IVI and Nepal
Member State Relations
On 30 May 1997, Ambassador of Nepal to the United Nations, H.E. Narendra Bikram Shah signed the Establishment Agreement of the International Vaccine Institute at UN headquarters in New York.
On 12 March 2021, IVI and the Nepal Health Research Council (NHRC) signed an MOU during a virtual ceremony, laying the foundation for the two organizations to build research and development capacity in Nepal and jointly pursue opportunities to improve public health in the region. As part of the MOU, IVI-NHRC collaborative efforts may include Good Clinical Practice and Good Clinical Laboratory Practice trainings at medical schools and hospitals, and vaccinology courses to train young scientists, healthcare workers, and researchers.
Since 2000, Over 30 Nepalese health officials have received training in IVI’s Annual Vaccinology Course.
Ongoing Collaboration
COVID-19 Vaccine Development
IVI and Nepal are contributing to a global Phase III trial to evaluate the efficacy of Sanofi and GSK’s vaccine candidate targeting the original SARS-CoV-2 virus as well as circulating variants. The trial expects to enroll 4,000 volunteers across 3 study sites in Nepal. In addition to generating local data to support the global clinical trial, the study will continue to build capacity and infrastructure for vaccine research and development in Nepal.
Typhoid Vaccine Development
IVI developed a a new-generation typhoid conjugate vaccine (TCV) that distinguishes itself from other typhoid vaccines with its immunogenicity in young children. IVI transferred the technology to SK bioscience of South Korea, Bio Farma of Indonesia, and Incepta of Bangladesh, and is currently working with SK bioscience and Bio Farma on clinical development for licensure and WHO prequalification, currently targeted for the end of 2022.
Large-scale Phase III studies with a single dose of Vi-DT started in the Philippines and Nepal in 2020. While the Philippines study is nearing completion, a pivotal trial involving four hospitals in Kathmandu, Dhulikhel, Dharan, and Nepalgunj has shown that the Vi-DT test vaccine was safe, immunogenic, and non-inferior to the WHO prequalified Vi polysaccharide-tetanus toxoid (Vi-TT) Typbar TCV vaccine in individuals aged 6 months to 45 years.
Oral Cholera Vaccine (OCV) Reformulation
In 2019, IVI received a grant from the Bill &and Melinda Gates Foundation to explore a reformulation of OCV that could lower the cost of Euvichol production by 20% and increase production capacity of Euvichol by 35%. The clinical trial to compare the lower cost formulation to Shanchol began enrollment in Nepal in October 2021 with expected completion in September 2022 and a final study report in 1Q1 2023.
Enhancing Cholera Control (ECHO) – Nepal
Since 2020, IVI’s ECHO program has been conducting a major cholera control and prevention project in Nepal, which included oral cholera vaccine (OCV) vaccination campaigns combined with Water, Sanitation, and Hygiene (WASH) activities, disease surveillance, and the development and approval of a National Cholera Control Plan. IVI works in close collaboration with the Ministry of Health and Population, the National Public Health Laboratory, and the Department of Health Services in Nepal. This program is made possible with funding from the Korean International Cooperation Agency’s Global Disease Eradication Fund, LG Electronics, and the Korean Support Committee for IVI.
Antimicrobial Resistance (AMR) Surveillance
In 2019, IVI initiated a program to study the prevalence of AMR in Nepal. The program, part of an IVI-led consortium known as CAPTURA, or Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions in Asia, works closely with the National Public Health Laboratory (NPHL) of Nepal and aims to increase the volume of data available to improve spatiotemporal mapping of AMR and antimicrobial use (AMU); assess the quality of data and provide meta-data to give regional and inter-regional context; undertake analysis of the data; and ensure findings are disseminated locally, regionally and globally. The project will identify gaps in data and areas for quality improvement that can be addressed in future initiatives to strengthen surveillance capacity. Finally, the information resource generated by the project will improve awareness, advocacy, policy, and interventions needed to combat AMR and antimicrobial misuse.
Hepatitis E
As part of the Enhancing Cholera Control (ECHO) cholera surveillance program, IVI and its partners in Nepal began an HEV epidemiological survey in 2021. The survey involves door-to-door visits to conduct interviews and collect blood samples among select cluster populations. The results will be used to determine the seroprevelance of HEV across age groups and ecological zones, help understand the associated risk factors for HEV seropositivity, and help inform public health decision makers on strengthening the national waterborne disease surveillance system and the future introduction of HEV vaccines.
In November 2015, IVI sponsored and supported a Hepatitis E Symposium in Kathmandu, Nepal that was organized by the Nepali government. Following the massive earthquakes that struck Nepal earlier in the year, there were concerns about outbreaks of waterborne diseases such as cholera, typhoid, and hepatitis E. While cholera and typhoid were well-known, less was known about hepatitis E. The symposium aimed to present and share Hepatitis E data among local public health and medical professionals and government officials and to discuss how to prevent, control and manage the disease in Nepal. Topics such as Hepatitis E epidemiology and surveillance, diagnostics, clinical presentation and management, impact on pregnant women, and preventive measures and vaccination were presented.
Previous Collaboration
Typhoid Vaccination
IVI vaccination campaigns led to over 140,000 Nepalese school children receiving the Vi-PS typhoid vaccine. In collaboration with MITRA Samaj and with funding from the Bill and Melinda Gates Foundation, the 2011 vaccination campaigns introduced an innovative cross-subsidization financing system, in which a $2.50 user fee from workers in the tourism sector funded free vaccinations for school children in Lalitpur and Bakhtapur districts. More than 2,000 tourism sector workers were immunized, and the school-based campaign immunized 140,873 students in the two districts.
Case-control studies ran from 2012 to 2013 in Kathmandu to assess the impact of vaccination, and in 2012 the National Committee on Immunization Practices (NCIP) convened a seminar with IVI, local media, policymakers, and stakeholders in Kathmandu to share findings from the vaccination campaign and to discuss strategies on typhoid control. The meeting culminated in an endorsement by the Health Secretary on the use of typhoid vaccines and a commitment by the local government to expand the vaccination campaign to high-risk areas and groups in Kathmandu.
Cholera Vaccination
Using the IVI-developed Oral Cholera Vaccine, IVI conducted vaccination campaigns in Nepal against endemic and epidemic cholera. In response to the 2015 earthquake, IVI provided its cholera vaccine to 9,000 people in Dhading and Nuwakot, and a 2017 initiative saw 27,000 people in Banke receive IVI’s cholera vaccine.
Supporting Independent Immunization and Vaccine Advisory Committees (SIVAC)
The Government of Nepal signed an agreement with IVI for its SIVAC team to provide technical assistance to the country’s National Committee on Immunization practice (NCIP), which was established in 2008. Working with the WHO Nepal county office, the WHO Southeast Asia regional office (SEARO), and the US CDC, SIVAC assisted the NCIP in developing a concept paper for its charter. In 2013, SIVAC co-organized a study tour in Canberra, Australia for a delegation from Nepal to observe the Australian Technical Advisory Group on Immunization.