The disparity between health requirements and spending is anticipated to grow as nations struggle with high levels of debt and inflation. Health spending in many low- and middle-income countries (LMICs), where health needs are greatest, is expected to decline or remain stagnant. This puts in jeopardy attempts to control continuing hazards, recover from disruptions brought on by COVID-19, and accomplish universal health coverage.

The global economic downturn is also shrinking aid budgets, hindering support for LMICs. Cuts in aid budgets by major donors like the UK and Sweden further strain resources. Worsening macroeconomic conditions may affect countries’ abilities to meet co-financing requirements for vital health programs.

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Ensuring access to quality healthcare services without imposing financial burdens on citizens is a cornerstone of any effective healthcare system. In Nepal, this endeavor is particularly crucial as high out-of-pocket (OOP) spending continues to be a dominant component of healthcare financing, leading to concerns about impoverishment due to healthcare costs. The National Health Sector Strategy (NHSS) has been instrumental in addressing these challenges by focusing on increasing investments in the health sector, improving resource mobilization, and enhancing risk pooling.

Despite these efforts, there are significant challenges that need to be addressed. One such challenge is the marginal increase in government spending on health as a share of GDP, with a concerning decline observed in the year 2022/23. While per capita government spending has shown an increase in real terms, it remains far below the recommended level to achieve universal access to primary care services. Additionally, OOP expenditure continues to constitute a significant portion of healthcare financing, demanding further strengthening of social health protection mechanisms.

The COVID-19 pandemic has underscored the importance of robust healthcare financing strategies. While it led to a temporary increase in the share of the health sector budget in response to the crisis, sustaining adequate funding for healthcare beyond the pandemic remains a challenge. Furthermore, the fluctuating contributions from health development partners (HDPs) highlight the need for a more stable and sustainable financing model.

Sustainable Healthcare Financing

In light of these challenges, a multi-faceted approach is necessary to ensure sustainable healthcare financing in Nepal. Firstly, there is a need to prioritize increased government spending on health, both in absolute terms and as a share of GDP. This can be achieved through effective allocation of resources and improved fiscal management. Additionally, efforts should be made to enhance the efficiency of healthcare spending to maximize the impact of available resources.

Furthermore, strengthening social health protection mechanisms, such as health insurance schemes, is essential to reduce reliance on OOP spending and mitigate financial risks for individuals. The increase in enrollment in health insurance schemes is a positive development, but efforts should be made to improve renewal rates and utilization, ensuring that more people can benefit from these schemes. The OOP expenditure remains to be a dominant component in healthcare financing in the latest years despite the implementation of various programmes aiming to reduce it. It demands further strengthening of the social health protection mechanisms in the country to accelerate the pace towards SDG.

Over recent years, there has been a noticeable rise in the portion of provincial government health budgets sourced internally, climbing from 34% in FY 2018/19 to 65% in FY 2022/23. Similarly, at the local level, the share of internal sources in health budget allocation has surged from 5% in FY 2018/19 to 22% in FY 2022/23. This trend reflects a growing capability among both provincial and local governments to finance health issues specific to their contexts using their own resources.

Moreover, fostering partnerships with development partners while maintaining a balance of contributions is crucial. While HDP support is valuable, efforts should be made to reduce dependency and gradually increase domestic financing for healthcare. As this will also be a learning for Nepal in its post Least Developed Country graduation journey.

In conclusion, achieving sustainable healthcare financing in Nepal requires a concerted effort from multiple stakeholders. By prioritizing increased government spending, strengthening social health protection mechanisms, and fostering partnerships, Nepal can move closer to ensuring universal access to quality healthcare services while safeguarding against financial hardships for its citizens. It’s imperative that the National Health Financing Strategy remains agile and responsive to evolving needs, ensuring that progress towards healthcare access and financial protection remains on track for the benefit of all Nepalese citizens.

(The writers are development practitioners associated with HERD International. The views expressed in this article do not represent the organisation they are associated with. They can be reached at Saugat.kc@herdint.com  Ghanshyam.gautam@herdint.com).

Nepal, a country known for its breathtaking scenery and strong communities, is aware that progress cannot exist without a healthy population. This article explores Nepal’s steadfast dedication to health, its national policies, and how they relate to the Sustainable Development Goals (SDGs). It also examines the development of Nepal’s health system along with key policy departures that have influenced it.

Journey of transformation

Over the past few decades, Nepal’s health system has witnessed a tremendous shift. It has developed against the backdrop of numerous donor-driven vertical programs, each of which focuses on a different health issue.

