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Nepal: Immunization Law Adopted

(May 24, 2016) On January 26, 2016, Nepal’s President, Bidya Devi Bhandari, signed into law legislation on immunization. According to the Sabine Vaccine Institute, the new law is “a landmark piece of legislation that will make the country’s national immunization program more financially sustainable as new, costlier vaccines are introduced.”  (Nepal Enacts Bill to Strengthen National Immunization Program, Reduce Dependency on External Funding (Feb. 3, 2016), Sabin Vaccine Institute website; Bill to Provide Immunization Services, 2071, Constituent Assembly of Nepal website, (in Nepali) (click on PDF for first item on webpage, as last visited May 24, 2016).)

Passage of the law, which took five years, marks the first time in the country’s history that financial independence for the immunization program is attainable. At present, Nepal relies on Gavi, the Vaccine Alliance, to provide financial support for 60-70% of its vaccine purchases, but by 2022 Nepal is expected to attain middle-income status and therefore become ineligible for Gavi support for low-income countries. In the next few years, the country must “establish reliable, domestic financing for immunization.”  (Devendra Gnawali, The Making of Nepal’s Immunization Law, HEALTH AFFAIRS BLOG (Mar. 7, 2016).) Gavi describes itself as “an international organisation – a global Vaccine Alliance, bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries.” (About Gavi, the Vaccine Alliance (last visited May 20, 2016).)

The immunization law provides for two domestic, potentially long-term financing methods for the country’s immunization program, one governmental, one private. In selecting the two methods, Nepal studied other countries’ approaches to the problem. Under the first method, the government is mandated to “allocate adequate funding for immunization to the National Immunization Fund,” whose monies will be collected by means of general taxation, with the amount determined by evidence presented to the Ministry of Finance “demonstrating how much money the immunization program needs to sustain current vaccine coverage and associated program operations, and purchase new vaccines.”  (Gnawali, supra.)  Thus far, NPR60 million (about US$550,000) has reportedly been allocated to the Fund; the private sector will manage it. (Nepal Enacts Bill to Strengthen National Immunization Program, Reduce Dependency on External Funding, supra.)

The second financing method set forth in the law, to supplement government funding, is through contributions from domestic private partners to a separate Sustainable Immunization Support Fund, which was created by the Rotary Club of Nepal. However, it has been pointed out, the new law does not address the need to give private partners an incentive, such as a tax credit or exemption, to contribute to the Fund, a problem for which a separate legislative solution is being contemplated.  (Gnawali, supra.)

To ensure the proper allocation of funds, the law also provides for oversight of both funds. A newly established Parliamentary Caucus on the Sustainable Immunization Program will oversee the private fund, and there will also be parliamentary monitoring of the private management of the National Immunization Fund.  (Id.)

There are further steps to be taken, however. It was reported in early March that the government had less than three months to prepare the necessary implementing regulations for the law and to then find the means in addition to taxation to finance the National Immunization Fund.  In addition, the government has to justify to the Ministry of Finance the budget amounts requested.  (Id.)

Reactions to the Legislation

According to Hon. Ranju Kumari Jha, Chairperson of the Nepali Parliamentary Committee on Women, Children, Senior Citizen and Social Welfare, “[t]his legislation is an important milestone for Nepal in protecting children’s rights to getting quality immunization service; increasing country ownership; and sustaining the national immunization program by securing adequate funding.” (Nepal Enacts Bill to Strengthen National Immunization Program, Reduce Dependency on External Funding, supra.) Another commentator averred that the collective action carried out by Nepal’s Parliament, the Ministry of Health, and the Ministry of Finance to develop and pass the law is an experience “all other countries can learn from.”  (Gnawali, supra.)