doses.Many institutions in the West that deal with global health may be embarrassed about not being able to persuade their governments to put their money where their mouth is and do the right thing.So far, their pleas for <a href="https://www.nepalitimes.com/opinion/global-solidarity-needs-intensive-care-in-pandemic-battle/" target="_blank" rel="noopener noreferrer">vaccine equity</a> have generally been ignored – even though they know an effective global vaccination drive would ultimately benefit them by reducing the risk of new variants emerging.In practice, if the production of vaccines revs up and COVAX is able to ship more vaccines to poor countries, regardless of boosting or no boosting by the richer countries, millions of people in the Global South will benefit.In the meantime, we have to continue to mask up, avoid crowds and sanitise, because the vaccine per se <a href="https://www.nepalitimes.com/opinion/dying-to-get-vaccinated/" target="_blank" rel="noopener noreferrer">will not stop transmission</a>.The other bit of good news is that the Nepal Health Research Council in conjunction with other local collaborators is  sequencing (identifying the molecular structure) of Covid-19 virus samples from various parts of Nepal.The Sanger Center, the world’s premier genomic institute based outside Cambridge in the UK, will validate the results from Nepal and enhance our capacity building in molecular medicine.This should help us in promptly identifying variants of Covid-19 so Nepal can deal with future infectious disease outbreaks in a scientific and orderly manner. <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">Covid-19</a> has emphasised the additional significance of sequencing even for other rampant diseases like  tuberculosis and typhoid in South Asia.Buddha Basnyat is a physician and clinical researcher at Patan Academy of Health Sciences and a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/&amp;source=gmail&amp;ust=1630901105986000&amp;usg=AFQjCNH6pJWJpOhLqwh7C7o4x6py0843Jg">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

To boost or not to boost

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151120/636d08aa9c7e80680e0a602ejpeg.jpg" alt="" width="1500" height="1000"/><figcaption></figcaption></figure>The Covid-19 pandemic has now killed more people than the devastating 2015 earthquake. Officially, over 9,700 Nepalis have died due to the coronavirus in the past year and a half, but the<a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer"> real figure</a> is said to be at least three times more.At a glance, it seems that densely populated urban centres with the most infections have <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">recorded the highest fatalities</a>. But analysing the available government data shows that the fatality rate among infected patients is higher in <a href="https://www.nepalitimes.com/latest/rural-nepal-fights-back-covid-19/" target="_blank" rel="noopener noreferrer">remote areas of the country</a>.In Bagmati province, of every 1,000 Covid patients, 11.9 individuals have lost their lives, but it is 21.1 in Karnali Province. District-wise, Kathmandu saw 9.1 deaths per 1,000 cases while Mustang recorded a whopping 111.9 fatalities per 1,000.Public health experts blame limited health care facilities in rural Nepal including ICUs, ventilators, drugs and oxygen for Covid-19 treatment for this huge discrepancy. They also have notably fewer doctors, nurses and other paramedics.“A majority of coronavirus patients recover but most of those who died did not survive because of the <a href="https://www.nepalitimes.com/latest/why-is-there-still-an-oxygen-shortage/" target="_blank" rel="noopener noreferrer">lack of medical oxygen</a> and this is also largely due to uneven distribution of health infrastructure,” says Bijay Acharya of the Massachusetts General Hospital, also associated with the US Nepal Health Foundation.He adds: “In many places, patients have died on their way to hospitals or while being moved from one to another. Many more people in the villages have likely passed away unable to access the treatment.”Binita Adhikari, a public health specialist affiliated with the Health Nepal Foundation and the Johns Hopkins Bloomberg School of Public Health agrees. “The fatality rate is high in remote Nepal also because many people who need treatment never reached the hospital. The Covid-19 outcome depends on how soon a person is diagnosed, hospitalised and receives treatment,” she says.The fact that the entire<a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer"> Karnali Province</a> has only two functional laboratories for Covid-19 testing (Karnali Academy of Health Sciences in Jumla and Surkhet’s Provincial Hospital) means that official figures for total cases in the region are largely under-counted. And this could also have made the fatality rate among confirmed cases higher.