The National Health Policy of 1991, which placed a strong emphasis on multisectoral coordination, decentralized planning and management, and overall health system strengthening, marked the beginning of Nepal’s transformation of its health system. However, Nepal’s goal of creating a strong health system never quite materialized. Instead, there was little focus on improving the overall healthcare infrastructure. The health system resembled a patchwork quilt of disease-centric vertical programs.

The government’s budgetary practices also showed this fragmentation, with spending categories still reflected disease-specific programs. Few resources were set aside to deal with the rising costs of non-communicable diseases, problems with mental health, and emerging health problems.It was clear that the health system needed a significant overhaul to meet the evolving health needs of Nepal’s population

Turning point

As Nepal transitioned from a unitary system to a federal structure, governance underwent a profound transformation. This shift had a significant impact on healthcare delivery and highlighted the need for innovative solutions. The federal structure offered opportunities for localized solutions tailored to the unique needs of each province. However, it also required a harmonized effort to ensure that healthcare remained accessible and equitable across the diverse provinces.

Decentralization became a key principle, but it was a delicate balance. Effective cooperation between federal and provincial authorities, especially in areas like healthcare financing and resource allocation, was crucial. Ensuring consistent, accessible, and high-quality healthcare across provinces became the overarching goal. Achieving this required a harmonized approach, improved resource management, and capacity building at all levels of government.

Resilience in the face of crisis

Nepal’s resilience was put to the test during the COVID-19 pandemic. In the face of adversity, the nation stood firm, even though the pandemic hit the economy harshly and health systems were over stretched during the peak. This demonstrated to the world that a robust healthcare infrastructure is not just a luxury but a necessity, particularly during times of crisis.

The pandemic underscored the importance of a well-functioning healthcare system that could adapt to emerging challenges. It highlighted the need for more healthcare infrastructure, a well-trained workforce, and ongoing investments in research and development. Policies needed to reflect this holistic approach, addressing not just treatment but also prevention and rehabilitation.

Key policy departures

One of the most significant policy departures that Nepal has embarked upon is the shift towards people-centered care. While vertical programs achieved successes in tackling specific diseases and improving maternal and child health, they also led to a narrow focus on disease-centric approaches. The burden of poor health in Nepal was compounded by the rising prevalence of non-communicable diseases, injuries, and chronic conditions. It became evident that acute, episodic care alone would not suffice to address these emerging challenges.

Structural innovations that facilitate seamless information exchange and shared responsibility within the health system became imperative. People-centered care, which considers the preferences, needs, and aspirations of individuals and communities while remaining accountable to users for improved health outcomes, became the guiding principle.

To achieve this, Nepal needed to move beyond the programmatic appetites of the past. It required informed choices that would instill quality improvements and responsiveness into the healthcare system. This transformation aimed to shift healthcare from being episodic and acute-focused to an integrated, holistic, and people-centered approach.

Looking ahead

As we chart the course for Nepal’s healthcare system amidst political transition and federal restructuring, we are at a pivotal moment in our nation’s history. Nepal has the potential to shift its healthcare paradigm, embracing a system that genuinely centers around its citizens. It aims to ensure that health becomes a right, not a privilege, for all.

In this journey, we must learn from the past and let go of the constraints of disease-centric vertical programs. Instead, we should embark on a path that prioritizes people-centered care. It should listen to the voices of our communities, empower individuals to take an active role in their health, and create a healthcare system that is not just reactive but proactive.

In Nepal’s pursuit of a people-centered health system, there is room for innovation, collaboration, and adaptation. We can leverage technology to bridge geographical gaps and improve access to healthcare in remote areas. We can invest in the training and development of a skilled healthcare workforce that can deliver high-quality care with compassion. We can work together, across all levels of government and society, to ensure that healthcare is not just about treating illnesses but about promoting well-being and addressing the social determinants of health.

Nepal’s health system transformation is not just a technical challenge. It is about recognizing the dignity and worth of every individual and ensuring that they have the opportunity to lead healthy lives.

Furthermore, we must recognize the importance of political commitment and leadership in driving this transformation. Our leaders must prioritize healthcare as a fundamental component of our nation’s development and commit to the necessary reforms. We should look to successful models from around the world where countries have achieved impressive healthcare outcomes by prioritizing people-centered care and investing in the health of their populations.

