The world is still in the midst of a COVID-19 pandemic. It has been reported in media that the efficacy of the two doses of Covid-19 vaccines being administered worldwide is going to wear off soon. Some countries have already started to vaccinate booster doses to elders, who are at great risk of getting seriously ill and dying. Many people have even started to fear that we may have to live with Covid-19 for quite some time.

Unfortunately our country is ignoring the World Health Organization ( WHO) guidelines, which lay specially great emphasis on prioritization of vaccination of elders. Perhaps much life could have been saved if we had followed the WHO guidelines.

Vaccines Do not Prevent Illness

It is now a common knowledge that the vaccines, in general, save millions of lives each year. Vaccines work by training and preparing the body’s natural defenses – the immune system – to recognize and fight off the viruses and bacteria they target. After vaccination, if the body is later exposed to those disease-causing germs, the body is immediately ready to destroy them, preventing illness. However, the Covid-19 vaccine does not prevent being infected but it does help to minimize severity of illness and deaths.

Why Elders are Given Priority

The WHO guidelines recommend vaccination against Covid-19 giving topmost priority to elders because until the very recent spread of the delta variant the death rate of the younger peoples from the Covid-19 was relatively very low whereas such death rate of the elders from the Covid-19 extremely high.

According to information included in the WHO guidelines in the United `States the mortality risk has been estimated to be 90 times higher among 65-74 year olds compared to 18-29 year olds. A similar pattern of significantly higher mortality in older age groups has been observed in multiple other countries. Certainly the mortality rate of elder over 65-75 years must be still much higher.

Countries in Europe, America and also in our region had started their vaccination activity following the WHO guidelines by giving topmost priority to elders. Viewers of television all over the world had been watching how those countries had initiated the Covid-19 vaccination program by administering vaccines to elders.

Nepal ignored WHO Guidelines

Unfortunately the Covid-19 WHO guidelines followed by all other countries have been ignored by our country. Priority has not been given in our country to vaccinate elders who might be over 75 or 85 or even 95 years in age. They were not included in the long priority list of the people to be vaccinated first.

Booster Doses and Elders

Many countries are rushing to provide booster doses of Covid-19 vaccine since elderly are at great risk of getting seriously ill and dying

Israel prime minister has recently said that about 420,000 elderly in his country have already received Corona virus booster.

French President Macron has said that Germany and France will start offering Covid-19 booster doses to elderly from September.

ITS Guidelines

The WHO has brought out on 13 November 2020 guidelines for prioritizing the use of COVID-19 vaccines in the context of limited supply.

In overall public health setting for this epidemiological setting initial focus is on direct reduction of morbidity and mortality, maintenance of most critical essential services and reciprocity. Achievement of further reduction of mortality and morbidity and to contribute to reduction in transmission, to reduce disruption of social and economic functions.

WHO identified Priority Use Groups

Stage I - (Very limited vaccine availability, for 1 – 10% of national population)

- Health workers `at high to very high risk of acquiring and transmitting infection

- Older adults defined on the basis of age-based risk specific to /region,

Specific age cut-off to be decided at country level

Stage II - (Limited vaccine availability for 11- 20 % of national population)

-Older adults not covered in Stage I

- Health workers at medium risk of acquiring and transmitting infection

- Groups with co morbidities or health states such as pregnancy, determined

to be at significantly higher risk of severe disease or death. Efforts

should be made to ensure that the disadvantaged groups in which there is

under diagnosis of comorbidites are equally included in this category.

- Health workers engaged in immunization delivery (routine programs and

Covid-19 vaccination)

- High-priority teachers and school staff

- Remaining teachers and school staff.

Stage III - (Vaccine availability for 21 – 50 % of national population)

- Workers, transportation workers, government workers essential to critical

functioning of the state not covered by other categories

- Personnel needed for vaccine production and other high risk laboratory staff

- Social employment groups at elevated risk of acquiring infection