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepals-local-governments-lead-from-the-front/" target="_blank" rel="noopener noreferrer">Poor road infrastructure</a> and having to travel distance, sometimes several days, for diagnosis or to access hospital care also adds to the casualties. This also means additional expenses for the poor.The annual per capita income of people in Karnali is $606, which is nearly half of the national average, and a third of the population there is living below the poverty line. The region’s Human Development Index (HDI) at 0.538 is also much lower than the rest of the country.Even within Karnali Province, the poorest and the most disadvantaged have been disproportionately affected. The coronavirus mortality in Karnali stands at 2.1%, but in remote Dolpo, the figure rises to 7.01%. There is just one ventilator here at the district hospital, but even that is non-functional in a lack of skilled human resources to operate it. There are only two beds with oxygen.Similarly, the fatality rates in Mugu, Humla, Rukum East and Salyan were 6.1%, 5.15%, 4.86% and 4.07%, all much higher than the national average of 1.5%. These are also some of Nepal’s most economically and socially disadvantaged districts. Dolpo’s HDI is 0.4 and Mugu’s 0.39.“It is very likely the total number of people infected and dying of the pandemic in the region is much higher than reported. Much of this is due to continued lack of testing and contact tracing,” says epidemiologist Lhamu Yangchen Sherpa.Director of Teku Hospital at Kathmandu Anup Bastola agrees: “The high fatality rates in <a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer">remote districts</a> don’t necessarily mean they have more deaths, but that many of them have not had sufficient testing, which means most of the infected people barring those in critical condition didn’t reach us.”It is however clear that regions with good health infrastructure, economically sound environment, and with higher human development index are better placed to save those infected.While Solu, Bhojpur and Ilam saw districts 5.06%, 4.8% and 4.09% of their Covid patients succumb to the disease, Morang, Chitwan and Kaski reported only 1.02%, 1.25% and 1.52% fatality rates respectively. The figure is even lower for Kathmandu at 0.91%.Province-wise, after Karnali, Lumbini has the highest Covid death rate at 1.77%. This is followed by Gandaki at 1.73%, with the lowest being Bagmati (1.19%).There is also a huge <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">disparity in Nepal’s Covid vaccination drive</a>. Of the 1.42 million Nepalis (4.9% of the total population) who have been fully vaccinated, 55.45% of them are from Bagmati Province alone. Karnali accounts for a mere 3.5% of people who have received either both doses of AstraZeneca Covishield or VeroCell or a single shot J&amp;J vaccine.In other words, 14% of Bagmati residents have been fully inoculated versus 3% of Karnali people. The figure is even lower for Province 1, 2 and Far West where 2.4%, 1.71% and 2.78% of their population have been fully vaccinated.However, some public health experts have argued that the vaccination drive when doses are scarce should not necessarily aim right now for equity, but focus on high-risk, crowded cities with mobile populations, and regions along the Indian border.Says Bijay Acharya: “Age alone shouldn’t factor into who gets the vaccine first, economic status and social background should also be taken into account to ensure those other than the affluent also benefit. Areas with a high risk of infection and marginalised communities with poor health infrastructure should be equally prioritised.”Nepal government is in a process procure six million dose of Pfizer vaccines for teenages from 12-18 years of age in the next six to nine months' time. Health Ministry is in the final stages of preparing -80 degree Celsius storage facilities in all seven provinces.Translated by Sonia Awale from the <a href="https://www.himalkhabar.com/news/125201" target="_blank" rel="noopener noreferrer">original in Himal Khabar</a>.

