Saturday was the extended deadline the Ministry of Health and Population had set to immunise 430,000 health workers, support staff at health facilities, female community health volunteers, security personnel involved in disposing of the bodies of Covid-19 victims, sanitation workers and elderly people living in care homes.

Although the number of those vaccinated till Saturday was not available, as of Friday only 171,486 had taken the the first of two doses of Covid-19 vaccine from the 201 immunisation booths operated throughout the country.

In the 10-day campaign to inoculate frontline workers, on average 43,000 had to be vaccinated in a day but only about 17,000 were inoculated.

“Who knows better than health workers about the risk of infection and importance of vaccines,” Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “A kind of vaccine hesitancy in frontline workers shows that our preparations to start the drive were insufficient.”

Nepal began the inoculation drive on January 27 with the Friday deadline after it received a million doses as a grant from India on January 21.

The second dose of the vaccine has to be taken 28 days after the first.

The ministry extended the immunisation deadline by one day and also asked its staffers and all health workers with licences from respective councils to take the jabs from the immunisation centre convenient to them.

Earlier, bureaucrats of the Health Ministry were not in the first priority list.

Dr Bikash Lamichhane, a former director at the Child Health Division of the Department of Health Services, got inoculated on Saturday on the insistence of his colleagues.

Deadline to administer the Covid-19 vaccine of the first phase drive was until Saturday noon, but he was preparing to go to the immunisation centre at 1 pm.

“Around half a dozen of my colleagues called me saying that I am the only one in our group [of doctors] left to be administered the vaccine,” Lamichhane told the Post. “I was thinking of taking the vaccine but it was not my priority right now.”

Even people serving in hospitals have not taken the jab, according to officials at the Health Ministry.

“I had personally insisted around 100 health workers to be immunised,” Dr Sagar Rajbhandari, director at the Sukraraj Tropical and Infectious Disease Hospital, told the Post. “This shows that authorities have to do a lot to take people into confidence.”

Experts say that the main reason many health workers are reluctant to be inoculated seems to be lack of proper communication and with the authorities preparing to launch a second phase of vaccination for people above 60 soon, intensive awareness drive for the success of the programme is imperative.

“Without launching effective communication drives about the importance of vaccines, it will be difficult to achieve the targeted results in the next phase,” Dr Radhika Thapaliya, a risk communication expert, told the post. “We have to work extensively on communication to remove misinformation and rumors about the programme.”

The World Health Organization says people are inevitably exposed to misinformation, rumours and false conspiracy theories, which may erode their confidence in vaccination.

“It is important to build trust in the Covid-19 vaccines before people form an opinion against them,” reads the WHO statement.

The UN health agency said that even after overcoming the imminent challenges of sufficient supply, efficient rollout and equitable access, a range of well-designed programme strategies will be needed to drive acceptance and uptake of the vaccine.

“Communicating consistently, transparently, empathetically and proactively about the uncertainty, risks and vaccine availability will contribute to building trust,” WHO said.

Communication of the Nepali government about the risk was never up to the mark right from the beginning of the pandemic. Authorities concerned did not bother to make the risk communication effective even after experts stressed its importance.

Apart from using all available means of mass communication, authorities should also work to increase interpersonal communication, so that even female community health volunteers could explain the importance of vaccines, according to Thapaliya.

There were problems in the estimation of targeted groups for the goal of 430,000 not being met.

Officials at the Health Ministry concede that estimation was made on the basis of assumption.

“We looked at the number of licences issued by several professional councils including Nepal Medical Council, Nepal Nursing Council, Nepal Health Professional Council and others and counted the number of drivers on the basis of the ambulances operating throughout the country,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “We will try to lessen those errors in the second phase of the drive.”

Moreover, apathy for extending the immunisation programme to remote villages was another reason for low coverage of the vaccine.

Female community health volunteers of remote villages could not reach district hospitals which could be several days’ walk away. Snowfall in mountainous districts, which blocked the roads, also prevented health workers from reaching district hospitals.

According to Adhikari, the health workers who did not get immunised will now get the jabs with the rest of the population according to their age group.

Meanwhile, given the stock of vaccines with the government, the Health Ministry has decided to inoculate diplomatic mission workers and journalists from Monday, according to a source at the ministry.

The source, who did not want to be named, said immunisation service will be provided from four hospitals—Shahid Gangalal National Heart Center, Tribhuvan University Teaching Hospital, Civil Hospital and Patan Hospital.

Vaccine hesitancy is not a big issue in Nepal, as coverage of regular immunisation is comparatively high, but doctors say that coverage of the vaccine depends on effective communication.

According to Serum Institute of India, the manufacturer of the vaccine developed by University of Oxford and pharmaceutical giant AstraZeneca, some common side effects, which may be seen in more than 1 in 10 people after the first vaccine dose, could be tenderness, pain, warmth, redness, itching, swelling or bruising where the injection is given.

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

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

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 must tell the health care provider of their medical conditions before taking the vaccine and some medical conditions that must be disclosed are severe allergic reactions after any drug, food or vaccine; bleeding disorder; blood thinner medication and immunocompromised or under medication that affect the immune system. In the case of women they must disclose if she is pregnant, plans to become pregnant or is breastfeeding.

But according to Adhikari, the joint spokesperson, there have been no reports of side effects so far.

“Effective communication is equally important as the vaccine,” said Thapaliya, the risk communication expert. “When we failed to convey the right information, rumors and misinformation spread fast, which ultimately hampered the success of the programme.”