Had everything gone as planned, by now all those over 55 years of age would have been given the first dose of vaccine, a major milestone in containing the severity of Covid-19 and deaths from it.

As per the data provided by the Ministry of Health and Population, of the 3,020 who have died from Covid-19 complications, 72.1 percent were above 55 years old.

“We had planned to inoculate all the people above 55 years in the second phase of the campaign,” Dr Tara Nath Pokhrel, director at the Family Welfare Division of the Department of Health Services, told the Post. “But without sufficient doses of vaccine at hand, we were forced to change the priority list at the last hour.”

The government decided to inoculate only those above the age of 65 in the second phase that lasted from March 7 to 15.

The government may have given the first of the two doses to those above 65 but it does not have enough for the second dose for them. The government has only 500,000 doses in stock.

According to Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, the vaccine manufacturing company had to provide the remaining one million doses a week after delivering the first consignment. The first consignment arrived on February 21.

But with the delay in delivery and the Indian government’s decision on Wednesday, Nepal’s vaccination plan has hit a snag.

Reuters reported on Wednesday, quoting two sources, that India has put a temporary hold on all major exports of the AstraZeneca coronavirus vaccine made by the Serum Institute of India to meet demand at home as infections rise.

On Wednesday, 53,419 new cases of coronavirus were detected in India from about 12,000 a day in February.

“The new decision by the Indian government could affect the supply of vaccines purchased directly,” Dr Shyam Raj Upreti, coordinator of the Covid-19 Vaccine Advisory Committee, told the Post. “Supply of one million doses, for which we have already paid, could also be affected by this new decision.”

The Ministry of Health and Population has planned to administer the second dose to those who were vaccinated in the first phase between January 27 and March 5—frontline health workers, prisoners, people in old age homes, journalists, elected representatives and staffers at local governments—from April 20 to 24. To those vaccinated in the second phase—people above 65 years—between March 7 and March 15, the ministry plans to administer the second dose from May 16 to 30.

But these dates could change with India’s decision to halt exports.

“We can publish the schedule for administering the second dose of vaccine to those who have taken the first dose in the second phase [from March 7 to March 15] only after we receive additional doses,” Dr Jhalak Gautam, chief of the National Immunisation Programme, told the Post.

“We have sufficient doses in stock to provide a second dose for those who took their first doses of the vaccine in the first phase.”

Adhikari, joint spokesperson for the Health Ministry, however, is hopeful. According to him, the vaccine manufacturing company has assured Nepali officials, who were in touch with the company until a few days ago, that Nepal’s immunisation for the second dose would not be affected.

While around 438,000 had been inoculated in the first phase, more than 1.35 million people above 65 years were immunised in the second phase of the campaign.

Besides a million doses that came in grant from India and two million doses that Nepal bought from the Serum Institute of India—of which one million are yet to be delivered, Nepal has also received 348,000 doses from the COVAX facility, which is committed to providing enough vaccines to inoculate 20 percent of the country’s population. This would mean about 13 million doses would come as a grant from the COVAX facility.

But the supply of vaccines under the COVAX facility is also likely to be affected by the Indian government decision, reported Reuters quoting UNICEF, the programme’s procurement and distributing partner.

India is the world’s largest manufacturer of vaccines. The Serum Institute of India has been manufacturing the Covishield vaccine of AstraZeneca and this is the preferred choice of poor countries, including Nepal, given its convenient storage and transport infrastructure requirements.

“We understand that deliveries of Covid-19 vaccines to lower-income economies participating in the COVAX facility will likely face delays following a setback in securing export licences for further doses of Covid-19 vaccines produced by the Serum Institute of India, expected to be shipped in March and April,” UNICEF told Reuters in an email.

As many as 64 lower-income countries, including Nepal, are to get vaccines from the COVAX facility.

According to Adhikari, the ministry has also drawn the attention of the World Health Organisation about Nepal’s immediate vaccine needs.

Besides Covishield, Nepali authorities have also granted emergency use approval for Chinese company Sinopharm’s BBIBP-CorV vaccine and Indian company Bharat Bioshield’s Covaxin vaccine.

China has given 800,000 doses of BBIBP-CorV vaccine in grant but it is yet to arrive in Nepal. Besides, reports say that three doses of the vaccine are needed, rather than two, as in the case of others, for it to be effective.

A Bahraini prince had also brought 2,000 doses of the China-made vaccine on March 15 but it has been embroiled in controversy as apparently there was no prior permission from the Ministry of Health and Population for their import.

As for Covaxin, the government does not have immediate plans to procure them as its price is not yet known, according to government officials.

Nepal has allocated Rs48 billion to inoculate 52 percent of its population at its expense. Only 72 percent of the population needs to be vaccinated against Covid-19 as existing vaccines have not been trialled in children below 14 years and this age group accounts for 28 percent of the population.

It had bought two million doses of Covishield paying $4 per dose and had made 80 percent of the advance payment. It had also been in touch with Serum Institute of India to buy an additional five million doses but had not heard definitively from the company in this regard.

And now with the Indian government’s decision restricting exports, Nepal’s attempt to procure more vaccines in the immediate future could hit a roadblock.

“This decision could affect the vaccine supply,” Pokhrel, the chief specialist, told the Post. “We are not in a position to say anything about this right now.”