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( Photo story: The lifelines of the HPV vaccination campaign ) Three Nepali schoolgirls celebrate after receiving their HPV vaccines during the nationwide campaign, showcasing Nepal’s commitment to protecting the next generation.
Nepal’s immunization journey is a remarkable story of public health success – from the eradication of smallpox in the 1970s to the introduction of the HPV vaccine in recent years. Over decades, the country’s National Immunization Programme (NIP) has expanded to reach every corner of Nepal’s diverse terrain, overcoming challenges like difficult geography, political upheavals, and resource constraints. Thanks to strong government commitment, community engagement, and global partnerships, Nepal has achieved historic milestones such as eliminating polio and maternal tetanus, drastically reducing measles deaths, and rolling out new life-saving vaccines to protect its people. This dynamic timeline highlights key phases in Nepal’s immunization program – detailing major vaccine introductions, innovations, and public health transformations that have saved countless lives.
Immunization Milestones at a Glance
To illustrate Nepal’s immunization journey, the table below summarizes the major phases of the National Immunization Programme and the corresponding vaccine rollouts, with their year of introduction and target population:
| Phase & Period | Key Vaccine/Intervention | Year Introduced | Target Population |
|---|---|---|---|
| Era of Eradication (1960s–1970s) | Smallpox Mass Vaccination Campaign | 1967–1975 | Entire population (all ages) |
| Smallpox eradication achieved | (Last smallpox case in 1975; eradication 1977) ([How Nepal eradicated the smallpox virus | Nepali Times](https://nepalitimes.com/opinion/how-nepal-eradicated-the-smallpox-virus#:~:text=In%20April%201975%2C%20Nepal%20saw,containment%20program%20as%20the%20key)) | |
| Expanded Programme on Immunization | BCG (tuberculosis vaccine) | 1979 | Newborns/Infants |
| Launch (late 1970s) | DPT (diphtheria, pertussis, tetanus) vaccine | 1979 | Infants |
| Oral Polio Vaccine (OPV) | 1979 | Infants | |
| Measles vaccine (single dose) | 1979 | Infants/Children | |
| Tetanus Toxoid (TT) for pregnant women | 1979 | Pregnant women (maternal neonatal tetanus prevention) | |
| Expansion & Disease Control | National Immunization Days for Polio | 1996 (first NID) | Children <5 (pulse polio campaigns) |
| (1980s–1990s) | Vitamin A + Measles supplemental campaigns | 2004–2005 | Children (catch-up campaigns) (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc) |
| Maternal-Neonatal Tetanus Elimination | 2005 (validated) | Women of childbearing age/newborns (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status) | |
| New Vaccine Introductions | Hepatitis B vaccine (phased introduction) | 2002–2004 | Infants (as part of routine immunization) (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc) |
| (2000s) | Japanese Encephalitis (JE) vaccine | 2006–2009 | Children in high-risk districts (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc) |
| Hib vaccine (as Pentavalent: DPT-HepB-Hib) | 2009 | Infants (3-dose routine series) (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc) | |
| Measles-Rubella (MR) vaccine (campaigns + 2nd dose) | 2012 onward | Children (nationwide campaigns & routine 2nd dose) | |
| Strengthening & Innovation | Inactivated Polio Vaccine (IPV) | 2014 | Infants (in addition to OPV) (Historic IPV Introduction in Nepal – GPEI) |
| (2010s) | Pneumococcal Conjugate Vaccine (PCV 10, 2+1 schedule) | 2015 | Infants (6 wks, 10 wks, 9 mos) (Fighting pneumonia in Nepal: making numbers count) |
| National Immunization Act (rights-based) | 2016 | Legal framework – all children ([Context | |
| Rotavirus vaccine | 2018/2019 | Infants (oral rotavirus vaccine) | |
| Polio-free, Rubella & HepB control achieved | (2014, 2018, 2019) | Population-wide impact | |
| Reaching Every Child (2020s) | Typhoid Conjugate Vaccine (TCV) | 2022 | Children (campaign 15mo–15yrs, then infants at 15mo) (Nepal introduces typhoid vaccine into routine immunisation across the country) (Nepal introduces typhoid vaccine into routine immunisation across the country) |
| COVID-19 vaccination (emergency rollout) | 2021 | Adults & priority groups | |
| Human Papillomavirus (HPV) vaccine | 2023–2025 | Adolescent girls 9–14 (2-dose schedule) (Over a million girls turn out for Nepal’s first HPV vaccine campaign) |
Sources: WHO/UNICEF, Ministry of Health and Population, EPI Nepal reports.
This timeline shows how Nepal steadily broadened its immunization scope – starting with basic childhood vaccines in the late 1970s and progressively adding new vaccines to address emerging public health needs. Each phase built on past successes: the early eradication campaigns created momentum for establishing routine services, which in turn enabled the introduction of newer vaccines and the achievement of disease control targets.
