Amid uncertainty over Covid-19 vaccine supplies to Nepal, the country’s one immediate hope, the COVAX facility, has communicated to the government that it won’t be able to provide the jabs before next year. With this, it remains unclear when those 1.3 million people above 65 years of age, who took their first shots between March 7 and March 15, will get their booster doses.

According to officials, COVAX, an international vaccine-sharing scheme backed by the United Nations, has requested Nepal to look for other options.

“COVAX has requested us to explore other vaccines apart from Covishield,” said Dr Dipendra Raman Singh, director general at the Department of Health Services.

According to the government schedule, the booster doses to the 1.3 million people, who took their first shots of Covishield, should have been given starting last Monday, which is eight weeks after the first dose as recommended.

Given the uncertainty over procurement of Covishield vaccine, the government is now mulling giving the second dose after 12 to 16 weeks.

Nepal is supposed to receive around 13 million doses of vaccines under the COVAX facility in installments, and around 2 million doses were expected to arrive by the end of March.

Officials until last week said that they were expecting to get “some” doses under COVAX.

But now with COVAX, a facility which is a partnership between CEPI (Coalition for Epidemic Preparedness Innovations), Gavi (Global Alliance for Vaccines and Immunizations), UNICEF and the World Health Organisation, admitting delays in supplies, Nepal’s vaccine hopes have suffered a major setback.

According to officials, COVAX, in a communication last week, said that it regrets that its schedule has been impacted by delays and reductions in supply availability.

Apart from Covishield, the AstraZeneca type vaccine manufactured by the Serum Institute of India, COVAX has committed to supplying Pfizer BioNTech vaccines to participant countries across the world.

Nepal so far has received 2.348 million doses of Covishield and 800,000 doses of China Sinopharm’s BBIBP-CorV.

Of the total doses of Covishield, 1 million were provided by India under grant assistance. Another 1 million doses were part of an order of 2 million doses Nepal had placed by paying in advance to the Serum Institute. The remaining 1 million doses are yet to arrive.

The first consignment of 348,000 doses of Covishield under COVAX arrived on March 7.

“As the supply of Covishield from the Serum Institute of India has become uncertain, the COVAX facility has asked us to choose some other vaccines,” Dr Shyam Raj Upreti, coordinator of Covid-19 Vaccine Advisory Committee, told the Post.

On Tuesday, Adar Poonawalla, chief executive officer of the Serum Institute, in a statement, said that his firm will continue to scale up vaccine manufacturing and “prioritise India” as the country is currently experiencing a deadly surge in coronavirus infections.

“We also hope to start delivering to COVAX and other countries by the end of the year,” the company said.

The Serum Institute is a major supplier to COVAX. The statement comes two months after the Indian government imposed restrictions on all major exports of coronavirus vaccines, which affected COVAX deliveries to low- and middle-income countries.

According to the updates provided by COVAX to the Health Ministry, Pfizer BioNTech vaccines are also on the list to be supplied to various countries by the third quarter of 2021.

“We recognise the difficult situation Nepal is facing to vaccinate priority populations, and the impact that vaccine supply constraints have had on battling the Covid-19 crisis,” reads the communication, which is seen by the Post, from COVAX to the Health Ministry. “We sincerely regret that COVAX’s schedule has also been impacted by delays and reduction in supply availability, and assure you we are working proactively to mitigate the disruption…”

Nepal plans to inoculate 72 percent of the 30 million population (around 22 million people), as those below 14 years of age account for 28 percent of the total population and cannot be inoculated as most vaccines have not been tested on them.

COVAX has committed to providing doses enough to vaccinate 20 percent of the population (6 million people).

COVAX’s inability to supply vaccines anytime soon and the Nepal government’s lethargy in procuring jabs may mean a deepening virus crisis, as the surge in the second wave has continued and experts are warning of a third wave.

“We are preparing to respond to COVAX,” said Singh, the director general of the Department of Health Services. “We have to use any vaccine and we should be prepared to use it, as people are dying throughout the country. We cannot wait on the pretext of our lack of capacity to store other vaccines.”

Singh, however, said that the UN agencies are aware of Nepal’s limitations, vaccine storage capacity and ongoing surge of the infections.

The European Medicines Agency last week recommended a change to the approved storage conditions of the Pfizer BioNtech vaccine and allowed storage between 2 to 8 degrees Celsius. In February, the US Food and Drug Administration (FDA) had allowed undiluted vials of the vaccine to be stored at conventional 2-8 degrees Celsius temperatures for a period of up to two weeks.

Nepal’s existing vaccine storage facility can store vaccines in 2-8 degrees Celsius.

“Authorities should accept whichever vaccine COVAX provides, as it does not supply without the World Health Organisation’s emergency use authorisation,” Upreti said. “Vaccine is complementary to other public health measures to control the pandemic.”

The Health Ministry says it has sent diplomatic notes to vaccine manufacturing countries like China, India, Russia, the United Kingdom and the United States of America, requesting them to sell vaccines to Nepal.

“We have requested them to sell vaccines under a government-to-government deal,” said Singh. “We have also made it clear that we are ready to pay the international market price if they cannot provide us at subsidised rates.”

Only last week, the United Nations in Nepal said it is advocating with the vaccine alliance for prioritisation of Nepal in the allocation of AstraZeneca vaccines.

“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,” the UN said in an email response to the Post.

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.

Meanwhile, nine public health experts including Dr Sarad Onta, Dr Binjawala Shrestha and Dr Aruna Upreti, among others, said on Sunday that the declaration of elections by the government in the midst of the pandemic is a sheer negligence of public health by the government.

“Declaring an election instead of focussing to save lives is a clear example of sheer negligence,” reads a statement issued by the experts. “Accepting the emergency condition on health caused by the Covid-19 pandemic and declaration of election is contradictory in itself.”

ENDS