The G7 summit held in person at Carbis Bay in the United Kingdom past weekend made for an interesting viewing from Nepal. Leaders of the seven rich and liberal democracies of the world frolicked maskless at the beach on the Atlantic coast even as virtually whole of Nepal is under prohibitory orders. The seven leaders, the majority of whom are over 65 years old with three septuagenarians and just two below 50, mingled without face masks even indoors and pledged more doses of vaccines to the global south. Indian Prime Minister (PM) Narendra Modi, invited as a guest country, virtually addressed the summit sounding a clarion call for following a "one earth, one health" approach to effectively deal with the pandemic globally. Nepalis, rubbing their eyes in disbelief, watched the Indian media rave about how Modi lectured the world leaders about their collective responsibility toward tackling the pandemic globally. Some may even have felt that the leader with recent 'sage' makeover has had an epiphany and would lift the export ban of vaccines at least in the immediate neighborhood. But there was no such epiphany alas and India has yet to relax export ban at the time of writing this editorial.
All that frolicking and pomp was vulgar to see from Nepal where around 1.4 million older adults are hopelessly waiting for the second dose of Covishield vaccine over three months after getting the first one. Nepal started its vaccination campaign with the one million Covishield (AstraZeneca manufactured in India) doses donated by India just a few days after it was started in India. The government did not choose to inoculate the most vulnerable older adults with the doses remaining after inoculating the frontline health workers and opted to jab journalists, government staffers and bankers among others instead. Nepal opted for inoculating older adults only after paying Serum Institute of India for two million more doses and one million of them arrived. The government, despite all its ineptitude in handling the pandemic, was cautious even after the one million doses arrived and consulted the WHO before starting to vaccinate the older adults. It started to inoculate people above 65 years from the second week of March only after consent of the WHO. With well over one million doses in hand, advance payment already made to Serum for another one million doses and assurances that it will also receive its share of vaccines from the global vaccine alliance COVAX. Nepal even agreed to inoculate foreigners working in different diplomatic missions and international organizations in Nepal ahead of the older adults with assurances that there will be no shortage of doses. This was kind of generosity not even the developed countries showed toward foreigners at that time.
But as the older adults started counting down the eight weeks they were told they had to wait for the second dose, the second wave hit India hard. Serum, on instruction of the Indian government, refused to deliver the one million doses Nepal had already paid for and also to COVAX as it was obliged to. The government requested New Delhi to at least provide enough for second dose to the older adults but to no avail. Serum has to supply the doses after taking advance payment for the sake of ethical business practice. The Modi government should allow export of the doses on humanitarian grounds if not for the millennia of special bread and daughter relation with Nepal that he repeatedly invokes. The quantity, that has become a matter of life and death for Nepali older adults, is almost irrelevant for a vast country like India. It is not even half of the Covishield doses that Serum manufactures each day on an average and can be easily offset by smoothening the supply chains inside.
The older adults have to hopelessly wait even as the western media report that the delta variant, first seen in India and assumed to be the dominant even in Nepal, is significantly more contagious than other variants. Studies show that while two doses of AstraZeneca provide full protection against serious disease from delta variant, single dose provides significantly less protection against the variant than against the original virus. Britain initially had gambled to extend the gap for second dose of AstraZeneca from four weeks to 10-12 weeks to ensure more people have some level of protection instead of a fewer having complete protection and others no protection at all. But considering the significant risk of delta variant even for those receiving one dose, it has brought the gap to well below eight weeks. It is now rapidly inoculating younger Britons having all but finished vaccinating most vulnerable older adults.
In this grim scenario, the only option the Nepal government has for the older adults if it doesn't get AstraZeneca/Covishield vaccines is to provide two doses of Chinese or another vaccine. Some studies are being done in the West about giving Pfizer vaccine as the second dose after first dose of AstraZeneca and preliminary results show that such mixing indeed works. But the results are just preliminary and it will be too late for such mixing to be officially authorized for the vulnerable Nepalis who received the first dose three months back.
