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A cremation site for COVID-19 victims in Kathmandu. Photo: Prakash Mathema/AFP via Getty Images

While India's second wave has alarmed the world, the situation is equally dire across the border in Nepal, which has now surpassed India's per capita death rate.

The big picture: A number of geopolitical, cultural and medical factors have created the perfect pandemic storm in the landlocked Asian nation.

What's happening: The virus is spreading rapidly, with around 9,000 new cases per day, and less than 10% of Nepalis are fully vaccinated.

  • Nepal has been relying on India for vaccines, liquid oxygen and other medical supplies. As the outbreak in India worsens, it has stopped exports of certain supplies and AstraZeneca vaccine doses, and Nepal is struggling to find other sources.

While the first pandemic wave mainly hit Nepal's big cities, this second wave has quickly spread to the villages where there is limited access to healthcare.

  • The COVID-19 positivity rate is around 30% in Nepal's capital city of Kathmandu, but as high as 65% in some more remote areas, Prabhat Adhikari, a doctor and infectious disease expert in Kathmandu, tells Axios.
  • And so many of those who are dying of the coronavirus in the villages are passing away without ever taking a test or getting to a hospital that "there’s a big chunk of data missing," says Adhikari. "We don’t even know the actual numbers."

Another big driver of the case spike is seasonal, experts say.

  • April is the peak of Nepal's wedding season, the start of crop planting season and Nepali New Year. So every April, Nepali migrant workers in the cities, as well as abroad in India and the Middle East, return home to celebrate with their families and help with farm work.
  • Says Aseem Bhattarai, another doctor in Kathmandu, "This is the time people always go home, and this time they brought COVID with them."

What to watch: Nepal desperately needs more vaccine doses, Adhikari says. While there is some flowing in from China as India's supply is paused, Nepal doctors are looking to the U.S. for help.

  • President Biden has committed to sharing 80 million stockpiled U.S. doses, consisting of the AstraZeneca, Moderna, Pfizer and Johnson & Johnson vaccines, with other countries.

Go deeper

Tina Reed, author of Vitals
Aug 20, 2021 - Health

The importance of vaccine timing

Illustration: Sarah Grillo/Axios

More time between COVID vaccine doses may help build more durable immunity, experts say.

Why it matters: The three- or four-week interval between the first and second doses of the Pfizer and Moderna vaccines was relatively short — and may help explain why the U.S. is now preparing for third doses.

29 mins ago - World

Biden's ambassador nominee: "China is not an Olympian power"

Nick Burns testifying before the Senate Foreign Relations Committee. Photo: Sarah Silbiger/Bloomberg via Getty Images

President Biden's nominee to serve as ambassador to China delivered a stark assessment of the challenges the U.S. faces in confronting Beijing, but stressed that the rising superpower is "not all-powerful" and the West retains "substantial" advantages.

The big picture: Nicholas Burns, a retired career diplomat and former U.S. ambassador to NATO, used his confirmation hearing Wednesday to echo the growing bipartisan consensus that China poses "the greatest threat to the security of our country and the democratic world" in the 21st century.

Scoop: U.S. and Israel to form team to solve consulate dispute

Secretary of State Antony Blinken (left) and Israeli Foreign Minister Yair Lapid (right) meet in Washington. Photo: Andrew Harnik/Pool/AFP via Getty Images

The U.S. and Israel are planning to form a joint team to hold discreet negotiations on the reopening of the U.S. Consulate in Jerusalem, Israeli officials say.

Why it matters: The consulate handled relations with the Palestinians for 25 years before being shut down by then President Donald Trump in 2019. Senior officials in Israeli Prime Minister Naftali Bennett's government see the consulate issue as a political hot potato that could destabilize their unwieldy coalition.