Nepal’s uneven Covid-19 deaths

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07d99c7e80680e0a5fe2jpeg.jpg" alt="" width="2048" height="1366"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The world is at a tipping point in the battle to contain the spread of Covid-19. <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">Countries across Asia are struggling to access vaccines</a> while tens of thousands are dying from the disease. Richer countries are sitting on enough doses to vaccinate their populations many times over.Sharing vaccine doses right now is our best shot if we are to prevent further catastrophe in Asia.Recently the G20 countries with 80% of the world's wealth held a global health summit and called for <a href="https://reliefweb.int/sites/reliefweb.int/files/resources/e006598.full_.pdf" target="_blank" rel="noopener noreferrer">sharing of vaccines and production technology</a> between nations.Pharmaceutical companies made commitments to sell cut-price vaccines to lower income countries. Some companies and countries have offered intellectual property waivers or sharing of technologies on Covid-19 vaccines. The United States and Europe offered to share more vaccines and the raw materials for manufacturing. These are all positive moves. Formany parts of Asia, the burning issue now is speed.Countries with vaccine stockpiles need to sell or share their millions of excess doses either directly or via the <a href="https://www.who.int/initiatives/act-accelerator/covax">global COVAX facility</a> to help save lives in countries experiencing record death rates. And they need to do so as quickly as possible.We only need to look at Britain and the United States to see how mass vaccination can help contain the disease. In the United Kingdom, Covid-19 vaccines have so far <a href="https://www.gov.uk/government/news/covid-19-vaccine-surveillance-report-published/">prevented 13,200 deaths and 39,700 hospitalisations</a> according to Public Health England. In the race against new waves, new variants, and new tragedies, we need such good news at a global level too.<a href="https://ourworldindata.org/covid-cases">Eight of the 10 countries</a> in the world that are seeing infections double the fastest are in Asia and the Pacific. Many of these countries, such as Fiji and Timor Leste have low vaccination rates and fragile health systems.Many countries in Asia, including Bangladesh, Sri Lanka and Nepal are down to their last doses, forcing authorities to suspend or scale down their vaccine rollouts. Just 3% of people in India and less than 1% in the Philippines <a href="https://ourworldindata.org/covid-vaccinations">have been fully vaccinated</a>, according to Oxford University's Our World in Data.A majority of Asian and other lower income nations simply cannot compete with richer countries in the race to buy vaccines. Pakistan has ordered enough doses to inoculate only 3% of its population, while the European Union has enough to vaccinate its population 3.5 times over, according to Duke Global Health Innovation Center.It's not just about purchasing power. It's also about the resources needed to distribute and vaccinate. Britain is vaccinating people 13 times faster than Nepal, while the United States is administering more than 2.5 times as many doses per day as India for every 100 people.Even with limited supplies, countries across Asia are rushing to <a href="https://www.nepalitimes.com/latest/vaccines-too-little-too-late-for-nepal/" target="_blank" rel="noopener noreferrer">vaccinate as many people as possible</a>. Every day, millions of <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer">frontline health workers</a>, including Red Cross and Red Crescent volunteers, are risking their own safety to provide lifesaving medical treatment and immunisations. These staff and volunteers needed to be vaccinated as a priority so they can make other people safe. Many critical workers have still not received even a first dose.I am writing this from Malaysia, which has one of the highest Covid-19 infection rates in the world. Intensive care units and hospitals in many countries around Asia are full. Judging from <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">what we've seen in India and Nepal</a>, demand for oxygen will outweigh supply in countries across the continent and many people will die, people who wouldn't die if they were vaccinated.The International Federation of Red Cross and Red Crescent Societies is supporting the vaccine roll out, working with health authorities to run vaccination centres, keeping people safe with clean water, soap and hygiene, and delivering <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">oxygen supplies</a>. It all helps but is a drop in the ocean compared to what is needed to contain Covid-19.The only solution is <a href="https://www.nepalitimes.com/opinion/no-country-is-safe-until-we-are-all-safe/" target="_blank" rel="noopener noreferrer">immediate vaccination</a> to scale at record rates. Scaling up production and sharing intellectual property rights will both make a huge difference in the medium term. In the short term, sharing surplus vaccine doses is one of the fastest ways to save lives. If there ever was a global imperative for the world to act in solidarity, it is now.Alexander Matheou is Asia Pacific Director at the International Federation of Red Cross and Red Crescent Societies.

