Nepal government imposed a lockdown on March 24 after the cases worldwide amplified, and further lifted it on June 21, without a robust plan to save the economy from the looming crisis. The three-month-long lockdown period should ideally have been the time to prepare isolation wards, adequate health services and facilities, increase the number of PCR tests, prenatal care homes, quarantine facilities, and more. However, the government lagged behind in taking any relevant measures, pushing the country into a state of uncertainty and insecurity. The decision to ease the lockdown without any protocol further triggered an increase in the number of cases.
Government’s bubble and the burst
The government’s claim that the virus transmission had come under control was an illusion. Furthermore, lifting the lockdown on the same account was another blunder. The reduction in testing prompted this illusion and the subsequent decision to lift the lockdown. However, when the government realized that the transmission risk was too high after Birgunj became the hotspot, it was already too late. The graph below represents the trend in the national Coronavirus cases and the number of PCR tests conducted. As the tests performed increased, the cases have also visibly increased.
On July 31, total reported infections stood at 19,771, and the death toll was at 56. But soon the transmission kicked in, taking the national toll to 34,418 cases with 175 reported deaths within the next four weeks (as of August 27, 2020). The government evidently increased the number of testing, and on August 26, 2% of the population had undergone PCR tests. Till July 31, only 375,416 PCR tests were performed which ballooned to 635,252 PCR tests, almost increased by two folds in August alone. Similarly, the death toll trend can be seen in the graph.
Why was there a sudden increase in the cases?
Following the decision to ease the lockdown on June 21, there was a heavy flow in the number of people entering Nepal illegally through the southern border. The uncalculated move by the government resulted in a rapid increase of cases in the Terai region which soon penetrated into Kathmandu valley, causing the national infections and death toll to surge. The rise in the number of cases is primarily attributed to the negligence of the government. Failing to understand the gravity of the situation was the biggest catastrophe.
Government initiative to control it
Nonetheless, the government again imposed a lockdown and further prohibitory orders in districts and municipalities where cases are swelling. Similarly, capital city Kathmandu valley is also under lockdown. The local government further mandated the hospitals and private medical institutions to reserve 20% of beds for Coronavirus patients. These restrictions and last resort attempts indicate towards the desperate struggle to curb the rising number of cases. However, the private hospitals have expressed reservations by stating that it is impossible to allocate as per government directive. The government had initially directed 1,000 additional beds and 100 ICUs but the private sector has revealed that it can only manage up to 500 beds and 60 ICUs.
The much-awaited vaccine
As nations worldwide are struggling to contain the spread internally, there is also a global race to develop and roll out the Coronavirus vaccine before any other government does. It is in the best interest of all the nations to cooperate and develop the vaccine as quickly as possible, but world politics is much complicated. The US-China rivalry may instigate the countries not to share and collaborate if one develops the antidote first. Similarly, the competition and conflict amongst the countries create a “vicious” circle. Currently, China, India, Britain, Russia, and America are the major countries in this rat race. According to the World Health Organization, over 165 vaccines are being developed while 32 are in the human trial stage.
What does this mean for Nepal?
Consequently, the main concern for Nepal is where it stands in receiving the vaccines being discovered. Russia and China have already committed to Nepal to provide the vaccine, while the southern neighbour, India, has prioritized Bangladesh.
Nepal’s health ministry has sanctioned to perform Phase III clinical trials of the vaccine. Phase III refers to the trial where thousands of people are inoculated, and the scientists observe how many people have relapsed or recovered from the virus. At least 50% of the people have to show positive recovery for the vaccine to be declared effective.
Way forward for Nepal
The Ministry has directed the Nepal Health Research Council to approve the companies which have fulfilled all necessary procedures and guidelines to move into Phase III trial. Furthermore, public health experts have requested the government to study the authenticity of the vaccines before giving a green signal for the trial. The companies attempting to inoculate Nepalis must have a local authority who would be held accountable for any adverse-effect scenario. Further, the participants who will undergo the trial must be insured and sign a consent form according to Nepal’s guidelines. However, the set of protocols for the trial hasn’t been established yet and may take up to four weeks.
According to experts, the clauses to enable these trials must include:
- a guarantee that Nepal will be on the priority list if the attempt is successful and
- the vaccine must be made available at an affordable price.
Russia has already offered its vaccine, Sputnik-V, to Nepal and is ready to conduct the phase III trial. Moreover, Hongshi Shivam Cement has also sought permission to inoculate 1,000 employees who would undergo the Chinese vaccine trial. Additionally, the international vaccine alliance, GAVI, has promised that Nepal amongst 92 other low-income countries will receive the Coronavirus vaccine at the same time as the wealthier nations do.
The stigma attached to the trial
While people express reservations to undergo such trials, it is a significant step to examine the credibility and validity of the vaccine. Dr Anup Subedee, an infectious disease expert, expressed that if the clinical trials are being conducted worldwide, Nepal mustn’t “hesitate”. The government’s decision to invite the trial was encouraged by health experts, but the government must also be cautious of the stigma and rumours that have been going around about COVID-19.
The concerned authorities must be responsible and accountable for conveying complete knowledge about the process, risks, objective, side-effects and other relevant information to the communities which are interested in participating in the trial. The citizens must not misunderstand that undergoing the Phase III trial will make them a “guinea pig”, but instead must perceive it as a step towards developing the vaccine for the lethal virus. Like mentioned earlier, it is a crucial phase of the process.
The following are a few other shortcomings which the government still needs to address:
- The private PCR tests are currently priced extremely high and cannot be afforded by the underprivileged.
- The uneven distribution of the health facilities concentrated in urban areas has been another significant drawback.
- The health and medical facilities are running short on the primary health equipment such as mask and PPE kits for the health workers.
- Health workers across 150 hospitals have been infected, and the people are nervous about undergoing contact tracing due to the stigma attached to it and fear of being isolated.
- Inadequate prenatal facilities has triggered a series of additional difficulties. The government airlifted around 200 pregnant women from rural areas; however, airlifting is not a solution.
Amid the rising number of cases, and shortage of isolations wards, adequate treatment facilities, mismanagement of quarantine facilities, and other shortcomings, the vaccine trial permission was a strong and required move. But this decision alone is insufficient; the government needs to ramp up tests and provide relief packages. Furthermore, the permission for vaccine trial may also be viewed as a populist agenda to overshadow other inadequacies. Nonetheless, the citizens are hopeful that these companies which will conduct the trial will prioritize Nepal while distributing the vaccine. Lockdown is not the solution to the rising number of cases, but building an appropriate response team and measures is the key. Lockdown will do worse than good to the economy, and the government has already failed once