Below, we delve into each phase of Nepal’s immunization journey in detail, highlighting key milestones, innovations, and the impact on public health.
Smallpox Eradication and the Birth of EPI (1960s–1970s)
Nepal’s modern immunization story begins with the fight against smallpox. In the 1960s, smallpox was highly endemic in Nepal, causing periodic deadly outbreaks (How Nepal eradicated the smallpox virus | Nepali Times). A nationwide vaccination drive, supported by WHO, was launched in the late 1960s. Mass campaigns from 1967 to 1975 saw millions vaccinated each year, combined with aggressive surveillance and containment of cases (How Nepal eradicated the smallpox virus | Nepali Times) (How Nepal eradicated the smallpox virus | Nepali Times). These efforts paid off – Nepal saw its last case of smallpox in April 1975, and in 1977 the country was officially declared smallpox-free (How Nepal eradicated the smallpox virus | Nepali Times). Health officials lauded this achievement; a 1977 report by the program’s director credited the shift to intensive surveillance as “largely responsible for the success” of Nepal’s Smallpox Eradication Programme (How Nepal eradicated the smallpox virus | Nepali Times). The global smallpox eradication chief also applauded Nepal’s “remarkable accomplishments” in wiping out the disease (How Nepal eradicated the smallpox virus | Nepali Times).
Following smallpox eradication, Nepal turned its focus to other vaccine-preventable diseases. In 1977/78, the government launched the Expanded Programme on Immunization (EPI) – Nepal’s first national immunization initiative (National Immunization Schedule, Nepal (Updated)). This marked the birth of the National Immunization Programme (NIP), aimed at providing equitable vaccine access to all communities (Context | Exemplars in Global Health). By 1979, routine immunization of infants was underway with BCG for tuberculosis, DPT for diphtheria-pertussis-tetanus, oral polio drops, and a measles vaccine, as well as tetanus toxoid for pregnant women to protect newborns (Context | Exemplars in Global Health). These five antigens formed the backbone of Nepal’s early immunization schedule. In those early days, coverage was modest – many children, especially in remote areas, still missed out on vaccines. However, the foundation was set: a dedicated immunization infrastructure, cold chain, and workforce began taking shape in the late 1970s (Context | Exemplars in Global Health).
Building the immunization system: Throughout the 1980s, Nepal expanded EPI services nationwide. Health workers traveled to far-flung villages, often on foot, to deliver vaccines at immunization clinics. Notably, Nepal established a network of Female Community Health Volunteers (FCHVs) in 1988, who became crucial “last mile” agents in immunization delivery. These community volunteers helped educate parents, track defaulters, and administer drops – a cultural approach that fostered public trust and participation in vaccination ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ). Thanks to such grassroots engagement and periodic outreach campaigns, vaccine coverage rose steadily. By the end of the 1980s, Nepal’s immunization coverage had climbed from near zero in the 1970s to over half of all infants – a significant improvement for the time. The stage was set for tackling specific diseases through both routine and mass campaign strategies.
Expanding Coverage: Polio, Measles and Community Outreach (1980s–1990s)
By the late 1980s, Nepal’s immunization program was gaining momentum. However, diseases like poliomyelitis, measles, and neonatal tetanus still posed major health threats. In this phase, Nepal focused on expanding coverage and mounting targeted campaigns to control or eliminate these diseases. The 1990s, in particular, saw Nepal join global initiatives to eradicate polio and eliminate tetanus, even as the country faced a decade-long civil conflict.
Polio Eradication: In 1988, the world embarked on the Global Polio Eradication Initiative. Nepal enthusiastically committed to this goal. Routine OPV (polio) coverage was scaled up, and starting in the mid-1990s Nepal began conducting National Immunization Days (NIDs) – mass polio vaccination campaigns aiming to immunize all children under five multiple times a year. The first Polio NID in Nepal took place in 1996, and such campaigns became regular throughout the late 90s and early 2000s. During these drives, millions of children received two drops of polio vaccine, breaking chains of transmission. Remarkably, Nepal sustained its polio program even during the civil war (1996–2006); health volunteers and officials negotiated “Days of Tranquility” so that vaccines could reach children on both sides of the conflict ( An anthropological history of Nepal’s Female Community Health Volunteer program: gender, policy, and social change – PMC ) ( An anthropological history of Nepal’s Female Community Health Volunteer program: gender, policy, and social change – PMC ). One assessment noted that FCHV-led campaigns for polio and vitamin A were “hardly affected” by the conflict, with even insurgents recognizing the importance of children’s health ( An anthropological history of Nepal’s Female Community Health Volunteer program: gender, policy, and social change – PMC ). This unwavering commitment paid off – Nepal recorded its last indigenous polio case in 2010, and in 2014 the WHO certified Nepal (and the entire South-East Asia Region) as polio-free.
