The World Health Organisation (WHO) will be nominating its South East Asia Regional Office (SEARO) Director at its 76th session starting 30 October in New Delhi.&nbsp;
Nepal’s candidate Shambu Prasad Acharya has emerged as a clear favourite among international public health practitioners. But vying for the same position is Saima Wazed, a psychologist and the daughter of Bangladesh Prime Minister Sheikh Hasina.&nbsp;
Many see this as a context between a professional with decades of experience in health against a political appointee. &nbsp;
The global health community is keeping a close watch, especially given that the region has a high disease burden and is a hotspot for both new and emerging infections as well as chronic illnesses.
Former UN Assistant Secretary-General and Deputy Executive Director of UNICEF Kul Chandra Gautam believes Acharya is the more qualified candidate, and not just because he is a fellow Nepali.&nbsp;
“The most important qualities for an incoming WHO regional director are a strong background in public health, a deep understanding of global and regional health challenges with the ability to prioritise them,” Gautam told Nepali Times.&nbsp;
“Sambhu Acharya has a strong track record and high credibility in dealings with global health leaders, academics, funding agencies, and national decision-makers, a proven ability to advocate for health as a key component of sustainable development, and a good understanding of WHO's strengths and weaknesses,” he added.
Acharya has a PhD in public health and has over three decades of experience in Nepal, Bangladesh, and other countries. He was instrumental in developing health systems at the local, national, and regional levels in maternity and child health, family planning, population, infectious and non-communicable diseases.
He also led World Bank-funded health and population programs in Bangladesh and helped establish the WHO Asia-Pacific Health Economics Network.&nbsp;
“For a region that has a quarter of the global population, selecting the right candidate is imperative, and Dr Acharya is the best candidate for the position,” says Bishow Parajuli, a former UN Resident Coordinator as well as UNDP and WFP representative in many countries.&nbsp;
Acharya himself told us that if elected, his top priority would be to improve health and well-being approaches by guiding countries toward a fundamental shift in health promotion, disease and injury prevention, and planetary health, by addressing their root causes.&nbsp;
“This region is home to 45% of all TB cases, but my priorities also include non-communicable diseases like diabetes and cancer,” he said, adding that he would also bolster real-time surveillance and mobilising new resources for the development of diagnostics, drugs, and vaccines, while combating antimicrobial resistance.
Acharya was born to a farming family in rural western Nepal where he saw firsthand the lack of basic health and essential services. Even as a boy, he had made up his mind to someday improve healthcare at the national, regional, and global levels.
Acharya is committed to accelerating universal health coverage with strong, inclusive primary health care by innovating and digitising the system for equity and solidarity in the region. He also wants to enhance education so that diseases can be mitigated or prevented altogether.
On the other hand, Wazed's educational background is in mental health. Since 2019, she has been an adviser to WHO’s director general on mental health and autism. She is a Canadian citizen, and has worked as a school psychologist in Florida.
“She is undoubtedly a bright, articulate, and versatile personality,” says Gautam. “However, her qualifications are somewhat limited when it comes to serving as a public health leader of global or regional stature.”
In the lead-up to the 153rd Executive Board meeting that follows the 76th World Health Assembly, 53 public health experts from around the world have issued a statement demanding more transparency and scrutiny regarding regional director elections.
‘Considering the challenges faced by WHO and the need for effective health multilateralism, regional office leaders have a critical task of persuading national political leaders to prioritize public health evidence and resolve differences at regional levels,’ the statement says. ‘To fulfil this role effectively, Regional Directors must possess the necessary technical and managerial competencies and exhibit political astuteness in navigating health diplomacy.’
Parajuli, who has also served the UN in Dhaka, says Wazed’s candidacy has also disadvantaged other qualified candidates from Bangladesh. He fears that experience may be overshadowed by politics.&nbsp;
Nepal’s international lobbying effort will be important for Acharya’s candidacy. Candidates for WHO elections are proposed by member states and then nominated by the Executive Board. The World Health Assembly then votes by secret ballot to elect the Director-General.
Says Parajuli: “Member states must select qualified candidates capable of delivering results. This should be the guiding principle.”&nbsp;

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Who’s WHO?

Today, on World Health Day, WHO celebrates 75 years of improving public health and well-being in the South-East Asia Region and globally, fully committed to achieving Health for All through universal health coverage (UHC), when all people can access the health services they need, when and where they need them, without financial hardship. For many decades now and since even before the 1978 Declaration of Alma-Ata, high-level leaders and policy makers from across the Region have recognised the critical role that access for all to quality, affordable and comprehensive primary health care (PHC) can play in achieving UHC, and therefore Health for All. However, global enthusiasm for UHC and the PHC approach has witnessed several peaks and troughs, resulting in public health services and programmes that have often become siloed, fragmented and divorced from wider multisectoral, social and economic processes and determinants. Today, in the shadow of the Covid-19 crisis, around 40% of the Region’s population is unable to access essential health services. In 2017, around 299 million people faced catastrophic health spending, and an estimated 117 million were pushed or further pushed below the purchasing power parity poverty line of $ 1.90 a day, a figure that has since been exacerbated.&nbsp; History’s lesson is as clear as it is urgent: sustained whole-of-government, whole-of-society action is needed to achieve UHC and Health for All, one of eight Regional Flagship Priorities since 2014, and a core pillar of the Region’s vision to build back better from the Covid-19 pandemic. We must all contribute.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230405150412_4f70dbbce169dea526df0ad6802705ba848ac4c51e48800ee98d050794c20fca.jpg" data-media-id="editor_0" data-image-id="20230405150412_4f70dbbce169dea526df0ad6802705ba848ac4c51e48800ee98d050794c20fca" data-rendition-name="original" width="2000" height="1333" loading="lazy" alt="hospitals in Nepal"> <figcaption>Photos: GOPEN RAI</figcaption> </figure>  First, high-level leaders from across the Region must maintain and strengthen political and financial commitment to achieve UHC, accelerating momentum ahead of the second UN General Assembly meeting on UHC in September this year. The Covid-19 crisis has shown that when health is at risk, everything is at risk. It has shown that investments in UHC and health system resilience underpin not just health, but social and economic security, as well as the achievement of an array of Sustainable Development Goals. Second, policy makers and programme managers must continue to implement the Region’s Strategy for PHC, launched in December 2021. Of specific focus should be strengthening public health infrastructure, workforce and financing, while at the same time increasing equity for those at risk of or who are already being left behind. Shared learning must continue to be a core priority, leveraging the full power of the Region’s new Forum for PHC-Oriented Health Systems. Third, people and communities must increasingly assert their voice and Right to Health, including by directly engaging in local health decision-making processes. As highlighted by the 2021 WHO handbook on social participation for UHC, as well as the Region’s recently adopted resolution on enhancing social participation in support of PHC and UHC, individuals and communities can play a key role in monitoring health service performance and holding health providers and policy makers to account. Fourth, partners, donors and other stakeholders in the Region must go all in on UHC and Health for All, recognising that the PHC approach is the most effective, efficient and equitable way to build national health systems that are unified, and which achieve healthier populations, health security and UHC. In all countries, policy makers must lead, and partners must support. Assistance must be fully aligned with national priorities, avoiding duplication and fragmentation. Crucially, given the magnitude of the challenge, we must recognizse that progress may not always grab headlines, but will nevertheless make a real difference to people’s lives. Between 2010 and 2019, the Region increased its UHC service coverage index from 47 to 61. Between 2000 and 2017, the Region reduced the number of households impoverished or further impoverished from out-of-pocket spending on health from 30% to 6%. Since 2014, the density of doctors, nurses and midwives in the Region has improved by over 30% – a tremendous achievement that must continue to be built upon. On this, WHO’s 75th founding anniversary, let us unite in purpose and be driven by action to achieve UHC and Health for All, ensuring all people have good health for a fulfilling life in a peaceful, prosperous and sustainable world. &nbsp; Poonam Khetrapal Singh is the WHO SEARO Regional Director.

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United by purpose, driven by action

