If what officials were claiming was anything to go by, around 6 million doses of Pfizer-BioNTech vaccine were due to arrive in Nepal “very soon”—by December-end or early January. But the shipment is not arriving now.

Highly placed sources at the Ministry of Health told the Post that the deal with the American firm was “suspended” at the last hour.

According to the sources, after Nepal received “sufficient” doses of the Moderna vaccine from COVAX, an international vaccine-sharing scheme backed by the United Nations, to inoculate children between 12 and 17 years, the government suspended the deal to buy the Pfizer vaccine.

“The Moderna vaccine doses we received from COVAX and the doses we have already purchased are sufficient to inoculate children aged 12 and 17 years,” an official at the Ministry of Health and Population told the Post on condition of anonymity. “The doses we have bought from the US firm will arrive within this month.”

The number of children aged between 12-17 years is around 3.6 million.

Using a World Bank loan, Nepal has placed an order for 4 million doses of the Moderna vaccine but none has arrived.

Earlier, the ministry had decided to purchase 6 million doses of Pfizer-BioNTech vaccine from the US firm under a non-disclosure agreement. The ministry had sent a proposal to the Cabinet for approval and the file was approved in the third attempt.

Officials told the post that the vaccines were purchased using the World Bank’s loan and have expected delivery of the vaccine from December.

“We held up the deal at the last hour, as we received sufficient doses of the Moderna vaccine from COVAX,” Dr Bibek Kumar Lal, director at the Family Welfare Division, told the Post. “We had decided to purchase the Pfizer vaccine to inoculate children aged 12 and 17, but when we have sufficient doses of Moderna vaccine for the same group, we don’t see a reason to buy the Pfizer vaccine.”

Officials at the Department of Health Services said that they are instead negotiating to purchase 8.4 million doses of Pfizer vaccine suitable for children between five and 11 years old.

“No new deal has been reached so far to purchase the Pfizer vaccine though,” an official at the Health Ministry, told the Post who also sought anonymity. “The previous deal to purchase 6 million doses has been suspended, and no new deal has been reached as of today [Tuesday].”

Lal, director at the Family Welfare Division, said that it took much time to reach a new deal to buy 8.4 million doses for children of 5-11 years due to Christmas and New Year.

There are two types of Pfizer-BioNTech vaccine against Covid-19 for children aged 5-11 and for those aged 12 and above.

The American Association of Pediatrics has recommended administering 10 microgram doses in a gap of 21 days to children between five and 11. The dose, 0.2ml, is one-third of what is administered to adolescents and adults.

The vaccine vial for children aged 5-11 is orange-capped to differentiate it from the other vial that is purple-capped.

Each vial with 10 doses needs 1.3 milliliters (ml) of diluent under Pfizer’s preliminary plan. The vaccines can be stored for six months in an ultra-cold freezer or 10 weeks in a normal refrigerator, under Pfizer’s proposal.

For the use of the 0.2ml Pfizer vaccine in Nepal, authorities need to take an emergency use approval from the Department of Drug Administration, the country’s drug regulator.

The US Food and Drug Administration in October authorised the emergency use of Pfizer-BioNTech Covid-19 vaccine for children between five and 11.

Nepal has already used Pfizer vaccines on its people—to those having comorbidities and children between 12 and 17.

Authorities had planned to roll out the vaccine for children between 12 and 17 in eight districts including the districts of Kathmandu Valley from last Tuesday but halted the vaccination due to shortage of the specialised syringes.

Nepal received 664,560 doses of the Pfizer-BioNTech vaccine, donated by the United States through COVAX, on December 24.

But syringes were not delivered with the doses.

Meanwhile, officials said they have now received the syringes.

“We received 466,000 syringes from COVAX,” said Bade Babu Thapa, a senior official at the Logistic Management Section under the Department of Health Services.

A 0.5ml auto-disable syringe is used for other vaccines while a 0.3ml syringe is needed for Pfizer-BioNTech.

Officials said that vaccination for children between 12 and 17 in eight districts including the Kathmandu Valley will resume within the next couple of days.

“All preparation regarding rollout of Pfizer vaccination has completed,” said Shambhu Kafle, chief of the Health Office Kathmandu. “We are ready to roll out the vaccine.”

He said that immunisation centers will be set up in schools each targeting 200 students.

So far, 10,710,721 people or 35.3 percent of the total population have been fully vaccinated.

On Tuesday, 393 people tested positive for Covid-19—355 in the 7,794 polymerase chain reaction tests and 38 others in 1,535 antigen tests. Three people died of Covid-19 in the last 24 hours.

As of December 24, Nepal has received 39,203,927 doses of various Covid vaccines.

And the reason behind the suspension of the deal is the government got sufficient doses of Moderna vaccine from COVAX to inoculate children between 12 and 17 years.

Officials at the Ministry of Health and Population had been claiming that they expected delivery of six million doses of Pfizer-BioNTech vaccine soon from the US firms until a few days ago.

But a highly placed source at the ministry informed that the deal had been suspended in the last hour.

The earlier 6 million doses for which a deal had been reached were 0.3ml type.

While the doses that are to be administered to kids between five and 11 require a different syringe, dilution requirements and storage conditions than the vaccines currently available for adolescents and adults according to Pfizer, according to the American Association of Pediatrics.

The currently available vaccine product with a purple cap has not been studied in children under 12 and therefore should not be used for this age group, according to the association. It recommends the vaccine vials for ages 5-11 years should have orange caps and borders to differentiate them.

Investigators tested the lower-dose Pfizer-BioNTech vaccine in 2,268 children and announced in late September that their data demonstrate it is safe and produces a significant immune response.