<figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101148/63720ee29c7e80680e0b7942jpeg.jpg" alt=""/><figcaption>BRIDGING THE HEALTH GAP: Community health worker Birma Devi Kunwar, 32, crosses a bridge in Darchula with a Covid-19 vaccine box on her back. Nepal’s success with previous vaccination drives is the main reason the country has now fully-inoculated 81% of its eligible population against Covid-19. But booster doses are trailing.</figcaption></figure>On 23 March, Nepal recorded 38 new Covid-19 cases, one of the lowest figures since early 2020. The pandemic does not make it to the headlines anymore, and Nepalis are going about as if the crisis is a thing of the past. 
But it is not over until it is over. Given the latest outbreaks in Hong Kong and China, the WHO has warned that we may only be ‘halfway’ through the pandemic. That surge is just across Nepal’s northern border. 
Parts of China are back under lockdown. Hong Kong with its world class health care system, is seeing high fatality rates from the Omicron and BA.2 sub-lineage.
Omicron and its stealth variant <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">may have run their course in the Subcontinent</a>, but the Deltacron hybrid has been detected in several countries, including India. 
While there is no evidence yet to suggest that the recombinant virus is more contagious or virulent than previous strains, it is too early to make any assumptions. 
“If the new surges around the world are due to the BA.2 variant, we might not have to be as concerned,  but the same can’t be said for Deltacron since we have not yet established its transmissibility and virulence,” says virologist Sher Bahadur Pun at Teku Hospital.
Physician at Patan Academy of Health Sciences Buddha Basnyat agrees: “It is an unfolding story, but it will be prudent to assume that the pandemic is not yet over. And if there is anything we should learn from the past two years, it is that this is a very wily virus.”
In January, the WHO projected that the <a href="https://www.nepalitimes.com/latest/from-pandemic-to-epidemic-to-endemic/" target="_blank" rel="noopener noreferrer">acute stage of the pandemic would end in 2022</a> provided that there was necessary treatment and equitable distribution of vaccines worldwide. 
But citing the latest rise in case numbers, it has changed its forecast saying the world is only in the middle of the pandemic. 
Universal vaccine coverage is the only way to prevent another surge, and newer variants from coming up. In the last two years, SARS-CoV-2 has proven to be very adaptable, naturally mutating and attacking the unvaccinated. 
In Hong Kong, the majority of those hospitalised had not been vaccinated, or had received the less effective Sinovac jabs. 
Nepal’s inoculation status is now relatively high: over 93% of the adult target population is partially vaccinated while 81% have got both doses. Much of the credit goes to <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">grassroots health workers mobilised across the country</a> who built on Nepal’s past success with vaccination drives for other diseases (pictured above).  
However, the figure for booster doses is at only 9.8% even though Pfizer vaccines are now easily available, and the government may soon start offering it to children up to five years. 
Nepalis do not show vaccine denial so much, but there is some Covid complacency. 
“We have to keep up with the pace of vaccination, but we must continue prioritising vulnerable populations and children," adds Pun. "And it might help to provide the rationale and evidence to back the need for a booster because for most people, complete vaccination means only two doses.” 
Nepalis are slowly becoming careless about <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">masking up</a> and avoiding crowds but, experts say, this must continue to be a part of prevention measures. Testing needs to continue, especially as countries around the world open up for businesses and tourism. 
Nepal has also now <a href="https://www.nepalitimes.com/latest/no-more-pcr-for-nepal-passengers/" target="_blank" rel="noopener noreferrer">removed mandatory PCR test</a> and quarantine for fully vaccinated visitors, but the country cannot let its guard down.
Says Buddha Basnyat: “Masks are protecting us, there is no harm in continuing to wear them. They in fact defend Nepalis from a myriad of other infections, as well as air pollution.”