Starting a new kind of vaccine for the older adults would mean that 1.4 million doses of Covishield given as the first dose will be wasted. That would be unpardonable considering how precious and scarce the life-saving vaccines are. Nepal and India also have another kind of special relationship apart from the clichéd bread and daughter relationship Modi always invokes. Nepali men have fought for India for centuries and thousands have died protecting the Indian borders over the years. Thousands of Nepalis still serve in the Indian army. The Nepali older adults awaiting the second dose include many veterans who have served India in the past and may well be parents and grandparents of many who are currently serving the Indian forces. Not providing these doses would tantamount to wastage of all the one million doses donated by India and another 400,000 procured by Nepal.
India at least can point at the devastation wreaked by the second wave in defense of its vaccine nationalism. But the richer countries do not even have that excuse. America has tens of millions of AstraZeneca doses that it doesn't intend to use. With the country securing enough doses of Pfizer, Moderna and Johnson & Johnson vaccines to inoculate the American people many times over, it has finally pledged to provide AstraZeneca to other countries. But it outrageously is waiting for approval of the Food and Drug Administration before supplying them to other countries despite it already being approved in those countries. America is the first country to have diplomatic relation with Nepal apart from British India and have invested billions in foreign assistance to Nepal over the years. It is baffling that America has not provided the AstraZeneca vaccines it won't use to solve the humanitarian crisis in Nepal.
Britain, like India, has special relationship honed over centuries with Nepal. It is troubling that Britain is not doing anything to avert the humanitarian crisis by supplying AstraZeneca vaccines developed there. Thousands of Nepalis have died fighting for the British Empire since their colonial rule in India. Selling AstraZeneca vaccines to Nepal to inoculate the older adults would be a small gratitude for the tons of Nepali blood shed for the British cause.
Japan is another example. It has ordered 120 million doses of AstraZeneca to be delivered by September that it will not use on Japanese people in all likelihood. It authorized use of AstraZeneca around three weeks back. But it has yet to start its use citing the very rare instances of blood clots and has already secured enough of the Pfizer and Moderna vaccines to inoculate those aged 16 or older. Japan has tremendous goodwill in Nepal despite not being an immediate neighbor or a global superpower and Nepali people consider it to be the only donor with no strategic interest in Nepal. It is regrettable that Japan sits top on the pile of AstraZeneca vaccines, many of them reportedly on verge of expiry, even as those above 65 here in Nepal are in this hopeless situation.
The communist government in its exuberance to please China may have rubbed Japan the wrong way in the past few years. There have also been murmurs from Japanese diplomats about the problem Japanese business folks face in repatriation of income generated here back to Japan. But that does not mean the Japanese diplomats, who have always been selfless friends for Nepal, should remain mere spectators to the humanitarian crisis unfolding here. We urge the Japanese Embassy to take initiative to allow Nepal to buy the AstraZeneca vaccines Japan does not intend to use if donating is too much to ask for in these troubled times.
The United Nations and health experts have been repeatedly pointing that no one is safe from this virus until everyone is safe but the rich countries despite paying lip service to that have been shamelessly practicing vaccine nationalism. It is criminal on part of rich countries to outbid and elbow out poorer countries with non-existent health infrastructure to secure enough vaccines to inoculate their people many times over and then allow the spare doses expire unused. It is obscene to bribe younger adults with joints and beer for vaccine when the pandemic has already waned there while even the frontline health professionals and the older adults in poorer countries in the midst of a surging pandemic cannot get the jab.
Vaccine delayed, like justice, is vaccine denied. But better late than never. The pledge of G7 to secure a further one billion vaccine doses for other countries over the next 12 months primarily through COVAX is welcome. But more is needed and needed today, not the next year as WHO Director General Dr Tedros Adhanom Ghebreyesus rightly says. "There are enough doses of vaccines globally to drive down transmission and save many lives, if they are used in the right places, for the right people," he stressed speaking after the G7 announcement. There are more than enough doses of unused AstraZeneca vaccines on verge of expiry around the world to provide second dose to the older Nepali adults. The international community with their collective conscience buried under the piles of unused surplus vaccines owe at least that much to Nepal.
