More than 20 weeks after they got their first dose of the AstraZeneca vaccine, roughly 1.4 million people aged 65 and over started getting their second dose on Monday.

When they took the first dose of the vaccine in the second week of March, they were told that they would get the dose in four weeks’ time.

The elderly were worried about the delay in getting the second dose, and, according to the authorities, the uncertainty made some of them seek and even take the Chinese Vero Cell vaccine as well.

“I have also heard rumours that the elderly who took the first dose of AstraZeneca sought Vero Cell and some even took it,” said Dr Samir Kumar Adhikari, joint spokesman for the Ministry of Health and Population.

Other ministry officials that the Post talked to said they had had similar reports from different parts of the country.

“After failing to get the second dose of the AstraZeneca vaccine, dozens of elderly people sought Vero Cell as the second dose,” Laxmi Koirala, health coordinator of Kageshwari Manohara Municipality of Kathmandu, told the Post.

“They queued for hours for vaccination, but we advised them that it would be risky to take two different types of vaccines and told them that we are not allowed to vaccinate them with another type of vaccine.”

The urgency the elderly and their family members felt for the second dose was because there are no signs of the pandemic coming under control as the number of cases continues to rise.

On Tuesday, the Ministry of Health and Population reported 3,194 new cases from 13,217 polymerase chain reaction tests and 1,710 from 5,906 antigen tests. The total number of cases since the pandemic began last year stands at 720,680. Of these 37,332 cases are active. With 35 more deaths reported Tuesday, the toll from Covid-19 stands at 10,150.

Another reason for worry has been the absence of proper communication from the authorities, according to immunisation workers.

The government had said that those aged 65 and above would get the second dose after four weeks hoping that the Serum Institute of India would deliver 1 million doses that Nepal had paid for. But with the Serum Institute not delivering them as a result of export restrictions by the Indian government in the wake of the second wave of the pandemic, the interval had to be prolonged.

The government announced that the second dose would be given after a gap of eight to 12 weeks. With no alternative arrangements to procure the vaccine, it later said the gap would be 12 to 16 weeks.

But Monday, when those aged 65 and older finally started getting the second dose, marked the beginning of the 21st week since their first dose.

Vaccines arrived from Japan and Bhutan over the weekend. Under the COVAX facility, Japan is providing, in a grant, 1.6 million doses of the AstraZeneca vaccine of which 847,320 doses have arrived. Bhutan has provided 230,000 doses of AstraZeneca vaccine that was surplus after immunising its population.

The ideal gap between the two doses of AstraZeneca vaccine is not clear although the World Health Organisation says it should be eight to 12 weeks.

Risk communication experts say that in the absence of the right message, people tend to believe whatever information is available.

“For the authorities to provide the right message to the public, there needs to be the right information,” said Dr Radhika Thapaliya, risk communication expert and director at the National Health Education Information Communication Centre. “It cannot provide the right message on time when it does not have the right information and when people do not get a message from a credible source, they take a message from any available source, which can be misleading sometimes.”

In Nepal, there is also the problem of proper record-keeping.

According to health workers at immunisation centres the Post talked to, the only way to verify which vaccine that a person has taken is the immunisation card that is issued after vaccination.

“But if they come without a card and say they are taking the first dose when in fact they are taking the second dose, we have to vaccinate them,” said Jagat Nepali, senior auxiliary health worker serving at Alapot Health Post of Kageshwari Manohara Municipality of Kathmandu.

Although the names of persons are taken down when they go to get the Covid-19 vaccines, the data collected is not managed.

“We don’t have any mechanism to verify who has taken which vaccine,” said Nepali.

The Health Ministry does, however, give an update on vaccinations and as of Tuesday, 4,541,682 have got their first dose while 2,722,020 have been fully vaccinated.

The ministry, however, does not provide weekly and monthly breakdowns of the number of people vaccinated.

To improve the reporting and recording system, the Health Ministry has set up an Information Management Unit with technical and financial support from the World Health Organisation. Such units have been set up in all seven provinces. But still, there are problems in the reporting.

“Immunisation centres throughout the country have no system of knowing who has taken which vaccine,” Rajendra Poudel, technical head of the Information Management Unit, told the Post. “The word of a person is the only way to know if they have been vaccinated earlier and the brand of vaccine.”

The problem is not only with those above 65.

Officials at the Department of Health Services said that they have received several reports about vaccine mixing.

“We got a complaint that a man first took Vero Cell and later took the Johnson & Johnson vaccine,” an official at the department told the Post, asking not to be named.

The government decided to administer the single-shot Johnson & Johnson vaccine, 1,534,850 doses of which the United States provided in a grant through the COVAX facility in June, to those aged 50 to 54.

But with calls for migrant workers to be given the vaccine since it would be convenient for them and destination countries allowed entry for only the vaccinated, authorities decided to include them for the Johnson & Johnson vaccination too. Earlier, the authorities had decided to give them Vero Cell jabs.

A number of countries in the Gulf region do not allow entry to those jabbed with the Chinese vaccine.

“It has also been reported that some people, who have taken the Vero Cell vaccine, have got the certificate of being jabbed with the Johnson & Johnson dose to go abroad,” the official from the department said.

Public health experts said that the collection and management of data by the government has been a kind of disaster since the start of the pandemic. They said that lack of the right information reporting system was one of the reasons that prevented the authorities from taking prompt action to tackle the pandemic.

“We have been asking the Health Ministry to improve the data collection and reporting for a long time,” said Dr Binjwala Shrestha, a public health expert. “But still they have to improve a lot of things. Authorities should also take action on the basis of the data they gathered.”

Although doctors say that exact information is necessary for formulating policies and making decisions, government officials point to their own challenges.

According to Adhikari, the joint spokesperson, there are problems in the reporting system from local units as health workers there are overworked.

“Besides their daily work, they have to update the reports too. Moreover, several local units have problems with the internet and health workers might also have problems with using the technology,” said Adhikari. “And the priority of health workers serving at the local level is to provide service rather than update the data.”

But without reliable information on how many people took which vaccines, decisions on purchasing vaccines, planning for the second doses, knowing the burden of diseases, taking preventive measures and making a budget and preparing other plans become difficult, according to experts.

“Without knowing the exact situation, how can you make plans?” Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “The existing recording and reporting system of the Health Ministry is a complete mess, which should be improved immediately.”

That will have a direct impact on the people, according to Thapaliya, the risk communication expert.

Having the right information is a must to disseminate the correct information so that the risks are minimised, Thapaliya said.