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Not over till it's over

<figure><img width="1098" height="732" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1d329c7e80680e0af39djpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The fact that Omicron was detected in an individual who had arrived in Nepal five days before the new variant was first identified in Botswana is proof it was already circulating and travel bans do not work.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/nepal-on-high-alert-for-omicron/" target="_blank" rel="noopener noreferrer">The new strain</a> has been detected in over 40 countries mere two weeks after it was first detected. What is known so far of Omicron is that it is highly transmissible but likely not very severe as there has been no significant increase in hospitalisations among infected individuals in places with outbreaks.
“Looking at preliminary findings I don’t think it will lead to another <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">major surge or lockdowns like Delta</a>, but having said that we must be prepared and contain it to prevent further mutation and more virulent strains,” says epidemiologist Lhamo Yangchen Sherpa of IPAS Nepal.
She adds: “We do that by vaccinating as many people as possible including boosters if they are nearing expiry date as we know them to be, following safety measures especially indoors and by better communicating government policies to control the spread of new strains.”
One of the main concerns with Omicron is mutations in the spike protein that binds it to the receptor. Most vaccines including Pfizer, Moderna, AstraZeneca and J&amp;J primarily target this spike protein, so there are worries that the new variant will escape immunity afforded by jabs.
Mutations are natural, but coronaviruses make fewer of them than other viruses because of their much stronger <a href="https://www.sciencedirect.com/science/article/pii/S1097276520305189" target="_blank" rel="noopener noreferrer">proofreading system</a> to survive.
<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.indiaspend.com/indiaspend-interviews/omicron-wont-be-much-more-dangerous-than-other-circulating-covid-19-variants-790812" target="_blank" rel="noopener noreferrer">Speaking with India Spend</a>, Polly Roy, professor of virology at the London School of Hygiene &amp; Tropical Medicine said: ‘Even though we have a mutation, it’s not in the receptor-binding site area so much. Thus, if they change too much, the virus will not bind to host cells and will not survive. And the vaccines target that area, so the vaccines will still work against Omicron infection.’
Says infectious disease specialist at HAMS Hospital Anup Subedee: “Even if the vaccines are less effective against this variant, it will still provide significant immunity to fight off new infections. And given that antibodies wane over time, <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">Nepal’s frontline workers</a> and the elderly should be prioritised for boosters, if possible with vaccines known to have higher efficacy.”
There are also concerns that despite registering only mild symptoms Omicron could affect vulnerable populations much later as it is the younger mobile population who are usually infected first without much impact on their health. 
Most of the initial Omicron infections are said to be mild and among young and vaccinated people, which means Nepal could be ripe for another surge. 
“Don’t be surprised if we do,” says Sushil Koirala, a Nepali public health expert based in Bangkok. “We have all the necessary fuel to start the wildfire: low vaccination coverage, poor adherence to public health measures, lackluster preparedness, and questionable surveillance,” Koirala warns.
But <a href="https://www.nepalitimes.com/here-now/do-nepalis-need-covid-booster-shots/" target="_blank" rel="noopener noreferrer">the moral dilemma over booster</a> remains when over 60% of Nepal’s targeted population is yet to even receive the first dose.
“In an ideal world, universal coverage is the way to go but the government hasn’t been able to vaccinate the majority of Nepalis, so we cannot wait forever for boosters either,” adds Subedee.With the rapid spread of Omicron in the region, the Nepal government has announced that it will vaccinate at least 200,000 people a day and the Health Minister Birodh Khatiwada has asked people who have inoculated with two doses of vaccine to also receive the third dose to prevent <a href="https://www.nepalitimes.com/latest/nepal-needs-to-prepare-for-new-covid-wave/" target="_blank" rel="noopener noreferrer">the risk of the third wave</a>.
Khatiwada was quoted as saying that the government had a stock of 20 million doses of different jabs and it will start administering the booster from mid-December with 16,000 vaccination centres across the country.
So far Nepal has received 25,658,630 doses of the Covid vaccine of which some 660,000 doses still in stock. In the next three months, a total of 34,594,460 doses of different jabs are arriving in Nepal: 9,403,000 doses of AstraZeneca, 3,000,000 Coronavax, 2,386,800 VeroCell (one vial, one dose), 2,174,400 J&amp;J and 1,965,600 Moderna.
But the government’s focal person for vaccine Shyam Raj Upreti told Nepali Times health authorities are authorised to administer only an additional dose, not <a href="https://www.nepalitimes.com/latest/booster-lack-strands-israel-bound-nepalis/" target="_blank" rel="noopener noreferrer">a booster</a>, and only for immunocompromised people and individuals above 60 who had received VeroCell, as recommended by the WHO.
“Our priority is still to vaccinate the targeted population and hence those who are still not vaccinated,” adds Uprety. “And for this, we are focusing on activities to convince more people to inoculate, add vaccination booths to increase access and where required administer the doses door to door.”
At present, 29% of Nepal’s population has been fully inoculated while 33.9% have been vaccinated partially. Experts say better communication about vaccination schedules a few days before the campaign in local language and on platforms most consumed is crucial in further <a href="https://www.nepalitimes.com/opinion/giving-all-nepalis-a-shot-at-the-covid-vaccine/" target="_blank" rel="noopener noreferrer">increasing the uptake</a>.
Equally important is building a storage facility for Pfizer and Moderna vaccines that are in the pipeline to vaccinate children 12 and above. A limited number of students who revived Pfizer jabs last month are yet to receive their second dose, recommended after three weeks of the first.
Speaking on his social platform, Sameer Dixit of the Centre for Molecular Dynamics Nepal recommended patience over panic: “Let’s wait and watch until we have more concrete findings on Omicron. Until then mask up and vaccinate as soon as it is available. As for boosters, those in vulnerable groups should get it.”

Sonia Awale

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Omicron may not be as risky, but take care

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161144/636d1d159c7e80680e0af392jpeg.jpg" alt="" width="1920" height="1080"/>I nternational tourist arrivals increased by 58% in July-September, compared to the same period of 2020. This is still 64% below average 2019 levels and 76% below pre-pandemic levels, according to the UN World Tourism Organisation. The figure will stay at 70-75% below average 2019 levels for the remainder of 2021. Mobility restrictions, vaccinations, and traveler confidence have meant improvement in parts of Europe and the Americas during the third quarter of 2021, but arrivals in Asia-Pacific were down almost 95%. The tourism sector could lose $2 trillion this year, the same as in 2020.

