The first million doses of the Covishield vaccine manufactured by the Serum Institute of India arrived in Nepal sooner than expected under a grant from the southern neighbour. The government then swiftly procured another 2 million doses last month; but the planned procurement of an additional 5 million doses for the second jab, which must be administered eight to 12 weeks after the first, has hit a hitch after the manufacturer refused to sell them at $4 apiece, the price Nepal paid earlier.

A shortage of the Covid-19 vaccine is the world’s biggest challenge right now. Ministry officials say the manufacturer has also refused to sell the vaccine directly to the government, and the rigid stance on prices follows worldwide demand for Covishield after the UN health agency authorised its emergency use last month.

Owing to the global supply shortage and soaring demand for Covishield, the World Health Organisation has also informed the government that it will only provide 13 percent of the vaccine doses it had pledged earlier under the COVAX facility. That’s 380,000 doses against the 2,256,000 doses forecasted earlier in February, and officials fear delivery could take months.

Covishield is Nepal’s preferred choice of vaccine because it is affordable, and the country’s existing system supports storage and supply. But the government must also explore options besides Covishield. The Department of Drug Administration has granted emergency use approval to China’s Sinopharm vaccine, and the northern neighbour has announced it will give 800,000 doses under a grant. The single-dose Johnson & Johnson’s Covid-19 vaccine, which was granted emergency authorisation in the United States last week, could also be a game-changer as it can be stored for at least three months at normal refrigerator temperatures.

The government needs to work around this newfound situation where doses are scarce and production is limited. For the procurement of the 5 million doses of Covishield, which is currently under review, the government must find a way to forge a negotiation. Regardless of the outcome, it should simultaneously secure the precious doses as per the Public Procurement Act and work closely with the private sector and the diplomatic community.

To start with, the massive deficit of doses will affect the government’s plan to inoculate some 3.7 million people above 55 in the second phase. The government has to understand that people in this age group are the most vulnerable to Covid-19 risks. It must ensure that they are prioritised before anyone else, no matter the number of doses it can secure. Meanwhile, some 429,705 people who have received the vaccine as of February 24 await their second dose in late April, and those who receive their first dose in the second phase are expected to receive their second dose in late May.

The government needs to crunch these numbers to make the vaccination drive effective. Of the 1 million doses provided under a grant by India, over half a million doses are in stock, but they expire on April 13. The government has already secured an additional 1 million doses, and officials expect another million doses to be delivered soon. According to Dr Shyam Raj Upreti, coordinator of the Covid-19 vaccine advisory committee, the available doses will be sufficient for around 80 percent of the targeted population in the second phase; but securing more doses will be crucial so that no one is left behind.

As Nepal sets to launch the second phase of the nationwide Covid-19 vaccination drive on March 7, there are challenges to securing enough doses, taking people into confidence and fighting misinformation on social media. These are a heap of challenges the government must swiftly overcome to ensure that no one is left behind, and no one jumps the queue.