Global solidarity needs intensive care in pandemic battle

Once Nepal gets vaccines, they need to be fairly distributed

This week at the National Population Policy launch Prime Minister K P Oli exhorted Nepalis to get married by age 20 and have three babies by the time they are 30. This was the first indication that the highest office in the land has understood the need to address Nepal’s dramatically <a href="https://nepalitimes.com/news/nepals-demographic-window-is-closing">falling birth rate</a>, but Oli’s statement was greeted with ridicule on<a href="https://nepalitimes.com/banner/avoiding-the-quicksand-of-social-media"> social media</a> — especially by women. Most urban young are already grappling with economic pressures and shifting life priorities. Even with a university degree,<a href="https://nepalitimes.com/here-now/workers-return-to-jobless-nepal?%2F"> many cannot find jobs</a>, and are taking the first flight out for overseas employment. Having a child is now a fraught decision shaped by income, individual autonomy, and family pressure. The <a href="https://www.unfpa.org/swp2025">UNFPA’s State of the World Population report </a>released last month, highlighted a significant <a href="https://nepalitimes.com/here-now/migrating-males-and-population-decline">decline in fertility rates </a>around the world. The global average fertility rate is 2.25 children per woman, and 18% of the reproductive adults said they will not be able to have the number of children they desire. The total fertility rate in Nepal has plummeted to 2.1 births per woman — down from 5 just 30 years ago. This is considered replacement level, meaning the newborns will replace their parents.&nbsp; However, birth rates are not declining as rapidly everywhere. The Tarai in has a total fertility rate of 2.20, and northwestern mountains is still 2.24.&nbsp; There are multiple factors in play, and the report broadly divides them into four categories: health issues, economic concerns, fears about the future, and lack of a supportive partner or their absence. More than half of the respondents said finance, which includes unemployment and increased cost of housing, as well as parenthood, was a barrier to having children. “More and more people prefer one or two children at maximum. Many women also decide to have children at a much later age,” says Kamala Devi Lamichhane of Tribhuvan University. “The opportunity cost is far higher for women.” But there is also a cost for the country, as the National Population Policy notes. At the rate the total fertility rate is falling it will soon be below replacement level — meaning that in the next three decades Nepal will be confronted with an <a href="https://nepalitimes.com/opinion/the-future-is-older">ageing population</a>.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291.png" data-media-id="editor_6" data-image-id="20250714140740_bac3e5a284b69a77d97b3b99daf2e7fd3019bc48f1a399fb2771381c751d8291" data-rendition-name="original" width="1302" height="501" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b.png" data-media-id="editor_7" data-image-id="20250714140740_251115b0a88d4e82be70245c43cb74477f3be18042ef1aa3b904c597d815f13b" data-rendition-name="original" width="1125" height="500" loading="lazy" alt="Nepalis having fewer babies. Why?"> </figure>  Besides income, there are also cultural factors at play in women having fewer babies — they are expected to do all the childcare duties, even putting their careers on hold. In general, there is little help from spouses, and with more nuclear families there is less support from relatives. “Women today are well educated, career-oriented, and economically independent, allowing them to delay marriage as well as being conscious about their body and <a href="https://nepalitimes.com/multimedia/nepal-far-from-hitting-contraceptive-target?%2F">reproductive rights</a>,” says Laxmi Tamang of the International Confederation of Midwives (ICM). Also present at the policy launch was demographer Yagya Bahadur Karki, who said that women are more educated and hence, empowered to take their own informed decisions regarding having children.&nbsp; He adds, “But the fertility rates have reached replacement rate, and that stands as a warning for the future.”