Hira Bahadur Thapa

As the developing world still grapples with a shortage of COVID-19 vaccines, new challenges of distribution and administration of available shots have emerged in recent times. Along with supply side, many afflicted countries are confronting the logistical challenges of vaccines. Definitively, those at higher risk of infection in the communities with rising caseloads should receive shots into their arms on a priority basis.
Seen from the supply side perspective, there are positive signs in Nepal. It has been provided 1.5 million doses of Johnson & Johnson vaccines donated by the US government as part of the COVAX scheme. It is an international initiative, which is supported by the World Health Organisation (WHO), Coalition for Epidemic Preparedness Innovations (CEPI), GAVI, a global vaccine alliance, is designed to assist poor countries have equitable access to vaccines.

Scarcity of vaccines
Despite COVAX’s good intentions of supplying certain quantity of COVID-19 vaccines to poor countries free of cost, the policy of distributing vaccines to cover the 20 per cent of all receiving countries does not do justice to those that have faced higher transmission rates and fatalities. There is no uniformity in infection and the death rates. Therefore, timely change in the distribution schemes of COVAX to prioritise the countries with higher rates of transmission and mortality is the need of the hour.
A scarcity of vaccines is not the sole problem. Some countries have even failed to utilise their own stock due to logistical and technical impediments. Nonetheless, there is still need for increasing the production and supply of vaccines around the world. In this regard, the poor countries are badly affected due to limited supplies. Nepal has not been provided one million doses of Covishield vaccines produced by the Serum Institute of India, the payment of which was made months in advance.
The above-mentioned manufacturer had delayed the supply to Nepal as well as a few other countries which relied on it citing the resurgence of second wave of COVID-19 in India. Furthermore, the Serum Institute of India, despite being the largest producer of vaccines, had not met the global requirement. Under COVAX, the vaccines are supplied at a reasonable cost. This programme has also been impeded because many eligible countries under its distribution scheme have not received the vaccine doses on time.
Vaccine hoarding compounded the shortage of supply. The production of vaccines was affected because of the World Trade Organisation (WTO) trade-related protections. In view of this, some members of the WTO, including India and South Africa, have been lobbying for waiver of trade-related intellectual property rights in order that more manufacturing companies in the developing countries could produce vaccines at lower prices.
Despite the valuable support extended by the US administration to the waiver proposal being considered by the WTO council, no decision has been made. There are some major European countries opposing the waiver. Countries like the UK and Germany have seen this issue with greater skepticism. This has delayed the process albeit the WTO Council in its July 20 meeting was considering the same.
The opposing nations have argued that the waiver alone would not resolve the problem. Manufacturing involves trade secrets and supply chain issues and is beyond the trade-related intellectual property rights.
Sooner or later, the issue of waiver would be settled and supply would increase to meet the global demands for vaccines.
Happily, the Serum Institute of India has announced that it will begin exporting vaccines this year, implying that India should have adequate vaccine supply by then. This makes us optimistic as we have been desperately waiting for the delayed supply of their product as we need to administer the second dose to our 1.4 million senior citizens, who received their first dose of Covishield in April. Although Nepal has been collecting Vero Cell manufactured by Sinopharm, those senior Nepali citizens won’t be administered this new vaccine as their final dose to conform to the health guidelines issued by the WHO.
Moreover, Pfizer/BioNTech has pledged to deliver two billion doses to low- and middle-income countries. But given our poor health infrastructure, we won’t be able to utilise such vaccines because they need to be stored in minus 70 degrees temperatures.
Of late, the Government of Nepal has bought the Chinese vaccines. With their smooth supply, the concerns of people waiting to be vaccinated are seemingly mitigated. However, vaccine distribution and administration challenges have impeded the rollout progress. Our weakness lies in properly managing the administration of available vaccines while a large majority remains unvaccinated.
If the world manufactures vaccines in adequate quantity, the afflicted countries like ours will be able to effectively administer vaccines.

Urgency of inoculation
The urgency of inoculation can never be less at a time when Delta, the wickedest variant of coronavirus, is spreading in many parts of the world, including Nepal. We are vulnerable to infection as every infected person anywhere in the world offers the coronavirus another opportunity to morph into a new variant.
In the opinion of Dr. William Hanage, the larger the force of infection that comes from the pandemic in unvaccinated populations, the more breakthrough infections will be. Breakthrough infections spread when vaccinated person contracts virus though such cases are extremely low. Even if vaccinated persons are infected, the chances of hospitalisations and deaths are rare. Hence, immunisation forms a buttress against the virus.
Truly speaking, global vaccine equity requires a broader definition and effort beyond just manufacturing supplies. Creating a global rollout plan and deploying health resources necessary to get shots into people’s arms quickly is the obvious solution to COVID-19.

(Thapa was Foreign Policy Advisor to the Prime Minister from 2008-09. thapahira17@gmail.com)