Nepal is likely to wait for the World Health Organisation’s Strategic Advisory Group of Experts on Immunisation (SAGE) recommendation to start second booster shots.

Several rounds of discussion have been held to decide whether to start second booster shots immediately or to wait for the WHO’s SAGE recommendation, officials at the National Immunisation Advisory Committee, said.

“We will most likely wait for WHO’s SAGE recommendation to start second booster shots,” said Dr Ramesh Kanta Adhikari, chairman of the committee. “There are divergent opinions among the experts, some want to start second booster shots immediately while others want to wait for WHO’s recommendation.”

Officials said that Nepal will not have to purchase vaccine doses if the UN health agency’s SAGE recommends the second booster shot. The COVAX facility, backed by the United Nations, which is an international vaccine-sharing scheme will provide the required doses free of cost.

The Ministry of Health and Population had started the first booster shots in January prior to the WHO’s SAGE formal decision on the same.

The National Immunisation Advisory Committee decided to start the booster shots for frontline workers and those with comorbidities.

Later the shots were opened to all eligible people above 12 years.

However, as many as 7,474,529 people or around 25.6 percent of the total population have been boosted so far. Despite the repeated appeals by the health agencies, uptake of booster shots has not increased significantly.

“We are aware that questions could be raised about equity since some people have not yet received even a single shot. Many have not taken booster shots and we have been having discussions about second shots,” said Adhikari. “But the fact is it has already been over six months that many elderly people and those with compromised immunity have taken the first booster shots.”

Study shows that immunity derived from vaccination or natural infection gradually wanes after six months.

Officials at the Health Ministry said that “pressure has been mounting to start inoculating” the selected group of people with the second booster shot since the number of new infections and hospitalisations has been increasing due to Covid infections.

Active cases stand at 5,259 in the country as of Tuesday.

Experts say vaccination is the only reliable way to prevent severity and deaths from coronavirus infections and suggest administering second booster shots to the elderly population and those with comorbid conditions, who were administered the first booster shots some six months ago.

“Authorities concerned should focus on vaccination, first booster shots and also provide second booster shots to the frontline workers, elderly people, and those with comorbidities,” said Dr Prabhat Adhikari, infectious disease and critical care expert.

Meanwhile, the Health Ministry said that children aged between five and 11 years from 50 districts are set to be inoculated against Covid from August 21 in a weeklong campaign. The number of children of this age group is 1.6 million, according to officials.

“We have already received all required vaccine doses and syringes for the second phase of the campaign,” said Dr Surendra Chaurasia, chief of the Logistic Management Section under the Department of Health Services. “The second phase of the campaign for children between five and 11 years will start on the stipulated date.”

In the second phase of the immunisation drive, children of this age group in Bhojpur, Dhankuta, Khotang, Okhaldhunga, Panchthar, Sankhuwasabha, Solukhumbu, Taplejung, Terhathum, and Udayapur districts of Province 1; Bara, Rautahat, and Sarlahi districts of the Madhesh Province; and Ramechhap, Dolakha, Dhading, Nuwakot, Rasuwa, and Sindhupalchok districts of the Bagmati Province will be inoculated.

Likewise, children in Baglung, Gorkha, Lamjung, Manang, Mustang, Myagdi, Parbat, Syangja and Tanahun districts of the Gandaki Province; and Kapilvastu, Arghakhanchi, Gulmi, Palpa, Pyuthan, Rolpa and East Rukum districts of the Lumbini Province will also be inoculated.

Similarly, children of the target group in West Rukum, Salyan, Dolpa, Humla, Jumla, Kalikot, Mugu, Dailekh, and Jajarkot districts of the Karnali Province; and Achham, Doti, Bajura, Baitadi, and Darchula districts of the Sudurpaschim Province will be also be inoculated against Covid during the campaign.

The first phase of the campaign was launched from June 23 to 29 in 27 districts. In some districts, the campaign was extended owing to a vaccine shortage.

Officials said that just like in the first phase of the drive, vaccines will be administered to children from schools in the second phase.

Officials at the Health Ministry said that the second phase of the vaccination campaign can also be extended as per local needs.

Nepal has received 8.4 million doses of paediatric doses of Pfizer-BioNTech Covid-19 vaccine from the COVAX facility.

There are two types of Pfizer-BioNTech Covid vaccines for children—one is for those between five and 11 years, and another for those aged 12 and above.

The Pfizer-BioNTech vaccine is the only jab recommended by the World Health Organization for use in children between five and 11 years old.

The American Association of Pediatrics 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 5–11-year-old children 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 US Food and Drug Administration in October authorised emergency use of the Pfizer-BioNTech Covid vaccine in children between five and 11 years. Several countries have already started administering the vaccine to children.

Although the Pfizer doses for adults can be kept in normal temperatures (2 to 8 degrees Celsius) for up to 31 days, paediatric doses can be stored in normal temperatures for up to 10 weeks, officials said.

Vaccine doses were supplied to provinces and districts upon arrival.

Nepal has so far received 61,776,770 doses of Covid vaccines of various brands—AstraZeneca, Vero Cell, Moderna, Janssen, Sinovac-CoronaVac, and Pfizer-BioNTech—including paediatric doses.

As many as 21,033,408 people or 72.1 percent of the total population have been fully immunised so far.

On Tuesday, one person died and 848 people tested positive for Covid—399 in 2,722 polymerase chain reaction tests and 449 in 2,897 antigen tests. The Health Ministry said that 68 infected people, whose health conditions are serious, have been admitted to the intensive care unit and four others in critical conditions have been placed on ventilators.