Nepal’s plan to vaccinte children aged five to 11 years old against Covid-19 could face a setback because of a resource crunch.

Officials at the Ministry of Health and Population say they are in a dilemma. They are weighing options—whether to procure vaccine doses or wait for COVAX, the United Nations-backed international vaccine sharing scheme, and other aid agencies to provide the doses for free.

“We have not taken any decision yet on signing any deal to procure vaccines for children aged 5-11,” said Dr Roshan Pokhrel, a secretary at the Health Ministry. “Keeping in mind the country’s latest financial condition, we prefer to have doses in grants, and we will purchase them only if we are unable to secure the doses in aid.”

The government had decided to inoculate children between five and 11 years

from April. For that, it had planned to procure 8.4 million doses of the Pfizer-BioNTech vaccine. A non-disclosure agreement with the American producer of the vaccine was signed. An agreement for a concessional loan of $18 million was also signed with the World Bank. Even with just ten days remaining for April to end, the authorities are not sure if they could launch the campaign to vaccinate children aged 5-11.

The Health Ministry had sought Cabinet’s approval on the terms and conditions of the proposal to procure vaccines for the said age groups.

The Office of the Prime Minister and the Council of Ministers, however, held the proposal for weeks and returned it to the Health Ministry asking it to explore the possibilities to secure vaccines under grant assistance.

“The Cabinet suggested that we explore possibilities to secure vaccine doses under grant and purchase the doses only if they cannot be obtained from donor agencies,” said Pokhrel. “We may secure some doses in grant and purchase the shortfall if any.”

Experts, however, say Nepal should not make the financial crisis an excuse to halt the plan to vaccinate children of the said group.

"We should not forget that the coronavirus pandemic too has contributed in deteriorating the country’s financial situation,” said Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division. "The indecision of the authorities concerned to inoculate children on time could cost dearly to the health of people and the country's financial health."

Nepal’s economic indicators have not been encouraging of late.

Last week, the Nepal Rastra Bank’s statistics painted a grim picture of the economy with rising inflation, falling remittances, ballooning balance of payment deficit, rising imports and dwindling foreign exchange reserves. The government is mulling various measures including import curbs on vehicles and luxury goods.

Though Covid cases have drastically come down in the past weeks, experts say there is no room for complacency and that authorities must not stop vaccinating all the eligible population, including children.

According to the Health Ministry, 83.2 percent of the population above 18 years of age has been fully immunised against Covid.

Concerns have been growing in Nepal about a possible Covid spike in the wake of rising cases in India, with which the country shares a long porous border. Previous waves have shown that the crest and trough of the Covid-19 pandemic in Nepal have been directly proportional to those in India.

Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post earlier this week that if past experiences are anything to go by, cases start spiking in Nepal two weeks after a surge in India.

Nepal has so far received 53,381,570 doses of Covid vaccines—AstraZeneca, Vero Cell, Moderna, Sinovac-CoronaVac, Janssen (single dose) and Pfizer-BioNtech. Some have been provided by COVAX and donor countries through COVAX and others were bought by the government.

Officials say last month the COVAX facility had informed about the possibility of providing vaccines for children aged between five and 11 years. According to them, the facility has asked Nepal to wait for a few days for an official confirmation for the supply of the vaccine for the said age group.

“They have told us they are seriously considering the possibility of providing vaccines for children, ” said Dr Bibek Kumar Lal, director at the Family Welfare Division under the Department of Health Services. “We are in constant touch with the Global Alliance for Vaccine and Immunisation and the possibility of securing vaccines for children.”

There are two types of Pfizer-BioNTech Covid vaccines for children—one is for those aged 5-11, and another for those aged 12 and above. Nepal has already used Pfizer vaccines on its people—on those with comorbidities and on children between 12 and 17 years.

The Pfizer-BioNTech vaccine is the only jab recommended by the World Health Organisation for use in children between five and 11 years. The American Association of Paediatrics has recommended administering 10 microgram doses in a gap of 21 days to children between five and 11 years.

The dose, 0.2ml, is one-third of what is administered to adolescents and adults. The vaccine vial for children in the said age bracket comes with an orange cap while the other vial is purple-capped. Each vial with 10 doses needs 1.3 millilitres (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.

There are also hopes that Nepal could make a special request to the World Health Organisation during its director general Dr Tedros Adhanom Ghebreyesus’ visit to Nepal. Ghebreyesus is arriving in Nepal on Thursday on a three-day visit.

Barring initial glitches following India’s decision to halt exports of Covishield, the AstraZeneca type vaccine, COVAX has been supplying vaccines to Nepal on a regular basis.

Dr Prabhat Adhikari, an infectious disease and critical care expert, says the virus does not differentiate between children and adults

"Children are even more vulnerable, as they cannot follow safety measures properly. Even if children do not get severely ill from infections, they can pass the infection to elder members of the family," Adhikari told the Post.

According to Lal, given the coverage and acceptance rate of Covid-19 vaccines in Nepal, the country is on the priority list of the COVAX facility to supply the jabs.

“Government procedures take time. We are expecting a decision from the COVAX facility to supply vaccine doses for children in Nepal,” said Lal. “We need not have to purchase vaccine syringes and diluent if the COVAX facility provides the vaccine, which will be a huge relief to us.”