June 20, 2025
What is the burden of antimicrobial resistance in Nepal? How can vaccines be leveraged to help control this growing health crisis in the country?
Read the GARP-Nepal Policy Brief, “The Role of Vaccines in Mitigating Antimicrobial Resistance,” to learn more.
Executive Summary
Antimicrobial resistance (AMR) presents a significant public health threat, contributing to higher mortality rates, prolonged illnesses, and increased health care expenses. In 2021, AMR was responsible for approximately 19,579 deaths in Nepal alone. Vaccinations are crucial in mitigating AMR because they reduce infections by providing direct protection against the targeted disease and lower transmission rates by promoting herd immunity. By preventing infections, vaccines reduce the need for antimicrobial use, a critical driver for AMR. Nepal has adopted policies to tackle AMR, including a National Action Plan, which focuses on building infection prevention, surveillance, and regulatory frameworks while taking a One Health approach. The plan also outlines several strategies that emphasize the importance of vaccinations to mitigate AMR.
The typhoid conjugate vaccines (TCVs) have effectively controlled typhoid fever outbreaks caused by drug-resistant Salmonella typhi. Similarly, integrating pneumococcal conjugate vaccines (PCVs) into the National Immunization Programme (NIP) in 2015 significantly reduced cases of pneumonia and meningitis. NIP aims to enhance vaccine coverage and ensure timely administration across Nepal. The program includes vaccines against high-burden diseases, such as tuberculosis, hepatitis B, influenza, polio, measles, and rubella, with plans to incorporate new vaccines, such as for human papillomavirus (HPV).
Effective vaccination campaigns can significantly avert antibiotic-treated cases of many of these diseases. For instance, modeling estimates find that more than half of the antibiotic-treated cases of acute respiratory infections caused by Streptococcus pneumoniae and diarrhea caused by rotavirus in Nepal are preventable by PCV and the rotavirus vaccine, respectively. Such high aversion is also projected in both antibiotic-treated cases and deaths for typhoid fever after the introduction of routine immunization with TCVs.
Addressing the AMR burden requires a multifaceted approach involving collaborative efforts across sectors. This includes implementing vaccination programs, conducting extensive research, and gathering data to understand drug resistance and develop effective strategies against it. Promoting vaccine uptake faces challenges, such as comprehension gaps among policymakers and logistical barriers in remote areas. Efforts to bolster evidence for vaccine promotion that assess cost-effectiveness and understand the role of herd immunity in reducing rates of disease transmission are crucial.
Nepal’s commitment to the Global Action Plan on AMR provides an opportunity to evaluate national progress. Enhancing the capacity for AMR surveillance in the National Public Health Laboratories is paramount. Stakeholders advocate prioritizing economic cost quantification and intervention impact assessment through localized case studies to effectively address AMR challenges.
The following are a few key recommendations by the Global Antibiotic Resistance Partnership Nepal that can be taken into consideration to inform decisions and develop strategies for effective immunization programs and tackle AMR.
- Strengthen surveillance systems to monitor AMR trends and local data on AMR vaccines
- Ensure equitable vaccine access.
- Highlight the role of vaccines in containing highly resistant infections and increase awareness among policymakers.
- Advocate for including the livestock sector in addressing zoonotic disease burdens via vaccination and community stewardship.
- Foster global collaboration, target high-risk populations, and advocate for regulatory support.
This publication was prepared by the Global Antibiotic Resistance Partnership – Nepal.
GARP Technical Working Group members:
Dr. Paras K Pokharel, B.P.Koirala Institute of Health Sciences (Chair); Dr. Abhilasha Karkey, OUCRU Nepal (Co-Chair); Dr. Sameer Mani Dixit, Center for Molecular Dynamics Nepal (Principal Investigator); Dr. Madan Kumar Upadhyay, Chief, Quality Standard and Regulation Division, Ministry of Health and Population; Dr. Abhiyan Gautam, Chief, Child Health and Immunization Service Section, Department of Health Services; Dr. Narendra Khanal, Curative Service Division, Department of Health Services; Prof. Dr. Sudha Basnet, Tribhuvan University Teaching Hospital; Dr. Ramesh Kant Adhikari, National Immunization Advisory Committee Nepal; Dr. Rupendra Chaulagain, Himalayan College of Agricultural Sciences and Technology; Ms. Sweety Upadhaya, National Public Health Laboratory, Ministry of Health and Population Nepal; Dr. Madhusudan Subedi, Patan Academy of Health Sciences; Ms. Santoshi Giri (GARP Coordinator)
GARP Workshop Participants:
Dr Urmila Lama, Medical Officer, The Family Welfare Division; Prof. Shyam Lamsal, Professor, B.P. Koirala Institute of Health Sciences; Prof. Dr. Hanoon Pokhrel, Birat Medical College Teaching Hospital; Prof. Dr. Anjana Singh Prof. Central Department of Microbiology, Tribhuvan University; Dr. Pradip Kumar Gupta Assistant Professor, Department of Paediatrics, Tribhuvan University Teaching Hospital; Dr. Sabin Thapaliya, Tribhuvan University Teaching Hospital; Dr. Nabaraj Shrestha, Senior Veterinary Officer, Department of Livestock Services; Ms. Lilee Shrestha, National Public Health Laboratory, Ministry of Health and Population Nepal; Ms. Pratistha Bhusal, Nepal Public Health Foundation
One Health Trust:
Mr. Rishiraj Bhagawati, Ms. Simran More, Dr. Oluwatosin Ajayi, Dr. Erta Kalanxhi
Download the full policy brief:
The Value of Vaccines to Mitigate Antimicrobial Resistance in Nepal
*Photo courtesy of the Center for Molecular Dynamics Nepal (CMDN) (2024)