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Tourism picks up

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141128/636cfd239c7e80680e0a0bcajpeg.jpg" alt="" width="768" height="512"/><figcaption>People lining up for Covid vaccination in Kathmandu this week. Photo: AMIT MACHAMASI</figcaption></figure>The unprecedented speed at which effective Covid-19 vaccines have been discovered is truly inspiring. The problem with acceptance and <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">distribution of those vaccines</a>, however, is another story.Scientists can invent vaccines faster than ever, but political scientists cannot find answers to the problems of <a href="https://www.nepalitimes.com/banner/once-nepal-gets-vaccines-they-need-to-be-fairly-distributed/" target="_blank" rel="noopener noreferrer">vaccine denial and inequity</a>.If this pandemic had happened 50 years ago and an effective and safe vaccine had ultimately been found, in all likelihood the administration of these vaccines would have happened more smoothly, probably with more equity and <a href="https://www.nepalitimes.com/opinion/why-vaccination-should-be-compulsory/" target="_blank" rel="noopener noreferrer">much less fuss</a>.To be sure, there was similar opposition to the smallpox vaccine when it was first developed, but eventually it was mandated by governments and the disease eradicated. And millions of lives are saved annually in low income countries by vaccines against preventable diseases.But the speed with which medical science has come up with effective Covid-19 vaccines has been a game-changer. If this is followed by treatment protocols, it will be even more spectacular.And the best example to showcase efficacious treatment has been the Oxford University-lead Recovery (Randomised Evaluation of Covid-19 Therapy) trial in which Nepal was the first actively participating site outside the UK.In June 2020, the results of this trial showed that an inexpensive and widely-available drug, dexamethasone (a corticosteroid) substantially reduced deaths in <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">hospitalised patients requiring oxygen</a>. As a result, the drug has saved millions of lives.For those of us in the health profession in Nepal, Covid-19 evoked a feeling of déjà vu. Common rampant infectious diseases like typhoid and tuberculosis are ideally controlled by <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer">contact tracing</a> and treatment. Implementing these measures against another human-to-human infection like Covid-19 should therefore have been a no-brainer.Unfortunately, in South Asia contact tracing even for biblical diseases like typhoid and <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener noreferrer">tuberculosis</a> is not done. We would have been able to more easily deal with Covid-19 if we already had contact tracing in place for these rampant, but overlooked, diseases mostly afflicting the impoverished.The trajectory of the pandemic has led to revelations. Herd immunity acquired with previous infections seems to be an unreliable and less robust way to seek protection from the virus. This was dramatically illustrated with the <a href="https://www.nepalitimes.com/here-now/delta-variants-wake-up-call-for-nepal/" target="_blank" rel="noopener noreferrer">spread of the Delta virus</a> in India where many people, including doctors, thought they had enough antibody protection.The BCG vaccine (against TB) was <a href="https://www.nepalitimes.com/latest/could-an-anti-tb-vaccine-be-protecting-nepalis/" target="_blank" rel="noopener noreferrer">thought by many to protect them</a>, and that has also turned out to be probably untrue. Protection afforded by prior exposure to other respiratory viruses including coronaviruses (non-Covid 19) also seems non-existent. The fallacious argument that we are hardy people from South Asia who are protected by our spicy diet also took a hammering.The most dramatic observation during this pandemic has been in human behaviour and psychology. Literate people (many in high income countries) refusing to <a href="https://www.nepalitimes.com/here-now/3-pronged-strategy-to-save-nepal-from-covid-19/" target="_blank" rel="noopener noreferrer">wear masks</a> or be vaccinated despite overwhelming scientific evidence, is bewildering.So, while vaccine stockpiles are nearing their expiry dates in the United States and parts of Europe, people in Africa and Asia are literally dying to be vaccinated.Vedic philosophy calls this era the Kali Yug, a time when knowledge does not translate into wisdom. When individualism takes precedence over collective welfare, people are unkind and intolerant to each other.Lack of humility and an excess of human hubris is also clearly in evidence during this pandemic. Leaders of countries who boasted that they were saviours of the world by promising vaccines were brought to their knees with <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">the spread of the Delta variant</a>. Those who extolled their superior public health status have had to eat their words.Hypocrisy is also in full display. Early grandiose talk of vaccine equity in high income countries even before the discovery of the vaccine <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">was soon forgotten</a> as countries stockpiled up to four times what was needed to vaccinate their eligible populations with two doses.Many countries did not put their money where their mouths were, espousing vaccine nationalism. The concept of vaccine distribution equity is now like talk of motherhood and apple pie.The virus clearly showed us that the world needs not only universal health care and universal basic income but just as much universal behavioural therapy. Even in their enlightened self-interest, these countries should ensure universal vaccination because science has shown that the more people remain unvaccinated, the <a href="https://www.nepalitimes.com/opinion/no-country-is-safe-until-we-are-all-safe/" target="_blank" rel="noopener noreferrer">more the danger of variants mutating</a>.Here on, since 70% vaccine coverage will take time, Nepalis need to <a href="https://www.nepalitimes.com/banner/vaccines-or-no-vaccines-mask-and-distance/" target="_blank" rel="noopener noreferrer">continue to mask up and wash hands</a>. Those who are vaccinated must remember that it does not always protect them from infection, just severe symptoms, and they can be carriers to spread it to others. Vaccines only reduce mortality and morbidity and hospitalisations.Same with masks. Wearing a mask and going into crowded places defeats the purpose. Those following proper guidelines have noted that they are less sick than usual with respiratory and gastrointestinal ailments. The use of masks and frequent hand washing in Nepal’s unsanitary conditions may lead to a decrease of other common infections besides Covid-19.All presently available vaccines are effective in the prevention of <a href="https://www.nepalitimes.com/banner/nepals-uneven-covid-19-deaths/" target="_blank" rel="noopener noreferrer">Covid-19</a> infections, especially regarding hospitalisation. The important thing is not to miss the opportunity to get vaccinated with whatever doses are available whenever. All the available vaccines are safe and have very few, if any, contraindications even in pregnancy.There is much less vaccine hesitancy and denial in Nepal now, especially after people saw how unvaccinated people in their families and neighborhood could easily succumb to the virus.We have to psychologically prepare ourselves for the likelihood that the <a href="https://www.nepalitimes.com/banner/how-nepal-must-prepare-for-3rd-covid-wave/" target="_blank" rel="noopener noreferrer">pandemic will continue for many more months</a> unless the vast majority of us in the world are promptly vaccinated. Herd immunity from vaccination is much more reliable than herd immunity from natural infection.Amazingly, no world leader has gone beyond rhetoric to actually start delivering vaccines to all corners of the world. As the pandemic plays out, the best-case scenario is that Covid-19 antibodies will be present even years after vaccination or post-infection, as was noted with SARS (a different but deadly coronavirus infection in 2002) and provide protection for years to come.Or perhaps Covid-19 will peter out and become like the influenza virus requiring a jab every winter. Variants may continue to be a problem, but no one knows for sure as this is indeed 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=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">novel coronavirus</a>, and we are still learning. In all likelihood, vaccines will continue to be effective even against variants.One thing is for sure, all this shall also pass. But we have to learn lessons to be better prepared for the next pandemic.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=1629080960620000&amp;usg=AFQjCNHYX5K-ItauU5qj1nRZM3tMxFIYsw">frequent health columnist</a> for Nepali Times.

