Nepal’s vaccination drive, which was suspended for an indefinite period earlier due to the government’s failure to secure doses, has finally resumed, as vaccines have started to arrive.

Nepal received 800,000 doses of Vero Cell vaccine on July 9, of the total 4 million doses the government has procured from China’s Sinopharm under a non-disclosure agreement. On July 12, the United States supplied 1,534,850 doses of the single-shot Johnson & Johnson vaccine, named Janssen, through COVAX, an international vaccine-sharing scheme backed by the United Nations.

Officials at the Ministry of Health say Nepal’s vaccination drive against Covid-19 has now come back on track. The ministry has already announced the dates for the administration of vaccines that have arrived from China and the United States.

Researchers as well as public health experts say the resumption of the inoculation campaign is encouraging, but the authorities in Nepal should also pay attention to research on the effects and efficacy of the vaccines that are being administered to the citizens. According to them, scientific studies within the country have become imperative as reports have surfaced in the international media about possible side effects.

“We should generate evidence of the vaccines’ efficacy and side effects on our own,” Dr Biraj Karmacharya, an epidemiologist, told the Post. “For that, a comprehensive study is needed.”

As soon as the J&J vaccine arrived in Nepal, reports in various international media surfaced about its side effects.

The US Food and Drug Administration (FDA) on Monday announced a new warning for the J&J vaccine. According to the FDA, the vaccine has been linked to a serious but rare side effect called Guillain-Barré syndrome, in which the immune system attacks the nerves.

Citing FDA warnings, media reports suggested that about 100 preliminary reports of Guillain-Barré syndrome were detected in the vaccine recipients after the administration of 12.8 million doses of the Johnson & Johnson vaccine.

Earlier, several countries had suspended the use of AstraZeneca vaccine after the regulatory authorities found possible links to very rare cases of unusual blood clot.

The Washington Post reported on Monday that vaccine safety officials in Europe have recommended that a warning be added about Guillain-Barré to the AstraZeneca vaccine.

There are growing concerns about whether BBIBP-CorV vaccine, developed by Sinopharm—an affiliate of China’s state-backed pharmaceutical giant, provides protection against the Delta and Delta Plus variant, first identified in India.

Karmacharya, who is also the head of the Department of the Community Programme at Dhulikhel Hospital, said since vaccines are the only reliable measure to contain the spread of the virus, focusing on acquiring as many doses as possible is the best way forward. “But since the virus continues to mutate frequently and more lethal types are also emerging, authorities in Nepal too must focus on conducting studies on the virus and vaccines,” Karmacharya told the Post.

The Epidemiology and Disease Control Division says Delta and Delta Plus variants are currently circulating in Nepal, prompting concerns if the country could see a second wave peak before it is hit by a third wave. Until a few weeks ago, Nepal was not even performing whole-genome sequencing tests to ascertain if any new variant was circulating in the country.

The National Public Health Laboratory has recently started performing whole-genome sequencing tests in its own laboratory. The technology was set up with financial assistance from the World Health Organisation.

Apart from the National Public Health Laboratory, three other laboratories also have the technology to perform whole-genome sequencing tests.

Doctors say study of antibodies generated by vaccines, and side effects on the vaccinated population helps authorities formulate policies and take appropriate decisions.

“None of the vaccines have been trialled in Nepal and we have not carried out any study on the people who have been immunised,” an official at the Department of Health Services, told the Post requesting anonymity. “The Health Ministry had plans to carry out the study, but it has not started yet.”

The J&J vaccine is the third vaccine against Covid-19 that Nepal is currently using after AstraZeneca and Vero Cell. As Nepal needs to inoculate around 72 percent of its population, it will need more vaccines, and the government is not in a position to pick and choose and it should accept or buy any vaccines, authorised by the World Health Organisation for emergency use, from any country or any company.

Experts say conducting studies on the effects and efficacy of a vaccine is a regular practice around the world and such studies should be carried out regularly.

“We have been administering vaccines without knowing how effective they are against the Delta and Delta Plus variants,” Dr Basudev Pandey, former director at the Epidemiology and Disease Control Division, told the Post. “Carrying out a scientific study not only helps us know the efficacy and effects of vaccines but also makes it easier for everyone when it comes to making policies. Such studies also help enhance our scientific knowledge.”

About four months ago, a team of experts had proposed a nationwide comprehensive study on the effectiveness of vaccines.

The Nepal Health Research Council, an agency that promotes scientific research in the country, had passed a proposal to conduct a nationwide study of Covid-19 vaccines currently in use in Nepal. But the research could not kick off as the agency concerned failed to release the budget, according to people familiar with the matter

“Had we carried out a scientific study, we would have our own evidence,” Dr Prabhat Adhikari, an infectious disease and critical care expert, who is also part of the team of experts applying for the comprehensive research, told the Post. “We have been relying on the reports of other countries, but we do not know what is happening inside the country. A study is necessary to know the actual status.”

Meanwhile, the Council said that it has been conducting a study on the side effects of Covid-19 vaccines on the recipients in Kathmandu Valley.

“We have planned a nationwide study but due to various reasons, it has not started,” Dr Megnath Dhimal, chief researcher at Nepal Health Research Council, told the Post. “The Health Ministry is also conducting seroprevalence studies, which also provide information on antibody levels among the vaccinated population as well as those who have not been vaccinated.”

Regular seroprevalence studies are needed to know how long the antibodies last after vaccination and to know if additional booster shots are required.

Dr Shyam Raj Upreti, coordinator of the Covid-19 Vaccine Advisory Committee, said that the World Health Organisation has asked some countries to carry out studies on the effectiveness of the vaccines and their effects.

“Adverse effects following immunisation have been reported in all districts throughout the country,” said Upreti. “Authorities have plans to carry out a comprehensive study on the effectiveness of the vaccines.”

Several adverse events—fever, vomiting, respiratory problems and even deaths—were reported after vaccination during the second phase of the immunisation drive from March 7 to 15, in which authorities had administered the Indian-made AstraZeneca type vaccine named Covishield. But the Health Ministry claimed that the reports of adverse health effects were not related to the vaccine.

Upreti said that the government will administer the J&J vaccine unless the World Health Organisation asks to halt vaccination.

“The benefits of administering the vaccine are more than the risks,” said Upreti.