&nbsp; Fertility rates have fallen in inverse proportion to the rise in female literacy. The regions of Nepal where couples have more babies is where women are less educated. Couples in Madhes and Sudur Paschim provinces, where child marriage, gender-based discrimination, menstrual huts and dowry are still widespread are where the fertility rate is still high.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39.jpg" data-media-id="editor_9" data-image-id="20250717120740_ababfd31ed5ff79ded427e1f1adfff02e6af2384bd541e51dfe05e52fbbccb39" data-rendition-name="original" width="994" height="682" loading="lazy" alt="TFR Map"> </figure>  And because female literacy also has a direct correlation with <a href="https://nepalitimes.com/news/fatal-discrimination">infant and child mortality</a>, couples in those regions tend to have more babies so some of them survive.&nbsp; But it is Nepal’s urban centres among the educated where the increased choices in reproductive health, including alternative methods of conception like IVF and treatment for infertility, as well as <a href="https://nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor">contraceptives</a> offer more options for family planning. “There are more choices regarding reproductive health, and there is more awareness as well, which is why people decide carefully on whether or not to bear a child,” says population expert Yogendra Gurung. <a href="https://nepalitimes.com/here-now/migrants-returning-from-the-gulf-with-infertility">Migration is another factor</a> adding to the decline in fertility rates. Many young Nepalis of reproductive age leave every day in pursuit of better jobs overseas. Spousal separation means fewer children.&nbsp; “Once away, even if not educated, they realise that child-rearing costs are high, and try to have fewer and even no children in some cases,” Gurung adds. Recent studies have also shown that men returning after their stint in the Gulf and Malaysia, where they are <a href="https://nepalitimes.com/news/gulf-workers-need-protection-from-heat">exposed to extreme heat </a>for extended periods as well as various chemicals and toxins in their work environment &nbsp;have a range of health problems, including infertility. To increase the birth rate, Nepal will have to reverse its family planning strategy of the past 40 years. Complicating this is that some regions of Nepal will need measures to control the birth rate, while urban areas will need a strategy to help parents have more babies. One way to help families have more children is to develop more <a href="https://nepalitimes.com/here-now/future-proofing-nepal-s-population-strategy?s=04&amp;fbclid=IwY2xjawFQf-NleHRuA2FlbQIxMQABHRxSwwGPfm7_2cBhDVAowPxEmFXP0Os-KRs1DXqIW_84wDhciExtZuNi1g_aem_jzRqN2cEVAppfwr5qedxRg">family-friendly policies</a> that favour women and youth as the Nordic countries, which also have falling birth rates, have done. They have introduced flexible parental leaves for both parents, including financial and health incentives. China, also concerned about its declining birth rate and an ageing population, now has a three-child policy as well as tax deductions, expanded childcare services, and leave policies to encourage couples to have more children. “We must work towards childbirth and childcare policies and plans that are suitable for Nepal, so that couples planning for children do not have to think twice about it because of finances or other reasons,” adds Gurung. Tamang of the International Confederation of Midwives says a gender transformative approach is needed to address the issues of the gender gap which is adding to the decline in childbirth. Husbands need to play a more important role in child-rearing. Instead of increasing fertility for the sake of it, the objective should be to assist young people to start the families they desire, at a point and time of their choice. Respect for everyone’s rights and dignity lays a foundation for a more balanced demographic trend. Lamichhane sums it up: “If fertility rates are to be sustained, it requires changes in the gender roles and behaviour, keeping the youth’s aspirations in mind.”

Nepalis are having fewer babies. Why?

