Nepal recorded 57 times more COVID-19 cases each day in June compared to the month before, with 44 per cent of tests returning positive results. Mass and social gatherings — including religious festivals, political meetings and weddings — continued in Nepal despite the government’s order to stay at home. Nepal’s former king and queen tested positive for COVID-19 after a visit to India to take a holy dip at the Har Ki Pauri ghat in Haridwar. Hundreds of people gathered at the Kathmandu airport to welcome the former king and queen upon their return, ignoring health restrictions.

Due to political uncertainty, the Nepal government is not prioritising the pandemic response. The Prime Minister is calling the disease a mere flu. This has impacted people’s sense of urgency and many are now not following necessary COVID-19 precautions.

India and Nepal share a porous border, which creates an additional hurdle to preventing transmission. Around 8 million Nepalese people live in India. There are also approximately 600,000 Indians living in Nepal. Increasing COVID-19 cases and mandatory lockdowns in India forced many Nepalese migrants, especially daily wage workers, to return to their home country. The spread of the virus began because of unrestricted people movement — flights from India were never suspended and borders never closed. Collective forethought and the implementation of effective mitigation plans are urgently required to stop cross-border transmissions between Nepal, India and beyond.

The unmonitored movement of returning migrant workers across the open border and inadequate COVID-19 testing facilities are boosting rapid transmission throughout the nation. Such spillovers may cause healthcare havoc and further worsen Nepal’s precarious healthcare system. In addition to a nationwide lockdown, the government of Nepal has clustered districts into different risk zones. The government has also increased resources and created COVID-19 dedicated hospitals but effective contact tracing and proper management of isolation centres are lacking. There are not enough vaccination sites, which leads to overcrowding. It is now assumed that there are high chances of COVID-19 spreading from such poorly managed vaccination sites.

As new variants of COVID-19, including the Delta variant, emerge around the globe, Nepal should further strengthen its sequencing facilities and regularly monitor mutations and variants through sequence-based surveillance, laboratory studies and epidemiological investigations. Additionally, the government should execute prompt interventions and screen incoming people from neighbouring countries. Otherwise, the present plight of India risks becoming Nepal’s future.

Nearly 2.1 million vaccine shots have been administered in Nepal, which is home to 29 million people, but only 400,000 people have received two doses. Nepal’s chance of procuring vaccines from India faded after the latter began to face the reality of its own COVID-19 crisis. Nepal is now in desperate need of vaccines and is trying to procure them from wherever it can — China, the United States, the United Kingdom and Russia.

Nepal has already received 1.8 million doses of the Sinopharm vaccine — provided for free under grant assistance from the Chinese government. The Nepalese people have had mixed responses to this as they are sceptical about the cost-effectiveness and efficacy of these vaccines.

The government of Nepal needs to make strategic plans to direct its available resources appropriately and bolster diplomatic efforts to procure more vaccines. Additionally, the government should start working with GAVI COVAX Advance Market Commitment. The government of Nepal recently received 1.5 million doses of the Johnson & Johnson vaccine, donated by the United States through the COVAX program. The international community should also come together and support resource-constrained countries like Nepal to fight the pandemic with the understanding that nobody is safe until everyone is safe.

Nepal needs to realise that proper use of face masks, social distancing and hand hygiene is still an effective public health strategy to minimise the transmission of any COVID-19 variant. All these safety and prevention protocols must become mandatory until enough of the country is vaccinated.

The government of Nepal must strengthen local government and primary health care centres with additional supplies of essential medicines and human resources. It should pay special attention to managing quarantine shelters by coordinating between local, provincial and federal governments. Increasing testing resources, effective contact tracing and providing sustained treatment for COVID-19 patients may yield control of the ongoing pandemic in Nepal. Additionally, the government should invest in health infrastructure, capacity and capability building, and pandemic preparedness to overcome future outbreaks.

While Nepal finds itself in a tough position, if it quickly puts the lessons learned from its second wave into action it can prevent worse outcomes down the track.

Arman Kishan is a Medical Intern at Kathmandu Medical College.

Binod Rayamajhee is a PhD candidate at the school of Optometry and Vision Science, University of New South Wales and the Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences.

Supram Hosuru Subramanya is Assistant Professor of Medical Microbiology at the Manipal Academy of Higher Education.