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205539c7e80680e0b28adjpeg.jpg" alt=""/><figcaption>Frontline workers waiting for their booster dose at a hospital in Kathmandu last week. Photos: AMIT MACHAMASI</figcaption></figure>As elsewhere in the world, the <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> in Nepal is starting to peak, but experts say the pandemic is far from over. The Health Ministry had previously projected new cases to soar to 20,000 a day, and the Omicron surge to peak in mid-February. But the fact that the variant spread rapidly like wildfire right across the country giving a majority of the population milder symptoms meant that it equipped them with antibodies to fight the infection.At Nepal’s biggest infectious diseases centre at Teku Hospital, virologist Sher Bahadur Pun predicts that the third wave will most likely peak in a few days, or by the end of next week.“For the past week, I have observed that the number of people coming in for tests and consultation every day has decreased by a half,” Pun says. “Of course, not everyone is coming to the hospital, but this is the beginning of the end of this wave.” To be sure, the government’s daily Covid-19 figures are gross under-estimations. Mostly symptomatic patients are testing, thus registering a very high positivity rate. Infected people with flu-like symptoms are isolating at home without a PCR test. There are also people self-testing with kits available at pharmacies, and these infections are not in the official tally.Even so, figures from elsewhere show <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">the Omicron surge</a> lasts only for a month or two. South Africa, where the variant was first detected in December, is over the hump. The UK and parts of the US have also passed their peaks. Many countries, including Australia, are now removing restrictions."It is too early to be sure about exactly when the high number of cases will subside completely," Andrew Pollard, of the team that developed the Astra Zeneca vaccine, told Nepali Times in an email interview from Oxford. "The main issue with rapid spread of Omicron is for the unvaccinated who may be at risk of severe disease, particularly if they are older adults and those with other health conditions."The spread of Omicron in Kathmandu Valley is expected to reach an equilibrium soon, with a steep fall in cases, says Bangkok-based public health expert Sushil Koirala. But he warns slower-moving outbreaks may continue outside the valley where the population is thinly spread. “These next 10 days are critical. It will tell us if the Omicron variant is indeed a quiet pass to a pandemic end-game, or we still have a big human cost to pay,” Koirala adds. “There is still little clarity on how severe this variant will be to those who are still unvaccinated and those who had the vaccines many months ago.” <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637205569c7e80680e0b28aejpeg.jpg" alt=""><figcaption> </figcaption></figure>The World Health Organisation (WHO) last week issued an <a href="https://news.un.org/en/story/2021/12/1108932" target="_blank" rel="noopener noreferrer">optimistic projection</a> that the pandemic would probably be over during 2022 — provided inequalities in the vaccine coverage and treatment are addressed.  Global health researcher and economist Christopher J L Murray <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext" target="_blank" rel="noopener noreferrer">writing for the journal Lancet</a> also said that after the Omicron wave, ‘Covid-19 will return but the pandemic will not.’ Pollard also explains that once health systems can cope with Covid-19, the pandemic could be considered over, but that doesn’t mean that the virus will be gone. "We have a pandemic because of pressure on health systems and deaths. With growing global immunity as a result of vaccination and previous waves of infection, both severe disease and deaths should decline during 2022," he says. Despite this, health experts in Nepal warn that severe infections needing hospitalisation have a lag of a few weeks after the surge in infections. And despite being a <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">milder strain</a> that primarily only affects the upper respiratory tract, Omicron can still lead to serious diseases in the elderly and people with co-morbidities. Indeed, ICU admissions and those needing ventilator support in hospital have tripled in one month, although nowhere near the figures in April-May. Also, the seven-day average for daily fatalities have remained below five.  Says infectious disease specialist Anup Subedee: “It will still take some time and a few more variants before the pandemic comes to an end. So our health system should be ever ready with the management and treatment of Covid-19, isolation and contact tracing.” Virologist Pun at Teku agrees: “We are now moving from pandemic to endemic, but this does not mean that we can sound the all clear. We must continue mass vaccinations and safety measures.” The general consensus is that increased vaccine coverage with boosting, more testing, whole genome sequencing to detect variants, and public adherence to safety measures will determine whether there will be a new surge, or if the virus will taper off. Nepal has 20 million doses of vaccines in stock for those waiting for first and second jabs, and has started booster shots for high risk groups. However, communication on location, eligibility and requirements for <a href="https://www.nepalitimes.com/latest/all-vaccines-prevent-severe-covid/" target="_blank" rel="noopener noreferrer">vaccination</a> centres is confusing and inadequate. With reports from India, Denmark and the Philippines of the even more transmissible ‘stealth Omicron’ sub-variant BA.2 that can evade PCR detection, Nepal needs to continue vigilance. This is also important to determine if the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">Delta variant</a> is still circuiting and how dominant it is. “Our Covid figures from the last four days strongly suggest that we have passed the peak,” confirms Sameer Mani Dixit of the Centre for Molecular  Dynamics. “But we must keep a close watch on next week’s numbers to know for sure if the cases are just levelling off, still peaking, or if it was just a momentary decline.”

Sonia Awale

Omnipresent Omicron starts to lose its edge

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161124/636d17e59c7e80680e0ac790jpeg.jpg" alt="" width="696" height="547"/><figcaption>Mosquirix</figcaption></figure>The endorsement on Wednesday in Geneva by the World Health Organisation (WHO) of the new malaria vaccine Mosquirix has been described as a milestone for Africa, but experts doubt if it will be as useful in the Subcontinent.WHO described the Mosquirix injection as a groundbreaking discovery and recommended its widespread use among children in sub-Saharan Africa and in other regions with moderate to high Plasmodium falciparum transmission.Every year, malaria kills 260,000 children under five in Africa. The new vaccine, the first to be backed by the WHO for the mosquito-borne parasitic disease, reduces severe infections by 30%, which translates into 78,000 lives saved annually.“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” WHO Director-General Tedros Adhanom Ghebreyesus announced at a <a href="https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk">press conference</a>. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”The vaccine called RTS,S (trade name Mosquirix) was proven effective six years ago, and through successful pilot immunisation programs, has reached more than 800,000 children in Ghana, Kenya and Malawi since 2019.The landmark vaccine however may not be as applicable in Nepal and the Subcontinent because malaria parasite here is different. The new vaccine was developed to fight Plasmodium falciparum, but in Nepal and South Asia the dominant malaria-causing parasite is P. vivax. Only a few candidates for P. vivax currently under trial and rhe progress has been slow.“The vaccine, its studies and recommendation are all Africa-centric,” explains Buddha Basnyat, as physician at the Patan Academy of Health Sciences. “A malaria vaccine with 30% efficacy against severe infections is being welcomed, and yet Covid vaccines, all of them known to reduce complications and fatalities by 80-90% are still rejected by vaccine deniers.”The approval of the new vaccine does have a lesson for Nepal and the rest of the world for vaccine acceptance as the <a href="https://www.nepalitimes.com/banner/the-jabs-and-jabnots/">Covid-19 pandemic</a> continues to spread and make people sick.Malaria is one of the oldest diseases known to human and still infects over 200 million people annually – 95% in Africa. The WHO and the United States led the global campaign to eradicate malaria in the 1950s and 60s, and while the effort fell short in many countries with mosquitoes quickly developing resistance to the insecticides, the program was relatively successful in Nepal.While <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/">writing for this paper in 2018</a>, environmental historian Tom Robertson stated: ‘Just as malaria shaped Nepal’s past, its almost complete removal in the 1960s and 1970s has shaped Nepal’s present, launching vast demographic, environmental, and political changes that are still playing out.’He continued: “The near complete removal of the disease from Nepal meant that there were vast movements of people from the hill ridges to valley floors and to the Tarai, as well as movement north from the plains. There was large-scale deforestation and habitat loss, and tumultuous social and political reconfigurations.”In the coming decades, malaria control was further aided by mass campaigns to raise awareness about preventives measures such as maintaining hygiene, clearing stagnant waters, and the use of treated mosquito nets and repellants.However, there is no clear data to estimate the disease burden of malaria in Nepal at present. Despite its decreasing trend, climate change is said to be pushing parasite-carrying mosquitos to higher elevations in the Himalaya.In 2019, Kathmandu saw its biggest dengue outbreak yet with 80,000 infections in five months with <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">outbreaks also in higher altitudes</a> where mosquito-borne diseases were previously unheard of. There are also seasonal outbreaks of viral encephalitis, which is also spread by mosquito bites.“Vector insects are moving up the Himalaya as warming increases, and so are the diseases they carry. Climate change is leading to changes in the geographic pattern of diseases,” Meghnath Dhimal of the Nepal Health Research Council told Nepali Times in 2019.His research has shown that mosquitoes do not just travel to higher altitudes in vehicles, but increasingly complete their life cycles in what used to be colder places. Added Dhimal: “Not just dengue: at any moment you can also have outbreaks of Chikungunya, Japanese encephalitis and Zika in the mountains of Nepal due to global warming.”

New malaria vaccine may not help Nepal

<figure><img width="900" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141152/636d02ed9c7e80680e0a36a8jpeg.jpg" alt=""/><figcaption>Photo: NEPALI TIMES ARCHIVE</figcaption></figure><a href="https://www.nepalitimes.com/banner/how-weather-elevates-air-pollution-in-kathmandu/" target="_blank" rel="noopener noreferrer">Kathmandu’s air quality</a> has just got considerably worse, not just because of dirtier air, but because the World Health Organisation (WHO) has revised its Global Air Quality Guidelines, halving the recommended value for annual average pollution levels. Safe exposure to concentrations of harmful particles below 2.5 microns (PM2.5) in diameter every year has now been halved, meaning that many Kathmandu residents could be breathing much more <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener noreferrer">polluted air</a> than they throught.On 22 September the WHO updated its Air Quality Guidelines (AQG) such that annual mean concentrations of PM2 should not exceed 5 kg/m3 and NO2 not exceed 10 kg/m3. In addition, peak season mean 8-hr ozone concentration should not exceed 60 kg/m3. The 2005 guideline values for PM2 and NO2 were, 10kg/m3 and 40 kg/m3 respectively, with no recommendation for long-term suspended particles and ozone concentrations.Environmentalist Bhushan Tuladhar immediately took to twitter to respond to the new recommended standard for air quality: ‘The WHO just released its new air quality guidelines which have halved the guideline value for annual average PM2.5 in ambient air. This means Kathmandu, which had annual PM2.5 levels that were about five times higher than the WHO guidelines now have pollution levels that are 10 fold higher.’The new standards are ambitious and reflect the large impact of <a href="https://www.nepalitimes.com/editorial/polluted-politics/" target="_blank" rel="noopener noreferrer">air pollution</a> on public health, and experts hope that it will influence air quality policy across the globe. They recommend bold action to clean up the air at all levels and across all sectors such as transport, energy, industry, agriculture and residential.“Air pollution is a major global public health threat that causes a range of adverse health effects, even at the lowest observable concentrations. The updated guidelines offer a wake-up call, to reconsider current air quality legislation and regulations,” noted a joint statement released by the International Society for Environmental Epidemiology (ISEE) with the European Respiratory Society following the revised guidelines.It adds: “There is ample evidence to strongly support government action to reduce air pollution and address climate change simultaneously. But the most important message is that each reduction in the outdoor concentrations of key air pollutants brings health benefits to the surrounding population, even in places which already have low pollution concentrations.”Additionally, most jurisdictions with <a href="https://www.nepalitimes.com/here-now/solution-to-pollution/" target="_blank" rel="noopener noreferrer">clean air</a> regulations have relied on fixed limit values with little incentive to further reduce air pollution levels once compliance with the limit value is achieved. Given the evidence that health effects occur down to very low concentration levels, future clean air policies must include incentives for progressive lowering of exposures of the entire population, thereby improving health for all.The new <a href="https://www.nepalitimes.com/here-now/how-transboundary-haze-affects-nepal/" target="_blank" rel="noopener noreferrer">air quality</a> guidelines are not legally binding however but experts believe can represent a turning point in the way we approach air pollution globally, and in particular, South Asia where the air pollution levels are consistently high and the health burden is stark.“The new guidelines offer a benchmark for South Asian cities and countries to plan their air quality agenda. This will bring renewed interest in the topic and create an opportunity to push for stronger action,” says Pallavi Pant of Health Effects Institute based in Boston.She adds: “We know where we’d like to get to, and the real discussion now should be focused on the basket of strategies and sectors we need to address.”Air pollution, indoors and outdoors, accounted for some 12% of all death in 2019. Air pollution currently ranks fourth among major risk factors for global disease and mortality, only behind <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/" target="_blank" rel="noopener noreferrer">hypertension</a>, smoking and dietary factors.In terms of economic burden, the estimated global health-related external costs were $5 trillion in 2013 with an additional $225 billion in lost labour productivity as per the World Bank Group 2016.Here in Nepal, the new guidelines hardly made it to the news. Nepal doesn’t even have a minister for the environment because of a continued political stalemate.Successive governments in the recent past have made commitments to promote <a href="https://www.nepalitimes.com/here-now/cleaner-air-with-greener-buses/" target="_blank" rel="noopener noreferrer">electric vehicles and transport for clean air</a>, but they have done the opposite. Earlier this year in the budget, it reintroduced tax rebates. But only this week, Prime Minister Sher Bahadur Deuba’s government slashed taxes on the import of 10 or more diesel buses by new luxury hotels to 1%. It also cut by half the duty on petrol motorcycle assembly in Nepal.The Covid-19 pandemic and subsequent lockdowns over the last two years have shown people that the <a href="https://www.nepalitimes.com/banner/nepal-lockdown-proves-air-quality-can-be-improved/" target="_blank" rel="noopener noreferrer">goal of clean air can be achieved</a>, and it has become even more crucial at this point where the coronavirus cases are going down, vaccinations have picked up and businesses are reopening for the Dasain-Tihar festive season.“There is no shortcut to clean air, we need long-term policies that target major sources including transportation, use of wood/animal dung for cooking and heating, brick kilns, coal power plants, industries and waste burning,” adds Pant ,who is from India.She adds: “Access to clean energy for all is one key policy that can help reduce the burden of air pollution. It is also useful to keep in mind that air pollution is a multi-sectoral problem, and we must engage not just technical experts but also legal and policy experts, economists, healthcare workers and others in developing solutions.In the short term, especially as we approach the winter season, the government should ensure the public that <a href="https://www.nepalitimes.com/here-now/open-air/" target="_blank" rel="noopener noreferrer">air quality data</a> is accessible and understandable. With this information, the public can avoid outdoor activities during hours when the pollution is at its peak and reduce the prevalence of allergies and immediate respiratory illness.