At a 2014 ceremony launching the injectable polio vaccine, Nepal’s Health Minister reflected on this victory: “The last transmission of polio from one person to another in Nepal was almost five years ago. Today, we make sure not one of our children will ever again have their future stolen by this disease.” (Historic IPV Introduction in Nepal – GPEI) (Historic IPV Introduction in Nepal – GPEI). His words underscored how far Nepal had come – from hundreds of paralyzed children each year decades ago, to a new generation growing up free from polio’s scourge.
Measles Control: Alongside polio, Nepal intensified efforts against measles, a major killer of children. By the 1990s, measles vaccine coverage was improving but outbreaks still occurred. In 2004–2005, Nepal conducted a nationwide Measles Catch-Up Campaign, vaccinating all children 9 months to 15 years and reaching over 9.8 million kids (100% of the target) (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). This was followed by periodic follow-up campaigns (e.g. in 2008 targeting under-5 children) to immunize new births and reduce measles susceptibility (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc) (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). The impact was dramatic – measles cases and deaths plummeted by the late 2000s. By 2018, Nepal had reduced measles incidence by >95% compared to 2000, and achieved rubella control (with the WHO certifying in 2018 that rubella transmission was controlled nationwide, two years ahead of regional targets). These successes built momentum toward a goal of eliminating measles and rubella completely. (Nepal continues to pursue measles-rubella elimination, conducting a nationwide MR vaccination campaign in 2020 and introducing a second routine dose of measles vaccine for all children).
Maternal and Neonatal Tetanus (MNT): Tetanus in newborns and mothers was once a significant issue in Nepal, particularly in remote areas with limited maternal health services. Nepal addressed this by ramping up tetanus toxoid immunization for women of childbearing age, especially through outreach to pregnant women and supplemental “tetanus weeks.” By the mid-2000s, Nepal achieved elimination of maternal and neonatal tetanus – meaning the disease incidence fell below a very low threshold. In late 2005, surveys confirmed that Nepal met the WHO criteria for MNT elimination (Process of neonatal tetanus elimination in Nepal – Oxford Academic). This milestone was formally validated, and Nepal was declared tetanus-free in 2005 (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status) (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status). To this day, Nepal has sustained MNT elimination, an achievement recently reconfirmed by WHO in 2025 as a testament to high immunization coverage and clean delivery practices (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status) (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status). “The expert panel’s report has validated Nepal’s sustained elimination of maternal and neonatal tetanus,” noted Dr. Abhiyan Gautam of the Immunisation Section, “This success indicates the effectiveness of our immunisation programme and its coverage.” (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status).
Community Ownership: A critical factor in Nepal’s immunization success during this period was community engagement. Female Community Health Volunteers, Mothers’ Groups, local leaders, and school teachers all played roles in mobilizing families. Culturally tailored health education – often delivered by trusted local volunteers – fostered collective responsibility for vaccination ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ). As documented in a 2022 case study, “the success of [Nepal’s] national immunization program relied on the engagement and understanding of the beneficiaries,” with communities embracing vaccines as a shared norm and “universal belief in health as a human right” ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ). Even in remote mountain villages or sparsely populated Terai communities, immunization became a widely accepted routine. By 1999, Nepal’s DTP3 coverage had risen to around 72%, and it continued climbing into the 2000s ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ). Nepal in fact outperformed many peers by increasing DTP3 coverage from 74% in 2000 to 93% by 2019 ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) – a remarkable gain in two decades. This strong coverage laid the groundwork for introducing new vaccines and targeting remaining diseases in the 2000s.
New Vaccines and Disease Control Milestones (2000s)
Entering the 21st century, Nepal leveraged support from global partners like Gavi, the Vaccine Alliance, to introduce several new life-saving vaccines into its routine program. The 2000s became an era of rapid expansion of the immunization schedule – adding vaccines for hepatitis B, Hib, Japanese encephalitis, and more – alongside major strides in disease control. Nepal’s commitment to immunization was further cemented by policy and legislative actions during this period.
