It was between March 7 and 15 that those above the age of 65 got the first dose of Covid-19 vaccine. But when they will get the second dose remains unclear even though the government has been scrambling to procure vaccines.

The announcement by the COVAX facility of the World Health Organization that it would provide 348,000 jabs in July is little relief for the authorities.

“We are informed that the COVAX facility will provide 348,000 doses of vaccine on July 22,” an official at the Health Ministry told the Post, asking not to be named. “We were hoping to get around 1.5 million doses—sufficient for all those who had taken the first doses of Covishield.”

Around 1.4 million people aged 65 and above had been given the first dose with the 1 million doses of Covishield that Nepal bought from the Serum Institute of India and 348,000 that the COVAX facility provided in March.

Authorities had banked on the Serum Institute to deliver the remaining 1 million doses that Nepal had paid for, but with the deadly second wave hitting India in April, the Indian government restricted the export of vaccines.

With no possibility of timely procurement of the second dose, the Health Ministry widened the gap between the first and second doses of Covishield from 8 to 12 weeks to 12 to 16 weeks.

Even if some of the 348,000 vaccines are given to those aged 65 and above, it will have been 18 weeks since the first dose.

The delay has its own complications.

According to Dr Basudev Pandey, former director at the Epidemiology and Disease Control Division, who is also a virologist, antibodies developed by the vaccine in people who have taken the first dose may decline if the second dose is not given on time.

But with the COVAX facility providing only about a fourth of the needed quantity for the second dose, Nepal’s immediate vaccine problem will not be resolved.

“It does not help us deal with the problem we are facing,” Dr Roshan Pokhrel, chief specialist at the Health Ministry, told the Post. “It will create chaos instead, as so many people are desperately waiting for their second shot.”

The 348,000 doses expected to arrive in July under COVAX would be enough to provide second shots to just 24 percent of those who took the first shots between March 7 and March 15.

Moreover, officials hoped that the COVAX facility, which had declared it would provide 2,256,000 doses in its interim forecast in February, would provide the remaining doses within May. But since the Serum Institute is also the major supplier to the facility, it was unable to do so.

The COVAX facility has said that it will eventually provide enough vaccines to inoculate 20 percent of the country’s 30 million population—that is 13 million doses in total.

Authorities say they are trying to get the AstraZeneca vaccine from other sources too. The vaccine developed by the University of Oxford and the pharmaceutical giant AstraZeneca is manufactured under the brand name Covishield by the Serum Institute.

“We are trying to secure AstraZeneca vaccines from all available sources including from Denmark but have not been able to sign a deal,” said Pokhrel. “Denmark, which manufactures the Oxford-AstraZeneca vaccine, is willing to supply only through COVAX.”

Although Nepali authorities have written to Denmark to procure the vaccines directly, they have not heard from them.

According to Dr Shyam Raj Upreti, coordinator of the Covid-19 Vaccine Advisory Committee, the latest announcement by the COVAX facility to provide 348,000 vaccines is of little help to Nepal.

“The announcement from the COVAX facility has not given any relief to authorities, as they have to bring over one million AstraZeneca vaccines at any cost,” Upreti told the Post.

While Nepal needs to make efforts to bring in vaccines other than AstraZeneca, the priority should be those people who have taken the first dose of Covishield.

“Vaccines developed by companies other than AstraZeneca should be procured but they cannot be used as second dose to those who have taken the first dose of Covishield,” said Upreti.

Nepal launched its vaccination campaign on January 27 with the 1 million doses of Covishield that India provided under a grant assistance.

Apart from that, China has provided 1.8 million doses of BBIBP-CorV vaccine developed by the Beijing Institute of Biological Products Co Ltd (BIBP) under Sinopharm in two phases—in March and in June.

Those aged 60 to 64 in Kathmandu Valley and those aged 62 to 64 in the rest of the country are currently being given the Sinopharm vaccine with the 1 million doses China provided earlier this month but there have been problems in distribution besides the inequitable distribution between the Capital and the rest of the country.

There are complaints from different parts of the country that the number of vaccine doses sent was not enough for the age group.

“There are about 1,200 people aged 62 to 64 in our rural municipality but we just received 650,” said Jit Bahadur Chaudhary, health chief of Janaki Rural Municipality, Kailali. “Earlier we had received only 400, but after our complaints, another 250 were sent.”

Health Ministry officials say there have been conflicts between health workers due to the lack of enough doses for the ongoing vaccination of the targeted population.

Nepal has decided to vaccinate 72 percent of its people against Covid-19, as children up to 14 years of age constitute 28 percent of the population. The Health Ministry has not decided yet on inoculating children under 15, though some countries are doing so with China approving the jabs for children aged 3 to 15 years.

According to the Health Ministry, until Friday, 2,383,098 have taken at least a single dose of Covid-19 vaccine and of them 691,497 people have taken both doses.

“Vaccine is the only way at present to save people from the infection,” said Pandey, the virologist. “Authorities should make every effort to bring the vaccine for all and try to arrange AstraZeneca vaccine to those who have taken their first doses.”

Though daily new infections have come down over the last few days after reaching close to 10,000 last month, experts say the risk is not over yet, as the virus has spread to the communities.

On Saturday, Nepal reported 2,382 new infections. The Ministry of Health and Population said 61 people had died from Covid-19-related complications, taking the death toll since the pandemic began to 8,366. The number of active cases stands at 71,301.

With the 348,000 doses of vaccine expected to arrive in July, authorities can prioritise the most elderly people, according to Pandey.

“Those who are too old or have comorbidities should be prioritised,” said Pandey. “Authorities should be mindful of not letting the vaccine go into the hands of influential people, thereby depriving the needy of the doses.”

(Ganesh Chaudhary contributed reporting from Tikapur.)