The United Kingdom rolled out a Covid-19 vaccine for its people last week. Russia too has started inoculation. The US Food and Drug Administration has authorised Pfizer-BioNTech vaccine for emergency use.

Indian regulators are considering issuing emergency use authorisation to three vaccine candidates—Pfizer, AstraZeneca and Bharat Biotech, according to Reuters. Sixty percent of the world’s vaccines are manufactured in India.

The vaccine developed by Sinopharma, China’s leading vaccine maker, is likely to get approval in China within December and be available in the market there, according to Global Times. At least three other candidates made by Chinese companies are also in the phase III trials.

The Nepal government too has started some initial homework to inoculate Nepalis against the coronavirus by amending the existing law through an ordinance to facilitate the procurement of suitable vaccine, formed several committees for necessary preparation and sent diplomatic notes to the five vaccine manufacturing countries for early availability of the vaccine produced in those countries.

“Yes, a lot of homework has been done. But we still do not know which vaccine will come and when it will come,” Dr Shyam Raj Upreti, coordinator of the government’s Covid-19 vaccine advisory committee, told the Post. “No vaccine is available in the market as of today.”

For any vaccine to come to Nepal, it needs to get the World Health Organisation’s prequalification status, after the UN health agency assesses its quality, safety and efficacy.

Under the COVAX programme, the World Health Organisation (WHO) will provide vaccines for 20 percent of the population of Nepal.

COVAX is a collaboration, with more than two-thirds of the world engaged, that has the world’s largest and most diverse portfolio of potential Covid-19 vaccines. It is co-led by Gavi, the global vaccine alliance, and WHO.

Of Nepal’s total population, 72 percent needs to be vaccinated since children under 14 cannot be inoculated.

As the vaccine against coronavirus has not been tested on children, a huge percent of the population would remain out of the vaccination programme. Doctors, however, say chances of the virus spreading through children do exist.

Of the 52 percent of the vaccine the government needs to procure, it can also purchase one which has got emergency use approval in the country it is produced, according to the amended law.

On November 18, President Bidya Devi Bhandari endorsed an ordinance to amend the Drug Act (1978) to facilitate the use of emergency medicines and vaccines for Covid-19 that have been tested and approved in other countries.

As of today only a few countries, including the United Kingdom and the United States, have given emergency approval for Pfizer-BioNTec’s vaccine.

But the existing storage facility of Nepal does not work for the Pfizer-BioNTech vaccine, as it needs to be stored in minus 70 degrees Celsius.

Existing cold chain facilities in the country can only store vaccines at 2 to 8 degrees Celsius.

None of the vaccines, which can be stored in plus temperatures, has got licences yet in the countries that have tested them successfully, according to Upreti.

But none of the vaccines that can be stored in temperatures above freezing point has successfully conducted clinical trials.

“Preparations are being made to purchase vaccines as they come into the world market,” Dr Jhalak Sharma, chief of the immunisation section at the Family Welfare Division under the Department of Health Services, told the Post. “But we don’t know how long it will take for the vaccines to be available in the global market.”

Public health experts say that authorities should continue efforts to acquire the vaccines at the earliest, and meanwhile they will be ready with the spade work like getting finances available as well as preparing on the technical part like storage facilities, supply systems and the human resource for inoculation.

According to Dr Bhagwan Koirala, chairman of Nepal Medical Council, the regulatory body of all medical doctors, authorities should continue their efforts to acquire the vaccine as financial arrangements will not be a big deal once the government makes necessary decisions.

On Friday, the Asian Development Bank said it had launched a $9 billion vaccine initiative offering rapid and equitable support to its developing country members, including Nepal, to procure and deliver effective and safe Covid-19 vaccines.

“We should not forget an equitable distribution of the vaccine to all the people,” said Dr Koirala. “It will be impossible to immunise all people at once and therefore authorities have to prioritise. There will be a lot of disputes while setting the priority. It will be tough but we have to do it.”

Doctors say the dynamics of vaccines will change in the days to come.

The vaccines, which are expensive at present, will be less expensive later.

New vaccines will enter the world market. Efficacy of the vaccines will also change. Administering of some vaccines might have to halt due to side effects.

“We should have multiple options to acquire vaccines—be prepared to purchase, continue dialogue with manufacturers and mobilise our diplomatic channel to talk with the manufacturing countries,” Dr Sarad Onta, a public health expert, told the Post.

He warned that there should not be a fiasco like the case of free testing, referring to the government decision to stop free testing in October, which it later had to reverse following a Supreme Court order.

“Authorities cannot give up in the middle and it is also not like changing rules of the polymerase chain reaction tests and contact tracing,” said Onta. “Government should ensure that all Nepali citizens are vaccinated. Time has come to learn from our failure.”

As governments are in the race to vaccinate their populations, reports suggesting that rich nations “have hoarded” vaccines come as a cause for concern for countries like Nepal.

According to Reuters, Amnesty International and other groups said on Wednesday that rich countries have secured enough coronavirus vaccines to protect their populations, possibly depriving billions of people in poorer areas.

The UN health agency has repeatedly called on governments to make the vaccine against Covid-19 a “public good.”

Dr Jagadish Agrawal, former dean at the Institute of Medicine, said that it will take another six months to one year for Nepal to have access to a vaccine.

“We have to keep ourselves safe until then,” said Dr Agrawal. “Authorities have formed several committees. They will bring vaccines one day but we do not know when. We have to keep safe until we get a vaccine.”

Nepal so far has reported 1,689 coronavirus deaths.

As of Saturday, 247,593 people have tested positive for the coronavirus throughout the country. According to the Health Ministry, 234,231 people, who were infected with the virus, have recovered as of Saturday.

The total number of active cases stands at 11,673.

Once vaccines are available, inoculating the Nepali population, however, may not be a problem, according to officials, as immunisation has been one of the major successes of Nepal’s public health programme.

Nepal’s mass immunisation programme has been credited for reducing child mortality rates from preventable childhood diseases like measles, rubella and Japanese encephalitis and the government has a long experience of conducting mass campaigns for vaccinations.

According to the Ministry of Health and Population, over 90 percent of the children have received the first dose of BCG vaccine.

It says it aims to use the existing channel of immunisation to administer the coronavirus vaccine.

But till then precautions need to be taken, doctors warn.

“We have already passed nine months of the pandemic and we did not face the worst but there is a chance of facing it in the days to come if we become careless,” said Koirala.

“We should not become overly confident about the news of vaccines. Getting a vaccine is a gradual process. Unless all people become immune with safe vaccines, we should strictly follow the safety measures.”