The first COVID-19 case in Nepal was recorded on 23 January 2020. The number of cases started increasing from the third week of March 2020 and by the end of 2020 there were 260 593 cases, with 1 856 recorded fatalities[1].

In early 2021, Nepal’s Ministry of Health and Population (MoHP) submitted the National Deployment and Vaccination Plan (NDVP), which was developed with technical support from WHO Country Office (WCO) and partners, to the COVAX Facility.  The NDVP was reviewed and quickly approved by the Regional COVID-19 Review Committee. The plan was to secure enough doses to vaccinate 20% of the population at highest risk of COVID-19 disease and death through the COVAX Facility.[2] Under the first COVAX allocation, the COVAX Facility was expected to deliver 1.92 million vaccine doses to Nepal, out of which 348,000 doses as a first tranche has already been delivered to the country in March 2021. Based on vaccine availability, Nepal could further receive 9.73 million vaccine doses (indicative allocation) in 2021.

Meanwhile, Government of Nepal has also proactively secured additional 2.8 million doses of COVISHIELD and SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) through diplomatic negotiations and direct procurement.

Nationwide vaccination campaign started at the end of January 2021 with operational committees and task forces formed at all levels - federal, province, districts, and local level (palika, municipality). These committees and task forces were leveraged existing immunization coordination committees that exists at all levels, which were expanded as per need for COVID-19 vaccination response. WHO Nepal played a role in coordinating and monitoring the action plan, alongside government, UNICEF and other partners. A dedicated team of WCO experts – under the WHO Immunization Preventable Disease programme (WHO-IPD) – advised MoHP on the introduction and rollout of COVID-19 vaccines as well as on other immunization-related policies and standard operational procedures based to ensure vaccine delivery with safety, quality, and efficacy. Furthermore, WCO served as technical secretariat for the National Immunization Advisory Committee (NIAC), mandated by the Immunization Act 2072 (C.E 2016) of Nepal to guide and support the overall immunization programme across the country. WHO Nepal also coordinated with different nodes of Ministry of Health and Population and helped design data systems to enable daily reporting of immunization data.

Nepal launched the COVID-19 vaccination campaign on 27 January 2021 and so far, has delivered 2.48 million vaccine doses vaccinating 6.95% of the total population with the first dose, and 1.2% with the second dose of COVID-19 vaccines. At first, based on the NDVP, health and social sector and front-liners (first priority group) were vaccinated achieving 86% coverage. Following this, people over 65 years old throughout the country and those over 55 years old in all high mountainous terrain districts were vaccinated, achieving 77% coverage (preliminary data). Recently, the first priority group have also been provided second dose of the vaccine.

The Department of Health Services of the Ministry of Health and Population, through the Integrated Health Information Management Section (IHIMS), has developed a daily reporting system and produces a daily bulletin on immunization coverage in DHIS-2 tool, with close support from WHO.

WHO-IPD staff at central level, and surveillance medical officers and consultants at field level supported the government in training, microplanning workshops, monitoring, and all aspects of surveillance concerning adverse events following immunization (AEFI). The National Immunization Programme conducted in-person health worker and vaccinator trainings that took place in the Kathmandu valley and nationwide in cascaded manner, and also virtual trainings from the centre for health workers, vaccinators, and AEFI focal persons, with close technical support from WHO-IPD.

WCO has also developed the monitoring checklist for the Government and partner agencies to use in the process of monitoring and supervision at vaccination sites. Monitoring checklist includes checkpoints for immunization site management, session site logistics, vaccine safety, information management, AEFI preparedness, and infection prevention and control measures (IPC). Data collected is collated and analysed by WHO and shared with MoHP, provinces and stakeholders on a regular basis to help programme mangers use that information for immediate corrective action.

Other partners that contribute significantly to the vaccination campaign are UNICEF, Water-Aid, Red Cross, and Nepal Health Sector Support Programme.

The Government of Nepal plans to vaccinate up to 72% of its population as COVID-19 vaccination response. As more vaccines need to be procured for the rest of the population besides the 20% fully subsidized doses expected from the COVAX Facility, there are multiple alternative strategies of the government addressing the matter: government-to-government agreements or in-kind support through diplomatic channels, direct procurement agreements, as well as intent to finance procurement of COVID-19 vaccines via the COVAX Facility beyond the fully-subsidized doses.

Based on its robust routine immunization system and experience of conducting nation-wide mass vaccination campaigns, and proactive vaccine acceptance in the community at large, Nepal has safely and successfully demonstrated rapid roll out of COVID-19 vaccination. However, uncertainty regarding supplies and shortage of vaccine doses remain challenges to quickly vaccinating the entire targeted populations.