With poor recording and reporting system, health workers suspect vaccine mix

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More than 20 weeks after receiving their first dose of the AstraZeneca vaccine, around 1.4 million people aged 65 and over started receiving their second dose on Monday.

When they took the first dose of the vaccine in the second week of March, they were told they would receive the dose in four weeks.

The elderly were worried about the delay in getting the second dose and, officials said, uncertainty led some of them to seek out and even take the Chinese Vero Cell vaccine.

“I have also heard rumors that older people who took the first dose of AstraZeneca looked for Vero Cell and some even took it,” said Dr Samir Kumar Adhikari, joint spokesperson for the Ministry of Health and Population.

Other ministry officials the Post spoke to said they had received similar reports from different parts of the country.

“After failing to get the second dose of the AstraZeneca vaccine, dozens of elderly people requested Vero Cell as a second dose,” Laxmi Koirala, health coordinator of Kageshwari Manohara municipality in Kathmandu, told the Post.

“They stood in line for hours to get the vaccine, but we told them it would be risky to take two different types of vaccine and told them we weren’t allowed to vaccinate them with another type of vaccine. vaccine.”

The urgency felt by the elderly and their families for the second dose was due to the fact that there is no sign of the pandemic being brought under control as the number of cases continues to rise.

On Tuesday, the Department of Health and Population reported 3,194 new cases out of 13,217 polymerase chain reaction tests and 1,710 out of 5,906 antigen tests. The total number of cases since the start of the pandemic last year stands at 720,680. Of these 37,332 cases are active. With 35 additional deaths reported on Tuesday, the Covid-19 toll stands at 10,150.

Another reason for concern has been the lack of proper communication from authorities, according to immunization officers.

The government had said people aged 65 and over would get the second dose after four weeks, hoping the Serum Institute of India would provide 1 million doses Nepal had paid for. But with the Serum Institute not delivering them due to export restrictions imposed by the Indian government following the second wave of the pandemic, the interval had to be extended.

The government announced that the second dose would be given after an interval of eight to 12 weeks. With no other arrangements to procure the vaccine, he later said the gap would be 12 to 16 weeks.

But Monday, when people aged 65 and over finally started receiving the second dose, marked the start of the 21st week since their first dose.

Vaccines arrived from Japan and Bhutan over the weekend. Under the COVAX facility, Japan is providing a grant of 1.6 million doses of the AstraZeneca vaccine, of which 847,320 doses have arrived. Bhutan provided 230,000 doses of AstraZeneca vaccine which were in surplus after immunizing its population.

The ideal gap between the two doses of the AstraZeneca vaccine is not clear although the World Health Organization says it should be eight to 12 weeks.

Risk communication experts say that without the right message, people tend to believe whatever information is available.

“For authorities to send the right message to the public, you need the right information,” said Dr Radhika Thapaliya, risk communication expert and director of the National Health Education Information Communication Center. “He can’t deliver the right message on time when he doesn’t have the right information and when people don’t get a message from a credible source, they take a message from any available source, which can sometimes be deceptive. “

In Nepal, there is also the problem of good record keeping.

According to health workers at vaccination centers the Post spoke with, the only way to check what vaccine a person has taken is through the vaccination card issued after vaccination.

“But if they come without a card and say they are taking the first dose when in fact they are taking the second dose, we have to vaccinate them,” said Jagat Nepali, senior auxiliary health worker at the health post in Alapot from the municipality of Kageshwari Manohara. from Kathmandu.

Although the names of people are noted when they go to be vaccinated against Covid-19, the data collected is not managed.

“We have no mechanism to verify who has taken which vaccine,” Nepali said.

The Ministry of Health, however, takes stock of the vaccinations and, on Tuesday, 4,541,682 received their first dose while 2,722,020 were fully vaccinated.

However, the ministry does not provide a weekly and monthly breakdown of the number of people vaccinated.

To improve the reporting and recording system, the Ministry of Health has set up an Information Management Unit with technical and financial support from the World Health Organization. Such units have been created in the seven provinces. But still, there are problems in the reports.

“Vaccination centers across the country have no system of knowing who has taken which vaccine,” Rajendra Poudel, technical manager of the Information Management Unit, told the Post. “A person’s word is the only way to know if they have been vaccinated earlier and the brand of the vaccine.”

The problem is not just for people over 65.

Department of Health Services officials said they had received several reports of the vaccine mix.

“We received a complaint that a man first took Vero Cell and then took the Johnson & Johnson vaccine,” a department official told The Post, asking not to be named.

The government has decided to administer the Johnson & Johnson single-injection vaccine, 1,534,850 doses which the United States provided a grant in June through the COVAX center, to people aged 50 to 54 years.

But with calls for migrant workers to receive the vaccine as it would be convenient for them and destination countries only allow entry for the vaccinated, authorities decided to include them for the Johnson & Johnson vaccination as well. Previously, the authorities had decided to beat them with Vero Cell.

A number of countries in the Gulf region do not allow entry to those who have received the Chinese vaccine.

“It has also been reported that some people, who have taken the Vero Cell vaccine, have been certified to be stung with the Johnson & Johnson dose to go overseas,” the department head said.

Public health experts have said that the government’s data collection and management has been something of a disaster since the start of the pandemic. They said the lack of a good information reporting system was one of the reasons that prevented authorities from taking swift action to tackle the pandemic.

“We have long called on the Ministry of Health to improve data collection and reporting,” said public health expert Dr Binjwala Shrestha. “But there are still a lot of things to improve. The authorities should also take action on the basis of the data they have collected.

Although doctors say accurate information is needed to formulate policies and make decisions, government officials point to their own challenges.

According to Adhikari, the joint spokesperson, there are problems in the reporting system of the local units because the health workers there are overworked.

“In addition to their daily work, they also have to update reports. In addition, several local units have problems with the Internet and health workers could also have problems with the use of technology, ”Adhikari said. “And the priority of health workers at the local level is to provide services rather than updating data. “

But without reliable information on how many people have taken which vaccines, vaccine purchasing decisions, planning for second doses, knowing the disease burden, taking preventative measures, budgeting and preparing other plans is becoming difficult, experts say.

“Without knowing the exact situation, how can you make plans? Dr Baburam Marasini, former director of the Division of Epidemiology and Disease Control, told the Post. “The Ministry of Health’s existing recording and reporting system is a complete mess, which should be improved immediately.”

This will have a direct impact on people, according to Thapaliya, the risk communication expert.

Having the right information is essential to disseminate the right information so that risks are minimized, Thpaliya said.


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