Nepal’s health system transformation is not just a technical challenge. It is a moral imperative. It is about recognizing the dignity and worth of every individual and ensuring that they have the opportunity to lead healthy lives. It is about fulfilling the promise of our constitution to provide basic healthcare as a fundamental right.The choice is clear, and the path forward is challenging but rewarding.

Saugat Pratap KC is a researcher associated with HERD International, a health research agency. The opinion expressed in this article does not represent the views of the organization he is associated with. KC can be reached at spk266@gmail.com.

The most recent study, which was recently published in The Lancet, estimates that 1.4 million people died in 2019 from diseases caused by resistant bacteria. By 2050, that number may rise to 10 million, making it one of the major causes of death globally.

Antimicrobial resistance is viewed as a global health issue from a One Health approach. The ability of different types of resistance to spread to other bacteria and the environment is being amplified by an increasing number of resistant bacteria. Multidrug resistance will be a reality for the majority of microorganisms if this trend keeps on. This implies that we won’t be able to treat bacterial infections with antimicrobials, which will result in a rise in infection-related fatalities.

World Antimicrobial Awareness Week (WAAW) is observed annually. This year WAAW is being observed from 18 to 24 November with the motto “Preventing Antimicrobial Resistance Together”.    Antimicrobial Resistance (AMR) is a growing threat to public health, which has become a matter of worry for stakeholders and policy makers in the healthcare industry. Infection prevention and control programs to stop the spread of resistant microorganisms and antimicrobial stewardship programs to prevent unnecessary usage of antimicrobials that could put patients and people around them at risk for AMR are the two main strategies for controlling AMR.

Although the problem of AMR and its solutions are discussed in numerous fora, there is a lack of patient and public participation, which can result in the public making decisions about infection control measures and using antibiotics without adequate information. AMR containment needs actions outside of healthcare settings. Patients and the general public can acquire and consume antimicrobials without a prescription, especially in many low- and middle-income countries (LMICs). Therefore, policies and initiatives to combat AMR need to recognize and take advantage of their participation and contribution.

Patients or communities who take an active role in their own treatment are more likely to be aware of their rights, express their demands, and get answers to their questions, whereas patients who aren’t involved in the decision-making process may get confused, frustrated, or anxious. Patients and the general public must, however, have a foundational understanding of infections, antimicrobials, and the complexity involved in their use in order to participate in and engage with the AMR issue.

Like the majority of medications, antimicrobials are purchased out of pocket in many LMICs. As a result, there is a tendency for expensive antibiotic treatments to be discontinued early, which could increase the risk of ABR. These problems raise the need for involvement of patients, caregivers, and the public in infection treatment decisions, particularly when it comes to the necessity or otherwise of antimicrobial administration.

The necessity for patient and public involvement has been underscored by the National Action Plans (NAPs) and policies of several nations to address AMR, with the possibility of AMR discourse in some countries. However, their practical application can be difficult. This is also the case for Nepal. AMR is still portrayed as a problem for the future, and it seems that most deaths that can be attributable to it go unreported.

Despite the fact that this may sound like some sort of sci-fi story, it’s vital to remember that the deaths caused by AMR are already happening and adding to the expected number. To encourage patient and public involvement and participation, we need to make AMR approachable by illustrating how it affects people’s lives and how it affects their families, livelihoods, and quality of life. Initiatives for patient involvement not only necessitate patient engagement and participation techniques, but also support the creation of a welcoming environment for patient involvement.

In order to address AMR, it is important to embrace the idea that there should be more stakeholder involvement from the community. This will guarantee that those who get medical treatment have a voice in decisions that will have an impact on them. This will aid in the development of a more balanced viewpoint of stakeholder involvement for AMR control, which will be advantageous to both healthcare providers and patients and lead to more impartial decision-making for AMR control.

Building a society capable of taking preventive action in the face of major global threats like antimicrobial resistance requires igniting interest and raising awareness. 

Saugat Pratap KC is a researcher associated with HERD International, a health research agency. The opinion expressed in this article does not represent the views of the organization he is associated with. KC can be reached at spk266@gmail.com.

Pandemics have been predicted in the past by mapping all known emerging infection episodes from the 1940s to the early 2000s and predicting that emergence will occur at one of those locales. However, emergence is a random phenomenon that occurs at any time and in any location, and mapping has not proven to be a reliable forecast.

