Shankar Prasad Adhikari of Bidur Municipality is worried. He is asking around when his parents will get the second dose of the vaccine against Covid-19.

“My father is 73 and mother 69,” Adhikari, a contractor by profession from Nuwakot, a district adjacent to Kathmandu, told the Post on Monday. “Corona cases are surging in my village too. They have taken the first dose, but I don’t know when they will get their second.”

His parents are among the 1.3 million Nepalis above 65 years of age who were administered the first dose of Covishield, the AstraZeneca type vaccine, manufactured by the Serum Institute of India.

After inoculating 438,000 people in the first phase from January 27 to March 5, the government conducted the second phase of the vaccination campaign from March 7 to March 15.

According to the government schedule, the booster doses to the 1.3 million people should have been given starting from Monday.

“We do not have vaccines to provide second shots to people above 65 years old, who were given the first doses in the second phase,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “We can say when they will get their second shots only after we get the vaccines.”

Nepal launched its vaccination drive within one year of the pandemic in the country after receiving 1 million doses of Covishield from India under grant assistance. A consignment of additional 1 million doses–of the 2 million doses for which Nepal had paid the Serum Institute of India–arrived on February 21. The second shipment of the remaining 1 million doses was expected to arrive within weeks, if not days. But it did not.

Meanwhile, India faced its own Covid-19 crisis, and on March 24, New Delhi put a hold on the export of AstraZeneca jabs to meet demands at home.

Government officials say their only hope now is COVAX, a facility that is a partnership between CEPI (Coalition for Epidemic Preparedness Innovations), Gavi (Global Alliance for Vaccines and Immunizations), UNICEF and the World Health Organisation, which has committed to providing Nepal with 13 million doses to inoculate six million people (20 percent of the 30 million population).

The Covid-19 crisis in India, however, has left COVAX in the lurch.

The BBC reported on Monday that the COVAX facility that aimed to ensure equal access to Covid-19 vaccines is 140 million doses short because of India's continuing Covid-19 crisis.

According to the report, the Serum Institute, the largest single supplier to the Covax facility, has made none of its planned shipments since exports were suspended in March.

"Unfortunately, we're in a situation where we just don't know when the next set of doses will materialise," Gian Gandhi, UNICEF's COVAX co-ordinator for supply, told the BBC. "Our hope is, things will get back on track, but the situation in India is uncertain… and a huge concern."

Under pressure, UNICEF, the in-charge of supplying vaccines for COVAX, now is calling on the G7 countries–Canada, France, Germany, Italy, Japan, the UK and the US–as well as the European Union, to donate their surplus vaccines urgently.

With no vaccines in hand, questions now have arisen if the Nepal government made a miscalculation and started vaccinating people without ensuring the second doses for those who took the first jabs.

Based on the doses of vaccines Nepal so far has received, there are 240,000 doses (calculation does not include wastage) of Covishield at different health facilities across the country. The stock is just not enough.

It was known that those who took the first jabs needed to take the second shots from May 16 onwards–given the 8 to 12 weeks’ gap suggested for the AstraZeneca vaccine.

There, however, was no effort to secure the vaccines. Instead, Health Minister Hridayesh Tripathi went out to the media, accusing “some agents” of foiling the government plan to import vaccines because they were seeking commissions. The Serum’s local distributors refuted the claim in an interview with the Post. On Saturday, Foreign Minister Pradeep Gyawali said, according to the Nepali Times, the non-delivery of the remaining 1 million doses was not because of middlemen or commissions.

The 65-year-olds who are awaiting their second vaccination, however, are bearing the brunt of the ongoing blame-game and government’s failure.

Officials at the Ministry of Health say officials from the UN agencies, including the World Health Organization’s country office in Nepal, had assured that Nepal would get additional doses by March-April. They then told the Post that they were hoping to get additional doses by June.

“Now it seems they (COVAX) won’t supply the vaccines in June also,” Dr Tara Nath Pokhrel, director of the Family Welfare Division which runs the country’s national immunisation programme, told the Post. “We will provide the second dose once we get the vaccine.”

Failure to acquire the vaccines on time for those who got their first dose is just a manifestation of how the government has failed to take the pandemic seriously, experts say.

Dr Keshav Deuba, a public health epidemiologist, said that authorities should have explored all possible options to inoculate people, but they did not.