Buddha Basnyat

Dying to get vaccinated

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08649c7e80680e0a6014jpeg.jpg" alt="" width="1319" height="1975"/><figcaption>Photo: UNICEF NEPAL</figcaption></figure>The <a href="https://www.nepalitimes.com/opinion/eu-will-stand-by-nepal-in-hard-times/" target="_blank" rel="noopener noreferrer">European Union</a> has renewed its committment to sharing more than 200 million doses of Covid-19 vaccines with low and middle-income nations, including Nepal, by the end of 2021.The doses will be delivered mainly through <a href="https://www.nepalitimes.com/opinion/hope-hyperbole-and-hypocrisy-of-covax/" target="_blank" rel="noopener noreferrer">the COVAX initiative</a>, which has so far provided 122 million doses to 136 countries. This is far less than the quantity originally promised because of supply chain issues and India’s ban on export of its AstraZeneca Covishield vaccine.“Team Europe takes its responsibility in helping the world fight the virus, everywhere. Vaccination is key – that's why it is essential to ensure access to Covid-19 vaccines to countries worldwide,” said EU President Ursula von der Leyen at this week’s Global Health Summit in Rome.In parallel, Europe is providing better access to vaccines, medicines and health technologies in Africa, in part by helping create the right conditions for local vaccine manufacturing in Africa.The initiative will be backed by a €1 billion grant from the EU, and European development finance institutions such as the European Investment Bank (EIB).On 9 July, Team Europe agreed to support large-scale investment in vaccine production by the Institut Pasteur in Dakar. The new plant will reduce Africa's 99% dependence on vaccine imports and strengthen future pandemic resilience in the continent.The European Union is one of the biggest donors of COVAX and has contributed at least €2.47 billion to the initiative, which had committed to providing free vaccines for 20% of Nepal’s population.It sent its first consignment to Kathmandu back in March with 348,000 doses of AstraZeneca Covishield manufactured by Serum Institute of India. But owing to a global manufacturing bottleneck and the export ban in India on vaccines, it was <a href="https://www.nepalitimes.com/opinion/im-sad-vaccines-are-delayed-in-nepal/" target="_blank" rel="noopener noreferrer">unable to deliver any more doses</a> till recently.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d08679c7e80680e0a6015jpeg.jpg" alt="" width="448" height="537"><figcaption></figcaption></figure>Even as Nepal was in the grip of the <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">devastating second wave</a> in May-June when there were close to 10,000 new cases daily and up to 250 fatalities a day, there was a complete stop to vaccinations.Nearly 1.4 million Nepalis above 65 are <a href="https://www.nepalitimes.com/here-now/lonely-wait-of-nepals-elderly-for-2nd-doses/" target="_blank" rel="noopener noreferrer">still waiting for their second doses of Covishield</a>, which they may now get with a grant of 1.6 million doses of AstraZeneca from Japan.In early July, the Americans flew over 1.5 doses of single-shot Johnson &amp; Johnson to Kathmandu under COVAX, which is sending another 350,000 doses by August.At present VeroCell and <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">J&amp;J vaccination</a> drives are running in parallel across Nepal and the vaccine supply chain is <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">less constrained</a>.But the decline in the number of new infections and deaths has now stalled. Public health experts have warned <a href="https://www.nepalitimes.com/banner/vaccines-variants-and-a-third-wave/" target="_blank" rel="noopener noreferrer">of a third wave</a> and there are threats of newer, more virulent variants as long as a major chunk of the population remains unvaccinated.Covid mortality rose by 50% this week, and urban centres in Kathmandu, Lalitpur, Chitwan, Kaski and Jhapa have recorded the most new cases.On Friday, there were a total of 2,977 new cases across the country, taking the total active infections to 28,518. There were 18 fatalities in the last 24 hours and 1,678 recoveries. So far, 9,679 people have succumbed to Covid-19 in Nepal since the outbreak in January 2020.

