Covid-19 in Nepal: a lack of preparedness and a lack of vaccines

Amid a worsening covid-19 crisis, the Nepali parliament has been dissolved. Buddha Basynat discusses Nepal’s covid response so far, and why vaccines are an urgent priority

It was no surprise that the international media took greater notice of the increase in covid-19 cases tragically unfolding all over Nepal after potential infections were reported at the Mount Everest Base Camp in the Khumbu Valley. Covid-19 in Nepal is out of hand and slowly, but surely tracking the infection in India. 

Nepal was faring better earlier in the year, but in all likelihood due to unrestricted travel through the porous Nepali/Indian border, the daily reported cases have gone up from about 50 per day a month ago to around 8,000 cases a day now. The official reported deaths from the beginning of the pandemic are above five thousand with a notable spike in deaths in the last few weeks. 

The government has imposed lockdown in certain areas, including Kathmandu, while continuing to strongly advocate masking, hand washing, and physical distancing. However the Nepali government have been struggling to obtain vaccines.

Although many healthcare workers have been vaccinated throughout the country, the actual vaccination rate is likely very low for the entire country. One way that the international community can help out is by trying to help secure vaccination as promptly as possible (through agencies like COVAX). The Nepali government’s part in obtaining the Oxford/Astra-Zeneca vaccine and successfully vaccinating healthcare workers was a great effort. This sudden arrival of vaccines in January took all of Nepal by surprise as no one really expected this. It was the best vaccine deal in terms of price and vaccine storage in a normal refrigerator. Even if Nepal had received the Moderna and Pfizer vaccines, it would be impossible to maintain the extreme cold chain required for those vaccines.  

But, for various reasons, including alleged corruption and agents taking kickbacks, Nepal has not been able to obtain all of the vaccine stocks it had been promised by the Serum Institute of India, which manufactures the vaccine.     

The Chinese Sinopharm vaccine is also being used and the government claims that it is working hard trying to obtain the Russian Sputnik V vaccine, although there are concerns about the efficacy of these vaccines. Although the Nepali government are getting it right by emphasizing the importance of vaccines as the most important exit strategy besides lockdown at present, the vaccination rollout itself has been hindered by a lack of vaccine stocks, with some left unsure of when they will receive their second dose.

Oxygen supplies are also running low for the treatment of covid-19, and the problem is clearly mirroring the situation in India. As a result hospitals are barely coping with healthcare workers increasingly exhausted and frustrated. Plans are afoot to strengthen oxygen plants and procure more oxygen concentrators. Unfortunately, it will be too late for many patients. 

The prime minister has been heavily criticized for promoting untested herbal remedies and for telling CNN that the covid-19 situation is under control, while simultaneously pleading for international help and rescue. This has not helped to clearly articulate Nepal’s problem, or to emphasise the growing crisis in Nepal from covid-19.

But policy makers in Nepal and elsewhere in South Asia need to also think beyond this pandemic. The inadequacy and inequity in the healthcare system in this part of the world is now apparent, exposed by the covid-19 surge clearly delineating the divide between the haves and have nots. The dominant method of healthcare delivery in the region, especially for curative services, are private enterprises that follow the corporate healthcare model based on the United States healthcare system.

South Asian policy makers need to seriously plan for universal healthcare (UHC) and even consider universal basic income (UBI), if they are going to improve healthcare for the vast majority of  people in the region. Even the US President Joe Biden is trying to reform US healthcare with a stimulus package that has clear aspects of UBI. Policy makers need to look at a combination of UHC and UBI in South Asia, including Nepal, because even once South Asia survives this pandemic, there is likely to be another one to contend with soon.

Buddha Basnyat, Director, Oxford University Clinical Research Unit-Nepal.

Competing interests: none declared.