"Members of the public are ready to get the jabs, but people in power do not seem to be making any efforts to procure the vaccines,” Deuba told the Post.

Government officials are now moving the goalposts.

Pokhrel said that the second dose can be administered within 16 weeks.

“India too has extended the gap between the first and the second dose. It is better to administer the two doses between eight and 12 weeks, but that is in an ideal situation… when vaccines are available,” Pokhrel, the director of the Family Welfare Division, told the Post. “But if we do not have any other option, the second dose can be administered in 16 weeks.”

The question, however, is not whether the second doses can be administered after 16 weeks, many say. The question is just like other bunglings, the government bungled the vaccine procurement as well, at least when it comes to second doses for the elderly, according to them.

Weeks after launching the vaccination drive for frontline workers, including health workers, sanitation workers, security personnel, journalists, staff serving in diplomatic missions, elderly people residing in old-age homes and prisoners, the government had signed a deal with Serum for 2 million doses. This ensured the second doses for those 438,000 people who took the first shots.

The glitch started after the Serum Institute refused to provide the remaining 1 million doses, saying it was rather ready to refund the money. The government, however, refused to make that public and continued to promise that the vaccines would arrive soon.

Asked why the government started administering the vaccines to people above 65 years of age without securing second shots for them, Pokhrel said it was the right decision “at that time” and that the UN health agency also had recommended increasing the coverage by extending the first dose to the risk group.

It now has become apparent that the government was totally relying on COVAX, as officials were well aware of the fact that the Serum was not going to provide any additional doses, leave alone the remaining 1 million doses for which the payment was already made.

But India’s Covid-19 problem has hit the COVAX vaccine-sharing programme hard.

On Saturday, Sara Beysolow Nyanti, the UN resident coordinator in Nepal, called on the world to send vaccines to Nepal.

“Is the world listening? With the highest case positivity rate in the world, the data is also speaking,” Nyanti wrote on Twitter. “Send vaccines to Nepal now!”

Only on Friday, the World Health Organisation chief Tedros Adhanom Ghebreyesus said that Nepal has emergency needs. During a regular media briefing, Ghebreyesus said that in a handful of rich countries, which bought up the majority of the vaccine supply, lower risk groups are now being vaccinated.

“I understand why some countries want to vaccinate their children and adolescents, but right now I urge them to reconsider and to instead donate vaccines to COVAX,” he said.

With Nepal case positivity rate hovering around 50 percent, the country’s Covid-19 pandemic is sliding into a devastating crisis.

The United Nations office in Nepal said on Monday that the surge in cases is concerning but it did not provide an answer as to when the country would be able to receive additional doses of vaccines under COVAX.

“The UN in Nepal is advocating with the vaccine alliance for prioritisation of Nepal for allocation of AstraZeneca vaccines,” said the UN in an email response to the Post. “The clearest pathway out of this pandemic is equitable distribution of vaccines, diagnostics and therapeutics and we are working towards it along with the COVAX facility.”

A Gavi spokesperson said the COVAX facility is currently assessing those countries that are impacted by the Serum Institute’s delays to support them wherever possible in ensuring the second dose is administered in line with recommendations.

“COVAX’s first priority, alongside raising the necessary financial support from donors to fully fund the Gavi COVAX Advance Market Commitment and procure 1.8 billion doses for lower income countries and finalising agreements with new suppliers, is to work with governments with the largest supplies to urgently deliver them, through COVAX, to countries where they can have an immediate impact in addressing this short-term supply disruption,” said the spokesperson in an email response to the Post.

For Adhikari from Bidur, however, concerns are growing, as he said both his parents have some preexisting conditions.

“My father has asthma and mother is a blood pressure patient,” he said. “I am worried about their safety.”

Dr Janak Koirala, an infectious disease expert, said that it was not a wrong decision to administer the first doses to elderly people, as the death rate from Covid-19 infection is high among people of this age group.

“What is worrying is the infection is now getting out of control,” Koirala told the Post.

Studies suggest even the first shot triggers antibodies against the virus but a booster dose, of the same make, is necessary for better protection.

Deuba, the public health epidemiologist, said the government should have started exploring options long ago and that now it's a race against time.

“Had the authorities not put all their eggs in one basket, things would have been different,” Deuba told the Post. “They initially relied on India and now they are hoping to get vaccines from COVAX. They never made any sincere efforts to bring in the jabs from other countries.”