India
Last week’s piece on India – click here to read - highlighted its battle against an overwhelming second wave of COVID-19 that shows no sign of abating.
Its closest geographical neighbours are vulnerable for more than one reason.
The physical transmission of the virus across porous land borders could fuel their own outbreaks but they were also relying on India for their vaccine supplies.
With a temporary ban on vaccine exports as it tries to contain its own crisis, it’s not clear when India will be able to send vaccines to other countries again.
Pakistan
Pakistan has recorded 810,231 cases and 17,811 deaths at the time of writing. Pakistan’s first wave of infections peaked in June 2020. This was followed by a smaller second wave that peaked in December 2020. (1)
Cases were falling from mid-January 2021 but, like India, it is now experiencing a third wave with rapidly rising numbers of cases and deaths. The daily death rate has now surpassed that seen in either of the first two waves. (2)
Background to COVID-19 in Pakistan
The government implemented some lockdown measures in March 2020 but they applied only to some of the larger cities and were seen by many as symbolic. They were lifted in May 2020 when case numbers were still rising. (3)
Since then the country has been instigating “smart lockdowns” which are similar in concept to the local lockdowns used in the UK. When an area has more than 1.5 cases per 1000 people it is placed in a mini-lockdown. Residents are given 24 to 48 hours’ notice and then are not allowed to leave their communities for two weeks. Only one person per household is allowed to go shopping and only food shops and chemists remain open. There are numerous checkpoints around the cordoned off area. Mask wearing is mandatory across the country and indoor weddings are not allowed. Restaurants, cinemas and shrines are closed. (4)
Many are reluctant to come forward for COVID-19 testing fearing they will be stigmatised if sick or denied a proper burial should they die. Officials acknowledge that it is impossible to know the true figures for Pakistan’s outbreak. (5) (6)
Pakistan’s Vaccination Programme
Pakistan began rolling out its vaccination programme in February 2021 beginning with its frontline health care workers and moving onto all citizens aged 60 and over.
China donated doses of its Sinopharm vaccine to Pakistan which was then sent to 279 vaccination centres across the country. Pakistan is also due to receive 14.6 million doses of the AstraZeneca vaccine through the COVAX initiative. Pakistan should receive 45 million doses in total through the scheme. It has also approved two other vaccines: Sputnik-V from Russia and Cansino Bio another from China. It hopes to reach 70% of its population over the next year. (7)
Concerns are growing that vaccine hesitancy is a threat to the vaccination programme. Conspiracy theories are circulating against COVID-19 vaccines in Pakistan as are claims that COVID-19 is a hoax. (8)
The government has launched campaigns on television and other media outlets to try and quell fears over the vaccine. The situation in India has started to positively influence people’s views on vaccinations and rising numbers of people are now actively seeking vaccination. (9)
Pakistan is now preparing to vaccinate the under-60s from the beginning of May. Unlike India, which is facing mounting criticism for not planning ahead, Pakistan used the lull between infection waves to install more ventilators and other equipment in its hospitals and boost medical training. (10)
Authorities are continuing to impose local lockdowns but in the face of a quickly rising third wave the government has sent troops onto the streets of the major cities to help enforce restrictions and is considering a national lockdown if the situation continues to deteriorate. All travel to and from India has been banned.
12-13 May sees the Eid al-Fitr holiday when people usually gather together to celebrate but the government has announced that there will be a travel ban from 8 May until 16 May and hotels, parks and public places will be closed. (11)
Bangladesh
Bangladesh has recorded 759,132 cases and 11,450 deaths from COVID-19 at the time of writing. Its first wave of infections peaked in June 2020. This was followed by a second and smaller wave that peaked in December 2020. Like India and Pakistan it is now experiencing a third wave with rapidly rising numbers of cases and deaths. The daily death rate has now surpassed that seen in either of the first two waves but there are some very early signs that the peak of its third wave may have been reached. Events in neighbouring India may however change that. (12) (13) (14)
The COVID-19 crisis in India is disrupting the supply of vaccines to Bangladesh which was expecting 23 million doses from the Serum Institute of India. So far it has received 7 million doses from the Serum Institute. (15)
The government imposed a nationwide lockdown from 5 April 2021 which it then tightened from 14 April. Some restrictions have now been lifted with shopping centres for example allowed to reopen but a ban on travel and gatherings will remain in place until at least 5 May 2021. (16)
Bangladesh has banned all travel to and from India. (17)
The Rohingya refugee camp in Cox's Bazar
The first cases of COVID-19 were confirmed in the Rohingya refugee camp on 14 May 2020. (18)
It is virtually impossible to find data for the true picture of COVID-19 in the camps. A lack of testing combined with a paucity of healthcare mean that the graphs and tables which are updated daily for countries worldwide simply don’t exist for the refugee camps. Various agencies and charities are actively working in refugee camps around the world and their reports are the main source of information.