Does anyone know that 2023-33 was declared the <a href="https://nepalitimes.com/banner/visit-nepal-again">Visit Nepal</a> Decade? Or that Pokhara announced that 2025 is a Special Tourism Year? The fuselage of Nepal Airlines jets still carry the Visit Nepal Year 2020 logos. Such ad hoc and unnoticed promotion is emblematic of the way Nepal has tried to increase visitor arrivals <a href="https://nepalitimes.com/news/nepal-hopes-for-tourism-rebound-in-2021-rk4dlo9t">post-Covid</a> — and of the country’s wider political disarray. Deepak Raj Joshi of the Nepal Tourism Board (NTB) has his work cut out to coordinate various agencies of the government to boost arrivals.&nbsp; He says, “We have been working on marketing strategies to revive the tourism sector, and are hopeful that this year will mark a 8-10% increase in arrivals compared to the pre-pandemic times.” On paper, tourist numbers have rebounded to pre-Covid numbers with over 1 million last year, but official figures do not give a true picture of duration of stay, average spending, and the fact every visitor is counted as a ‘tourist’, even repeat visitors who come on business. The few bright spots are largely a result of private sector promotion of niche tourism products, individual social media posts of <a href="https://archive.nepalitimes.com/page/top-10-treks">adventurous treks in Nepal</a>, or the fact that Indians are allowed to enter China again to visit Lake Mansarovar and Mt Kailash via Nepal. Indeed, Simkot airport has up to 15 flights a day from Nepalganj bringing in <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims</a> who are then ferried by helicopter to the border in Hilsa, or Lapcha Pass from where the holy sites in Tibet are visible. The rudimentary hotels and rest houses along the route in Humla have been bursting at the seams for the past month, to the point that some establishments are no longer able to provide patrons basic amenities.&nbsp; Last year, 1.14 million tourists visited Nepal, and the government has projected up to 10% increase in tourist arrivals this year. International tourist arrivals to Nepal have been steadily increasing, especially from the US, Europe, and India. Domestic and regional travel has also increased after the <a href="https://nepalitimes.com/news/lockdown-5-utlzqtvs">Covid lockdowns</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505.jpg" data-media-id="editor_5" data-image-id="20250717120756_e1c8f08e7e26496d2b2394e0be776e147fb46c415347b781ed9e5c64d9c9e505" data-rendition-name="original" width="1145" height="668" loading="lazy" alt="Tourist numbers"> </figure>  The tourism industry employs at least 1 million people, trekking injects money directly into the <a href="https://nepalitimes.com/editorial/not-rising-nepal">rural economy </a>and sustains ancillary sectors like handicrafts and domestic aviation. In the last fiscal year, tourism brought in Rs82.33 billion, according to Nepal Rastra Bank. But the industry has been affected by negative publicity about poor infrastructure, air pollution in Kathmandu, travel safety and news of disasters like the <a href="https://nepalitimes.com/news/rasuwa-flood-likely-a-glof">China-Nepal flood last week</a> that made international headlines. Growing worries about the climate crisis is also affecting youth travel, especially from Europe. Read also: <a href="https://nepalitimes.com/news/missing-out-on-nepal-s-tourism-potential">Missing out on Nepal’s tourism potential</a> “The limitations of airport and road infrastructure has hindered the development of the tourism sector,” admits Joshi. “And many are put off by the appalling state of our road network, especially during <a href="https://nepalitimes.com/opinion/managing-the-monsoon">the monsoon season</a>.” Nepal is home to 20 protected areas, 10 heritage sites, and eight out of the world’s 10 highest mountains, and despite all the obstacles it is still the perfect destination for the modern social media savvy traveller, who are experience-driven and inclined to look for itineraries that emphasise wellness and cultural immersion.&nbsp; Some hotels around Kathmandu, Pokhara, Jomsom and the Khumbu have strived to adapt to this new tourism landscape, expanding facilities with significant international investment. <a href="https://nepalitimes.com/business/a-thamel-within-thamel">Luxury hotels like Aloft Kathmandu</a> in Thamel were inaugurated just before the pandemic lockdowns, survived the crisis and thrived as it. Says General Manager Vikram Singh (pictured, below): “Our prime location in Thamel enhances the guest experience, especially for those seeking convenience and immersion in the local scene and travellers who want to be in the centre of it all.