Dirty Kathmandu air gets dirtier

<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 width="3675" height="2453" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08689c7e80680e0a6016jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The death of five children by drowning last month in Dhanusha made headlines. A week later, two boys drowned in a pit left by a brick kiln in Mahottari. On Friday, five people died of drowning in Banke and Chitwan.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/turning-on-the-heat/" target="_blank" rel="noopener noreferrer">Hot summers</a>, rivers in spate, and pits left by sand miners and brick kilns make up a deadly combination which means that drowning is a common occurrence across the country, particular in the Tarai. There is no nationwide tally, but <a href="https://uwe-repository.worktribe.com/output/870497/status-of-drowning-in-nepal-a-study-of-central-police-data" target="_blank" rel="noopener noreferrer">a 2015 survey</a> based on Nepal Police data found that there were 1,507 cases of drowning between January 2013 and December 2015.Nepal is among the most vulnerable countries to drowning with a death rate of 5.4 per 10,000 population, according to the world Health Organisation (WHO). The rate for Bangladesh and India are 4.6 and 3.8 respectively. It was much lower for Sri Lanka and the Maldives at 3.2 each, and 2.1 for Bhutan.In 2019, over 144,000 people drowned in the Asia-Pacific region, accounting for 61% of global drowning deaths, according to the <a href="https://apps.who.int/iris/handle/10665/343073" target="_blank" rel="noopener noreferrer">first regional assessments on drowning prevention</a> released ahead of World Drowning Prevention Day, which is being marked for the first time on 25 July 2021.Drowning claimed the lives of an estimated 70,000 and 74,000 people in the Southeast Asia and Western Pacific regions, respectively, and experts warn that <a href="https://www.nepalitimes.com/banner/nepal-villages-learn-to-cope-with-climate-crisis/" target="_blank" rel="noopener noreferrer">climate change</a> places already vulnerable communities and people at increased risk of drowning.More frequent and extreme weather events due to the climate crisis can lead to <a href="https://www.nepalitimes.com/banner/disasters-in-nepal-come-in-waves/" target="_blank" rel="noopener noreferrer">frequent and intense floods</a>, increasing the exposure of populations to potentially hazardous situations along waterbodies. “Despite many lives being lost each year, drowning remains a largely unrecognised threat to health and well-being,” says Poonam Khetrapal Singh, WHO Regional Director for south and southeast Asia. She adds: “We need to work across all sectors to develop national water safety plans and policies and implement tested and low-cost water safety interventions to prevent drowning and save lives. No child or adult should lose their life to drowning.”In Asia, most drowning deaths <a href="https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death" target="_blank" rel="noopener noreferrer">occur among children and men</a>. Of the 70,000 drowning deaths in the region in 2019, more than a third were among children aged under 15 years. On average, men were three to four times more likely to drown than women. Even in case of rescue or resuscitation, the survivor often suffers from severe brain damage resulting in memory problems, learning disabilities and permanent loss of basic function.The <a href="https://www.who.int/publications/i/item/global-report-on-drowning- preventing-a-leading-killer" target="_blank" rel="noopener noreferrer">best practices on drowning prevention</a> include day care for children, the use of barriers for controlling access to water, public awareness campaigns focused on behaviour change, and policies and legislation on water safety, including regulation of recreational boating and maritime transport.In Dhanusha tragedy, one of the girls had problems staying afloat in a pond and her four other friends died one after another while trying to save her. Construction contractors have left large gaping holes along river banks and road embankments that fill up during the monsoon and become death traps for children.WHO is initiating <a href="https://www.who.int/publications/i/item/preventing-drowning-an-impl ementation-guide" target="_blank" rel="noopener noreferrer">prevention measures</a> for children that include survival swim and water skills training in Bangladesh, India, Nepal, Sri Lanka and Thailand, community-based daycare for young children in Bangladesh, India and Thailand, and improved information systems and public awareness campaigns focused on behaviour change in Thailand."We are proud to be able to highlight, through these two reports, examples from our member states of leadership, innovation and strong partnerships within and beyond the health sector on drowning prevention,” says Takeshi Kasai, WHO Regional Director for the Western Pacific.

Death by drowning on the rise

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06f59c7e80680e0a5f92jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>The past year-and-half since the Covid-19 outbreak, Nepal’s limited health resources all had a singular focus. But now that the second wave is waning and the lockdown has been eased, hospitals are once again flooded with patients with <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener noreferrer">diabetes</a>, cardiovascular diseases and kidney ailments.Many of these patients had left these conditions untreated, and doctors say nursing them back to health will be more complicated. One of the most common disorders is hypertension or high blood pressure, which has become an epidemic.Hypertension is a silent killer and one of the most common causes of chronic conditions like <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener noreferrer">kidney damage</a> that are often too costly to treat for the majority of Nepalis. Now, mental stress due to Covid has also added to the problem.“Hypertension makes up for the majority of patients in hospitals these days now that the lockdown has been relaxed,” says cardiologist Prakash Regmi. “Also worrying is that many of these are new patients coming in due to Covid-related stress, a large number of people who had their blood pressure under control previously after treatment are also relapsing.”To be sure, Nepal has been seeing a dramatic rise in hypertension patients even before the pandemic – some of them in their teens and 20s. <a href="https://www.hindawi.com/journals/ijhy/2021/6610649/" target="_blank" rel="noopener noreferrer">A paper published in March</a> in the International Journal of Hypertension, shows that since 2000, the hypertension rate in Nepal has been increasing at 3.5% per decade, and 44.7% of Nepali men will be suffering from hypertension by 2025.The study also found that high blood pressure is disproportionately affecting men, the elderly, those without formal education, and those who reside in urban areas, and seems to be most common in Gandaki Province.Worldwide, an estimated 1.13 billion people have hypertension, and it is responsible for 9.4 million deaths globally every year. In 2015, 1 in 4 men and 1 in 5 women had elevated blood pressure.In Nepal, close to one-third of the adult population has some form of hypertension, but in urban centres the figure is as high as 40%, with 25% in rural areas suffering from it.There is no specific cause of hypertension, but its biggest risk factor is high sodium intake. A survey in 2020 revealed that on average, the mean dietary <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jch.13813#:~:text=Overall%2C%20estimated%20mean%20salt%20intake,d%20(SD%20%C2%B1%204.7)." target="_blank" rel="noopener noreferrer">salt intake of a Nepali</a> per day is 13.3 mg. Most of the world consumes double the WHO recommended 5g of daily salt intake, increasing the risk of heart disease and strokes, which kills some 3 million people annually worldwide.“Traditionally Nepalis have a preference for salty food, but now with higher consumption of processed and <a href="https://www.nepalitimes.com/banner/nepalis-binge-on-junk-foods-the-west-rejected/" target="_blank" rel="noopener noreferrer">junk food</a>, our salt intake has grown,” says public health expert Aruna Uprety, adding that the sodium content in packaged foods is often much higher than what companies claim.In May WHO (World Health Organisation) released a new set of <a href="https://www.who.int/news-room/events/detail/2021/05/05/default-calendar/launch-event-who-global-sodium-benchmarks-for-different-food-categories" target="_blank" rel="noopener noreferrer">global benchmarks for sodium levels</a> that will act as a guide for countries and industry to reduce sodium content in more than 60 categories of processed foods, in line with the global target of reducing salt intake by 30% and hypertension by 25%, both by 2025.Another prominent risk factor is mental stress and lack of physical exercise, both of which have been exacerbated with people staying at home for months and under the uncertainty of the pandemic. Family history of hypertension also plays a significant role in an individual developing high blood pressure, as does smoking and drinking alcohol.Undetected hypertension, and non-medication to control it, can lead to other disorders like stroke, heart disease, kidney failure, etc.Despite the huge burden of the disease on public health and the economy, treatment of hypertension is ill-managed. Patients are never diagnosed because often times there are no prior symptoms.And of the 50% who are diagnosed with high blood pressure, half ignore their condition and get no treatment. Of the remaining, 25% do get some kind of treatment but half of them again do not follow-up or take the correct dose of medication.“All in all only about 10% of hypertension patients get proper treatment in Nepal. Lack of proper health monitoring system, as well as misconceptions about life-long medications, hasn’t helped,” says cardiologist Prakash Regmi. “This often leads to a point where treatment is either too expensive, or even unmanageable.”Hypertension is first and foremost a lifestyle disease with strong ties to a possible failure of crucial organs in the human body. Its prevention and control are heavily dependent on an <a href="https://www.nepalitimes.com/banner/junk-food-is-making-nepali-children-shorter/" target="_blank" rel="noopener noreferrer">individual’s choice of diet</a>.A state-sponsored robust awareness campaign to focus on preventive measures and a strong healthcare system are urgently needed to reduce the epidemic of hypertension.Says public health expert Aruna Uprety: “Mandatory blood pressure check-ups for certain age groups at fixed intervals is a good place to start. It goes a long way in reducing the cost of the disease and human lives.”Stages of hypertension<ul style="font-weight: 400;"><li>Normal: Less than 120/80 mm Hg</li> 	<li>Prehypertension (Elevated): Systolic between 120-129 and diastolic less than 80</li> 	<li>Stage 1 (Moderate): Systolic between 130-139 or diastolic between 80-89</li> 	<li>Stage 2 (Severe): Systolic at least 140 or diastolic at least 90 mm Hg</li> 	<li>Hypertensive crisis: Systolic over 180 and/or diastolic over 120</li></ul>Types of hypertension<ul style="font-weight: 400;"><li>Primary or essential: Most common high blood pressure among adults. No specific cause but risk factors include diet, age, physical activity and genetics.</li> 	<li>Secondary: Up to 10% of hypertension is secondary. Most often caused by another medical condition or the use of certain medicines.</li></ul>Risk factors<ul style="font-weight: 400;"><li>High salt/sodium intake</li></ul>WHO recommendation: 5gm/day<ul style="font-weight: 400;"><li>Mental stress</li> 	<li>Lack of physical exercise</li></ul>WHO recommendation: at least 150–300 minutes of moderate-intensity aerobic physical activity<ul style="font-weight: 400;"><li>Family history of high blood pressure</li></ul>

