In ‘vaccine apartheid,’ Nepal is ground zero. It needs U.S. help

The world has reached the era of Covid-19 “vaccine apartheid.” That was the warning this week from World Health Organization Director-General Tedros Adhanom Ghebreyesus. Nepal is now ground zero.

Nepal has surpassed India in terms of Covid-19 deaths per capita, and is far ahead of other south Asian countries. About 40% of Covid-19 tests are coming back positive. With fewer than 2,000 ICU beds and 600 ventilators for a population of 30 million, Nepal’s health care system is collapsing. As a member of the Nepali Parliament (G.K.T.) who represents a hard-hit area of Kathmandu and a U.S. physician-researcher who has collaborated with colleagues on strengthening health systems for 15 years, we implore action.

The humanitarian crisis posed by the pandemic is likely to exceed the fallout from the 2015 earthquakes that devastated the country and took nearly 9,000 lives. This crisis has the potential to invite political instability and threaten the foundations of Nepal’s democratic institutions.

The United States is uniquely positioned to avert further catastrophe in Nepal. Immediate, bilateral support through sharing AstraZeneca Covid-19 vaccine doses from its stockpile is essential to save further loss of life in Nepal and to complete the initial round of vaccination of Nepal’s population, something that can go quickly, since Nepal has extraordinary vaccine infrastructure. If given the opportunity, the country can equitably and rapidly deliver vaccines to its population. Nepal has comparable rates for many childhood vaccinations as the United States, and has rapidly and equitably distributed Covid-19 vaccines it received earlier this year. There is a strong ethical argument for immediately supporting countries with the greatest need.

As was made clear in testimony before the U.S. Senate Committee on Foreign Relations on May 12, what happens to Covid-19 globally will fundamentally affect health, human rights, and economic interests in the U.S. Beyond the horrific toll of deaths and personal loss, preventable vaccine inequity could cost the global economy nearly $10 trillion.

Nepal is of particular strategic importance to the U.S. as well as a democratic ally. In addition, there are more than 200,000 people of Nepali descent living in the U.S. who contribute vitally to its society.

Before the second wave of Covid-19 started this spring, the virus had already forced millions of Nepalis to the brink of starvation and caused widespread economic damage. The country’s medical infrastructure was inadequate before the virus hit. Now it is completely overwhelmed.

Nepal, like many other countries, is wholly dependent on other countries that are able to make — or donate — Covid-19 vaccines. Nearly 2 million Nepalis are awaiting their second dose of the AstraZeneca vaccine, which had previously been produced in India but have been halted as that country copes with its own Covid-19 crisis. Until those individuals get their second doses, Nepal is unwittingly in the middle of a large-scale epidemiologic experiment. With only partial immunity in large numbers of the population, it is possible that some of them will produce new variants. These strains, called escape variants, emerge from the evolutionary pressure posed by partial immunity. The potential for these escape variants have been a concern of virologists and epidemiologists throughout the global vaccine roll-out. While the chance of such variants arising is low, it is not a risk that we want to take.

The U.S. has already started mobilizing immediate disaster relief for the Covid-19 crisis around the globe. The Biden administration is now providing funding for the global vaccine facility, COVAX. While it will be an essential player moving forward, there is a specific need in Nepal’s case for direct and immediate bilateral vaccine support from the U.S. Nepal, which has been wholly dependent on manufacturing in India, needs vaccines now to control the pandemic while India struggles to bring its own pandemic under control and once again begin manufacturing vaccines — and other therapies — for other countries.

We urge the Biden administration to commit to an immediate release of up to 12 million vaccine doses from the U.S.’s stockpile — enough to complete the vaccination course for those who have received their first dose while also completing full vaccinations for the entire elderly and highly vulnerable populations in the country. Given the severity of Nepal’s Covid-19 pandemic, all efforts should be made to get Nepal’s entire eligible population vaccinated this year.

Nepal can deliver on the ground. We have seen health workers reach the most extreme and unreachable corners of the country, from the tropical climate of the Terai to villages in treacherous mountain environments in the Himalayas. While Nepal’s infrastructure for hospital care is fragmented, its human infrastructure to equitably deliver vaccines to every corner of the country is a global model.

If provided with sufficient vaccine doses, Nepal will get them delivered to its residents. Providing vaccine doses to Nepal is an unparalleled opportunity for the U.S. to save lives, recommit to its friendship with the country, and add another chapter to America’s long and storied collaboration in strengthening Nepal’s health system.

Gagan K. Thapa is a member of Nepal’s federal parliament and former minister of the country’s Ministry of Health and Population. Duncan Maru is an internist and pediatrician at NYC Health & Hospitals/Elmhurst in Queens, New York, and associate professor at the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai.