When Usha Devkota woke up on Wednesday morning, she was excited and nervous at the same time. Devkota, in charge of the intensive unit care unit at Sukraraj Tropical and Infectious Disease Hospital, was set to receive the coronavirus vaccine.

“I was excited to get the jab,” Devkota, 49, told the Post. “I am certain that now chances of transmitting the virus by me will be minimal and I can be with my family.”

For the 49-year-old mother of one, it was also an emotional moment, as she was hoping to spend time with her family properly.

As a frontline worker, Devkota for the last one year has been providing care to the coronavirus patients admitted to the intensive care unit of Sukraraj Tropical and Infectious Disease Hospital.

“My initial nervousness vanished as soon as I received the jab,” said Devkota who got the vaccine at around 11am. “I am pretty much fine.”

Immediately after being inoculated, she returned to her daily routine—taking care of those at her hospital’s intensive care.

Devkota is one of those frontline workers who are going to be vaccinated against Covid-19 over the next few days.

Nepal rolled out its Covid-19 vaccination drive on Wednesday, a little over a year after the country confirmed its first coronavirus case on January 24, 2020.

The virus so far has infected 270,375. As many as 2,020 have died of the complications resulting from the infection.

The inoculation drive was launched after India supplied one million doses of Covid-19 vaccine, developed by the University of Oxford and pharmaceutical giant AstraZeneca and locally manufactured by the Serum Institute of India, world’s largest vaccine manufacturing company.

The India-manufactured vaccine, named Covishield, is Nepali authorities’ preferred choice, as the country’s existing storage facility supports the vaccine to maintain its cold chain. The Covidshield vaccine needs to be stored in temperatures between 2 to 8 degrees Celsius.

The vaccine is made from a weakened version of a common cold virus (known as an adenovirus) from chimpanzees. The vaccine, once injected into a person, prompts the immune system to start making antibodies and prepares it to attack any coronavirus infection, as the common cold virus has been modified to look more like a coronavirus. It, however, cannot cause illness.

With the available doses, which have been already shipped to all seven provinces, the government plans to inoculate around 430,000 health care providers and frontline workers, including female community health volunteers, security personnel, elderly people taking refuge in old age homes and prisoners.

The vaccination drive kicked off from Sukraraj Tropical and Infectious Disease Hospital after Prime Minister KP Sharma Oli inaugurated the campaign.

Dr Sagar Rajbhandari, director at the hospital, who was the first one to get vaccinated in the country, described it as one of the momentous events.

“This is a safe vaccine and there is no need for people to be concerned or worried about,” Rajbhandari, who received the jab at around 10am, told the Post. “I want to send across a message to one and all that people should receive the vaccine without any fear.”

The government has said it plans to procure an additional four million doses of vaccine, most likely Covishield, within a month.

The first phase of immunisation is taking place as per the Health Ministry’s plan to inoculate people in a staggered manner based on priority.

After the frontline and healthcare workers, those above 55 years are the priority, as Covid-19 death rate in this age group has been reported to be the highest. Everyone between 40 and 55 years will be immunised in the third phase and the remaining population will be inoculated in the fourth round.

According to the Health Ministry, 9,084 people were vaccinated at 93 immunisation centres in 64 districts throughout the country on Wednesday.

“The first day of the vaccination drive went smoothly, without any glitches,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “Today’s coverage is almost close to the target.”

According to a statement issued by the ministry, 2,694 people were administered the vaccine in Bagmati Province; 1,843 in Gandaki Province; 1,255 in Province 1; 1,082 in Sudurpaschim Province; 751 in Karnali Province; 733 in Lumbini Province; and 726 in Province 2.

The ministry had said it would inoculate around 12,000 people on the first day.

“But due to various reasons including supply problems, vaccination could not start in 12 districts of Sudurpaschim, Lumbini and Province 1,” said Adhikari.

As the country was launching its vaccination drive, there were some concerns about vaccine hesitancy, a phenomenon defined by the World Health Organisation as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”.

However, doctors say that’s natural when it comes to a new drug or a vaccine and they stress the need to raise awareness among all sections of the society and people from across the professional spectrum, including those in health care services.

Some health care workers the Post spoke to said that they too were concerned before they received the jabs, given the reports that the vaccine was not widely tested and that some side effects were seen.

Dr Saili Pradhan, head of the dental department at Bir Hospital, said that until Tuesday her concern was if there could be some side effects.

“Just as fear had gripped [us] during the initial stage of the pandemic, I was kind of concerned about the vaccine too,” Pradhan told the Post. “But it was until I took the jab. Thereafter, I encouraged others to get vaccinated without any fear.”

The manufacturer said some common side effects could be there after the first vaccine dose, which could include very common, which may be seen in more than 1 in 10 people, side effects like tenderness, pain, warmth, redness, itching, swelling or bruising where the injection is given.

People may feel generally unwell, tired or can have chills or a feverish feeling. Nausea and joint pain or muscle ache are other possible side effects.

Other common side effects, which may be seen in up to 1 in 10 people, include a lump at the injection site, fever, being sick (vomiting), flu-like symptoms (high temperature, sore throat, runny nose, cough and chills).

Some uncommon side effects, which may be seen in up to 1 in 100 people, include feeling dizzy, loss of appetite, abdominal pain, enlarged lymph nodes, excessive sweating and itchy skin or rashes.

According to the manufacturer, people, however, must tell the health care provider of their medical conditions before taking the vaccine jab.

Some medical conditions that must be disclosed are if anyone ever has had a severe allergic reaction (anaphylaxis) after any drug, food or vaccine; has bleeding disorder; are on blood thinner medication, are immunocompromised or on medicines that affect the immune system. If a woman is pregnant, plans to become pregnant or breastfeeding, she must inform health care providers.

Unless there are medical conditions, according to doctors, anyone above 18 years of age can receive the vaccine.

Dr Netra Bahadur Amatya, 80, was probably the oldest person to receive the Covid-19 vaccine on Wednesday.

Amatya, former director at Bir Hospital, who retired some 20 years ago as a radiologist, has been serving at Sukraraj Hospital as a part-timer.

“There was a kind of positive feeling that came to me after receiving the vaccine,” Amatya told the Post. “The vaccine comes as a hope that the pandemic would end soon. I would advise all to get vaccinated when the jabs are available without any fear.”

But the question as to when additional doses will be available for the masses remains.

While inaugurating the vaccination drive on Wednesday, Prime Minister KP Sharma Oli said that the government is planning to immunise all eligible citizens within the next three months.

Over 21 million Nepalis (72 percent of the population) need to be vaccinated against Covid-19, as vaccines produced so far have not been tested on children up to 14 years of age. Covishield, however, can be administered only to those aged 18 and above. The number of people to be vaccinated could be lower, as around four-five million Nepalis live abroad.

However, there is no clarity yet as to how the government is planning to procure around 45 million—given 10 to 15 percent possible wastage—doses of vaccines required to vaccinate all eligible citizens.

If Nepal receives six million doses of vaccines through the World Health Organisation’s COVAX programme, which will be enough to inculcate 20 percent of the population, the government still needs to procure around 40 million doses of vaccine.

Officials at the Health Ministry said they are prepared to conduct the vaccination exercise once the vaccines arrive.

“If the government can bring sufficient doses for all remaining eligible populations, we will prepare to inoculate them accordingly,” Dr Roshan Pokhrel, chief specialist at the Health Ministry, told the Post.

Given the reports and the World Health Organisation’s warning about inequitable vaccine distribution, inoculating all eligible citizens in Nepal, as claimed by Oli, appears to be a task easier said than done.

On January 18, the UN health agency warned that the world faces a "catastrophic moral failure" because of unequal Covid-19 vaccine policies.

Tedros Adhanom Ghebreyesus, the WHO chief, said it was not fair for younger, healthy people in richer nations to get injections before vulnerable people in poorer states.

“Over 39 million vaccine doses had been given in 49 richer states—but one poor nation had only 25 doses,” he said.

In December, Amnesty International and other organisations including Frontline AIDS, Global Justice Now and Oxfam said that rich countries had secured enough coronavirus vaccines to protect their populations nearly three times over by the end of 2021, possibly depriving billions of people in poorer areas.

Asked how possible it is for Nepal to secure vaccines for all within three months, Pokhrel said it won’t be difficult if the government is committed to its responsibility to inoculate all.

“Our relations with India have improved and since the world’s largest vaccine manufacturer is in India, we can secure a deal to get the vaccines,” Pokhrel told the Post.

According to reports, the Serum Institute of India is producing more than 50 million doses a month. Even though the vaccine’s emergency use approval was granted only on January 3, according to the livemint news portal, the company started production when the pandemic started to unfold in the country.

India rolled out its vaccination drive on January 16 and it shipped one million doses to Nepal on January 21, six days after Nepal’s regulator granted emergency use approval to the Oxford-AstraZeneca vaccine.

Apart from India, China, Russia, the United Kingdom and the United States have developed Covid-19 vaccines.

Badrinath Aryal, yet another frontline worker to receive the Covid-19 jab on Wednesday, described the moment as historic.

A nurse aide by profession, Aryal for decades has been part of the country’s immunisation programmes.

“I might have inoculated thousands of people in my career,” Aryal told the Post. “And today was one important day when I was the one who got vaccinated for a disease that has put the whole world on the tenterhooks. As I have encouraged all to get vaccinated during other inoculation exercises, I would like all to take Covid-19 vaccine without having any fear.”

According to health care officials, though some people who receive the vaccine developed some common symptoms, as could happen with every other drug or vaccine, there was nothing to worry about, as they were fine after a few minutes’ rest.

The Nepal Health Research Council, the country’s top public health research agency, however, has said it will continue to monitor and study side effects and the immunity developed on the people who received the vaccine.

“We are preparing guidelines,” said Dr Pradip Gyanwali, executive chief of the council, “to study overall effects of the vaccine.”