Why do so many Nepalis have high blood pressure?

<figure><img width="1430" height="872" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111015118/636d06329c7e80680e0a5f4djpeg.jpg" alt=""/><figcaption></figcaption></figure>A group of European, Nepali and Bhutanese personalities have sent an <a href="https://www.petitions.net/vaccines_to_himalayas" data-saferedirecturl="https://www.google.com/url?q=https://www.petitions.net/vaccines_to_himalayas&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNEuu109cz_uT0mzvuFORxCpVo-70A">open letter</a> to the European Commission, asking it to allow member states to send surplus vaccines directly to Nepal and Bhutan, by-passing delays through COVAX.
EU member states have millions of doses of excess vaccines, but donations or transfers of these surplus doses are severely constrained by the <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNEOGELikZJFPj6cPmuERuwgR5_tDA">contracts between EU, member states and vaccine manufacturers. </a>
‘We appeal to European Commission to facilitate a mechanism which would allow member states to transfer vaccines bilaterally to other countries or enable member states to target their vaccine contributions multilaterally to the countries where it is most urgently needed,’ the appeal states. 
Millions of people in Nepal and Bhutan are in urgent need of Covid-19 vaccines, especially AstraZeneca, in order to vaccinate their citizens with second doses. Nepal needs 1.4 million doses immediately for people above 65 years who got their first doses, and are still waiting for their second jabs because India banned the export of Covishield AZ. 
Nepal has not even got an additional 1 million doses<a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/&amp;source=gmail&amp;ust=1625660311215000&amp;usg=AFQjCNG91MGxSlsuyUqVeeU6-wQZv9jkrg"> it already paid Serum Institute of India for</a>, and needs a further 20 million doses for the rest of its population. Nepal government is buying 4 million doses of VeroCell from SinoPharm in China and the first of the weekly shipments will start arriving on Thursday. 
Similarly, Bhutan has inoculated most of its eligible population of 500,000 with Covishield AZ from Serum Institute India, but only with their first doses. 
Some European countries like Denmark, Norway and the Czech Republic have excess AZ vaccines which they want to send to Nepal and Bhutan directly, but they are constrained by legal agreements to go through the EU and COVAX.
However, WHO’s COVAX facility has also not been able to dispatch promised vaccines to Nepal, Bhutan and other developing countries because it had sourced it from Serum Institute India. COVAX has only sent 835,000 of the 2.26 million it promised before India stopped its export. 
Nepali officials disclosed this week that 1.5 million doses of Johnson &amp; Johnson vaccines from the United States through COVAX would be delivered later this month.
The open letter states: ‘While COVAX is a fair mechanism of vaccine distribution among the low and mid income countries, its prioritisation is not taking into account the receiving country's actual situation amid Covid-19 pandemic, its specific vaccination needs and its vaccine administration preparedness. Ability to direct at least part of the available supplies to the places where the vaccines are currently most needed would overcome these shortcomings.’ 
Despite the urgency of second doses, the COVAX mechanism prioritises countries by population and not by the current pandemic situation. The open letter argues that European countries have stockpiles of vaccines that are nearing expiry, and the European Commission could expedite shipments if it facilitated direct transfer of doses from EU member states.  
It also says that by denying the requests by Bhutan and Nepal for direct vaccine donations, EU is ‘damaging its international image ... and reinforces the EU’s stereotypical image as bureaucratic, inflexible and alienated’. 
It says failure to respond to the urgent requests from Nepal would hurt the EU because other vaccine manufacturing countries ‘are successfully using vaccine diplomacy to increase their soft-power’. 
Signatories of this open letter are known personalities from EU countries, Nepal and Bhutan. This includes members of European Parliament Tomáš Zdechovský and Kateřina Konečná, academics Françoise Pommaret and Karma Phuntsho, former under secretary general of the United Nations<a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNHDSyw9q0gS0XWMLZzZS82mvNgKcg"> Kul Chandra Gautam from Nepal, </a>artists, mountaineers, activists, public health workers and others. 
Other prominent Nepalis include writers Manjushree Thapa and Budhhisagar, as well as former Miss Nepals Malvika Subba and Srinkhala Khatiwoda.
The open letter idea was initiated by a group of Czechs with close ties with the Himalaya who sent an earlier open letter to the Czech Government calling on it to gift its surplus vaccines to Nepal and Bhutan. 
“In subsequent unofficial consultations, it became clear, that Czech Government is not at a liberty to donate or sell its excess doses of AstraZeneca vaccine due to the constraints of the contract between EU, Czechs and the vaccine manufacturer,” explained photographer Michal Thoma, one of those behind the initiative. “It also became apparent that the same situation applies for other EU countries which purchased vaccines through the EU vaccine procurement mechanism.”
So Thoma teamed up with Věra Exnerová, the Nepal Country Director of humanitarian organisation People in Need, mountaineer Jan Tráva and filmmaker Petr Horký to write to the European Commission with other Nepalis and Bhutanese.
On 1 July, Denmark announced that it would donate 250,000 vaccines to Bhutan. However, it is understood that these grants still need to be facilitated by the EU. 
Says Thoma: “The European Commission should stand up to its responsibility so that the EU can fight the pandemic not only within its borders but everywhere else around the world.” 
Those interested can sign the petition at <a href="https://www.petitions.net/vaccines_to_himalayas" data-saferedirecturl="https://www.google.com/url?q=https://www.petitions.net/vaccines_to_himalayas&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNE8S4KxCeyaljq2uj4jL7emQuTHgg">https://www.petitions.net/vaccines_to_himalayas</a>.
Full Text of the Open Letter:
European Commission Ms Ursula von der Leyen President of the European Commission 
Open Letter to the European Commission to facilitate direct transfers of excess Covid-19 vaccines from EU member states to the countries with most urgent needs, namely Nepal and Bhutan 
Dear Commission President von der Leyen, 
We would like to bring to your attention the pressing issue of excess vaccines which were purchased by the member states through the centralized EU vaccine acquisition mechanism. Many of these vaccines, such as Vaxzervia produced by AstraZeneca, are not being administered or their use in most EU member states is substantially restricted. As a result, millions of doses are now idly awaiting other allocation. 
Many foreign governments, namely Bhutan and Nepal, asked for donation or purchase of excess vaccines from EU member states. Many public initiatives in EU member states also appealed to their respective governments to facilitate transfer of excess vaccines to Nepal and Bhutan or other mid and low income countries. 
However, EU member states are not in liberty to donate the surplus vaccines directly due to the legal constraints of the contracts between vaccine manufacturers, member states and EU. 
We, an informal group of people with close relationship to the Himalayas, namely Bhutan and Nepal, are nonetheless convinced that these countries, currently affected by regional outbreak of Delta variant, would be best helped by direct vaccine donations. Nepal and Bhutan urgently need almost two millions doses of AstraZeneca vaccine in order to administer second rounds to its citizens. Unfortunately, it has been reported by the media that WHO’s COVAX facility asked Nepal and Bhutan to request doses from other vaccine manufacturers. This may cause delays and complications for rapid response to fight against Covid-19 pandemic in these countries.
We thus appeal to European Commission to facilitate a mechanism which would allow member states to transfer vaccines bilaterally to other countries or enable member states to target their vaccine contributions multilaterally to the countries where it is most urgently needed. 
The reasons for above are as follows: 
<ol><li>While COVAX is a fair mechanism of vaccine distribution among the low and mid income countries, its prioritization is not taking into account the receiving country's actual situation amid Covid-19 pandemic, its specific vaccination needs and its vaccine administration preparedness. Ability to direct at least part of the available</li>
</ol>Prague, 6th July 2021 
supplies to the places where the vaccines are currently most needed would 
overcome these shortcomings. 2. By denying the foreign government requests for direct vaccine donations, EU 
member countries and the EU itself is damaging its international image. At the same time, other vaccine manufacturing countries are successfully using vaccine diplomacy to increase their soft-power and will certainly yield from that in the future. 
<ol start="3"><li>Inability to react positively to the appeals of member states’ citizens to donate vaccines to countries in urgent need reinforces the EU’s stereotypical image as bureaucratic, inflexible and alienated. Allowing member states and its people to decide on how to distribute the excess of vaccines would counteract such feelings among EU citizens.</li>
<li>The USA just recently decided to distribute its excess vaccines partly through COVAX and partly bilaterally according to US foreign policy prioritization. We believe that this is an example to follow.</li>
</ol>On top of that, many EU member states will soon have vast caches of soon to expire vaccines for which there will be no recipients among the EU citizens. In such a case, European Commission should pave the way for the member states for the swift transfers of such expiring doses to the third countries which are ready to receive and administer such supplies in the short time. 
We would like to request you to consider the above points thoroughly. We have full faith and hope in the European Commission's ability to make the right decisions that would be taking into account a global responsibility of the EU as well as the international relations priorities and wishes of EU citizens. 
Yours sincerely, 
Michal Thoma, photographer and writer, Czechia 
Věra Exnerová, Nepal director of the humanitarian organisation People in Need, Czechia 
Jan Tráva, mountaineer, Czechia 
Petr Horký, filmmaker, Czechia 
Kunda Dixit, editor and publisher of <a href="https://www.nepalitimes.com/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com&amp;source=gmail&amp;ust=1625660311216000&amp;usg=AFQjCNFueSB5zZbscyAgy7DPVj7QFyZZuQ">Nepali Times</a>, Nepal 
Françoise Pommaret, ethnohistorian and Tibetologist, France &amp; Bhutan 
Karma Phuntsho, Loden Foundation, Bhutan and Cambridge University, UK 
Stanislav Tomka, entrepreneur, Slovakia 
Gabriel Točka, Namasté, Society for Nepal-Slovakia Friendship, Slovakia 
Zdeňka Karky, former Czech honorary consul in Nepal, Czechia 
Kul Chandra Gautam, former deputy executive director of UNICEF, Nepal 
Manjushree Thapa, essayist, fiction writer, translator and editor, Nepal &amp; Canada 
Tomáš Zdechovský, Member of European Parliament, Czechia Buddhisagar, writer, poet, columnist, author of Karnali Blues and Firfire, Nepal 
Saurav Dhakal, curator, Story Cycle, Nepal 
Malvika Subba and Shrinkhala Khatiwoda, both Miss Nepal, Nepal
Buddha Basnyat, Himalayan Rescue Association and Mountain Medicine Society of Nepal 
Kateřina Konečná, Member of European Parliament, Czechia 
Šimon Pánek, director of the humanitarian organization People in Need, Czechia

