Nepal : Responsive COVID-19 Vaccines for Recovery Project under the Asia Pacific Vaccine Access Facility

Project Name

Responsive COVID-19 Vaccines for Recovery Project under the Asia Pacific Vaccine Access Facility

Project Number

55084-001

Country / Economy

• Nepal

Project Status

Closed

Project Type / Modality of Assistance

• Loan

Source of Funding / Amount

Loan 4088-NEP: Responsive COVID-19 Vaccines for Recovery Project Under the Asia Pacific Vaccine Access Facility

Source	Amount
Concessional ordinary capital resources lending	US$ 165.00 million

Operational Priorities

• OP1: Addressing remaining poverty and reducing inequalities
• OP2: Accelerating progress in gender equality
• OP7: Fostering regional cooperation and integration

Sector / Subsector

• Health / Disease control of communicable disease

Gender

Effective gender mainstreaming

Description

The project will support the procurement and delivery of safe and effective vaccines against COVID-19 through APVAX's RRC in compliance with ADB's vaccine eligibility criteria to the country. It aims to finance the procurement of about 15.9 million doses of vaccines, which will be administered to about 6.8 million Nepalese by 2024, with data collected and disaggregated by sex and age.

Project Rationale and Linkage to Country/Regional Strategy

Since the first case of COVID-19 was confirmed in Nepal on 27 January 2020, 591,494 cases have been confirmed and 7,990 people have died from the virus as of 7 June 2021. The pandemic resulted in high costs to the country's overall health, well-being, and economy. The disease's infection rate previously peaked in October 2020 with a monthly average test positivity rate of more than 24%. After a subsequent decline, Nepal has been facing a second wave since April 2021, with test positivity above 45%. The crisis is compounded by the country's severe lack of qualified health care workers; there are reports of one nurse caring for 20 critically ill patients. Recognizing the need for vaccination, the government acted swiftly to roll out inoculations starting 27 January 2021. More than 2 million (2,113,080) people received the first dose and 691,494 the second dose by 7 June 2021. Nepal aims to inoculate 71.62% of its population. However, it has not secured a pipeline for vaccines and faces significant financing gaps for vaccine procurement. The government requires timely financial support to procure safe and effective vaccines and limit the adverse impacts of the pandemic.

Impact

Accelerated health, social, and economic recovery from COVID-19 in Nepal.

Project Outcome

Description of Outcome

Target populations safely vaccinated against COVID-19

Progress Toward Outcome

Nepal achieved high COVID-19 vaccination results. In total, 24.44 million people (89.44% of the targeted population) received the full primary series of COVID-19 vaccines. The ADB target, to ensure at least 6.8 million would receive the full primary series from ADB financed vaccines, was for more than 90% (6.16 million) substantially achieved.

Implementation Progress

Description of Project Outputs

Safe and effective COVID-19 vaccines delivered

Status of Implementation Progress (Outputs, Activities, and Issues)

The project closed in March 2024. The Government of Nepal indicated it did not require any more funds to procure COVID-19 vaccines. As Government of Nepal received majority of vaccines as grant, 50% of the ADB funds were utilized to procure vaccines, with the rest of the funds cancelled as savings. As the vaccination campaign was very efficient, the number of Nepali vaccinated with ADB financed vaccines was close to the original target. With regard to the output target 2, in more than 93.19% of the COVID-19 vaccination sessions at least one female health worker/volunteer was present on site, indicating the target was achieved. (Source: Verification of the presence of female health worker or volunteer in COVID-19 vaccination sessions in Nepal to provide a gender-friendly and safe environment, November 2022 by ADB and World Bank in coordination with Ministry of Health and Population and the Family Welfare Division from Department of Health Services).With regard to output 3, a dedicated study showed that awareness about the risks of COVID-19 increased from 68.2% in 2021 to 91.9% in 2023, and that knowledge that treatment was possible increased from 23.2% to 72%, indicating the target is achieved.

Geographical Location

Nation-wide

Safeguard Categories

Environment

C

Involuntary Resettlement

C

Indigenous Peoples

C

Summary of Environmental and Social Aspects

Environmental Aspects

The project supports the procurement and delivery of COVID-19 vaccines at the delivery points in the country. It will not entail any activities with the potential to cause adverse environmental impacts. However, the administration of vaccines will generate biomedical waste, which will require safe treatment and disposal. ADB carried out due diligence of the current health care waste management (HCWM) status in the country and the plans to strengthen HCWM. The results of this due diligence is recorded in a due diligence report. ADB supported together with other partners through TA the strengthening of HCWM.

Involuntary Resettlement

The project will not require any land acquisition or lead to any involuntary resettlement impacts. Improved medical waste management will not result in civil works under the project.

Indigenous Peoples

While indigenous (janajati) communities are present in the country, they will not be targeted as a group of distinct and vulnerable indigenous peoples, as defined by ADB's indigenous peoples safeguard policies. The project will ensure that members of indigenous people groups will not be excluded and will not suffer any disadvantages in targeting because they belong to an indigenous people group. The Government of Nepal treats all citizens with equal significance, and this is reflected in the vaccination program.

Stakeholder Communication, Participation, and Consultation

During Project Design

ADB closely coordinated with key development partners involved in the health sector, especially with those supporting the vaccination campaign, on risk communication and community engagement (RCCE) activities to inform all Nepali, with special attention to the poor and vulnerable, on the risks of the COVID-19 pandemic and the benefits of and access to vaccination using a variety of communication tools and techniques, including consultation.

During Project Implementation

Civil society organizations will raise awareness about the vaccine to all Nepali, with special attention to women, poor, and vulnerable groups, through RCCE activities implemented by UNICEF and partially funded by ADB TA. ADB conducted a study on the effectiveness of RCCE, which shows good results as well as important lessons learned.

Business Opportunities

Procurement

Procurement will be undertaken in a manner consistent with simplified and expedient procedures permitted under the ADB's Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time). Since the project will be financed under APVAX, ADB member eligibility restrictions will be waived and universal procurement will apply. The procurement of vaccine may be done through (i) Accessing additional vaccines through COVAX; (ii) Engaging UNICEF or other UN agencies to support procurement of vaccines outside COVAX; (iii) Entering into direct bilateral deals with vaccine manufacturers; and (iv) Entering into Government to Government (G2G) contract for procuring vaccines. ADB will prior review all agreements. Value for money in procurement will be achieved by (i) Selecting vaccines that are best suited to domestic supply chain; and (ii) the recommended procurement strategy involves entering into service contract with UNICEF outside COVAX facilities as UNICEF is best positioned to manage vaccine purchasing complexities and the intricate logistics requirements for these temperature-sensitive items and UNICEF has been assisting for a long period in supporting the vaccine procurement for Nepal's National Child Immunization Program. ADB's Anticorruption Policy (1998, as amended to date) will apply to all contracts to be financed under the loan.

Contact

Responsible ADB Officer

Van Dael, Rudi Louis Hendrikus

Responsible ADB Department

Sectors Group

Responsible ADB Division

Human and Social Development Sector Office (SG-HSD)

Executing Agencies

Ministry of Finance

Timetable

Concept Clearance

-

Fact Finding

12 Apr 2021 to 30 Apr 2021

MRM

26 May 2021

Approval

22 Jul 2021

Last Review Mission

-

Last PDS Update

02 Apr 2024

Funding

Loan 4088-NEP