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d.jpg" data-media-id="editor_11" data-image-id="2025071805070_8d29803e8b52bcd4439422e7b7a0bc25aa68ef3d227b9130bd0e079af626677d" data-rendition-name="original" width="1066" height="1600" loading="lazy" alt="Aloft GM"> </figure>  <a href="https://nepalitimes.com/here-now/what-sustainable-tourism-means-in-practice">Sustainability </a>and environmental consciousness has also become an integral part of the hospitality industry. ISO certifications as well as sustainability initiatives like the Travelife sustainability certification for eco-friendly resorts validate credibility of hotels. Aloft is the first five-star hotel in Nepal to have earned the Waste Smart Certificate, and it has also been awarded the ISO 14001:2015 certification, which is the internationally recognised standard for environmental management systems (EMS). But such investments will not amount to much unless Nepal makes serious efforts to promote itself as a<a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz?utm="> tourism destination</a>, especially to its two giant neighbours. More importantly, the country needs to increase activities in which tourists can spend the money they want to. “While <a href="https://nepalitimes.com/here-now/nepal-pushes-mountain-bike-tourism?fbclid=IwAR1MNH0iFGv1vRz5G9uZ4AzUlKxB6nY7JKq0qT6je_FV4_SuxPZqviwKGn0">mountaineering and adventure tourism</a> are extensively promoted, we have fallen short of marketing other elements such as wildlife, pilgrimage and cultural heritage,” says Joshi. “There is a need to diversify promotion to increase income from the tourism sector.” Meanwhile, making Nepal more accessible to international and domestic visitors, must also be a priority. Kathmandu remains the sole aerial gateway despite new airports in Pokhara and Bhairawa. “International airlines have shown interest, and if access and flights are increased these airports can be fully functional,” says Joshi. But Sichuan Airlines has stopped flying to Pokhara, and there does not seem to be much interest from Thai, Vietnamese and Cambodian carriers to fly directly to Lumbini. Says Singh: “There’s tremendous opportunity to strengthen Nepal’s destination marketing by telling richer, more compelling stories that <a href="https://nepalitimes.com/opinion/comment/culture-cannot-be-an-afterthought">connect travellers with our culture</a>, nature, and people.”

Tourism needs a new push

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

Local residents of Mustang, including a sitting MP and several politicians, submitted a petition to Prime Minister KP Oli in Kathmandu this week urging the government to lift the region’s ‘restricted’ status. This is not the first time such a demand has been raised, and as infrastructure the region’s accessibility improved over the years, calls to remove the long-standing restriction have grown louder.&nbsp; Upper Mustang is no longer weeks away <a href="https://nepalitimes.com/here-now/postcards-from-kathmandu">from Kathmandu.</a> Nearly 85% of the road from Beni to Kagbeni has been blacktopped, and one can drive from Kathmandu to Lo Manthang with an overnight stop in Pokhara. Between April 2024 and April 2025, Lower Mustang received 144,745 international tourists, a near 50% increase compared to the previous year. Most of these were <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds">Indian pilgrims </a>travelling to Muktinath. <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a> is also gaining popularity among Nepali visitors, with 700,000 visiting the region in 2024. A hotel operator in Kagbeni estimated that about 20% of Nepali visitors to Muktinath also travel to Korala, the trade and transit checkpoint on the <a href="https://nepalitimes.com/latest/north-of-the-border">China border</a>. That would mean that nearly 100,000 domestic tourists visit Upper Mustang annually. In stark contrast, international tourist numbers to Upper Mustang (north of Kagbeni) have remained stagnant, hovering around 4,000 visitors per year. The primary reason is the continued enforcement of the region’s restricted status. Foreign visitors must pay a steep permit fee: a minimum of $500 for 10 days, with an additional $50 per day thereafter. Tourism some entrepreneurs, politicians, and residents want these fees to be abolished so Upper Mustang can attract a broader range of international travellers. The success of Lower Mustang, where relaxed restrictions have led to a<a href="https://nepalitimes.com/here-now/boom-time-in-central-tarai"> tourism boom</a>, is often cited as proof of what lifting restrictions could achieve. Upper Mustang is not the only region in Nepal with a restricted status. Several northern areas prefixed with ‘Upper’ (Upper Manaslu, Upper Dolpo, Upper Kanchenjunga, and Upper Arun) also need similar permits and fees. Although no clear official explanation exists, these areas were primarily restricted due to historical inaccessibility, ecological and cultural fragility and security concerns. Read also: <a href="https://nepalitimes.com/news/upper-mustang-opposes-prohibited-areas">Call to scrap Upper Mustang tourist fee</a> In the 1960s and 1970s, these remote regions served as shelters for Khampa guerrilla fighters who launched cross border ambushes on the <a href="https://nepalitimes.com/here-now/the-last-days-of-the-khampa">Chinese military </a>across the border.