VOL. 06, NO. 04, July 27, 2012 (Shrawan 12, 2069)

Hepatitis E is probably the commonest cause of adult jaundice in Nepal.Outbreaks are common in the summer in Nepal. This viral disease is transmitted through the fecal- oral route. In Kathmandu this act is not difficult to envision. Vegetables washed in the Bishnumatiriver are brought to wedding parties and restaurants and served up as fresh green salad. If they were properly cooked or soaked in adequately iodinated water for at least 20 minutes, there would be less of a problem; but uncooked, these vegetables pose a threat of acquiring hepatitis E and other interesting organisms.  Most people that suffer from this disease eventually recover, but if you are pregnant and acquire hepatitis E, things could easily be life threatening( see  below).

A potentially life-saving vaccine for our part of the world hasjust  recently been approved by China’s State Food and Drug Administration.The world’s first commercial hepatitis E vaccine (Hecolin) is now available in China, and the Chinese are targeting the vaccine on their vulnerable population (women of child-bearing age and patients with chronic liver disease) who, if affected by hepatitis E often suffer life-threatening complications of this viral disease.

Hepatitis E like typhoid fever is a water-borne infection that has caused epidemics in Asia, the Middle East, Africa, and Central America. According to the WHO, one third of the global population may have been infected by the virus, and an annually estimated 14 million people have the symptomatic disease with 300,000 deaths and 5200 stillbirths. Doctors who look after pregnant women in Nepal know full well the possibly tragic outcome ( by some estimates 30 %) in pregnant women who are affected by this virus who may go on to suffer fulminant hepatic failure and death. Hence the drive in certain parts of China to vaccinate women of child-bearing age.The other well- known group predisposed to suffering from severe hepatitis E are patients with chronic liver disease. Often a patient with cirrhosis (an example of a chronic liver disease) who has been stable will suddenly take a turn for the worse and succumb to their illness when infected by this virus.

Chinese vaccines have been used in Nepal with excellent success.The administration of the Japanese encephalitis ( JE) vaccine which is made in Chengdu, China has been instrumental in decreasing Japanese encephalitis rates in Nepal, especially in the Terai region. Unlike its Western counterpart, the Chinese JE vaccine is very cost-effective, and importantly side-effects have been minimal.

The Chinese don’t do things in small numbers. The hepatitis E vaccine trial which was published in the prestigious medical journal Lancet in 2010 revealed that a total of 112, 604 healthy adults participated in the trial with 100 % effectiveness  and good tolerance to the vaccine. Even women who became pregnant during the course of the trial had no adverse effects of the vaccine. The US Army working together with the Nepal Army and GlaxoSmithKline did work on another effective hepatitis E vaccine almost eight years ago, but unfortunately this vaccineis unavailable. An exercise in futility.

As they did with the successful use of the Japanese Encephalitis vaccine, Nepal’s health ministry will hopefully strongly considermaking this vaccine available to the vulnerable population in Nepal. 

Millennium Development Goals
Beyond 2015

As the deadline to achieve the millennium development goals (MDGs) is coming closer, people have already started talking about the post 2015 scenario. South Asia Watch on Trade, Economics & Environment (SAWTEE) organized a validation workshop recently on ‘Nepal case study for European Report on Development 2013’, where experts shared the post 2015 situation and Nepal’s progress on MDGS.

After around a decade of millennium goals, the development has been tremendous on the MDGs front and Nepal is among the countries that are on course to achieving most of the goals. Nepal is on track on achieving all the other MDGs except for employment and climate change goals, according to Dr. Posh Raj Pandey, executive chairman of SAWTEE.

“There is the need to debate the post-2015 scenario. What next is a big question,” said Dr. James Mackie, Senior Adviser, EU Development Policy and lead author, European Report on Development 2013. He also stressed that countries should learn from the experience and use that experience for the post 2015 development agenda.

Speaking on the occasion, Governor Dr. Yubaraj Khatiwada opined that Nepal needs to include a broader target and it is fundamental to discuss broader human security issues after 2015. He also stressed the need to work in partnership with international community for better development. “Our resources, market and technologies are not sufficient. So, we need international support,” he said.

“Beyond 2015, economic growth and social policy should move together and complement each other,” he added. “Nepal is on track on achieving most of the MDGS at aggregate level, but at disaggregated level, we find various variations on the results.”

Aerial Interest

With the introduction of flights from Air Asia and MALAYSIA Airlines (MAS) on the Kathmandu-Kula Lumpur route, one more gateway to enter Nepal has been opened for the tourists. Previously there were no other international airlines companies that were operating in the Kathmandu-Kula Lumpur route except Nepal Airlines.

AirAsia X has already started its operations while MALAYSIA Airlines (MAS) is planning to expand its network by starting thrice-weekly Kuala Lumpur-Kathmandu services from September 2012.

As of 2011, Indian Airlines was the biggest international airline carrier to Nepal as it flew some 48 percent of tourists visiting Nepal, according to Tribhuvan International Airport (TIA). And the International airlines market in Nepal is also mainly dominated by Indian airlines companies. So, the introductions of flights by these Malaysian companies have high values for the Nepalese tourism future as well as for the migrant Nepalese workers who have now other alternatives than the National Airlines.

Luxury Tours Malaysia manager, Ganneesh Ramaa said with two airlines operating on the route, Kuala Lumpur would become a gateway for neighboring countries without direct access to Kathmandu.

There are rising interests from other international airlines companies as well.