On Monday, Deepak Bhurtel, a local from Ward 15 of Kathmandu Metropolitan City, accompanied his daughter Sambhabi to her school, Siddhartha Vanasthali Institute, where the vaccine against Covid-19 was being administered to children aged five to 11 years.

Sambhavi, a second grader, is seven years old.

The school administration took the signature of Bhurtel and other parents as the consent to administer the vaccine, a regular process, to their children and asked parents to accompany their children at the time of vaccination.

“All eligible members of my family have already been vaccinated against Covid,” said Bhurtel. “Today my daughter also got jabbed.”

Bhurtel seemed pretty confident about the vaccine. “I think this vaccine will give a level of protection to my child.”

There may have been some concerns from a handful of people, but most eligible Nepalis seem to have visited vaccine centres to get jabbed against Covid-19, and during the campaign for vaccinating children, the response was by and large overwhelming. It was also evident from the fact that the districts where the first phase of the campaign to vaccinate children aged between 5 and 11 was conducted ran out of doses.

A multi-national study carried out in Nepal by the Centre for the Study of Labour and Mobility in collaboration with the US-based Yale University after the coronavirus pandemic shows that Covid-19 vaccine acceptance rate in Nepal is the highest in the world.

The study shows that 97 percent of the Nepali population that is eligible for vaccines is ready to take the jabs.

Not only the Covid-19 vaccination, when it comes to health programmes, acceptance rate of most of them is very high in Nepal.

But when it comes to booster shots against Covid-19, Nepalis seem to have paid little attention.

Bhurtel was administered the Janssen vaccine a year ago. Although Janssen was first considered a single-shot vaccine against Covid, the Ministry of Health and Population urged people to get a booster shot of all the vaccines including Janssen.

For two-dose vaccines, a booster shot means a third dose after three months of administration of the second dose. Those who took Janssen were advised to take the second dose after three months.

Bhurtel admitted that he has not taken the booster shot.

“I know that I have to take the additional dose but I have not yet,” he said. “But I definitely did not want to take any risk when it comes to my daughter.”

Binod Shrestha, a resident of Ward 6 in Nagarjun Municipality in Kathmandu, waited for hours on Monday to get his son Dipson vaccinated at his school.

“We don’t know if there’s another wave coming, but we know vaccine is the best way to protect us from the coronavirus,” he said. “We don’t want our children to suffer from Covid in case they get infected.”

Shrestha took the Vero Cell vaccine more than a year ago. But he too has not gone for the booster shot.

“I am informed that Vero Cell is not available now,” said Shrestha. “I was offered the Indian vaccine [Covishield] but I refused, as I wanted to make sure that I would take the booster shot of the same vaccine. And anyway, the infection rates have been down lately.”

The decline in Covid cases over the last few months appears to be the main reason why people are complacent and ignoring the booster shots.

As many as 20,308,310 people or 69.6 percent of the total population have been fully vaccinated so far. Of them, only 6,412,358 people, or around 22 percent of the total population, have taken booster shots in the last five months, according to the Health Ministry.

Experts say apart from complacency, authorities’ failure to convince people about the effectiveness of the Covid vaccine could also have stopped them from taking the boosters.

According to them, Covid-19 is far from over yet, hence the authorities must not stop the vaccination campaigns.

After a steady decline—reaching just two cases on May 14—Covid infections have gradually surged in recent days, stoking concerns if another wave is on its way.

On Wednesday, 62 people tested positive—51 in 1,008 polymerase chain reaction tests and 11 in 612 antigen tests.

Daily test positivity rate of polymerase chain reaction test crossed 5 percent.

On Thursday, 55 people tested positive—36 in 1,532 polymerase chain reaction tests and 19 in 1,166 antigen tests.

The number of active cases in the country currently stands at 280.

On June 22, Anup Subedee, an infectious disease expert, sent out a caution.

“The daily Covid-19 test positivity was well below 0.5% until 1 week ago. This has been creeping up slowly in the last week. Today's rate is 1.27%. This past week's average seems to be around 0.87%,” Subedee wrote on Twitter. “It seems we all need a lot more caution once again.”

“Today’s Covid-19 test positivity has suddenly jumped to 3.8%,” Subedee tweeted again on Wednesday, exactly a week later, referring to the combined positivity rate from PCR and antigen tests.

Amid such alarms, a highly contagious Omicron sub-variant BA.5 has been detected for the first time in the country.

“We have found the BA.5 subvariant of Omicron in a patient,” Dr Rajiv Shrestha, an infectious disease expert at Dhulikhel Hospital, told the Post.

The first wave of Covid-19 was caused by what scientists dubbed SARS-CoV-2, first detected in Wuhan of China. Later, the virus’ variants were seen in the UK, the Middle East, and India.

Then came the Delta variant that fuelled the second wave, killing 8,000 people across Nepal and infecting hundreds of thousands. The third wave of the pandemic was driven by the Omicron variant in January this year. BA.1 and BA.2 subvariants of the Omicron were responsible for infections as of now.

Omicron is highly contagious but severity of infection was low largely because many in Nepal had been vaccinated.

The BA.5 subvariant has been spiking globally, as it can spread faster than other circulating variants and evade vaccine immunity. But this latest variant is causing fewer deaths and hospitalisations than the previous ones.

The person infected with the B.A.5 subvariant is believed to have returned from abroad.

Shrestha said severity and hospitalisation from Covid-19 infection can be lessened if the authorities concerned administered all eligible people with booster shots.

Coronavirus has been circulating in communities since the start of the pandemic, said Shrestha. “It may continue to spread and can remain like a Covid flu. When we carry out more tests, we can detect more cases and when we reduce test numbers we find fewer infected persons.”

Studies show immunity level achieved from vaccination or natural infection wanes over time and SARS-CoV-2 virus is evolving continuously, which increases its chance of evading vaccine protection.

“Even if the vaccine cannot stop reinfection, it reduces the chances of getting severe and hospitalisation,” said Dr Prabhat Adhikari, an infectious disease and critical care expert. “Authorities should administer the booster shots to the elderly people, and those whose immunity level is low.”

The Health Ministry has opened booster shots to all people above 12 years old who took a second dose of any Covid vaccine three months ago. But authorities in many districts including in the districts of Kathmandu Valley have not been able to provide booster shots to the people of 12–17 years age group. Officials say they have not been able to administer vaccines to the targeted population due to funds crunch.

Nepal has so far received 55,584,770 doses of Covid vaccines of various brands—AstraZeneca, Vero Cell, Moderna, Janssen, Sinovac-CoronaVac, and Pfizer-BioNTech, including paediatric doses.

“When infection rate declines, everything becomes normal and authorities cannot launch vaccination programmes as a campaign and coverage will not be high,” said Dr Radhika Thapaliya, a risk communication expert. “People’s interest in Covid vaccine might have declined, as they have already taken two doses, but it is the responsibility of the authorities concerned to communicate to them about the risks of not taking the boosters and benefits of getting boosted.”