When Nepal launched its vaccination drive against the coronavirus on January 27, the number of new infections was already in decline. There were few hospitalisations. It looked like the country had returned to a near normal situation. An over-enthusiastic KP Sharma Oli, the prime minister, at the time declared that everyone in the country would be vaccinated within three months.

Things indeed were not looking that grim then. India had provided 1 million doses of Oxford-AstraZeneca vaccine in a grant assistance, with which the inoculation campaign was launched. Nepal became one of the first countries to roll out vaccines against Covid-19 even as more than 100 countries were struggling.

That the world’s vaccine powerhouse was next to Nepal was a big respite. A month later, in February, Nepal placed an order for 2 million doses of the AstraZeneca vaccine, produced by the Serum Institute of India under the brand name of Covishield, and paid 80 percent of the total amount in advance. Half of the order swiftly arrived, with which the government launched the second phase of vaccination drive. Nepal’s another giant neighbour in the north, China, too pledged vaccines in grant assistance. The 800,00 doses promised by China, however, took time to arrive.

Then suddenly, India put a ban on exports of the AstraZeneca vaccine, citing the growing demand at home. No sooner, India was hit by a second wave of the pandemic. The catastrophic situation–daily new infection count soaring to more than 350,000, burning funeral pyres, new daily deaths in four digits, low supplies of oxygen, shortages of hospital beds–forced India itself to look to other countries for support.

The second wave of the coronavirus has engulfed Nepal as well. Hospital beds have filled up, ventilators and oxygen supplies are running out. There is no vaccine. The last three months were largely unutilised by the government in diversifying vaccine procurement, as it was apparently complacent for having the world’s largest vaccine maker as its next door neighbour.

Amid criticism for its failure to reach out to other countries for the coronavirus jabs, the government now says it has activated multiple channels–official and diplomatic–to acquire vaccines from China to Russia to even the United States.

“We are in talks with the Russsians,” Health Minister Hridayesh Tripathi told the Post on Wednesday. “By the beginning of May, we can expect some good news.”

Russia’s Sputnik V is the fourth and last, so far, vaccine that Nepal’s drug regulator has granted emergency use authorisation.

According to officials, a high-level Russian team is currently in town to hold negotiations with the Health Ministry and discussions are taking place on logistics, the number of doses, the price and delivery time.

The makers of Sputnik V have set two different prices for their two types of shots–one is double-shot jab with up to 91 percent efficacy and the other is Sputnik Light, a one-dose version which has yet to complete Phase III trials.

Officials said the Russians have, during talks, offered an international competitive price of around $19.90 (approx Rs. 2,369.70) for two shots.

“We are in talks to procure around 8 million Russian vaccines,” said Tripathi.

The Russian Direct Investment Fund, the sovereign wealth fund marketing the vaccines abroad, previously suggested the one-shot version of Sputnik V could be a "temporary" solution for countries with high infection rates that need to make the vaccine go further.

Amid criticism that the United States was hoarding the AstraZeneca vaccine while other countries were in dire need, the White House earlier this week said that it would share up to 60 million doses with other countries.

According to the BBC, the White House on Monday said it expected that about 10 million doses of the AstraZeneca vaccine could be released when the Food and Drug Administration finishes its review in the coming weeks. Another 50 million doses were in various stages of production, it said.

“The government has launched diplomatic efforts to secure the maximum doses possible from the US,” Foreign Minister Pradeep Gyawali told the Post. “We are already in talks and in touch with US officials.”

According to Gyawali, efforts are also being made to acquire vaccines developed by Johnson & Johnson from the US.

“We are also in talks with the Russian as well as Chinese governments. We will first try to secure vaccines under grant assistance and if that is not possible, we will negotiate if we could buy them at subsidised prices,” said Gyawali. “To procure the vaccine, we have created a pool of funds of over Rs 36 billion with contributions from donor agencies like the World Bank and the Asian Development Bank as well the government and other interested parties and stakeholders.”

Nepal has so far granted emergency use authorisation to AstraZeneca, China’s Sinopharm, Bharat Biotech’s Covaxin and Russia’s Sputnik V vaccines.

Health Ministry Tripathi said the government is currently holding talks to fulfil the immediate requirement of 8 million doses. “The talks so far with the Russians have been positive.”