Nepal-Bhutan vaccine appeal to European Commission

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b920a9c7e80680e06f125jpeg.jpg" alt="" width="2048" height="1466"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>South and southeast Asian countries have in recent months witnessed a  sharp and sustained surge of SARS-CoV2 infection. For consecutive  weeks in April and May, the region has reported more than 2 million new cases, with some areas reporting test positivity rates of upwards of 40%.Variants of concern and their sub-lineages have been detected in several countries, and may be associated with increased rates of transmission. Both the Region and world are at a critical moment in the battle against  Covid-19. No country is safe. We are all at risk.Populations are exhausted. For almost 18 months they have doneeverything they can to protect themselves and their loved ones, and yet we are still very much in the acute phase of this pandemic. Vaccine euphoria and the complacency it can bring are real dangers, especially as some countries return to normal.In our own region, we must continue to sustain and scale up the response, and see this challenge through. But how must south and southeast Asia forge ahead?First, by aggressively applying the public health and social measures that are proven to be effective, and which are our best defence against new variants. Physical distancing works. Mask use works. Hand hygiene works.Ventilation, testing, contact tracing, and isolation – they all work to control spread, save lives and minimise impact. We must continue to act on the 3Ws – wear a mask, wash hands and watch distance. And we must continue to avoid the 3Cs – crowded places, close-contact, and confined spaces.Second, monitoring and expanding health system capacity to ensure it can meet population needs, whatever the caseload. In the event of a surge in cases, step-wise plans must be activated to enhance space, staff and  supplies – including oxygen and beds – and to heighten coordination between and among facilities.Essential health services must continue to be maintained to ensure that all people can access the services they require to stay healthy and well--one of the Region’s key points of focus throughout the pandemic response.Third, vaccinating priority groups, as defined in national deployment and vaccination plans. Amid ongoing supply challenges, countries should optimise the use of available doses to expand protection among priority groups and maximise public health benefits.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b920d9c7e80680e06f126jpeg.jpg" alt="" width="532" height="175">Political and public support for vaccination must continue to be promoted, while acknowledging that vaccination alone will not end the pandemic. It is imperative that countries with a surplus of doses share them with the COVAX Facility, which aims to deliver 2 billion doses to participating low-and middle-income countries globally by the end of 2021.We must all do our part. False rumours and misinformation can increase risk-taking behaviours, facilitate disease transmission, and intensify or lengthen an outbreak. They can cause confusion and erode social trust, which is among the most important elements of any outbreak response.Before sharing information, consider its source, and whether the information is verified and reliable. Be an ambassador of high-quality information, which can be accessed online via WHO’s website and social media accounts, and those of national and local authorities.No person or community can be left behind. Across the world, Covid-19 has disproportionately impacted key demographics, who for a range of social and economic reasons, may be more susceptible to transmission, or may struggle to access health care. This is not only inequitable, but also inefficient.In all countries of the Region, equity must continue to be a core feature of Covid-19 decision-making, whether on access to testing and treatment, or the provision of social and economic protection.We must go hard, and go all out. Since the beginning of the pandemic, WHO has provided countries in the region critical guidance and support, which has in recent months included thousands of oxygen concentrators, millions of respirator masks, and a series of auxiliary health facilities.Thousands of staff have been repurposed in support of national response efforts. Countries in the region continue to reap life-saving benefits from the Access to Covid-19 Tools Accelerator, which is the fastest, mostcoordinated, and successful global collaboration in history to accelerate the development, production, and equitable access to Covid-19 tests, treatments, and vaccines.It is only through solidarity, and by sustaining region-wide resolve, that we can drive infection down, prepare for and prevent new waves, and bring evidence-based treatments and technologies to all who need them. Lives and livelihoods are at stake. We must all stay the course.Poonam Khetrapal Singh is the World Health Organization (WHO)  Regional Director for South-East Asia.