ReliefWeb is a humanitarian information service provided by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). It collates information from more than 4,000 sources, including humanitarian agencies at the international and local levels, governments, think-tanks and research institutions, and the media. Its website has a dedicated COVID-19 hub with pieces on all 63 countries being helped by the Global Humanitarian Response Plan (GHRP) for COVID-19 which was launched on 25 March 2020. (19)
The UNHCR and WHO (World Health Organisation) have worked together training 1,400 Rohingya refugees to become community health workers. They go through the camps explaining about COVID-19 and are described as “the bridge” between the camp communities and health facilities. As fellow camp dwellers, they are able to gain people’s trust in a way outsiders wouldn’t. One worker will visit up to 150 families each week.
The UNHCR (United Nations High Commissioner For Refugees) and MSF (Médecins Sans Frontières) have built two isolation and treatment centres with 200 beds for the camp communities. The aim is to expand this to around 2000 beds. They are also co-ordinating the delivery of food and other essential items to families with symptoms of COVID-19 to enable them to isolate at home. (20) (21) (22)
There have been 500 confirmed COVID-19 cases in Rohingya refugees in Bangladesh and 11 deaths officially recorded but with more than one million people scattered throughout 34 refugee camps in the area the true figures are likely to be much higher. (23)
Nepal
There have been 323,187 cases and 3,279 deaths from COVID-19 in Nepal to date. Like Pakistan and Bangladesh its first wave of infections peaked in June 2020 and was followed by a second that peaked in December 2020. It too is now experiencing a third wave with rapidly rising numbers of cases and deaths that surpass those of its previous waves. (24) (25)
The fear is that this third wave is being driven by the ongoing crisis in India. Nepal shares a long and porous border of more than 1000 miles with India and has detected both the UK variant and the Indian variant in its own cases. The border was closed during the first lockdown from March until July 2020 but has remained open since.
Nepal's former king Gyanendra and his wife have both tested positive for COVID-19 after attending a religious festival in India and are being treated in a private clinic in Kathmandu. The monarchy was abolished in 2008 and the ruling communist party has been embroiled in power struggles that have worsened in recent months. Prime Minister KP Sharma Oli dissolved parliament in December 2020 after rescinding on an agreement to share power with a rival party which led to protest rallies across the country. Nepal’s Supreme Court ordered the reinstatement of parliament in March 2021. (26) (27)
Nepal began its vaccination campaign in January and has so far given a first dose to 1.9 million of its 30 million population. Nepal bought all its initial vaccines from India and China but is no longer able to procure more from India leading to fears that its vaccination programme will grind to a halt. However, Nepal was the first country in the Asia-Pacific region to begin vaccinating refugees. (28)
Public health officials in Nepal fear that the health system will soon be overwhelmed in a similar way to India’s. Doctors are warning that they are seeing more children and young adults in this wave who are arriving at the hospitals critically ill but government officials repeatedly claim that no further lockdowns are required. (29) (30) (31)
However, Kathmandu is now going in a one week lockdown from 29 April until 5 May 2021. (32)
Controversially Nepal continues to allow access to Mount Everest and there have now been cases of COVID-19 at the Everest base camp. Seasoned climbers describe the situation at base camp as becoming “out of control” but report that officials are repeatedly denying there is a problem. (33)
Nepal has already issued 377 permits this year to climb Everest, it issued 381 for the whole of 2019. With access to the mountain not allowed from the Chinese side, it is increasing the numbers on the Nepalese side. (34)
Bhutan
The tiny Himalayan kingdom of Bhutan has recorded 1,074 cases and just one death from COVID-19. (35) (36)
Bhutan has just 337 doctors for its population of 760,000 which is half the WHO’s recommended ratio of doctors to people. Only one doctor has specific Intensive and Critical Care training and there is one laboratory capable of testing for COVID-19. It also has a porous 434 mile border with India. (Its northern border with China is permanently closed.)
Perhaps in recognition of its vulnerability, Bhutan reacted quickly at the start of the pandemic. It began airport and land border screening on 15 January 2020. It confirmed its first case of COVID-19 in a 76-year-old American tourist and within six hours 300 possible contacts has been traced and quarantined.
By March 2020, the country was in lockdown with all schools and public buildings closed except essential shops. It also went further than the WHO recommendation of 14 days quarantine for anyone testing positive for the virus and insisted on 21 days. Lockdowns of three weeks each were re-implemented each time a case of community acquired infection was detected (a “new” infection that could not be traced back to a specific contact.) (37)
Bhutan has administered a first dose of vaccine dose to more than 60% of its total population. Its small population made possible a mass vaccination drive that ran for two weeks in March 2021. The vaccine was offered to everyone aged 18 and over and uptake was very high at 93% of all those eligible.
All of the vaccine doses used were donated by India who have so far gifted a total of 550,000 doses of the AstraZeneca vaccine to Bhutan. What is less clear at the moment is when Bhutan will receive the doses it needs to administer a second round of vaccinations. (38)
