Nepal moved a step closer to buying the Covid-19 vaccine after the Cabinet on Tuesday approved the advance payment to procure two million doses from India.

“Today’s Cabinet meeting decided to buy two million doses of Covishield vaccine from the Serum Institute of India by sending 80 percent as down payment,” Health Minister Hridayesh Tripathi told the Post. “We have secured the vaccines at $4 per dose.”

The total cost of the two million doses will be approximately Rs936 million. The down payment will be Rs748.8 million.

Officials at the Ministry of Health had told the Post earlier in the day that they had been unable to sign a deal with the vaccine manufacturer to buy two million doses of the Covishield shot, as the latter had asked for payment in advance, given the high value commodity the vaccine has become.

“We have to pay at least 80 percent of the total cost in advance for the vaccine,” Dr Roshan Pokhrel, chief specialist at the Health Ministry, had told the Post earlier on Tuesday. “But our existing rules do not allow us to pay the price in advance.”

The law governing the procurement of goods and services by the government is the Public Procurement Act, as per which there must be an open bidding for procuring items worth over Rs2 million.

In some special or emergency cases, according to government officials, the Cabinet can give approval, in principle, to sign a government-to-government deal, under which the government of the country where the company is based can vouch guarantee to facilitate the process.

"As per the concerned government agency’s proposal, if the Cabinet gives the nod for procurement, advance payment can be made,” said Shekhar Poudel, director at Public Procurement Monitoring Office.

The Health Ministry had sent the proposal to Cabinet earlier on Tuesday to ensure that Nepal could procure the high demand commodity.

“Since our Public Procurement Act did not allow us to pay full down payment, in order to ease the process and to secure early supply of the vaccine, we changed the payment guideline for this particular case and decided to send advance payments,” Tripathi said.

The vaccine manufacturing company’s representative had told ministry officials that the company could not supply vaccines without getting payment in advance, as it had taken advance payment even from the Indian government, according to sources at the ministry.

India had launched its vaccination drive on January 16 with Covishield vaccine.

For special circumstances, the Cabinet can expedite the procurement process by lessening the time needed for procurement, according to Poudel of the Public Procurement Monitoring Office.

The government needs to inoculate 52 percent of the population for which it had estimated that Rs48 billion (at $10 per dose) would be needed. Each person requires two doses of the vaccine.

Of Nepal’s total population of about 30 million, only 72 percent needs to be inoculated as children below the age of 14 will not be included in the campaign.

Existing vaccines have not been trialled on below this age group.

The COVAX facility under the World Health Organisation will provide vaccines for 20 percent of the population, but Nepal will have to bear the management costs like transporting and administering the vaccines it receives under the facility.

Nepal launched its Covid-19 vaccination campaign on January 27 with one million doses of the Covishield.

The vaccine, developed by the University of Oxford and British-Swedish multinational pharmaceutical company AstraZeneca, is Nepal’s vaccine of choice because the existing storage and transportation infrastructure supports it.

Nepal is set to receive 2,256,000 doses of Covid-19 vaccine by the end of this month under the World Health Organisation’s COVAX facility, according to the first interim distribution forecast published by COVAX on February 3.

The United Nations health agency on Monday listed two versions–AstraZeneca-SKBio (Republic of Korea) and the Serum Institute of India–of the Oxford-AstraZeneca Covid-19 vaccine for emergency use, giving the green light for these vaccines to be rolled out globally through COVAX.

WHO’s Emergency Use Listing (EUL) assesses the quality, safety and efficacy of Covid-19 vaccines and is a prerequisite for COVAX facility vaccine supply.

According to Minister Tripathi, after the WHO approved the vaccine manufactured by the Serum Institute of India, its price jumped as demand rose. But Nepal was able to get the vaccine at a subsidised rate, he said.

The Health Ministry, meanwhile, aims to launch a community rollout of the vaccine from March 7, after the UN health agency supplies jabs, and the first priority will be people above 55 years old among whom the mortality rate from coronavirus infections is high.

Officials, however, said that the immunisation on the said groups depends on availability of the doses of vaccine.

So far Nepal has included three groups of people to be inoculated with the million doses it received under grant assistance from India. These include health workers and other frontline workers like sanitation workers at hospitals and ambulance drivers; journalists and staff at diplomatic agencies; and elected representatives and staffers at local governments.

Nepal has also been promised 500,000 doses of vaccine from China but the Chinese vaccine still has to get emergency use approval from the Department of Drug Administrator, the drug regulating agency of the government.

Of the total cost of $8 million for the 2 million doses with $6.4 million paid in advance, Tripathi said the remaining 20 percent 0f money (Rs187.2 million) will be released to the Serum Institute of India after the vaccine starts being delivered to Nepal.

Public health experts say that money should not be an issue in saving people's lives.

“The government has already committed to providing vaccines to its people free of cost,” Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “Money should not be an issue and authorities concerned must acknowledge the current situation, shortage of the vaccine and others.”

Anil Giri contributed reporting.