No country is safe until we are all safe

One smoggy winter morning in February 2019, Ekta regretted coming to her sculpture class. It was the first day of her period, and the 19-year-old wished she was home, curled up in bed with a hot water bag to soothe her cramps.
Her class was at Kalapremi Ceramic Studio, a dark room on the ground floor of a house in Maharajganj, and Ekta’s teacher was the artist Gopal Das Shrestha ‘Kalapremi’, a noted sculptor.
Two other students were already there, using all their muscle strength to knead the sculpting clay. Ekta, now 24, recalls how Kalapremi asked her if she was feeling all right. She avoided him, as she did not want everyone to know she was menstruating.
Kalapremi repeatedly asked Ekta what was wrong. She finally muttered that she was having her period, after which he grabbed her hand and led her to a partitioned corner of the studio and sat her on a chair. Before she could stop him, he slid his hand under her dress, and started massaging her abdomen.
“I was horrified,” Ekta recalls. “I told him to stop, but he didn’t listen, asking me not to be shy, saying he knew how to relieve my pain. He stopped only after I protested furiously.”&nbsp;
The art tutor then said, “You’re like my daughter. I’m doing it out of love to make you feel better, but you’re so stubborn.”&nbsp;
“Instead of saying sorry he acted like I was the one having crazy thoughts,” remembers Ekta, adding that from April 2016 to August 2020 beginning the time she was 16, the artist sexually abused and harassed her on several occasions. &nbsp;
Now, Ekta and the artist’s other former students are finally sharing their experiences and some are pressing legal charges against him, hoping that others do not have to endure what they did.&nbsp;
Award-winning artist and teacher Gopal Das Shrestha ‘Kalapremi’ (the name means ‘Art Lover’) is known for his ceramic art, sculpture, and contemporary pottery. He was <a href="https://nepalitimes.com/review/the-house-of-kalapremi">profiled in Nepali Times after a collaborative exhibition</a>, ‘Where the Wild Things Are’ at the Siddhartha Art Gallery three years ago.&nbsp;
His pieces, titled Gaalis, featured sculpted female figures with the heads of dogs, sheep, and donkeys (pictured) to depict derogatory terms for women. Some critics said the collection was a satire on feminists.
Kalapremi started his artistic and teaching career in 1983 and over the years taught at Bhanubhakta School, Kathmandu University School of Arts, Lalitkala Campus and at his private Kalapremi Ceramic Studio. He has also lectured at Jeonju University in South Korea and recently at Tabor Academy in the United States.
Seven of Kalapremi’s former students were interviewed for this story. Five female students said he touched them inappropriately in his studio or at Kathmandu University. Two male students said they witnessed him abuse and harass the women. In all cases, the students struggled to recognise the abuse when it occurred, and the lack of reporting systems left them to cope on their own for years.&nbsp;
Earlier this year, students shared a social media post hinting at Kalapremi’s history of abusive behaviour following which more students of the artist reached out sharing similar experiences. Some students spoke of abuse that happened as long as 20 years ago.
Kalapremi, 60, has denied the allegations. He told Nepali Times: “Some years ago, there was a movement encouraging people to hug and kiss. I used to do it purely out of friendship and love. But after seeing posts on social media last year calling out my behaviour, I realised my actions may have hurt some people. I understand now that I should have been more mindful.”
He added: “I am also an auxiliary health worker, so I know the exact points to massage to relieve menstrual pain. It’s not just menstruation, I take anyone who is ill to the hospital.”
Sexual abuse is much more rampant than reported given how difficult it is to prove it in court. The law defines sexual abuse as occuring when someone touches another’s private parts, coerces them into touching theirs, uses vulgar language, shows degrading images, or behaves indecently towards them without consent.&nbsp;
Ekta and her fellow students are consulting lawyer Suneeta Regmi Pokhrel, who says they know that even if the court decides in their favour, it is difficult to survive after speaking up, and influential men defend themselves saying they are being framed.&nbsp;
“They are in a lot of pain and weep when recalling how he abused them,” Regmi Pokhrel told us. “They are angry and have filed a case against him, but they are also terrified. They know he is a powerful man and they have seen how our society treats women who speak up against abusers. Unless people speak up, perpetrators will be emboldened.”
Art and academia in Nepal simply reflect the power imbalances in society where people with intersecting identities experience worse forms of abuse. Theatre actors Raj Kumar Pudasaini, Rajan Khatiwada, and Sunil Pokhrel were called out during the #MeToo movement in the Nepali theatre scene in 2019. Even after the allegations Pokhrel went on to receive national awards, while others continued to work without repercussions.
“If you speak up against abusers, you gradually get sidelined from projects,” explained a theatre artist who wished anonymity fearing professional setbacks. “The theatre scene in Nepal is quite small, you just have to make peace with the perpetrators and work with them if you want to sustain yourself.”&nbsp;
In academia there is a history of faculty members sexually harassing students and getting away with it. After Tribhuvan University (TU) lecturer Krishna Bhattachan was accused of harassing women students, the university said it would follow Nepal’s sexual harassment law and set up a reporting mechanism. But nothing happened to the professor, who had already retired. Instead, he counter-accused the students of 'attacking the indigenous people’s movement with baseless allegations' as <a href="https://kathmandupost.com/letters/2019/01/29/bhattachan-responds">he told the Kathmandu Post in 2019</a>. He continues to be featured as a prominent speaker including at TU.
Other faculty members previously accused of sexual harassment include Jagadish Murti Koirala from TU, Bishnu Prasad Acharya from Ratna Rajya Campus, and Bodha Raj Tripathee from Lalitpur Madhyamik Vidhyalaya. A woman staff member from TU also filed a sexual abuse complaint against Dambar Chemjong from TU.
Prominent figures like <a href="https://nepalitimes.com/news/the-rise-and-fall-of-nims-purja">mountaineer Nims Purja</a> have been <a href="https://www.nytimes.com/2024/05/31/sports/mountaineering-sexual-harassment-abuse-nims-purja.html">accused of sexual assault</a>, and cricketer Sandeep Lamichhane, actor <a href="https://nepalitimes.com/news/celebrity-rape-case-spotlights-nepal-laws">Paul Shah</a>, and former speaker of Parliament <a href="https://nepalitimes.com/news/mahara-arrested">Krishna Bahadur Mahara</a> have been accused of rape, but society-at-large has let off the alleged perpetrators amdist a larger debate about justice for survivors and punishment of perpetrators.&nbsp;
‘Gaushala-26’ is the court name given to the 18-year-old who accused Sandeep Lamichhane, former captain of Nepal’s national cricket team and skipper of Biratnagar Kings in the <a href="https://nepalitimes.com/here-now/here-comes-the-nepal-premier-league">ongoing Nepal Premier League</a>, of rape. She left the country citing society questioning her character affecting her mental health while Lamichhane got an outpouring of support. In May, the Patan High Court overturned a prior verdict that found Lamichhane guilty of rape and had sentenced him to eight years in prison. During the 23-month legal battle to pursue justice, Gaushala-26 faced threats of gang rape and acid attacks.&nbsp;
Exhausted by the struggle, Gaushala-26 sought to “move to a new world” where she could live free without hiding her identity.
Actress Samragyee Rajya Laxmi Shah in an Instagram video now deleted detailed the harassment she faced from a filmmaker during a movie shoot. She did not name any name but veteran actor Bhuwan KC filed a defamation case against Rana, but the court ruled that the charge lacked sufficient evidence.&nbsp;
Former Kathmandu mayor <a href="https://nepalitimes.com/opinion/theytoo">Keshav Sthapit also mocked the #MeToo movement</a>, calling accusations against him by journalists Rashmila Prajapati and Ujjwala Maharjan “a rape of men’s rights”.
Serial Abuse
Back at the Kalapremi Ceramics studio, another former student, 24-year-old Rajiv, says he felt the need to speak out after seeing his female classmates being abused.&nbsp;
“He frequently kissed them on their cheeks,” he told Nepali Times. “Whenever they walked into the studio he flailed his arms like a child asking for a hug. They awkwardly hugged him from the side, but he pulled them closer, held their chin, and kissed their cheeks.”&nbsp;
Rajiv says he also saw Kalapremi pull the women’s bra straps, touch their breasts, and slap their buttocks. The young students would freeze, not knowing how to react, and if they protested, he would say it was “normal in art”. Rajiv, 19 at the time like his classmates, remembers thinking perhaps the well-respected artist was right after all.
Another student, Luna, who took lessons at Kalapremi’s studio from 2020 to 2022 did try to confront the tutor after he made an obscene proposal to her. She recalls: “One day when the other students had left the studio and it was just the two of us, he told me that God had given him special artistic talent and he could transfer those powers to me. But to do that both of us will have to be naked, inside a dark room, and have sex.”
Luna, who was 18 then, was livid and told him she did not want any of his powers, but she says he laughed at her as if he was joking. She did not tell her family about the incident because she thought no one would believe her.&nbsp;
“They were all in awe of this famous artist and felt I should be grateful that to be learning sculpting from him,” she says. “I was scared to be alone with him in case he talked about sex again. My coping mechanism was to be rude so he wouldn’t try to come close to me.”
Seeing how some classmates were standing up to Kalapremi, Ekta too tried to push back against his advances, but she said he found ways to coerce her. Since Ekta, Rajiv, and Luna could not afford Kalapremi’s Rs30,000 monthly fee for lessons, he had offered them all a stipend to assist him in the studio.
“He had spondylosis and took me to his therapy sessions to learn massage techniques, then he often made me and other students massage him,” says Ekta. Whenever she refused, he would feign pain to make her feel sorry for him. “He would insist that I put my hands under his shirt so that I could massage him better,” she adds.
The art tutor often tried to “seduce sympathy” from Ekta by sharing how he had never been loved as a child and was “sexually frustrated” as an adult.&nbsp;
“At 7PM, he would pour himself Signature whiskey and immediately go off again about how he was sex-starved. I didn’t know how to respond. It took me time to realise alcohol was just an excuse to talk about sex,” Ekta says.
If convicted, Kalapremi could face financial penalty and/or a prison sentence of up to three years according to Section 224 of National Penal (Code) Act 2017.&nbsp;
Data suggests that victims of child sexual abuse on average take nearly 24 years to tell someone about their trauma, and some may never disclose it at all.&nbsp;
“In our culture, children are rarely taught about boundaries. They often react, show anger when adults pinch their cheeks. But adults insist they did it out of love, and force the children to accept it,” says Sita Lama, a psychotherapist at Manka Kura. “And even when someone touches them inappropriately they struggle to identify and verbalise it.”
When perpetrators claim to be “acting out of love”, Lama says survivors are likely to perceive it as something safe, rather than recognising it as abuse.&nbsp;
“It may take years for them to realise they were abused,” she explains. "And even when they become aware, the power imbalance with the abuser and the associated shame often prevents survivors from speaking up."
Other former students from the School of Art at Kathmandu University have also come forward years later, saying Kalapremi sexually abused them. As young adults, they felt his behaviour was off but were uncertain if it was inappropriate, illegal, or they did not know how to respond. After having understood that it was indeed abuse, they say they are speaking out now to protect others.&nbsp;
Amina Singh, a visiting faculty member at Kathmandu University, says there is no clause against sexual abuse in contracts of teachers, and there is no formal grievance handling mechanism for the students.&nbsp;
“So the only way students can to deal with sexual abuse is approach someone they trust,” she says.
Eight other former art students of Lalit Kala Campus and Srijana College of Fine Arts of Tribhuvan University and other private art studios in Kathmandu say they were also sexually abused by their art teachers. Three faculty members interviewed from these institutions said they saw the abuse, but felt it was futile to report it given how powerful the teachers were.
In the absence of a formal system, some longtime women artists warned each other about “problematic” artists. They shared &nbsp;a “heads-up” to be more cautious when collaborating with them, and avoided responding to their calls and texts after work hours.
To ensure art institutions are safe for all, galleries, museums, artist studios, and smaller art spaces need to develop policies on sexual harassment. This would include a code of conduct or studio policies that hold the leadership accountable and outline the principles of professional ethics.&nbsp;
Students and employees should inquire about accountability mechanisms for raising concerns, both formally and informally, advocates say.
Three years after Ekta left the ceramics studio, she learnt that Kalapremi had harassed many other women. Still trying to get a footing in the art industry, she attended a workshop in Kathmandu where women artists discussed ways to stay safe in the art sector.&nbsp;
Since it was a close-knit group Ekta opened up about how she felt violated and realised she was not alone, he had been abusing underprivileged students for years, and this was common knowledge among artists in Nepal.
Ekta says that even after she quit, Kalapremi continued sending her text messages like ‘I am thinking of you’, ‘Why have you stopped speaking with me’, or ‘I am waiting for your call’.&nbsp;
But what really forced her to act was when Ekta found out that he was sending similar texts to her younger sister.&nbsp;
“I’ve had enough,” she told us. “He abused me all these years but I won’t let him abuse my sister.” &nbsp;
Ekta, Rajiv and Luna are not the real names of the students.&nbsp;

