The COVID-19 crisis in Nepal is outpacing the chaos in next door India. In Kathmandu, the best private hospitals are turning patients away for lack of beds and supplies, and in rural parts of the country, where hospitals do not exist, people are dying at home. A large swath of western Nepal depends on oxygen cylinders shipped from a single city, Nepalgunj, driven for hours over potholed roads. Official statistics — widely believed to be an undercount — put the death toll at around 4,700, while the University of Washington’s Institute for Health Metrics and Evaluation (IMHE) predicts 40,000 deaths by the beginning of July, a projected per-capita toll worse than any other country in South or Southeast Asia.
“People are dying every few minutes because of a lack oxygen, we don’t know when this will end,” said Bhola Paswan, a journalist in Saptari District, in the eastern plains. “It’s chaos.”
COVID-19’s wreckage is likely to be worse than the catastrophic earthquakes Nepal suffered just six years ago, in April and May 2015. At that time, the international community quickly came together to pledge over $4 billion in aid to Nepal. A few days ago, Nepal’s Health Ministry put out an urgent international call for supplies — including oxygen generation plants, ventilators, and 37 million doses of vaccine, for its population of 29 million people. (So far, only 2.4 million shots have been administered, and just over 1 percent of people have received both doses.) However, with other countries battling their own emergencies at home, the Ministry’s wish-list may be difficult to fulfill.
India, which donated or sold to Nepal the bulk of its vaccine doses to date, is now preoccupied with its own health crisis. China has also donated various medicines and supplies, but its vaccine production capacity is much smaller than India’s. The U.S., through the COVAX facility, has contributed far fewer jabs to Nepal than either India or China have. Many Nepalis are hoping that the United States will step up aid, in line with President Joe Biden’s recent call to become the world’s “arsenal for vaccines.”
Distractions Amid a Health Crisis
As in India, Nepali society let its guard down after weathering last fall’s first wave of COVID-19. As daily infections hovered in the low hundreds, many people stopped wearing masks. Major festivals and weddings garnered large crowds in March and April.
Meanwhile, Prime Minister Khadga Prasad Sharma Oli and other leaders mired themselves in a political crisis that distracted precious attention away from COVID-19. Amid a feud with his fellow Nepal Communist Party (NCP) co-chair Pushpa Kamal Dahal, a.k.a. “Prachanda,” Oli dissolved Parliament in December 2020 in order to consolidate power for himself. In February, the Supreme Court ruled Oli’s move unconstitutional and reinstated Parliament. Subsequently, the NCP split into the Maoist Center, led by Dahal, and the United Marxist Leninist (UML) Party, led by Oli.
Oli lost a vote of confidence in Parliament on May 10, but nonetheless appears set to retain power in the near-term. Because the Maoists failed to cobble together an alternative coalition, Oli could remain prime minister if he survives a second confidence vote within the next month. If he loses that, the government could call new elections — but those would probably be postponed due to the health crisis, further extending Oli’s tenure.
Distracted with political machinations, Oli’s government failed to ramp up testing even as cases soared. As daily cases increased 2,900 percent between April 1 and April 30, testing increased only 260 percent. Testing is much worse in rural areas than in cities. On May 13, the test-positivity rate in Lumbini Province, which is mostly rural, was 56 percent, compared to 45 percent nationally.
Lhamo Sherpa, a medical doctor and epidemiologist in Kathmandu, said, “The data are very skewed — we are not getting data from the districts connected with India, which are very poor districts near Bihar, Uttar Pradesh, and Uttarakhand,” Indian states where the pandemic is raging.
Seeking Help from the International Community
Sherpa says that vaccines, along with oxygen, are the country’s primary needs. “We cannot maintain social distance — we have too many poor people living in slum areas, in densely populated areas. We need vaccines, fast,” she said.
In January, India donated 1 million AstraZeneca-Covishield doses to Nepal. Soon after, the Nepali government signed a deal to purchase an additional 2 million doses from the Serum Institute of India, the Indian manufacturer of the AstraZeneca vaccine. India’s provision of those vaccines helped ameliorate its relationship with Nepal, which deteriorated after India’s unofficial blockade in 2015 and a border dispute in early 2020. In addition to Nepal, India has donated vaccines to other South Asian neighbors, minus Pakistan.