EU to share 200 million vaccines by 2021

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f09c7e80680e0a5febjpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>For the first time in weeks, Nepal recorded more than 3,000 new cases on 20 July. There were 25 deaths. The country is on the tail end of what has been a deadly second wave, but the rate of decline in infections and mortality has stalled.Public health officials blame it on <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">sudden reopening following two-months of lockdown</a> in which many mingled without masks, low vaccination rate, and minimal testing and tracing.While some experts say Nepal and India are now safe against another major surge of the Delta variant that was largely responsible for <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave</a>, others warn of a third wave if safety measures are not enforced.The Delta mutant is now ravaging Indonesia, and spreading across Europe and North America. And scientists say it has affected mostly countries and regions with low vaccination rates.“The third wave is a matter of when not if. And if we don’t vaccinate as many people as soon as possible, there will be a continued threat of more dangerous variants, and we will be repeating the whole cycle,” warns Buddha Bansyat, a physician at the Patan Academy of Health Sciences.So far, Nepal has fully vaccinated 1,158,130 people, 3.6% of its total population. Some 10% Nepalis have received the first dose of either AstraZeneca Covishield, Chinese Sinopharm VeroCell or <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">single-shot Johnson &amp; Johnson</a> jabs.Another 8 million doses of various Covid-19 vaccines are expected by September – some purchased from China, more doses from COVAX, as well as a direct grant from Japan. This should take the total fully vaccinated population near 20%, which together with antigen positive population could cushion the impact of a possible third wave.“We have now moved on from vaccinating <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> and frontline workers to groups less at risk of the Covid-19, and we have more vaccines in the  pipeline,” says Shyam Raj Uprety, head of government's Covid Vaccine Strategy. “We have applied to buy 10.5 million more doses of vaccines from the COVAX at a subsidised rate.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f39c7e80680e0a5fecjpeg.jpg" alt="" width="448" height="537"><figcaption> </figcaption></figure>Indian public health experts have projected the third wave to hit that country in late August. What happens in India usually follows in Nepal within 12-13 days, and if that is true this time too, Nepal cannot be  unprepared like in March.“If the vaccination program progresses as smoothly as it is happening now compared to the first two surges, the third wave might not be as significant if it happens at all. By Dasain, a significant chunk of Nepalis should have been vaccinated,” explains Sameer Dixit of Centre for Molecular Dynamics Nepal.Apart from vaccines, in case of a sudden surge, hospitals need to be ready with sufficient beds and ICUs, oxygen, life-saving medical equipment, drugs and <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">functioning oxygen plants</a>. Hospitals must also prepare their paediatric wards since the third wave could affect a younger population.Since the peak of the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">second wave</a> when there were close to 10,000 new cases a day and over 200 daily fatalities, international donors have been supplying essential medical equipment to Nepal.The Health Ministry received 385 ventilators and 970 oxygen concentrators in May June from various donors. District hospitals at local levels have also received direct supplies from aid agencies. These should be in running  condition and on standby instead of being stockpiled in Kathmandu, say doctors interviewed for this report.With the <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">vaccine supply chain less constrained</a>, there is now a debate about reprioritising the doses and a more strategic distribution of supply. Some experts have suggested a ‘firewall strategy’ wherein densely populated cities are fully vaccinated to reduce transmission, and to revive  the economy that will in turn restore jobs.Equitable vaccination is ideal, but in epidemiological terms inoculating a thinly-spread population is not the best use of limited doses. Inoculating  younger adults mean they are less likely to carry the virus and transmit it to <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">children</a>, the largely unvaccinated group. Even within cities, the focus must be on the urban poor in congested areas.“Moving forward, we must now prioritise crowded cities and highly mobile groups for vaccination to help blunt the effect of another wave and save as many lives as possible,” says Sher Bahadur Pun, a virologist at Teku Hospital.However, epidemiologist Lhamo Yangchen Sherpa worries that focusing in cities may mean the underserved are neglected. “While reprioritising, our strategy should be such that the supply isn’t misused and the neediest aren’t missed out.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f59c7e80680e0a5fedjpeg.jpg" alt="" width="2048" height="1366"><figcaption> </figcaption></figure>At present VeroCell and J&amp;J vaccination drives are running in parallel across Nepal. Soon, the Japanese grant of 1.4 million <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AstraZeneca</a> will be used to inoculate the elderly who have been waiting for four months for their second doses.Social media is rife with speculation about the jabs and who should and shouldn’t get it, leading to widespread confusion and vaccine hesitancy. People are also comparing the efficacy level of one vaccine against the other.“Let’s take any vaccine available, they do what they are supposed to do, prevent deaths and hospitalisations in most cases,” says Buddha Basnyat.  “I encourage people with heart conditions, cancer and liver diseases to vaccinate, they are high-risk group, as well as pregnant women.”According to Public Health England, Covid-19 vaccines have so far  prevented 13,200 deaths and 39,700 hospitalisations in the United  Kingdom, even while the country sees a surge in Delta variant cases.As Nepalis inoculate against SARS-CoV-2, people are starting to forgo <a href="https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/" target="_blank" rel="noopener noreferrer">safety measures</a> even if the majority of the population remains unvaccinated. They are back on the streets taking part in political rallies and conducting crowded indoor meetings. Jam-packed and poorly- managed vaccination centres could themselves be super spreaders.Says Sameer Dixit: “In midst of vaccines, variants and new surges, we cannot forget masks and physical distancing, it is still our first line of  defence against the coronavirus.”