‘Art Lover’ accused of sexual abuse

It was 8:15 in the evening of 25 March 1968 when everyone in the village of Batulechaur near Pokhara heard a deafening sound like thunder as a bright flashing object hurtled down to land in a field.&nbsp; That field belonged to Kul Timilsina, and the next morning he retrieved a sheet of metal about 2m by 1m and carried it home with the help of a few others, thinking it would be useful for his buffalo shed.&nbsp; Before he died at age 83 three years ago, Timilsina had told photo archivist Sunil Ulak that the black metal sheet was not rectangular and had rounded corners. There are a few witnesses still alive who have a clear recollection of the object that fell from the sky that night.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014.jpg" data-media-id="editor_0" data-image-id="2024120707128_75cc85aac56b9cc4a77366471f058d7b3eb6868776811b0923845c2d0a61f014" data-rendition-name="original" width="1170" height="601" loading="lazy" alt="UFO over Pokhara"> <figcaption>The field in Batulechaur belonging to Kul Timilsina where fragments of a flying object fell from the sky in 1968.</figcaption> </figure>  One of them is Timilsina’s wife Gyanu, who was 22 at the time. She had been at home, and remembers hearing the big bang and the sky becoming very bright. “We saw the thing in the field in the morning,” she told us. “It looked like a lid, a covering of some sort. The way it was stuck in the ground, it must have fallen from the sky. We thought we could use it to dry clothes on, and took it home.”&nbsp; Another witness is Kul Narayan Paudel. “I was only eight then. We ran to the field to see what had fallen. It was a four-sided metal sheet. The elders took it away, and I don't know what happened to it.” &nbsp; Ram Bahadur Baniya, a teacher at the local school, says he had heard the sheet had been brought to the school, and later handed over to the Zonal Commissioner at the time, Nanda Prasad Malla. “But that is all hearsay,” he says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54.jpg" data-media-id="editor_1" data-image-id="2024120707128_0bf207a12063fb8155b3c8d9a00a94887b126380c9e0627527c84cf5e1101f54" data-rendition-name="original" width="1170" height="610" loading="lazy" alt="UFO over Pokhara"> <figcaption>Gyanu Timilsina, wife of Kul Timilsina.</figcaption> </figure>  There are two versions of what happened to Kul Timilsina’s metal sheet. One is that an American Peace Corp Volunteer teaching at the nearby Bindyabasini School took it, and another is that it was handed over to the government. Recently declassified Central Intelligence Agency (CIA) and US State Department documents from the time say that the US Embassy in Kathmandu tracked down the object two years later and had it shipped back to the US. A telegram from the Department of State and Department of Defense tagged as ‘MOON DUST / Space Fragments’ dated 1 March 1972 stated: ‘1. Restored space fragment will be on board Embassy support flight 115 arriving Kathmandu on or about March 10. Fragment is packed in shipping crate (cargo no. 72-33365) marked in care of DAO.&nbsp; 2. State and Defense representatives examined fragments prior to shipment finding restoration acceptable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df.png" data-media-id="editor_2" data-image-id="20241207071212_929d903ee06d41baa4f6040e981cd7c7d7bd75cc9c37c9b617d307fc8538d2df" data-rendition-name="original" width="856" height="568" loading="lazy" alt="UFO over Pokhara"> <figcaption>Declassified CIA documents about the investigation into the object sighted in Pokhara. </figcaption> </figure>  The documents show that the US government, military and intelligence agencies investigated this incident thoroughly when it occurred, and have continued to revisit it ever since, as recently as five years ago. What is even more intriguing is that the object that fell in Pokhara was not the only unidentified space object that fell to earth that year. There were similar sightings of objects falling from the sky in Ladakh, Sikkim and Bhutan between 19 February and 25 March 1968.&nbsp; These mysteries were the subject of a CIA investigation in 1968 titled ‘<a href="https://www.cia.gov/readingroom/docs/CIA-RDP81R00560R000100070007-8.pdf">Sighting of Unidentified Flying Objects in Ladakh, Nepal, Sikkim and Bhutan</a>’, and the report is part of the recent online declassification of 800,000 top-secret documents from the period.&nbsp; &nbsp;Although unidentified flying objects (UFOs) have a connotation now of being alien craft, it could be pieces of satellite, missile, rocket or even aircraft. The CIA report documents six sightings in 1968 and quotes local sources as describing all of them having similar characteristics: bright blue or red streaks in the sky accompanied by loud sounds like lightning and thunder and objects falling to the ground. Aside from the metallic object that was found in Batlechaur, there were other items also found nearby in Tallakot, Tureypasal, Armalakot and Maidan. Whatever the object was, it seems to have disintegrated even before it hit the ground.&nbsp; The CIA report records the first sighting on 19 February 1968 in various parts of Sikkim and Olangchung Gola and Ghunsa in eastern Nepal. The light was said to be ‘long and thin’ and giving out ‘green and red light’. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb.png" data-media-id="editor_4" data-image-id="20241207071212_c3c825027d966a2aedc846970390eebe063957503c7eacc8e01e0517843f9bbb" data-rendition-name="original" width="892" height="596" loading="lazy" alt="UFO over Pokhara "> </figure>  Two days later on 21 February, a soundless blue object was seen traveling fast across the sky above Thimphu in Bhutan. Then on 4 March there were multiple daytime sightings or white streaks in the sky at Chang La Pass, Fukche and Koyul in Ladakh. There were more sightings in Ladakh on the very day fragments fell near Pokhara on 25 March 1968.&nbsp; After the sightings in Pokhara, rumours started flying in Kathmandu that these were aliens trying to land on Earth, it could be Russian or Chinese spy planes or satellites, and some even say it as a sign from heaven that the end of the world was near. This was at the height of the Cold War. The Russians and Americans were testing their thermonuclear devices as well as intercontinental ballistic missile delivery systems. The Washington-Beijing rapprochement had not yet happened, and China was making quick progress testing atomic bombs. Within two years after its first atomic test, in 1966 China exploded its first hydrogen bomb at the Lop Nur site in Xinjiang, 3,000km to the north from Nepal. After neary six decades, what is still intriguing is that all the sightings within a few months of each other in 1968 were along the Himalayan arc bordering Tibet: from Bhutan, Sikkim Nepal, to Ladakh. The US military intelligence seems to have concluded that this was not a coincidence and there were frequent research trips to the site in Pokhara by American officials in the months after the incident. With the help of the Royal Nepal Army, the region north of Pokhara was thoroughly searched.&nbsp; A confidential memo dated 25 June 1968 by Jerry C Trippy to a ‘Mr Farley’ mentions that the US Air Force’s Foreign Technology Division had decided that the debris could be important because it may be related to a Chinese missile test or a Soviet ‘Vehicle Venik’ rocket.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe.jpg" data-media-id="editor_5" data-image-id="20241207071216_feb5425692dc36b20187de4e4fcc2ce9fd12b6d9e1b8724398e50bcdbf9032fe" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="UFO over Pokhara"> </figure>  On 28 August 1968 the US Embassy in Kathmandu sent a letter to Washington DC saying that the object could be of Soviet origin, possibly from when the rocket carrying the ‘Kosmos 208’ satellite re-entered the atmosphere. But why were the fragments falling to earth several weeks apart, and in the same region? No one knows where the metal sheet that Kul Timilsina recovered is now. It was definitely packed in a crate and taken to the US, and although it is rumoured that it was returned that is not very likely. Archivist Sunil Ulak heard from the Timilsina family that CIA officials had returned to the site five years ago. &nbsp; Interest in UFOs peaked in the US in the 1950s, with the Cold War space race and tests of atomic weapons and delivery rockets. CIA and scientists were being sent to investigate sightings, both publicly and privately. Could the Pokhara fragments as well as the sightings in Ladakh and Bhutan actually be alien craft falling to earth? The renewal in interest in space travel in large part due to Elon Musk’s SpaceX, UFOs and sightings are again subjects of public interest.&nbsp; Even 57 years later, even if there was definitive proof about whether the Batlechaur fragment was from a Chinese missile or a soviet rocket, it has not been made public in documents declassified so far. We may never know.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598.jpg" data-media-id="editor_6" data-image-id="20241207071216_b6938795f40731e7657fd6dcbb3cf460a326186a15eb11d4f832f602201ff598" data-rendition-name="original" width="642" height="320" loading="lazy" alt="UFO over Pokhara"> </figure>  Sunil Ulak speculates if the debris actually came from an American aircraft, perhaps on an intel mission upon China. “Which could explain why they were so thorough in collecting the fragments in Pokhara,” he says. But that still does not explain the multiple sightings weeks apart in 1968.&nbsp; Indeed, US military aircraft were at that time flying frequent night-time missions from air force bases in India to supply weapons to Khampa guerrilla camps in Nepal located north of Pokhara in Mustang. It could very well be that the Chinese shot down one such aircraft. The other sightings could have been contrails of US spy planes, or Chinese anti-aircraft missiles.&nbsp; There were quite a few developments regarding UFOs in 2024. In a US congressional hearing in July, former intelligence officer David Grusch claimed that the government had long been involved in a program to investigate and retrieve non-human craft crashes, and then try to reverse engineer them. However Grusch did not show any evidence.&nbsp; The UAP Disclosure Act of 2024 was signed into law by Joe Biden in December 2023. It plans to oversee the public disclosure of UFO information. However, there is a clause in it that prevents disclosure if it would cause threats to military defense, intelligence operations or foreign relations.&nbsp; It is unlikely that the declassified documents about sightings in the Himalayan will cause any real surprise about definite evidence of alien life even if it was found. It seems humanity will continue, at least for now, to wonder about curious lights in the sky and whether there is anybody out there.&nbsp;