However, India halted vaccine exports in late March in order to ensure inoculations for its own citizens as the virus began to rage. As a result, Nepal received only half of the 2 million doses it ordered from India’s Serum Institute. (It offered Nepal a refund, which it has thus far refused to accept, demanding shipment of the goods instead.)
In late March, China donated 800,000 Sinopharm vaccine doses to Nepal, followed by 10 ventilators and other equipment in May. China has strengthened political ties with Nepal since the NCP was elected in 2017, and its ambassador attempted to mediate the NCP’s internal disputes before the party ultimately broke up in March this year. China’s donation of vaccines to Nepal is its second–largest in South Asia after Pakistan. However, Chinese vaccine production capacity is much smaller than India’s, and some analysts think China will struggle to meet its international promises while also administering the drugs to its own citizens over the coming months and years.
The US, which has purchased enough vaccines to inoculate its population twice over, has begun to roll back Trump-era isolationist policies around COVID-19. In January, the new Biden administration rejoined the World Health Organization and in February, it announced that it would commit $2 billion to the Global Vaccine Alliance’s COVAX-AMC facility to provide free vaccines for low- and middle-income countries. (This makes the U.S. COVAX’s largest contributor, providing 37 percent of the facility’s funding to date.) Biden has come out in favor of a proposal to ease intellectual property restrictions on vaccine production at the WTO, although many experts say global production will not significantly expand without also facilitating technology transfer.
So far, Nepal has received 380,000 vaccine doses from the COVAX facility — far fewer than donations from India and China — although 1.9 million more doses are expected. The U.S. has also donated 100 ventilators and recently announced $8.5 million in additional support, which, according to USAID Nepal Mission Director Sepideh Keyvanshad, will be spent by USAID in coordination with Nepal’s Health Ministry. (Human Rights Watch recently reported that Nepal has about 560 ventilators, less than half of what may be needed.)
Many Nepalis are hoping Washington will provide doses from its stockpile of AstraZeneca vaccines, which are unlikely to be used in the United States because they have yet to receive the necessary approval from U.S. health authorities. The Biden administration announced in late April that it would donate 60 million AstraZeneca doses internationally after performing safety checks. It has yet to announce the intended recipients, but in a hopeful sign, on May 12, at a Senate Foreign Relations Committee hearing on USAID’s and the State Department’s COVID response, Senators Chris Murphy of Connecticut and Jeanne Shaheen of New Hampshire both asked specifically about aid to Nepal. Jeremy Konyndyk, USAID’s COVID coordinator, replied, “I would say that…Nepal, alongside India, is our highest priority right now.” He mentioned testing as a possible avenue for support but did not mention vaccines, oxygen, or other needs.
Shots in Nepali arms
Domestically, many Nepalis are frustrated with what they see as their government’s poor leadership on COVID-19. On April 24, amid a thronging crowd, Prime Minister Oli inaugurated the new Dharahara Tower, a public monument in Kathmandu, even as Nepal recorded the fastest COVID-19 rate of spread in the world. Two weeks later, in an interview with CNN on May 9, Oli said Nepal’s COVID situation was “under control.” Then the very next day Oli wrote in The Guardian that “Nepal is being overwhelmed by Covid.” Leaders close to Oli have also been accused of corruption in the procurement of COVID-related supplies, including testing equipment in 2020 and vaccines in 2021.
Some local-level elected officials are seen as more responsible than national leaders. During the first wave of COVID-19, many local governments successfully set up and managed isolation centers. Recently, Nepali media carried a story about a mayor in Chitwan District who is operating his personal car as a makeshift ambulance for constituents.
Steven LeClerq, who heads Johns Hopkins University’s public health research programs in Nepal, says Nepal can carry out a successful vaccination campaign — if it can get hold of more shots. “They do it with other things, like polio vaccine, and the annual Vitamin A campaign throughout the country. If they can do that, they can certainly manage the vaccine drive,” he said.
Ramu Kharel, a Nepali-American doctor who is back in Nepal helping local governments set up isolation centers, said he recently signed a petition to the U.S. ambassador urging more support. “I worked in the U.S. during the pandemic on the front lines, when I was not vaccinated, like many other Nepali-American health workers,” he said. “I hope the U.S. won’t forget Nepal when allocating vaccines.”