Vaccines, variants and a third wave

<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

<figure><img width="722" height="482" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111152/636b86609c7e80680e06784ejpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The flood of social media posts of <a href="https://www.nepalitimes.com/here-now/aid-pours-into-nepal-but-where-be-vaccines/" target="_blank" rel="noopener noreferrer" 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=1622019280162000&amp;usg=AFQjCNFw4HGIaJzWsPjE6KDbOCN9BO71nA">donated medical supplies</a> being unloaded at Kathmandu airport every day, gives the impression that the outside world cares more about the humanitarian emergency in Nepal than the country’s own leaders.
This week proved that the <a href="https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-sets-elections-in-middle-of-pandemic/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGnYd3WYcqcWZhTuAO1fDLmr6DWrw">Nepali politicians still do not get it</a>. Except for the chatting classes locked up at home, not many Nepalis follow, or care, about a dissolved Parliament, elections in November, or writs at the Supreme Court. They are preoccupied with trying to prevent relatives from <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG0TkkaP2byuZ7gTldxbjVgjSti9w">breathing their last</a>.
Prime Minister K P Oli has proven that he is not just a shrewd manipulator, but also has elastic ethics. In the past year, he has shown that he will stop at nothing: split the NCP that he himself united, dismantle his own UML, dissolve a Parliament in which he had a two-thirds majority. All is fair, it seems, in love and politics. 
Nepalis might have followed the political games in Kathmandu more closely if the alternatives to Oli inspired more confidence. But they are all tried, tested and failed ex-prime ministers themselves. The main contender Sher Bahadur Deuba of the Nepali Congress lined himself up to be PM for the fifth time, and has still not given up.
The crises due to the pandemic would have been the opportunity to form a national unity government, and work together to fight the virus. This would be the time for all the parties to skip a generation and bring up some young do-ers. That is what they may have done if this was a war. But <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/this-is-war/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEWgT9G992ZUlwbDLKjh5yVL3iW-A">this is a war</a>.
The needs are great: ensuring <a href="https://www.nepalitimes.com/here-now/its-an-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/its-an-emergency/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNEbjbLTsFcBFUFjyD0KkohRt6dD0w">adequate oxygen supply</a>, rushing relief for the millions who have lost their income during the lockdowns, ensuring that ICU care is available and affordable to the general public, and negotiating a reliable vaccine pipeline. Preoccupied with politicking, the leaders had little time for any of this. 
Most of Nepal’s politically-appointed ambassadors overseas are more beholden to their patrons back home than to the people. With the exceptions of our female envoys in <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Oman and Spain</a>, other missions have not stepped up to the task of conveying the emergency like we did after the 2015 earthquake.
The oxygen cylinders and medical equipment that have arrived are mostly through donations from the <a href="https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-diaspora-comes-to-the-rescue/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHqcfVevxxV6taMreBzCHkR2W-pNw">Nepali diaspora</a>, citizens groups that have mobilised through social media, and friends of Nepal. 
No wonder the rest of the world does not take us seriously. When a state does not demonstrate accountability towards its own citizens, there is little trust even from governments that genuinely want to help, to provide urgently needed material. 
And there is not much the outside world can do when the malaise is within. Nepal has to resolve its own governance crisis that has messed up its Covid-19 response. 
Having said that, the international community could show more concern for the urgent need for vaccines. There are many flights bearing ventilators, concentrators, PPEs and test kits, but much vacillation on vaccines. 
Nepal is not getting the urgent help it needs to immediately vaccinate 1.4 million people whose default date for the second dose is now. On Monday, the government extended the dose gap to 16 weeks in the hope that someone somewhere will quickly send the <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNG_KLW5M52MZ3Y7ijjHYNDTM3xYdQ">AstraZeneca (AZ)</a> vaccines we paid the Serum Institute of India for, but which were never delivered.
This is a major <a href="https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-is-a-priority-for-vaccine-shipments/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNGmt0XUUHhxlq6n1BtsGFdw3YfM_w">failure of Nepal’s vaccine diplomacy</a>, but it is also India, Britain, the EU, US, the WHO that have let us down in this hour of need. We get it that vaccines are now a geo-strategic item, and countries are stockpiling it for the third wave. But some countries have enough doses to vaccinate their populations several times over, at a time when their own citizens are refusing to take AZ because of the panic over clots. 
Across France, AZ vaccines are being dumped because they are nearing expiry, the <a href="https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepal-needs-urgent-american-vaccine-support/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNHGyEJVpvRxkfBu00MFW-UbFzLJxQ">United States has a cache</a> of 80 million Covid-19 vaccines, and nearly half its population refuses to be vaccinated. <a href="https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/vaccines-are-the-only-solution/&amp;source=gmail&amp;ust=1622019280162000&amp;usg=AFQjCNF0Zuj2D_3iMclB9cP3qSBYR8nxPQ">Ship the shots </a>to people who want and need the vaccines.
We would like to see fewer Tweets of donated items that Nepal can afford to buy, and more timetables for vaccine deliveries.

