Glimmers of hope for Nepal on vaccine

Many Nepalis who had felt their government had not done enough ‘vaccine diplomacy’ to for Covid-19 immunisation could have been assured by visiting Indian Foreign Secretary Harsh Vardhan Shringla’s remarks on Thursday that India would give preference to Nepal when trials are over.

Indeed, it may be more practical and cheaper for Nepal to rely on vaccine supplies from research centres in India and China than multinationals, whose supplies of new vaccines are ‘booked’ by the world’s richest countries into next year.

Handing over 2,000 vials of the broad-spectrum antiviral drug, Remdesivir, to Foreign Minister Pradeep Gyawali, Shringla said: "We will make the vaccine accessible and affordable, and it goes without saying that first priority will be for our closest neighbours like Nepal. We will put our health ministers and regulators in touch when this vaccine enters the market, Nepal will have the fullest benefit."

This week, the vaccine made by Oxford University in collaboration with the British-Swedish firm AstraZeneca was said to have 60-90% efficacy against Covid-19. The Oxford Vaccine has relevance for Nepal because the Serum Institute of India had started manufacturing millions of doses of this vaccine long before the preliminary results of the trial came in.

The Serum Institute of India is the world’s largest vaccine producer and already well-known in Nepal, especially for its anti-rabies vaccine that is commonly used here. The company had so much faith in the Oxford Vaccine, and it felt there would be such a rush later on, that it just went ahead and started manufacturing the vaccine, glass vials and stainless steel vats.

Sure enough, preliminary results of the Oxford Vaccine now show that this gambit may have paid off for all concerned, including the people in India and its neighbouring countries.

Adar Poonawallah, CEO of the Serum Institute of India has clearly made it his mission to manufacture the Covid-19 vaccine for the world’s poor. None other than Bill Gates is so impressed with his dedication that his foundation has committed millions of dollars to help with the project.

Even as global Big Pharma roll out new vaccines, the difficult part will be to find ways to pay for the poorest people in the world’s poor countries to be immunised against Covid-19. Collaborative efforts like the one by the Serum Institute of India and COVAX appear to be the way to go.

There is another interesting connection between the Oxford Vaccine and Nepal. The Chief Investigator of the Oxford Vaccine study, Prof Andrew Pollard has a long history of working in Nepal, especially in the prevention of typhoid fever. In December 2019, a paper on the milestone typhoid conjugate vaccine trial was published in The New England Journal of Medicine by doctors at Patan Hospital in collaboration with Pollard and colleagues. This breakthrough may well lead to policy changes around the world where typhoid is still rampant.

The unusual thing about the Oxford Vaccine is that, for some reason, the scientists administered only a half-dose of the vaccine on one group followed by the full second dose, as opposed to administering two full doses. Amazingly, the group that got the half dose followed by the full dose had a 90% vaccine efficacy compared to the group that was administered the full two doses, which registered only a 60% efficacy.

It will be intriguing to see if the half dosage was planned, or was an oversight that leads to this welcome finding. The history of medical breakthroughs abounds in such serendipitous discoveries.

The Oxford Vaccine announcement was preceded by American companies Pfizer and Moderna unveiling the breathtaking efficacy (>90%) of their own Covid-19 vaccines. However, besides the $60 cost per dose, the cold chain maintenance of -70oC for Pfizer’s vaccine would be impossible for countries like Nepal.

The Oxford Vaccine, on the other hand, does not require such extreme cold chain maintenance. The regular vaccine cold chain 2-8^oC will suffice. More importantly, the cost is thought to be substantially less.

It is clear that for Nepal, just the discovery of an efficacious vaccine will not be enough. We must be able to have access to it, and also afford it. In addition, whether the vaccine prevents transmission or not is also going to be important -- together with whether or not it prevents severe illness.

Their important considerations are all pending, but for now, we need to continue to wear masks, wash hands, and maintain social distancing. We may have to continue that practice even after the vaccination campaigns start.

Because the Oxford Vaccine will be distributed by governments (not Oxford University) the Nepal government will need to liaise with the World Health Organization-initiated COVAX, which is the only global inter-governmental initiative working with manufacturers to ensure Covid-19 vaccines are available worldwide to both the rich and the poor.

Most industrialised countries have already started placing orders for vaccines from Pfizer, Moderna and AstraZeneca, so there is every likelihood that COVAX will concentrate on ensuring vaccine supply to less-developed countries.

Along with the Indian vaccines, results of the Chinese vaccine against Covid-19, which may well be just as effective and affordable, will probably be announced soon.

The Nepal government needs to coordinate closely with groups like COVAX and keep its attention focused on obtaining the vaccine for Nepalis of all socio-economic strata.

With Harsh Vardhan Shringla’s assurance this week in Kathmandu, it may also be useful to connect directly with the Serum Institute of India, which can play an instrumental role in supplying this all-important vaccine against Covid-19.

Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and contributes this health column, Dhanvantari, for Nepali Times.