When India delivered a million doses of vaccines against Covid-19 as a grant on January 21, the Nepal government announced that 430,000 health workers, sanitation workers and ambulance drivers, among other frontline workers who are most at risk of being infected, would be inoculated.

The vaccination campaign began on January 27. The government set the deadline of February 5 to vaccinate the 430,000 targeted individuals. But only 171,486 took the jabs.

The government’s excuse for failure to reach the target: it overestimated the number of frontline workers, many health workers could not reach inoculation centres because their work stations were too far and there could have been pregnant and lactating health workers who could not be inoculated considering that the vaccine is not safe for them.

It extended the deadline by a day and said any health worker with a licence could avail of the vaccine.

By Saturday only an additional 12,000 or so were vaccinated.

With just 184,857 of the targeted 430,000 immunised, the Ministry of Health and Population decided to inoculate journalists in Kathmandu Valley and those working at diplomatic missions.

“We decided to inoculate journalists and those working at diplomatic missions because they were at risk of exposure,” Dr Samir Kumar Adhikari, joint-spokesman for the Ministry of Health and Population, told the Post.

When the deadline to inoculate the second prioritised group, for which the government did not even bother to have a target, was over on Friday, some 200,000 had been inoculated in total in the 18 days since the vaccination campaign against Covid-19 began.

By officials’ own admission, the government failed miserably in meeting the target it had set.

“Despite having sufficient doses, we could not use them,” said an official at the Department of Health Services on condition of anonymity. “This is a shameful failure.”

On Sunday the Ministry of Health and Population started immunising the third group of people which it estimates to number 300,000.

The third group includes those serving at financial institutions, health workers, journalists outside Kathmandu Valley, elected representatives of local governments and staffers serving at local government offices.

According to Adhikari, these people are at high risk of exposure, as they come in contact with many people seeking service from their offices.

Also those in the first group—health workers, female community health volunteers, ambulance drivers and security personnel deployed to manage bodies of those who died of Covid-19 complications—who did not get the jabs earlier due to various reasons will be immunised in the third phase.

But going by the achievement of the target in the first group, officials are doubtful about meeting the target for the third group.

“Coverage rate will not be different from the first round this time too,” said the official. “We are not serious about achieving the targets.”

There is no proper planning and the mistakes are repeating, he added.

According to experts, making vaccines available is only part of any immunisation drive.

Proper communication is equally important, and the government has failed in this.

“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 rumours about the programme.”

The World Health Organisation 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.

Among the Covid-19 vaccines available, Nepal’s vaccine of choice has been Covishield that the University of Oxford and pharmaceutical giant AstraZeneca developed because the existing transportation and storage infrastructure to immunise babies can be used.

Nepal has not utilised the existing facilities so far.

For regular immunisation programmes, the Health Ministry runs over 16,000 immunisation centres, but the Covid-19 vaccination programme is being run from only around 200 centres.

Dr Shyam Raj Upreti, coordinator of the Covid-19 vaccine advisory committee, concedes that the new target will not be met without increasing the number of immunisation centres.

“I hope they [Health Ministry officials] will increase the centres,” said Upreti. “Without increasing the number of immunisation centres, it will be difficult to meet the target.”

But the government is not doing that.

“We will immunise people of the targeted group from the existing immunisation centres,” Dr Jhalak Shrma, chief of the Child Health Section at the Family Welfare Division of the Department of Health Services, told the Post. “As most of the financial institutions are at the district headquarters, there will be no problems for the target group getting the vaccine. People serving at the local level and elected representatives will have to come to the district headquarters or to the designated centres.”

Vaccine hesitancy is not a serious issue in Nepal, as coverage rate of the regular immunisation programme is comparatively good. People know the importance of the vaccine but due to the apathy of authorities for extending the programmes and addressing the problems of target groups, coverage rate of the Covid-19 vaccine has been too low, experts say.

“We need not have to teach the authorities concerned about what to do to meet the immunisation target,” Dr Mingmar Gyelgen Sherpa, former director general of the Department of Health Services, told the Post. “There are an effective system and human resource in place for immunisation. What is lacking is the willpower to extend the programme.”

Experts say the lackadaisical approach taken by the authorities since the beginning has not changed even after a year of the pandemic.

When the country went into lockdown on March 24 last year authorities decided to conduct rapid diagnostic tests rather than polymerase chain reaction tests, testing centres were insufficient, quarantine centres were poorly managed, lockdown was lifted without preparations on July 21, personal protective equipment for frontline workers was not sufficiently distributed, free testing and treatment was halted and later resumed only after a court directive and contact testing altogether stopped, to name a few of the failures of the government in fighting the pandemic.

“It is unfortunate that the programme has been launched in a haphazard way,” added Sherpa. “We cannot expect better results when we do not make a proper strategy. If they cannot make their own plans, they should copy others’.”

Even after vaccines became available, the government said the second dose would be given four weeks after the first but it is now considering administering the second dose 8 to 12 weeks after the first dose after the World Health Organization’s Strategic Advisory Group of Experts on Immunization on Wednesday recommended maintaining an interval of 8 to 12 weeks between the first and second jabs of the vaccine developed by the University of Oxford and pharmaceutical giant AstraZeneca.

The government’s decision to extend the vaccination campaign to additional groups of people has also come under criticism.

“We are facing a double whammy—first we have not been able to secure sufficient doses and second we have failed to make use of the available doses,” Dr Sarad Onta, a public health expert, told the Post. “Without improving the existing management system, we cannot achieve any target.”