UFO over Pokhara

When Rastriya Swatantra Party (RSP) president Rabi Lamichhane was arrested in October on charges of defrauding depositors of cooperatives, the party’s vice president Swarnim Wagle gifted him Fareed Zakaria’s book, Age of Revolutions.
Since then, Lamichhane has been shunted around from Kathmandu to Pokhara to Chitwan and back to Pokhara to attend police investigations and court proceedings. He was being flown to Birganj via Kathmandu on Buddha Air on Monday. There is another pending case in Janakpur.
Human rights groups and civil society have criticised the government for hounding Lamichhane with inhumane treatment that borders on physical torture. The two parties in the coalition, Nepali Congress (NC) and the UML, see Lamichhane’s RSP as a potentially formidable challenge to their power.
Even if the fraud charges against Lamichhane are true, the Nepali public is increasingly looking at the government’s actions through the police and courts as political vendetta.
Despite all the travelling, sometimes by plane and often by road at night, Lamichhane appears to be in high spirits, waving to supporters who often gather if they know he is going to be driven around. A social media video shows him giving high fives to fellow passengers on a recent flight to Pokhara.&nbsp;
In the past weeks, streets in Pokhara have erupted with parallel protests by Lamichhane’s supporters as well as depositors of cooperatives who lost their savings to the scam.&nbsp;
Although family visits are allowed, prison officials in Pokhara told Nepali Times that not many people visit Lamichhane these days. He added, “When he does get visitors, he asks them to bring him books.”
Lamichhane is currently Nepal’s most high-profile public figure in custody, and highlights the stark difference between how influential prisoners are treated compared to ordinary inmates.
There are six prison cells at Kaski District Police Office’s two-story detention centre, three on each floor. And while authorities pack prisoners into already overcrowded cells, Lamichhane has an entire room on the second floor to himself.&nbsp;
He has also been allowed to call his family every few days. Other prisoners are not permitted phone calls except for emergencies.
Meanwhile, Lamichhane’s former business partner Chhabilal Joshi, an ex-Deputy Inspector General of Police with whom he established his Gorkha Media Network, is in custody under the same charges in the prison cell next to him.
Lamichhane is accused of siphoning off depositors' money to the tv network in which he was part-owner and anchor. &nbsp;
Both Lamichhane and Joshi are able to buy food from the police canteen instead of being served the regular meal like other prisoners. Joshi has also given his statement to authorities in Rupandehi and Kathmandu for his alleged role in the scam. Lamichhane is yet to be presented in Kathmandu for questioning.
While he was in custody at the Kathmandu District Police Complex, Joshi expressed his desire to sleep in a police officer’s office, reportedly assuring authorities that he would not run away and he was entitled to certain facilities as a former officer of the law.
“He seemed to be under the impression that he is still a police officer,” says a source at the Kathmandu District Police. “We made it clear to him that as someone accused of a crime, he was not entitled to special treatment.”
Former ministers Balkrishna Khand and Top Bahadur Rayamajhi, and ex-home secretary Tek Narayan Pandey, who were arrested in connection with the fake refugee scam last year, were similarly housed in the offices of law enforcement officials instead of prison cells. Khand has since been released after six months in jail.
While there is no legal provision to keep high-ranking officials in separate detention centres when they are arrested, authorities granting them special facilities is not uncommon. Law enforcement officials say VIP detainees expect preferential treatment while in police custody.
Among those is former Kosi Province minister Lila Ballav Adhikari, who was arrested from Biratnagar on 10 November over his alleged involvement in human trafficking and brought to Kathmandu. Adhikari had flown to Japan without government approval with three individuals on 29 October to attend a cultural conference, but had been sent back to Nepal from Narita.&nbsp;
His three companions were arrested at Kathmandu airport upon their arrival, but Adhikari was able to exit unscathed from the VIP lounge. Adhikari had resigned as the Kosi Province Minister for Internal Affairs and Law when it became public that his companions had been taken into custody, and was himself arrested shortly after. He has since been cleared by the courts.
Throughout his detention, Adhikari was kept separately from other inmates. Senior Superintendent of Police (SSP) Basant Rajouri, head of the Bhadrakali complex, says that while there is no separate detention area for VIPs, some detainees are kept separately depending on the nature of their crime.
However, sources say that arrangements were made for retired judges and others to visit Adhikari frequently worked at the office of a Deputy Superintendent of Police (DSP) during his time in custody.&nbsp;
“He used to constantly pester the authorities to let him sit outside in the sun, and to be able to use the police officer’s shower area,” added an officer.
Adhikari was released on 25 November after the government prosecutor’s office decided not to charge him in a move that was seen to expose the government’s double standards.
Over at Kathmandu’s Dilli Bazar Prison, former Kist Bank CEO Kamal Gyawali emerges from his prison cell into the courtyard of the prison’s ‘Ka (क)’ block every morning with a thick book in his hands, ready to give his daily sermon.
With his long beard, Gyawali, who is serving a prison sentence for banking fraud, looks the part of a religious guru as he implores his rapt listeners to “walk the right path, abandon bad thoughts and turn to scripture and spirituality”.&nbsp;
Afterward, the attendees gather to discuss politics and current affairs. Inmates at his daily sermons at the prison include other high-profile detainees, including former MP Ichchha Raj Tamang, who is in jail for money laundering and cooperatives fraud, former joint secretary Chudamani Sharma, who was convicted of corruption, as well as NC leader Chandra Bahadur Lama and Krishna Bahadur Upreti of the UML both of whom are on trial for embezzling billions of rupees.
Victims of the cooperatives scam that former lawmaker Tamang was involved in have made trips to the prison and requested visits, but he has refused to meet with any of them.
“Tamang often complains that the state has prevented him from returning the money to the victims by locking him up,” says a police officer at the Dili Bazar jail.
“All you hear every day from the VIP prisoners is that they have been framed,” adds the officer. “No one admits that they were involved in misdeeds.”
But while most high-profile prisoners complain about prison conditions, one exception is former provincial lawmaker Deepak Manange, who is serving a sentence at Dilli Bazar Jail for attempted murder.
“He is the happiest prisoner here,” says a warden. “Unlike the others, he doesn’t claim to have been framed, in fact he doesn’t seem to care that he is in prison.”
Manange is detained in the ‘Kha (ख)’ block of the prison complex, which he renovated at his own expense. The block previously housed female prisoners, but Manange used his influence to transfer them elsewhere. He faces no shortage of visitors, who range from political leaders to people from the underworld.
Along with Manange, other well-known prisoners in this block include Nepal Telecom Managing Director Sunil Poudel, and former executive director of the Surakshan Printing Centre Bikal Poudel, who are serving time for corruption.
Former prisoners at Dilli Bazar prison include ex-ministers Khum Bahadur Khadka and Shyam Sundar Gupta, NC leader Ganesh Lama, Maoist MP Balkrishna Dhungel, Nagarik Unmukti Party leader Resham Chaudhary, as well as former IGs Ramesh Chand Thakuri, Om Bikram Rana, and Hem Bahadur Gurung.
Section 54 of Nepal’s Prison Act assigns each prison’s internal administration the
responsibility of governing its prisoners, which means the more favourable the jail management is, the more comfortable it is for prisoners.
Dilli Bazar prison has been the prison of choice for many high-ranking prisoners, especially those convicted of white collar crimes, due to its more accommodating administrators. The prison, which has the capacity to house 700 inmates, is also less crowded than other jails.
Anuj Bhattarai, spokesperson of the Department of Prison Management, says that there is no legal classification in Nepal for felons to be assigned prisons based on the nature of their crimes.
“That Dilli Bazar Jail has a higher number of prisoners convicted of crimes like corruption is most likely a coincidence,” says Bhattarai. “There is no provision for influential people to be able to choose where they will be incarcerated.”&nbsp;
Translated by Shristi Karki from the Nepali original published in himalkhabar.com

What Nepal’s VIP prisoners do in jail

If you were raised in Nepal, you must have picked up its unique set of vocabulary: आन्दोलन, चक्का जाम, बन्द, राँके जुलुस, आफ्नो मान्छे, हाम्रो दल, कर्फु and many more words connoting political protest.
We became familiar with the acrid smell of burning tyres, and eyes smarting from tear gas. And yet, everyone speaks of another revolution in the making. Not by desire, but by suffocation.
We heard speeches about नयाँ नेपाल, but the New Nepal never arrived. The governance system changed, but it did not reflect on people’s lives — except for those close to centres of power. The state is still unreachable and is not bothered about <a href="https://nepalitimes.com/here-now/matter-of-life-and-debt">victims of loan sharks</a>, cooperative scams and other injustices.
Politicians continue to speak in sound bites, but fail to deliver. They have mastered the game of pointing fingers towards an external enemy and convincing people that they are never at fault. The political narrative is so disconnected from the actual analysis of the problem that suffocation doesn’t go away after every revolution.
No genuine effort has been made to deliver at all, which is why there is a palpable sense of disillusionment in the air forcing us to seek another revolution, even if Nepal may not be able to afford it.
How has the current system successfully held power, even if the public is deeply frustrated? How is it that for three decades we continue to be led by the same faces, who have time and again, proved to us that they may be great politicians but not national leaders?
<a href="https://nepalitimes.com/opinion/improving-internet-governance-in-nepal">My experience at the epicentre of politics</a> has led me to identify three cultures that have enabled political parties to keep a tight hold on power: acceptance, silence and dependency.
We accept things the way they are. We use fatalistic phrases like “नेपालमा यस्तै हो” or “नेपालको कानुन दैब जानुन”. While this resilience enables us to rise back up from devastating calamities, it is also a reason for our compliance with the status quo.
Despite so many ‘revolutions’ that have led to significant reforms, these phrases keep getting reinforced, to the point that the upcoming generations have made it their lingo.&nbsp;
This acceptance is not a symbol of law-abiding citizens, but citizens living in fear of those in power, unable to ask the whys and why-nots.
Innovation suffocates in this culture of acceptance of the status quo. This is manifested in remarks like “but we don’t have any laws for this,” or “we don’t have the capacity to implement this”. An innovator or entrepreneur therefore has to spend that energy to become a political lobbyist, often educating and convincing the bureaucracy.&nbsp;
Remember when locally assembled <a href="https://nepalitimes.com/banner/designed-and-made-in-nepal">Yatri motorbikes</a>, despite having willing customers, had to suffer to secure license numbers because of a lack of regulations? Instead of creating new laws, the government kept chanting the “We will promote Nepal-made goods” mantra, leaving entrepreneurs in a labyrinth of bureaucracy. The weight of acceptance of the law lies heavily on innovators. Fatalism is a tactic used by those in power to generate mass fear in society.
When we accept, we become silent. This is a pervasive phenomenon. We are trained to keep quiet, lest we ruffle feathers, burn bridges, or not get the help we need in future. We know, yet we don’t speak.
Read also: <a href="https://nepalitimes.com/here-now/bureaucratic-hurdles-in-researching-nepals-bureaucracy">Bureaucratic hurdles in researching Nepal's bureaucracy</a>, Daniel W Edwards
Here is one example: the 2021 census shows that the number of baby boys born for every 100 baby girls is 112. This is a clear indication of female foeticide because of boy preference in society.
Despite such horrifying realities, there is finger-pointing within the government between the Ministry of Health and Population with the Ministry of Home Affairs. At the citizen level, we know those who are involved in killing girls. Yet, we don’t speak up. The Nepal Medical Council reports state that despite this gender imbalance at birth, there is no indication of any action.
But why would anyone speak against one's own fraternity, no matter how vile the act is?
When we accept and keep quiet, we become dependent on those who yield power. From getting our government procedure completed on time to getting transfers, to accessing any of our legally protected rights as well, we are forced to depend on our networks of चिनेको मान्छे people we know by blood, village, relations, political affiliation.
The culture of dependency has been the established way in Nepal. If you drive a two-wheeler or four-wheeler, and you get into a small accident, you will be asked to sort it yourself, dialing up the most powerful person you know. It becomes a competition of who knows who.
Recently I was told that there were calls from the Ministry of Health and Population and another from the Prime Minister's Office for just one medical position in a private hospital. Each was pushing its own candidate. Guess which candidate got the position.&nbsp;
The dependency of people is not on the laws or the state, it is with people in power, a reliance on the network of somebody who knows somebody, including those not officially in power.
These cultures are deeply ingrained in our heads, and in society. Collectively they form a vicious circle that helps those in power to retain power. This is not the society we want to live in.
Then, what do we do as a collective to break away from this? How do we break away from the cultures of acceptance and silence that have created this dependency? What can we do to ensure that our children do not have to learn the jargon of आन्दोलन before they learn about the state?
These are the cultures political parties need to shed rather than use them to perpetuate their power. This is what <a href="https://nepalitimes.com/opinion/comment/an-alternative-to-alternative-politics-in-nepal">alternative politics</a> needs to be about.
Sumana Shrestha is a member of Parliament’s Education, Health and Information Technology parliamentary committee and represents the Rastriya Swatantara Party.

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