in Nepal, “we have no choice, we take what there is” – Liberation


Wrapped up in a thick blanket, Guna Baba Kayastha patient in a tent set up in front of Patan hospital, near Kathmandu, where two cases of omicron variant infection were detected this week: she has finally received her first dose of vaccine. , almost a year after the first administrations in the rich countries. “I live in the village, it was not easy to come”, explains the 65-year-old woman, who suffers from chronic illnesses. His village, Chapagaun, is only twenty kilometers from the hospital. But traveling this distance is a challenge: a grueling journey on poorly drivable paths, for a significant amount of money. “We have already been to Kathmandu four months ago. My husband had just tested positive for Covid-19 and he started to cough. He was admitted to this hospital but we were not allowed to see him. Five days later he was dead ”, she says. At that time, no vaccine was available for her.

In the spring and summer of last year the eyes of the world were on India in the grip of a deadly second wave. The same tragedies have nevertheless played out in its small Himalayan neighbor, which lacked everything: beds, oxygen bottles, medicines, and even hospitals to welcome the sick, failing to be able to treat them. Since the start of the pandemic, more than 823,000 people have been infected and more than 11,500 have died, out of a population of 28 million. A largely underestimated assessment: the tests, initially free, are now charged at least 1,500 rupees, or more than 17 euros, a sum inaccessible to the vast majority of the population. And since hospitals cannot accommodate them all, many patients stay at home and die at home, falling under the radar of statistics. “People have lost their jobs, their daily income, their savings, analyzes doctor Sharad Onta, specialist in public health. The price of food has risen a lot, only the rich could get enough of it at the height of the crisis. It is difficult to imagine the pain of disadvantaged populations, they are the ones who suffer the most. And our government, by imposing lockdown without distributing food or subsidies, has cruelly reinforced these inequalities. ”

“Unacceptable inequality”

The relatively early vaccination began on January 27, with help from one million doses of Covishield (one of the trade names for AstraZeneca’s vaccine) from India. After this first delivery, the vaccine continues to arrive drop by drop in Nepal: on March 28, 100,000 doses of Covishield given by the Indian army to the Nepalese army; on March 29, 800,000 doses of Vero Cell, developed by Sinopharm, donated by China, which again sent one million doses in June; on August 6, 230,000 unused doses of AstraZeneca donated by Bhutan; in October, the Maldives, which had extra doses of the same vaccine, expiring within a week, sent 201,600 …

The vaccines delivered to Nepal reflect the relationships with its historical partners. Of the approximately 19 million doses already administered, 5.5 million are Covishield from India and more than 12 million are Vero Cell, sent from China. At Patan Hospital, Guna Baba Kayastha received a dose of Pfizer, which is exceptional: only 100,620 doses of this vaccine, among the most effective in combating severe forms of the disease, have been received in Nepal. These were given through the Covax mechanism, an international initiative co-led, among others, by the World Health Organization (WHO), whose mission is to ensure equitable access to vaccination against Covid-19 in countries that do not have the means to acquire or negotiate vaccines. According to Budhi Setiawan, health chief for Unicef ​​Nepal, “22.9 million doses have been promised in Nepal and so far only 6.3 million doses have been received. Countries have decided to keep the doses to themselves. This inequality in access to vaccines is unacceptable. We spend our time trying to defend Covax with foreign embassies here ”.

While the western world is already distributing booster doses, as of December 6, only 34.4% of Nepalese have received at least one dose of the vaccine, and 28.7% have completed their immunization cycle. To remedy the situation, Nepal had to mobilize its funds and contract loans to supplement the donations. In February, he, among other things, purchased two million doses of Covishield from the Serum Institute of India. Half of the doses were dispatched immediately, but the rest, promised within ten days, was not delivered until October. In the meantime, the Indian authorities had banned all exports of vaccines …

The neglected disadvantaged areas

These delays, as well as the droppings of products, have serious repercussions: many people have only received one dose, and are desperately waiting for the second. Buddhiram Budha Magar lives more than two hours drive from the capital, in Melamchi, a small town at the foot of the Langtang mountains. “I received my first dose several months ago. I have already tried to do my second dose twice, but there was no vaccine and they do not know when they will have it ”, laments the retiree, wearing the dhaka topi, Nepal’s traditional headgear. Kamal Kumari Basnet tells the same story. “I walked for two hours to get my second dose but they refused me. I move with a stick, it’s difficult to take such a path ”, complains the 71-year-old woman. Pandab Adhikari, teacher at Melamchi Primary School, is no better off. He received his first dose in June, then nothing. “I am worried because the wait is long, explains the young man. You know, here, we do not wonder if it would be better to take this or that vaccine. We have no choice: we take what there is. Getting immunized is, in a way, a survival strategy. Our health centers do not have the means to save us if we fall ill. ” A little higher in the valley, at the level of the municipality of Helambou, the buildings dedicated to the reception of Covid patients no longer exist: they were washed away by several floods which devastated the region during the monsoon this summer . The village of Sermathang, perched high in the hollow of a pass, finally had “luck” in its misfortune: as it was cut off from the world for more than two months after the floods, the health authorities dispatched there on the back of ‘men and women get the doses of vaccines needed by its oldest population, deprived of roads to go down to the valley to be vaccinated.

In Kathmandu, when the second doses of Covishield bought from India were slow to be delivered, some people, among the richest in the city, did not hesitate to buy at a high price doses stolen by caregivers little scrupulous. But the capital has suffered less from the lack of vaccines than the other provinces of Nepal. “The government failed to protect the country from the second wave, but it followed the recommendations for vaccination, recognizes Binjwala Shrestha, public health specialist at Kathmandu University Hospital. The strategy plans to vaccinate first the areas where the virus circulates a lot, in urban centers and at the borders, and people according to their vulnerability, from the oldest to the youngest. ” When Pfizer recently arrived in Nepal, deemed to be more effective, it was given first to those suffering from comorbidities and who could not yet have been vaccinated, then to 12-17 year olds, who had not yet received any vaccine. because none had until then been adapted to their age. At the start of December, Bagmati province, to which Kathmandu belongs, had 53.2% of its population, all ages combined, benefiting from a complete vaccination cycle, while only 24.2% of the population of Karnali province , one of the poorest and located in the west of the country, was fully vaccinated. “It’s unfair, but we must do the best in a context where we lack vaccines for all”, Comment Binjwala Shrestha.

In the district of Thamel in Kathmandu, usually teeming with tourists, but deserted for more than a year and a half, Anil Bhattarai, mountain guide and fully vaccinated, wonders. “The cases of Covid are fewer at the moment, we hardly think about it anymore [le pays comptabilise moins de 300 cas quotidiens, et très peu de décès, ndlr]. But until when ? You have all the vaccines you want, and some people don’t even want them in you. Give them to us! We will know what to do with it, because many Nepalese are just waiting for this. We need to start welcoming clients, working and feeding our families again. ”

This report was supported by the European Center for Journalism (EJC) as part of its fellowship program on global health topics.

Source: Libération by www.liberation.fr.

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