“Immature planners in the health sector; the frequent changes in age groups for immunisation is just an example,” Dr Guna Raj Awasthi, chief of the Sudurpaschim provincial health directorate, wrote on his Facebook page on Tuesday. “How many times do we have to lie to the people in the community?”

Awasthi was referring to the announcement by the Ministry of Health and Population on Monday evening about inoculating people with the 1 million doses of the Chinese vaccine. Revising its earlier decision, the ministry said that in Kathmandu Valley, people aged 60-64 would be vaccinated, but elsewhere, those between 62 and 64 years would get the jabs.

Last week the government had announced that all Nepalis aged 60 to 64 would be given the Sinopharm shots that China donated.

Public health experts have criticised the government decision to focus on Kathmandu Valley as inequitable.

“Vaccinating people of Kathmandu Valley was fine earlier, as the infection was spreading fast and all three districts of the Valley are densely populated,” Dr Binjawala Shrestha, a public health expert, told the Post. “But how can the authorities give priority only to the Valley every time? Aren't the people residing throughout the country equal to the government?”

Although the number of cases across the country and in Kathmandu Valley has been coming down as prohibitory orders have been in place since April 29, the number of cases in rural Nepal has been increasing, according to doctors.

On Tuesday, Nepal reported 3,870 new infections from 12,065 polymerase chain reaction tests. The Ministry of Health and Population also reported 1,283 positive cases from 5,611 antigen tests conducted largely in rural Nepal. Despite the rise in number of cases in rural Nepal of late, the government focus continues to be on Kathmandu Valley.

And this is not the first time that the government has prioritised the Valley for Covid-19 vaccination over the rest of the country.

Most of the 800,000 doses of Sinopharm’s BBIBP-CorV vaccines that China had donated in March were also given to the people residing in Kathmandu Valley, besides businesspeople and truck drivers from Nuwakot, Rasuwa, Kavrepalanchok and Sindhupalchok districts as they made frequent trips to China.

Students studying in China were also given the jabs.

Nepal was among the first countries in South Asia to start the immunisation drive against Covid-19. But right from the start its vaccination programme has not been up to the mark.

The government initially announced that health workers and other frontline workers at risk of being infected like cleaners and Nepal Army soldiers handling the bodies of Covid-19 victims would be inoculated with the 1 million doses of Covishield vaccines that India donated in January. To that, it later added journalists and staff at diplomatic missions based in Kathmandu Valley. Inclusion of journalists and staff of diplomatic missions had met with a fair share of criticism from some quarters. Later elected officials and staff and local governments as well as parliamentarians were also given the jabs.

When Nepal received the delivery of 1 million doses of Covishiled bought from the Serum Institute of India in February, the Health Ministry said all above 55 years would be inoculated. Later, it revised the priority group and decided to give the jabs to those above 60, but finally only those above 65 years were inoculated between March 7 and March 15.

Altogether 1.4 million are yet to get the second dose and it is unclear when they will get them as the government has not procured additional doses of Covishield, the AstraZeneca type of vaccine, although the gap between the two doses has been increased to 12 to 16 weeks from 8 to 12 weeks. The Serum Institute has yet to deliver 1 million doses of vaccines that Nepal has already paid for.

“Only after wide discussions should programmes be finalised,” said Awasthi in his Facebook post, “and not change them immediately afterwards.”

As decisions made by officials at the Ministry of Health and Population have to be implemented by those in the field, they face the brunt of frequent changes in plan.

“Health workers in our province have reached every community and invited them to come to the immunisation centres for inoculation,” Awasthi told the Post over the phone from Dhangadhi. “What will they tell the people coming with hopes of getting the vaccine? It is very easy to issue a circular from Kathmandu but very difficult for those working at the health facilities.”

Health Ministry officials had an excuse for the sudden change in age groups eligible for the Chinese vaccine.

“Due to the ongoing pandemic, demand for vaccines is very high,” Dr Jhalak Gautam, chief of National Immunisation Programme, told the Post. “Another reason for changing priority groups is that it is not feasible for the preloaded vaccines to be sent to the districts as they take up more storage space.”

Of the 1 million vaccines that China donated, 800,000 came from Beijing and 200,000, donated by the Tibet Autonomous Region of China, came in syringes from Kunming.

Health Ministry officials last week had, however, said health workers would be trained on using them through a virtual orientation programme.

Officials had also said that they would be able to inoculate all those between 60 and 64 with two doses even though they estimated there are 850,000 people in this age group.

Gautam told the Post last week that with 100,000 of the 800,000 China donated earlier in March still in stock there would be enough for both doses as many of the 60 to 64 year-olds would not turn up for immunisation. Many of them from the mountain districts had taken their jabs when those above 65 were given the jabs in March.

“Immature decisions of the authorities only increase the risk of a conflict between health workers and local residents,” Dr Mingmar Gyelgen Sherpa, former director general at the Department of Health Services, told the Post.

Before Tuesday, just over 2.1 million people had been immunised. Of them, only around 700,000 have been given both doses.

But many above 65 are still to get the first dose.

All those above 65 did not take the jabs due to various reasons like vaccine hesitancy, limited immunisation centers, lack of proper and sufficient awareness drive, and lack of access to immunisation centers, Health Ministry officials said.

“Only those who are aware of the risk took the jabs. A significant number of people above 65 years missed vaccination due to various reasons,” Dr Anup Subedee, an infectious disease expert, told the Post. “Even all health workers who were on the first priority list have not taken jabs.”

But officials say that they cannot do anything about the targeted groups not getting vaccinated.

Asked about the mismanagement of the vaccination programme with even those not on the priority list taking the jabs, Gautam of the National Immunisation Programme said that the priority list was made based on risk assessment and it is not possible to monitor that every dose is administered to the intended person.

But the risk of the pandemic now has spread to the villages, and the government’s priorities are misplaced, experts say.

“Infections have been exploding in the rural areas, and the authorities are still prioritising Kathmandu Valley,” said Shrestha, the public health expert who is also an assistant professor of Community Medicine at the Institute of Medicine, Tribhuvan University. “People residing in the rural areas are at high risk. They are not getting vaccines and there is no easy access to health facilities. Nor are there enough health workers to provide treatment.”