Climate change’s primary causes can also raise the likelihood of pandemics. More and more animals are coming into touch with humans as a result of deforestation, urbanization, and the massive livestock husbandry required for a burgeoning meat-production business. As a result, the infectious agent is more likely to ‘jump’ from animal to human. It is widely believed that another pandemic will occur and that people are increasing the chances of pandemics by engaging in many of the same activities that cause climate change.

That is why a “one health” strategy is critical—the animal health, human health, and environmental sectors must collaborate to recognize and respond to pandemic threats quickly. As much as human health, pandemic prevention and preparedness must be considered in the context of the ecosystem and animal health. We can only hope to secure human health by preserving a healthy environment and animal populations.

Next outbreak?

The most important issue facing all countries is how they detect outbreaks. This involves pathogen genetic sequencing and the exchange of sequence data in international databases. Industrialized nations should assist low and middle-income countries in strengthening their public health capability in order to achieve the best possible health security for the human population. Another important aspect of monitoring is the need to change the focus from finding infections in humans to detecting them early in animal populations and preventing them from spreading to humans.

The effectiveness of any efforts to prepare for the upcoming pandemic depends on how well-developed national mechanisms are for identifying and combating outbreaks. Nevertheless, nations must work together more effectively to ensure a more equitable distribution of the equipment required for preparation and response. Rich countries prioritized their own populations over a fairer global response during the Covid-19, likely extending the pandemic’s consequences. Some developing countries had trouble getting the tests, vaccines, and treatments they required to react appropriately.

Due to the advances in vaccines, diagnostic tests, and therapies, the world is better equipped for the next significant outbreak or pandemic. 

So are we prepared for the next pandemic? Due to the advances in vaccines, diagnostic tests, and therapies, the world is better equipped for the next significant outbreak or pandemic. These tools are the result of years of research, and the Covid-19 pandemic has hastened their development significantly. Similar technology may be used to develop efficient vaccinations, diagnostics, and treatments more promptly in the event of another influenza or coronavirus pandemic.

Politics may provide the biggest obstacle to the next pandemic’s preparedness. National sovereignty must be maintained, just as it is in the case of the present pandemic, but the difficulty is to make sure that these considerations do not trump the cooperation needed for an effective international response.

There is no alternative to the determined implementation of traditional public health measures, such as test, trace, isolate, and physical distance, as recognized by the nations whose response has been most successful. Even the best health systems in the world will be overwhelmed if an infectious disease is allowed to grow unchecked. Supporting and showing solidarity with the populations that are negatively impacted by the public health measures required to address the pandemic is essential to accomplishing that successfully.

The importance of collaborative and coordinated leadership among political decision-makers, academics, public health experts, and national and subnational authorities is an important lesson to be learned. As Covid-19 grows endemic, politicians face the risk of losing the drive to support and lead the measures needed to maintain and develop global pandemic preparation.

Like climate change, pandemic preparedness depends on collaboration between developed and developing countries as well as the political emphasis on finding solutions rather than playing the blame game.

Saugat Pratap KC is a social science researcher. The views expressed in the article belong solely to the author. Email: spk266@gmail.com

Financial issues underpin many aspects of health system functioning. Financial incentives are important for changing service providers’ and patients’ behavior. These incentives also affect the stakeholders who are seeking to shape health policies and thus influence the overall performance of the system. Increasing effective access to health services depends on creating more resources for health as well as magnifying the efficiency and equity in the use of resources. Health financing reforms affect equity by shifting the way resources are allocated across age and income groups. They also affect health, as medical expenses are a common cause of household impoverishment and can be a significant barrier to seeking care.

Health financing reform that focuses on expanding effective coverage involves complex interactions among a range of stakeholders in the health sector and beyond, with varying power and influence. This can make reform politically contentious and difficult to move forward to adoption and implementation. Over the years, health financing has been a major obstacle to building a resilient health system in many low-and middle-income countries, and Nepal is no exception. The health financing system is not able to ensure adequate financial protection for a large share of the population despite various schemes and programs being introduced.

Health financing reform that focuses on expanding effective coverage involves complex interactions among a range of stakeholders in the health sector and beyond, with varying power and influence. 

During the past two decades, Nepal has gone through tremendous political and social changes transitioning from a unitary system to a federal republican democracy. Its politics, society and economy have been irreversibly altered by coups, civil wars, and political movements. The transition has been an ambitious change, requiring major reforms and investments to prepare all levels of government with the tools, resources and skills to perform new functions. Along with this, the recent Covid-19 crisis has exposed key structural challenges in terms of education, safety, and health and it has magnified the vulnerability of already marginalized households and communities. During the time of the pandemic, there was a challenge in terms of limited cooperation, collaboration and coordination among the three tiers of government which resulted in confusion in the government’s response to the crisis.