&nbsp; Though the Khampa have long gone, security concerns rooted in that era seem to persist. The government in Kathmandu is seemingly unaware of the changed political and security landscape. If concerns do remain, they are not made public. One of the main reasons for maintaining the restricted designation is to limit visitor numbers. But with <a href="https://nepalitimes.com/opinion/the-road-out-of-nepal">improved road access and services</a>, as Upper Mustang has seen, this justification no longer holds. When Upper Mustang first opened to international tourists in 1992, it had no formal lodges or hotels, and it took four to five days of trekking from Jomsom to Lo Manthang.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f.jpg" data-media-id="editor_8" data-image-id="20250716120744_4e4405cf10e6f127f90a1cd40feda0b9d8d69efd13093a2563530ca31489ba9f" data-rendition-name="original" width="2000" height="509" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: SHRIJAN PANDEY / NT ARCHIVE</figcaption> </figure>  Without a nechyang (a household with traditional friendship), it was difficult to find a place to stay or get a proper meal. Only a few elite households offered accommodation. Today, there are now more than 80 lodges and hotels above Kagbeni, spread across nearly every village. Several upmarket hotels now struggle to stay afloat during the off-season, relying on low-spending domestic visitors to survive. Lo Manthang, once a remote destination, is now just a few hours’ drive from Jomsom, easily reachable by lunchtime for early starters. Once the remaining road sections are blacktopped, travel time will be further reduced. Yet, the government still charges a flat $500 fee for a 10-day permit based on outdated &nbsp;assumptions from a bygone era. There has been no serious review of the permit structure to align with current realities, nor any response to local aspirations to attract more international tourists and <a href="https://nepalitimes.com/here-now/peak-tourism-in-2023-9ukoi8iz">harness tourism for economic development</a>. Concerns about over tourism are valid. There is a risk that increasing visitor numbers could erode Upper Mustang’s <a href="https://nepalitimes.com/here-now/a-million-mantras-in-mustang">cultural heritage</a>, social fabric, and fragile natural environment, precisely the features that make it special. However, the region’s 33 years of tourism experience have been largely positive.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a.jpg" data-media-id="editor_11" data-image-id="20250716120744_5c7e5e05097cd0e5a1027b51c7e3db3be0bd67e0f7cbaea6d2c447b1dacafc8a" data-rendition-name="original" width="1400" height="1050" loading="lazy" alt="Lift restrictions on Upper Mustang"> <figcaption>Photo: MUKESH POKHREL / NT ARCHIVE</figcaption> </figure>  Tourism has contributed significantly to the restoration and <a href="https://nepalitimes.com/here-now/the-history-of-heritage?%2F">preservation of religious and historical sites</a> like the Thubchen and Jampa monasteries in Lo Manthang, the ongoing conversion of the old palace in Ghami into a premium hotel, and the rehabilitation of many monasteries and chortens.&nbsp; These efforts, supported by international donors and heritage experts, demonstrate that tourism—when well managed—can be a powerful driver of <a href="https://nepalitimes.com/here-now/shrinking-tourism-s-ecological-footprint">conservation</a>. The high permit fees have been somewhat effective in limiting international visitors, but they have no influence on the growing number of domestic tourists, particularly during the Dasain and Tihar holidays. The most pressing need now is for all levels of government—federal, provincial, and local—to<a href="https://nepalitimes.com/news/why-invest-in-nepal"> invest in </a>managing tourist flows and maintaining tourist sites. These efforts are essential not only to enhance visitor experience but also to build long-term resilience and sustainability for the destination. Read also: <a href="https://nepalitimes.com/news/greening-nepal-s-tourism">Greening Nepal’s tourism</a>, Hanna Wells Visitor numbers are central to any tourism development strategy that aims to balance economic, social, and environmental goals. Clinging to obsolete policies and concerns to justify Upper Mustang’s restricted status is not only unfair, it also suggests an undemocratic and discriminatory attitude toward a remote district.&nbsp; Shailendra Thakali, PhD, is from Jomsom and is a freelance consultant on protected areas, tourism, conservation, and sustainable livelihoods.

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