While focus is on vaccination, other strategies to fight pandemic ignoredThe European Union had offered help to perform a seroprevalence study and strengthen surveillance and early warning systems a year ago but the government has not taken up the offer yet.
In May last year, the Epidemiology and Disease Control Division sought help to recruit 22 staff for polymerase chain reaction laboratories then in operation across the country in order to improve collection of personal data of those infected with the coronavirus.
The Ministry of Health and Population approved the proposal after a few weeks but the Ministry of Finance approved the budget only a month before the end of the fiscal year.
The division could not hire any staff, as it was not possible to complete all necessary procedures within a month and, besides, the budget was not released.
“There were 22 polymerase chain reaction laboratories then and we had sought one staff for each lab,” Dr Basudev Pandey, then director at the division, told the Post. “Data collection was so important at the time, as it was only medium to trace contacts of the infected, keep them in isolation but we could not recruit any staff for data collection.”
The number of polymerase chain reaction laboratories has now reached 88 and the number of infections continued to rise since May up to October but data collection efforts never improved.
The division had also asked the Health Ministry for Rs 240 million to hire staff for contact tracing about a year ago, but the budget for it is yet to be approved.
“The file keeps moving from one section to another and one room to another but the proposal has not been approved yet,” Pandey added. “We could not hire staff for contact tracing, which is one of the reasons for the massive spread of the infection in the society.”
The government instead stopped free testing later of symptomatic patients only to resume following a Supreme Court order. Contact tracing, however, was not resumed.
The extent of negligence and apathy on part of the authorities does not end here.
Even after a year of pandemic, the Health Ministry does not have a risk communication strategy, which is the key to convince people about the risks of any disease, according to public health experts.
And with the country launching a vaccination and vaccine hesitancy being apparent since fewer half of the targeted 480,000 frontline workers got vaccinated in January and February.
The Health Ministry now plans to inoculate 3.7 million people above the age of 55 from March 7 in the second phase of the vaccination campaign but adequate risk communication strategy is missing, according to experts.
At present, agencies under the Health Ministry are completely focussed on immunisation. First phase of immunisation drive which is run in phases have completed in which around 430,000 people were immunised and these included elected representatives and staffers at local bodies, journalists and staff at diplomatic missions after the original target of inoculating 430,000 front line workers was not met.
Another example of government apathy, according to officials of the Health Ministry, is the absence of adequate seroprevalence studies which are very important to know the infection status, risk level and to make policy.
One such study has been carried out but is yet to be made public. The Health Ministry had announced several months ago that it is planning to carry out another such large scale study but the study has not yet started.
Officials at the Department of Health Services said that money was not the issue to carry out strengthening such disease surveillance and early warning systems of the country.
The European Union has offered financial help for over a year to strengthen surveillance and early warning systems and carry out seroprevalence study and contact tracing.
“But we have not yet okayed the guidelines,” an official at the Department of Health Services, told the Post asking not to be named. “Had we taken help offered by several aid agencies, and strengthened our system, we could have managed the infection far better.”
The World Health Organization too had offered technical support to the government to make a risk communication strategy but the strategy is yet to be implemented.
“Effective surveillance measures are necessary, not only for the ongoing Covid-19 pandemic, but also for possible other epidemics,” Dr Sameer Mani Dixit, director of research at the Center for Molecular Dynamics Nepal, told the Post. “It is not possible to overcome the pandemic by ignoring the risks, refusing to acknowledge the facts shown by the study.”
Doctors say that seroprevalence is necessary even to know if the vaccine is working properly or not against the existing virus and also against the new variant.
“Without knowing the virus variant and seroprevalence study, how do we know that the vaccine is working properly,” added Dixit. “Authorities should even focus on active case findings to lessen the risk of a second wave of coronavirus infections.”
Doctors say that the ongoing coronavirus pandemic is neither the first nor will it be the last and there is a high chance of the new variants of SARS-CoV-2 detected in many countries across the globe entering Nepal.
Several new variants of the SARS-CoV-2 have developed in many countries across the globe including the one detected in the United Kingdom known as UK variant, South African variant, Brazilian variant, Japanese variant and two new variants in India. As the coronavirus is an RNA virus, it keeps mutating and new variants might even have developed within Nepal, according to experts.
“Active case surveillance helps us to know changes in the virus variant,” Dixit said. “We can perform whole-genome sequencing, once we find something unusual in the virus variant.”
Even antigen tests will be helpful to carry out active case findings in the community, according to doctors.
“Strengthening early warning and reporting system, surveillance system focus on active case findings and seroprevalence study are the measures needed to lessen the risk of spread of diseases,'' Dr Binjawala Shrestha, assistant professor at the Institute of Medicine, told the Post. “We too have such measures, but time has come to review if those systems are working effectively or not.”