Nepal so far has inoculated close to 2 million people against Covid-19. During the first phase, from January 27 to March 5, around 438,000 people were administered the first dose of Covishield. All of these people have already received their booster shots. In the second phase, from March 7 to March 15, a little over 1.3 million people, above 65 years of age, were administered the first dose. The second phase of vaccination was possible with the 1 million procured from the Serum Institute, which has yet to supply another 1 million doses, and 348,000 doses received under the World Health Organisation-backed COVAX facility.

The government had announced that they would be taking their second shots from May 16 to May 29.

Around 300,000 people have received Chinese Sinopharm’s vaccine.

The government currently does not have the stock of Covishield to administer the booster shot to over 1.3 million people. Health Ministry officials hope to receive some doses under the COVAX facility by May-end.

Tripathi said buying Covid-19 vaccines is not like buying any other item from the international market and that a lot depends on availability.

There are also questions as to why Nepal did not approach China to procure vaccines, as the northern neighbour too has been producing the shots in huge numbers.

Officials at the health and foreign ministries say talks about procuring vaccines from China have been ongoing for quite some time but there has not been much progress.

A joint secretary at the Health Ministry told the Post on condition of anonymity that there are differing opinions about procuring vaccines from China.

“While the Foreign Ministry has no issues with buying vaccines from China, the Health Ministry has expressed some technical and statistical reservations,” said the joint secretary. He would not elaborate what those reservations are.

After initially pledging 300,000 doses of vaccine in the end of January, China in February said it would provide 500,000 doses to Nepal under grant assistance.

During a telephonic conversation on February 5 with Foreign Minister Gyawali, Chinese Foreign Minister Wang Yi said Beijing would accord priority to Nepal in vaccination cooperation.

In March, 800,000 doses of the Sinopharm vaccine were flown to Nepal after the government sent a Nepal Airlines Corporation jet to bring the vaccine.

A senior Foreign Ministry official said that the Health Ministry is “sitting on” the plan to bring vaccines from China.

“Earlier this year, it took three months to bring the vaccines from China despite the northern neighbour agreeing to provide the shots under grant assistance,” the official, who did not wish to be named, told the Post. “Other details like price and logistics can be worked out once we make a request to procure the vaccines.”

The government’s reluctance to look to its immediate northern neighbour for the vaccine at a time when there was no certainty of supply from the south had even made some people question if Nepal was caught in a geopolitical game over the world’s most sought-after commodity. Many even wondered if Oli was apprehensive about offending the South. But long before India could lift the ban on vaccine exports, the country itself was in a crisis of its own, making distress calls to the world for help.

A senior official at the Health Ministry ruled out geopolitics in procurement of vaccines. Rather, the country’s own logistical and other issues had more to do with the delay, the official said.

Tripathi, the health minister, has often told various media outlets, including the Post, that some “middlemen” were to blame for the delay in acquiring the 5 million doses of vaccine from the Serum Institute, for which the government had taken initiative about two months ago.

Tripathi, however, has not revealed who those “middlemen” were said to be seeking 10 percent commissions per dose of vaccine.

When the Nepal government placed an order for the 2 million doses, the Serum Institute had agreed to provide the vaccine at $4 (approx Rs 476. 19) per dose.

After initially announcing that it would provide Covishield at INR150 (Rs240) to the central government, INR400 (Rs640) to the state governments and INR600 (Rs960) to private hospitals, the Serum Institute reduced the price for the state governments from INR400 (Rs640)to INR300 (Rs480).

For Nepal, Covishield may be the best vaccine in terms of price and storage arrangements, but chances of acquiring these jabs are slim, given the soaring demand in India.

Officials say there is no option than to look to other vaccine-producing countries.

On Tuesday, Chinese Foreign Minister Wang held a meeting with foreign ministers of Nepal, Bangladesh, Afghanistan, Pakistan and Sri Lanka.

According to a joint statement issued by the Chinese Foreign Ministry on Wednesday, discussions were held, among other things, on vaccine cooperation.

Currently, according to officials, Nepal is trying to reach a deal to acquire Russian vaccines.

“We have asked [Russia] to provide some quantity in grant, but we are trying to reach a government-to-government deal to procure more,” said Tripathi. “We hope to reach an agreement as soon as we finalise the price and logistical issue.”