Vacillating on vaccines

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9a79c7e80680e0878d1jpeg.jpg" alt="" width="995" height="659"/><figcaption>Photo: NEWS MEDICAL LIFE SCIENCES</figcaption></figure>As a physician, I am at the receiving end of a lot of questions from friends and relatives about the pandemic. While some want to know about their symptoms, most questions are about <a href="https://www.nepalitimes.com/here-now/why-nepals-covid-19-figures-are-deceptive/" target="_blank" rel="noopener noreferrer">whether the number of cases in Nepal is actually going down</a>.It is hard to tell. There a lack of tracing, testing is inadequate, and record keeping is unreliable. The media carries a daily tally that is based on government figures, and they show confirmed cases have now dipped to below 1,000 per day, almost half of them in Kathmandu Valley.The Ministry of Health statistics also show that there are about 250 patients in critical care, and some 50 of them require ventilator support. If these figures are to be believed, the death rate from Covid-19 does not seem to have decreased.More worrying are reports that <a href="https://www.nepalitimes.com/banner/bala-chaturdashi-and-covid/" target="_blank" rel="noopener noreferrer">Pashupatinath now sees 80 cremations daily</a> as opposed to 30 per day at this time last year. Are some of these unidentified Covid-19 ‘excess mortality’? It is all guess work, but this more than double increase in funerals needs to be accounted for.It is indeed possible that although some of the excess mortality is due to undiagnosed Covid-19, it could very well be that the <a href="https://www.nepalitimes.com/latest/covid-19-will-get-worse-before-it-gets-better/" target="_blank" rel="noopener noreferrer">winter death rate</a> has gone up this year because people with other pre-existing conditions like cancer, cardio-vascular diseases, diabetes or kidney patients needing dialysis are not visiting hospitals for treatment. These ‘indirect’ Covid-19 deaths could be a useful research project.Despite this, there are indications that young urban Nepalis are letting their guard down. The parties during the <a href="https://www.nepalitimes.com/here-now/tying-the-knot-during-covid-19/" target="_blank" rel="noopener noreferrer">wedding season</a>, unmasked crowds at Thamel’s indoor nightclubs and concerts and the throngs in Pokhara Lakeside and Sauraha show a <a href="https://www.nepalitimes.com/banner/concerts-rallies-and-crowded-malls/" target="_blank" rel="noopener noreferrer">‘what will be will be’ attitude</a>.An affordable and effective vaccine is still some way off. Wearing a mask, preferably a N95, which serves the dual purpose of protection from SARS-CoV-2 as well as Kathmandu’s air pollution, maintaining safe distance and frequent had washing with soap and water are our ‘vaccines’ for now.Japan has important lessons for us. So far, it has kept Covid-19 death rate at the lowest by far among G7 countries by strictly following guidelines including avoiding the ‘san-mitsu’ or the 3Cs: closed spaces, crowded spaces and close contact settings.<a href="https://www.nepalitimes.com/latest/nepal-must-hope-for-the-best-prepare-for-the-worst/">We in Nepal will be lucky</a> if a <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/">vaccination</a> arrives by mid-2021. Current vaccines like Pfizer and Moderna are out of the question because of their cost and the lack of capacity to maintain the very cold storage that they require.The <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">Oxford University Astra Zeneca vaccine</a> that the <a href="https://www.deccanherald.com/national/serum-institute-of-indias-covid-19-vaccine-not-to-get-nod-till-uk-authorises-astrazeneca-shot-931200.html">Serum Institute of India</a> is manufacturing appears to be our best bet because it is relatively inexpensive and only requires the regular 3-6o Celsius cold chain. The good news is that the Serum Institute of India is also studying other vaccines such as an <a href="https://www.livemint.com/companies/people/intra-nasal-covid-19-vaccines-will-be-far-easier-to-deliver-kiran-mazumdar-shaw-11603681291099.html">intra-nasal vaccine</a>, which can be stored at room temperature. If effective, this would be the answer for countries like Nepal.We are awaiting published results of trials of the <a href="https://www.nepalitimes.com/latest/nepal-to-test-covid-19-test-kits-from-china/">Chinese</a> vaccine, and that could also be the answer for developing countries like <a href="https://www.nepalitimes.com/latest/90-in-poor-countries-will-miss-covid-vaccinations/">like Nepal</a>. The Chinese have an impressive track record of making vaccines, and to combat infectious diseases. For example, the inexpensive <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">Japanese Encephalitis</a> vaccine made in Chengdu helped control the deadly disease in rural communities throughout Asia.This Chengdu vaccine cost less than $5, in contrast to the $100 per shot encephalitis vaccines made by Western pharmaceutical companies. The Chinese <a href="https://archive.nepalitimes.com/news.php?id=18079">Hepatitis E vaccine</a> could prevent infection and save lives of pregnant women in the Subcontinent where the virus is a scourge due to poor hygiene.TherapiesAside from vaccines, research into treatment of Covid-19 is also making progress. For example, the Recovery Trial in the UK has convincingly showed that dexamethasone, a readily available and inexpensive steroid saves lives in the treatment of moderate to severe Covid-19 patients.In all this confusion regarding treatment, however, it is equally important to note what does not work. Drugs like hydroxychloroquin do not work in the treatment of this disease, despite its false efficacy touted by Donald Trump. The <a href="https://www.who.int/nepal">World Health Organisation</a>’s Solidarity research also showed that the expensive remdesivir drug that our government was at one time handing out freely to Covid-19 patients is not very helpful, either.Reliable diagnosis of Covid-19 is important, especially in countries like Nepal as there are many other infectious diseases that may at first present with fever and cough, like tuberculosis. The PCR (polymerase chain reaction) test still remains the gold standard for Covid-19, but they are expensive and may take a day or two for the results.Antigen tests are being carried out in Nepal and can give a quick diagnosis in symptomatic individuals within 30 minutes. But they are not as accurate as the PCRs. There are other commercial brands, and some may not be as accurate as others.New variantNews of the new variant of Covid-19 reported in England and South Africa and now spreading across the globe, sound alarming. It is interesting that this new variant was discovered in the UK where a great emphasis is given to finding its chemical constituents.One of UK’s prime institutions for this is the Sanger Centre near Cambridge, with whom we at Patan Hospital also collaborated to delineate a variant of typhoid organism mutation, helping establish a new treatment strategy for typhoid in the Subcontinent in 2016.The best way to handle the new Covid-19 variant is <a href="https://www.nepalitimes.com/opinion/a-covid-19-exit-strategy-for-nepal/">continued vigilance</a> about preventive measures, especially since the mutation gives the virus the ability to spread faster. It is best to be over-prepared than under-prepared to fight this wily virus.Masking up, safe distance and hand washing are our best course of action for us to stop the pandemic in 2021 and beyond.<a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">Buddha Basnyat</a> is a clinical researcher at Patan Academy of Health Sciences and writes Dhanvantari, a <a href="https://www.nepalitimes.com/opinion/what-is-novel-about-the-novel-coronavirus/">frequent health column</a> for Nepali Times.