There are two overarching reforms driving Nepal’s health financing system. First is the new model of federal governance and second the implementation of national health insurance that substitutes and restructures the prior prepayment schemes in an impartial and sustainable way. However, Nepal’s health policy lacks key definitions related to several important aspects of health financing such as redefining and costing a unified national package of basic health care; strengthening effective mechanisms for pooling funds, and strengthening the capacity development of provincial and local governments to implement the health budgets.

Going forward

Nepal has the potential to achieve fruitful results in the health sector in a variety of ways. Connecting financing to performance is one of the key areas where these benefits can be achieved. Efficiency gains can also be achieved by improving the design of existing grants. In addition, major resources can be provided by addressing drug stockouts, health worker absenteeism, drug supply and distribution, equipment maintenance, and preparation in the procurement of equipment.

In this context, the Ministry of Health and Population needs to reflect on its role as a steward of the sector. They are the policy, technical, and quality wing of Nepal’s health. They need to prioritize the health status of Nepalis as they already are and ensure that they receive financial protection against the risk of poverty due to ill health, based on the equity of care, not on the basis of who provided the health service and service delivery. The recently drafted Health Financing Strategy can address the issues and control them in the future. The health sector needs to develop a holistic plan, based on the dialogue and expectations of key stakeholders and based on a thorough analysis of strengths, weaknesses, opportunities and threats. This would help in developing multi-year plans on which the annual budget would be based.  The multi-year plan should reflect the mission, vision, values ​​, and long-term goals of the ministry, responsible for managing the sector, and coordinating with all stakeholders.

Seizing this opportunity to address a number of health financing challenges will mark the beginning of a positive transformation in Nepal’s healthcare metrics and guide in an era of increased productivity in the country.

Saugat Pratap KC is a social science researcher. The views expressed in the article belong solely to the author. Email: spk266@gmail.com

People who already have chronic illnesses are already vulnerable to complications and death from Covid-19 and face significant indirect health consequences. People with chronic illnesses need ongoing and accessible routine care but the pandemic has disrupted this essential care. Examples of such indirect health effects include delay in diagnosis, cancellation of care, neglect and delays.

The pandemic has highlighted that for the health system to be resilient to health shocks like Covid-19, policy responses must address both direct and indirect threats. Primary health care at the forefront of all health systems plays an important role in this regard. Strengthening this front line by expanding the role of primary health care helps relieve the pressure on the entire health care system by reducing the burden on the hospitals, apart from protecting the individuals from indirect threats from pandemic and other health crises.

Primary health care ensures continuity of care for all patients. In addition to providing temporary care and response to acute health problems, robust primary health care provides routine, preventive, patient-centric care. It also acts as a simple access point to the health system. These services are needed to ensure that everyone’s concerns, fears and needs are heard and that potential health problems are managed in the initial phase.

As a place of first contact, primary health care provides accessible, comprehensive, continuous, and coordinated health care, improving prevention, detection and care of people and helping them manage their own health issues. It has the full potential to improve the health of people at all socio-economic levels and reduce unnecessary use of more expensive professional services. These positive results are because primary health care is the first contact for the needs of most patients, with providers having complete access to the patient’s history coordinating other medical services and care as needed.

What have we learned? Active primary health care during and after a pandemic can provide comprehensive and continuum of care in three main ways. First, it maintains continuity of care through chronic care management, disease prevention activities, health education for chronic disease self-management and community involvement in the context of chronic diseases. Second, it supports mild cases of Covid-19 and provides a first line of defense by diagnosing, tracking, and preventing the spread of the outbreak. It promotes the dissemination of public health measures and provides psychological support to people. Lastly, it can assist people facing poor health as a result of the direct and indirect effects of the crisis. Solid primary health care is perfect for meeting the growing need for care.

Expanding the role of primary health care helps relieve the pressure on the entire health care system by reducing the burden on the hospitals, apart from protecting individuals from indirect threats from pandemic and other health crises.

For all of these reasons, primary health care should be the foundation for global response and recovery in the current and future public health crisis. This is the most comprehensive, efficient, and effective way to protect the health of individuals and communities.

