Hira Bahadur Thapa

With an encouraging news of COVID-19 vaccines, lower-income countries are presented with the challenge of ensuring a quick inoculation of their populations. The establishment of COVAX (COVID-19 Vaccine Global Access Facility) has raised hopes for Nepal, which is one of the 92 lower-income participating countries.
A group of organisations has joined the COVAX plan under the leadership of the World Health Organisation (WHO). It aims at accelerating the COVID-19 vaccine development, securing doses for all the countries, and distributing those doses in a fair manner. A total of 180 countries with two-thirds of the world’s populations are represented in the COVAX. But with advanced economy, scientific and medical research, the US is not yet a member of the above initiative.
China has joined the initiative since October. The election of a pro-multilateralist US president has revived the hope that America would coordinate the global response to the pandemic. No doubt, coronavirus is the most urgent problem in today’s world.

Fair distribution
Samantha Power, a former US ambassador to the UN, in Foreign Affairs essay, has argued for America’s active role in handling the pandemic by collaboratively working with other countries to distribute vaccines quickly and more equitably. Given president-elect Joe Biden’s pledge to rejoin the WHO, hopefully, the US would participate in global campaign to facilitate fair and equitable distribution of vaccines once produced in a sufficient quantity.
Compared to past, COVID-19 vaccines have been developed in a very shorter period of time and hence there is enthusiasm among nations. For countries like ours, there are technical and financial hurdles before immunisation is accessible to all those in need. A shortage of trained manpower to run inoculation programme is no less daunting besides procurement, transportation and maintenance of cold chain.
Despite being 95 per cent effective, the vaccines do not eliminate the pandemic. Therefore, the scientists prefer us to continue masking and maintaining physical distancing even after we get vaccinated. A cent per cent risk-free society is not conceivable in the opinion of Anthony Fauci, the leading US infectious diseases expert.
Moreover, the COVAX plan is being implemented with certain procedures. It is a cumbersome process and involves various stages before vaccines are delivered. Under the plan, the vaccines will be distributed in two phases. All the participating countries would receive doses.
In the first phase, the countries would receive vaccines only enough to immunize three per cent of their populations at highest risks, especially frontline workers in health and social care. After that phase, vaccines are supplied until 20 per cent of the country’s population is immunised. The elderly and those with comorbidities would receive the priority in this case too.
In the second phase, the vaccines will be delivered to specific countries based on how quickly the virus is spreading. Vaccine delivery decisions will be determined by considering whether the countries are also battling with other viruses like measles. Eligibility for access to vaccines depends on how vulnerable the country’s health infrastructure is.
Given the constraints Nepal is faced with the handling of coronavirus pandemic, our infection rate is still high that is close to 20 per cent. Public health experts are worried that the country’s health facilities could be overwhelmed once massive testing is undertaken. Fortunately, though Nepal’s recovery rate is one of the highest (92 per cent) among the SAARC countries.
The good news is that American pharmaceutical company Pfizer having announced the development of 95 per cent effective vaccine collaborating with German company BioNTech, has recently filed application to the US Food and Drug Administration (FDA) for emergency authorisation. It would probably take a few weeks, if not months, before FDA grants the permission.
Besides this authorisation process, there is some technical difficulty associated with administering the vaccines to the public. The vaccine developed by Pfizer and BioNTech must be administered in two doses three weeks apart. Available statistics suggest that they would at most produce 1.35 billion doses by the end of 2021. Considering the need of the vaccine worldwide, it is a matter of concern whether there would be fairer and more equitable distribution of the same. The hoarding race for the vaccines among rich countries is making the fair distribution issue more complicated. In such scenario low-income country like Nepal would be hard-hit.
Reportedly, some member countries of COVAX plan are rushing to strike bilateral deals with the companies whose vaccines have proved 95 per cent effective. COVAX does not bar any of its participants from securing such deals if they are willing to. That is why the United Kingdom has reserved 40 million doses of the Pfizer-BioNTech vaccine. Likewise, other European countries are understood to have also placed such orders in advance to ensure early immunisation of their populations. The role of vaccine diplomacy will be crucial to ensure that any country’s population, regardless of affordability, is not deprived of inoculation.
Pfizer has sold more than 80 per cent of the vaccine doses it will be able to produce by the end of next year. Those rich nations that are receiving vaccines represent 14 per cent of the global population. This clearly exposes the vulnerabilities of low-income countries with poor health infrastructure. Such nations can’t afford to place orders in advance.

Resource mobilisation
Resource mobilisation is going to be a big hurdle for Nepal against the background of vaccine nationalism. The costs might go up fueled by competition among nations to get the doses quickly and in sufficient quantities. Some vaccines like Pfizer’s will have to be kept in very low temperatures at below -70 degree Celsius. So, storage of vaccines will be problematic too.
Hopefully, as announced by the Minister for Health and Population, the government is making all efforts to ensure the smooth delivery of vaccines. Nepal’s limited success to control the rapid transmission of COVID-19 makes people less assured about timely access to immunisation. The government must not take it for granted only because we are a member of COVAX plan.

(Thapa is a former foreign relations advisor to the Prime Minister from 2008 to 09. thapahira17@gmail.com)