Staying safe in 2021 and beyond

<figure><img width="640" height="311" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181120/636be1b29c7e80680e083e62jpeg.jpg" alt=""/><figcaption>Nepal Army special funeral team brings home the first fatality from Covid-19 in Bhojpur District. She was a 24-year-old woman. The government's challenge is to bring the Covid-19 vaccine to remote parts of Nepal like these. Photo: RSS</figcaption></figure>Nepal’s <a href="https://www.nepalitimes.com/banner/heat-map-of-nepals-covid-19-hotspots/" target="_blank" rel="noopener noreferrer">surge of Covid-19 continues unabate</a>d  with new hotspots, and because of inadequate testing, no one really knows how much and how fast the pandemic has spread.The government has left Nepalis to their own devices, only issuing guidelines on precautions, but stopping free testing and treatment. Meanwhile the daily positivity rate and fatalities have not come down. As of Thursday, out of the 9,805 people tested nationwide 2,103 were positive, which gives a very high positivity rate of 21.4%.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">When will Nepal's Covid vaccine turn come?</a>, Sonia Awale Nepal’s death rate from the coronavirus of 43 per million is much lower than India (93%), but much higher than China and Sri Lanka (3%). This points to poor prevention measures as well as inadequate or unaffordable hospital treatment. The only option for Nepal is to <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">wait for vaccines to be available</a>, but even on this it has moved too late. Many governments around the world have pre-booked vaccines from pharmaceutical companies like Pfizer and Moderna, and most countries will first prioritise their own citizens.Last week, the Nepal government finally set up a committee of secretaries of the Finance, Home, Health and Foreign Affairs ministries to study vaccines under development as well as procedures to procure them.On Wednesday President Bidya Devi Bhandari signed an ordinance empowering the government to import Covid-19 vaccines from international pharmaceutical companies, and to use them even if they are authorised only for emergency use.Despite this, Nepal will possibly be one of the last countries in the world to get a vaccine, and even when the first vials arrive perhaps by the middle of 2021, the poorest Nepalis living in the remotest areas will be the last in line to get them.The government, which has <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/here-now/kcs-fast-highlights-nepals-covid-19-failure/&amp;sa=U&amp;ved=2ahUKEwiSi7fx3pDtAhWlwjgGHWzzCnwQFjAAegQIBBAC&amp;usg=AOvVaw18PYxlijebm6Z8s6c8PcRX" target="_blank" rel="noopener noreferrer">failed all these years to make free health care accessible to all</a>, will have to prove that its vaccine distribution is fair, and the poor in remote areas of the country are not left out. Says Bikash Gauchan, a physician stationed in remote Achham district: “We need to immediately start identifying vulnerable groups like frontline health workers, the elderly or those with co-morbidities to prioritise for immunisation, and to have an effective distribution plan for remote areas.”Nepal is internationally recognised as a model low-income country with an effective vaccination programs against measles, <a href="https://www.nepalitimes.com/banner/polio-hunt/" target="_blank" rel="noopener noreferrer">polio</a> and other childhood killer diseases. It has valuable experience in deploying a nationwide network of <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/&amp;sa=U&amp;ved=2ahUKEwjaqeaY35DtAhUSyzgGHYXhBtoQFjAAegQIAxAC&amp;usg=AOvVaw1_j5Qa_kWIBHLL5EZjqV1b" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a>, and Nepal’s Covid-19 vaccine delivery will have to re-learn from its own best practices.Monitoring the follow-up vaccine dose can gain from Nepal’s acclaimed <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/tb/&amp;sa=U&amp;ved=2ahUKEwjxlPay35DtAhWizDgGHd_SDB4QFjAFegQIBRAC&amp;usg=AOvVaw1d367zHYY84fBDOJyCB8HY" target="_blank" rel="noopener noreferrer">DOTS program</a> to deliver anti-tuberculosis therapies, and Nepal’s rural health care workers have experience in maintaining the cold chain from previous <a href="https://www.google.com/url?client=internal-element-cse&amp;cx=bead8272edd0f2143&amp;q=https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/&amp;sa=U&amp;ved=2ahUKEwj07oLT35DtAhW6yDgGHe6ZCsYQFjAAegQIABAC&amp;usg=AOvVaw2VfJkLuf5k3bEjPG4_59-X" target="_blank" rel="noopener noreferrer">vaccination programs</a>.  Despite recent breakthroughs in trials, public health experts say Nepal should be looking at neighbouring China and India and belatedly begin ‘vaccine diplomacy’ to secure its supply.Nepal Health Research Council is once again considering conducting Phase III clinical trial of Coronavac by China’s Sinovac Biotech after an initial divided opinion over its safety. The vaccine has shown quick immune response in mid-stage trials in South America and parts of Asia.In India, the Serum Institute has anticipated demand by already manufacturing 40 million doses of AstraZeneca’s potential Covid-19 vaccine. It will also soon manufacture Novavax.“There is bound to be vaccine politics and it will mostly likely be ugly,” predicts Sher Bahadur Pun of the Health Ministry. “But we should not lose track of two things: efficacy of the vaccine against our population and its economic viability. If we do that we should be on the right path, more or less.”

vaccines