Universal public health systems rooted in solid, inclusive, accessible, and socially and culturally oriented primary health care is one of the main pillars of the society that respects the most fundamental rights of the people. In uncertain times like these, in the face of a pandemic of this scale, it is critical to optimize primary health care to maintain essential health care services and address the health needs of the vulnerable groups. Primary health care should be central to these efforts and it is critical for countries to invest in primary health care.

There is no room for ideas that cast a shadow over human life.

Saugat Pratap KC is a social science researcher. The views expressed in the article belong solely to the author. He can be reached at spk266@gmail.com

A large number of LMICs are yet to administer the first dose of vaccines to their population. This is the case for Nepal too. The vaccination campaign in Nepal began on January 27, 2021, and as of April 20, 2021, 1.7 million first doses had been administered to selected populations as part of its vaccine rollout plan. However, in Nepal, the export of AstraZeneca vaccine from India was suspended to meet India’s domestic demand, making it difficult for Nepal to vaccinate its targeted population. Hence, the government turned its head towards diplomatic channels to appeal to other nations to support Nepal with vaccines. Nepal aims to vaccinate 72 percent of its population as part of its Covid-19 response but only 10.1 percent have been fully vaccinated as of August 11, 2021.

Risks remain  

Although daily life is slowly returning to normalcy amidst the risk, many Nepalis still have a false sense of security, assuming that the worst is over with the deployment of vaccines. But the bitter reality is that people are still struggling to get a jab and have been queuing up in long lines in front of the vaccination centers. During such a crisis, inequities sharpen internally within the existing socio-economic disparities. Moreover, in Nepal, where urban and rural divisions are strong in terms of access to infrastructure, education and health, these divisions are closely linked to wealth and social inequalities in times of crisis creating pressure on the already fragile health system.

With the scarcity of resources within the country and with no other option open when it comes to Covid-19 vaccine, a major question for Nepal is how it will vaccinate its entire population. This is where the term vaccine equity comes in to play. We do see reports of uneven distribution of vaccine globally and high income countries hoarding vaccines for its population. Director General of WHO rightly stated: “Vaccine equity is the challenge of our time and ending the pandemic is a solvable problem and we need to act together”. The uneven distribution of Covid-19 vaccines around the world is not limited to ethical and moral issues. Infectious diseases that do not respect borders will continue to threaten the international community as long as they exist around the world.

The battle against Covid-19 is a battle against time. The day ahead will be the test of whether the world can come together and keep its pledge of international solidarity to achieve herd immunity.

Today, all of us share the same hope that we can build a stronger international healthcare architecture to protect future generations as we fight together to overcome the Covid-19 pandemic. No single government or multilateral body can tackle this threat soon on its own. Jointly, we must be better prepared to anticipate, prevent, detect, assess and respond effectively to the pandemic. The Covid-19 pandemic has proved that no one is safe until everyone is safe.  Therefore, ensuring all nations are committed to universal and equitable access to safe and effective vaccines is critical.

To circumvent the country’s purchasing power-based allocation system, the Covid-19 Vaccine Global Access facility, known as COVAX, was established to help immunize the population of poor countries, global cooperation led by WHO, GAVI, the vaccine alliance and Coalition for Epidemic Innovations (CEPI) to ensure equitable access to 92 low and middle-income countries that cannot provide for vaccine needs.

Vaccinate all  

Covid-19 does not seem to end with a bang or a parade. Throughout history, pandemics have ended when disease no longer dominates daily life and fades into the background like other health issues. We do see areas of uncertainty, we are seeing emergence of new variants that reduce the effectiveness of the vaccines against death and serious illness. And how we can manage the virus in low and middle-income countries like Nepal, where the people are still largely unvaccinated and still susceptible, is a continuous challenge. It is now imperative that the richer nations who are emerging from the pandemic, come into aid to support countries like Nepal with limited resources, with vaccines and resources they require. It is necessary to ensure government-to-government agreement or to ensure that diplomatic channels are in place to address the dire situation of vaccine shortages if we are to rapidly vaccinate the targeted population in time.

Nepal, with its pandemic mortality and morbidity and economic damage, should proactively work for Covid control. We know that the more the virus spreads among unvaccinated people, the more it will continue to mutate and eventually threaten the health of those vaccinated.

The battle against Covid-19 is a battle against time. The day ahead will be the test of whether the world can come together and keep its pledge of international solidarity to achieve herd immunity.

Saugat Pratap KC works as Knowledge Management Officer at HERD International, a health research agency. Opinion expressed in this article does not represent the views of the organization he is associated with.