Uttam Maharjan

Vaccines against COVID-19 have been developed by some pharmaceutical companies and some countries have even administered them to their people. Many more vaccines are in the trial phase as well. These developments hold out hope for the world as a whole that the disease will come to an end sooner or later. Nepal is also preparing to acquire vaccines. For this, in November a committee of secretaries of Finance, Home, Health and Foreign Affairs Ministries was set up for the purpose of studying vaccines being developed around the world and of drawing up procedures for procurement. Further, the existing law, the Drug Act 1978, was amended in the same month through an ordinance to enable the government to import vaccines from international pharmaceutical companies and to use them even if allowed for emergency use only.

Diplomatic notes
Nepal has written diplomatic notes to foreign countries to facilitate the procurement of vaccines at the earliest. The country is also in negotiations with some pharmaceutical companies. For example, the country has written to Serum Institute of India, which is producing vaccines in collaboration with AstraZeneca, for the purchase of vaccines with a request to India to provide vaccines enough for 20 per cent of the population. It costs USD three or four per dose in India. If vaccines are procured from drugmakers directly, the desired number of doses can be obtained at cheaper prices. The vaccines will also be the ones approved by the concerned regulatory authorities and tested in the countries of manufacture. So such vaccines will be deemed safe and effective.
On the other hand, Nepal is also trying to acquire vaccines under the COVAX facility. Under the facility promoted by the WHO, GAVI and CEPI, nine drug companies are developing vaccines, which are in different trial phases. The country intends to get vaccines enough for 20 per cent of its population. If the country succeeds in obtaining vaccines both from Serum Institute of India and under the COVAX facility, there will be vaccines for 40 per cent of Nepalis.
Nepal has planned to inoculate 72 per cent of its population within two years. Children under 14 will not be inoculated. This is because vaccines have not been tested on children, although there is a chance that they will catch the disease or the disease will be transmitted through them. The government is planning to administer vaccines to frontline health workers, social workers, older people above 55 years of age, chronic patients and those working in areas where social distancing is difficult to maintain in the first phase. Other groups of people will get the shots later on. For this, it is indispensable to identify priority groups so as to ensure that those who need most get the doses first.
In developing countries like Nepal, there are challenges in the management of vaccines after they arrive. In Nepal, storage and distribution remain as main hurdles. Some vaccines require ultra-cold temperatures for storage. The Pfizer-BioNTech vaccine needs to be kept at a temperature of minus 70 degrees Celsius, while the Moderna vaccine should be kept at a temperature of minus 20 degrees Celsius. The country does not have cold chain facilities for such vaccines. So the Oxford-AstraZeneca vaccine, which requires a temperature ranging from two to eight degrees Celsius for storage, is suitable for the country. Additional cold chains are required to be set up in all the seven states of the country to manage the storage satisfactorily.
Nepal is a country with difficult topography. Distribution of vaccines to remote areas is a challenge. A robust distribution mechanism should be in place, failing which those living in remote areas may be deprived of vaccines. However, it is gratifying to note that the country has a success story with immunisation campaigns under public health programmes. The country has experience with preventing childhood diseases like measles, rubella and Japanese encephalitis through inoculation programmes. In this regard, female community health volunteers may be mobilised for the distribution of vaccines. And an adequate number of paramedics ought to be mobilised to make mass inoculation programmes a success.
Vaccines are required to be administered in doses in spaced intervals. So it is equally important to monitor the situation after first doses have been administered to people to ensure that they will get second doses after a required interval. It is found that two doses administered some weeks apart are more effective than a single dose.

Public good
It is feared that it may be hard for poor countries like Nepal to acquire vaccines soon as rich and developed countries have booked a large quantity of vaccines for their people from drugmakers. On the other hand, the quantity of vaccines produced by pharmaceutical companies around the world may not suffice for the world population, given the sheer scale of COVID-19 spreading all over the world, with second waves of the disease emerging in European countries and new variants of the virus surfacing in some parts of the world. It is, therefore, surmised that poor countries may not get vaccines any time soon.
However, the WHO has been emphasising the fair and equitable distribution of vaccines so that all countries can lay their hands on them. The UN agency has also requested all countries to treat the vaccine as a public good. Nepal has been assured that vaccines will arrive in the country within three months of this year (2021). As vaccines will not be universally available till the end of 2021 or even beyond, it is wise to follow health protocol such as maintaining social distancing, wearing face masks, washing hands and avoiding gatherings and crowds.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000. uttam.maharjan1964@gmail.com)