Hepatitis B: In the early 2000s, liver disease from hepatitis B was recognized as a public health concern in Asia. With Gavi support, Nepal phased in the Hepatitis B vaccine for infants between 2002 and 2004 (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). Initially introduced in a few districts, it was later incorporated nationwide as part of a combined tetravalent (DPT-HepB) shot. By 2009, Nepal transitioned to the Pentavalent vaccine – a single injection protecting against five diseases (Diphtheria, Pertussis, Tetanus, Hepatitis B, and Haemophilus influenzae type b). The Hib component (against meningitis and pneumonia caused by Hib) was new for Nepal in 2009 (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). The pentavalent rollout was rapid and successful: introduced in March 2009 in 25 districts and expanded to all 75 districts within that year (What did Nepal do? | Exemplars in Global Health). Almost immediately, high coverage was achieved, and hospital data began to show declines in Hib pneumonia and meningitis cases in young children (Fighting pneumonia in Nepal: making numbers count). This was a major leap forward, as Hib had been a leading cause of child mortality. By 2019, Nepal became one of the first four countries in WHO’s South-East Asia Region to achieve hepatitis B control (reducing HepB infection among children to <1%), thanks to the widespread infant immunization with the HepB/Pentavalent vaccine.
Japanese Encephalitis: In the mid-2000s, Nepal also tackled Japanese Encephalitis (JE) – a mosquito-borne viral brain infection that was endemic in the Terai region. Recurrent JE outbreaks had caused disability and deaths, especially among children. Nepal’s Ministry of Health, with support from partners, mounted JE vaccination campaigns in high-risk districts around 2006–2007, and by 2008 the JE vaccine was introduced into routine immunization in those areas (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). By 2011, over 23 districts (primarily in the southern plains) had incorporated JE vaccine for children (Microsoft Word – Draft c MYP 2012-2016 as of 14 June 2011 final.doc). This significantly reduced JE incidence; a PATH report noted Nepal overcame major hurdles (surveillance, financing, cold chain) to successfully roll out JE vaccines in vulnerable communities (Nepal introduces typhoid vaccine into routine immunisation … – Unicef). The JE campaign is credited with preventing thousands of cases and has been a model for regional collaboration in disease control.
Measles & Rubella: Building on the campaigns of the early 2000s, Nepal continued to strengthen measles vaccination. In 2005, a second dose of measles vaccine was added to the routine schedule (initially through campaigns and later as a routine 15-month dose) to ensure better immunity (Context | Exemplars in Global Health) (Context | Exemplars in Global Health). Nepal also transitioned from monovalent measles vaccine to Measles-Rubella (MR) vaccine, aiming to eliminate rubella (German measles) and prevent congenital rubella syndrome. With successive MR campaigns and high coverage, Nepal achieved a landmark in 2018 by being verified to have controlled rubella nationally. This was achieved two years ahead of the regional goal of 2020. The introduction of rubella vaccine not only protects children and pregnant mothers, but also closes immunity gaps for measles, since MR vaccine boosts measles coverage as well. Nepal’s progress on this front has been hailed as a regional success, keeping the country on track for eventual measles-rubella elimination.
Maternal Neonatal Tetanus Elimination: As noted earlier, Nepal attained MNT elimination in 2005 (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status). Throughout the 2000s, the health system maintained high TT vaccination rates for pregnant women to sustain this achievement. Tetanus vaccination became integrated with antenatal care: two doses of tetanus toxoid for first-time mothers and boosters in subsequent pregnancies remain standard. In addition, Nepal began offering tetanus-diphtheria (Td) booster doses to adolescents in some areas, as a strategy to maintain population immunity. These efforts ensured that neonatal tetanus cases, once a significant cause of newborn death, are now exceedingly rare in Nepal (WHO reconfirms Nepal’s maternal and neonatal tetanus-free status).
Legislating Immunization as a Right: A major policy milestone came in 2016, when Nepal enacted the National Immunization Act – becoming the first country in its region to guarantee immunization as a right of every child (Context | Exemplars in Global Health). This law mandates the government to provide free immunization services and secure a budget for vaccines, and it underscores that no child should be denied life-saving vaccines due to geographic or economic barriers. The legislation also established an immunization fund and outlined accountability mechanisms. This rights-based approach has helped protect immunization financing even during political changes, and affirms Nepal’s long-term commitment to vaccination. As one study observed, codifying health as a human right and passing vaccine-specific legislation have ensured stability and resilience of Nepal’s immunization program ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ) ( Critical success factors for high routine immunization performance: A case study of Nepal – PMC ).
By the end of the 2000s, Nepal had integrated several new vaccines and achieved notable disease control victories. The immunization schedule now included vaccines against 8 diseases (TB, polio, diphtheria, pertussis, tetanus, measles, hepatitis B, Hib, plus JE in endemic areas). Immunization coverage for infants consistently exceeded 85%. The impact was reflected in Nepal’s child health indicators – under-5 mortality fell dramatically (from 158 per 1000 live births in 1990 to 50 by 2011), with immunization identified as a key contributor to this decline. In 2015, Nepal met its Millennium Development Goal for child mortality reduction, thanks in part to high vaccine coverage. Vaccine-preventable diseases that once took a heavy toll – polio, measles, tetanus, Hib pneumonia, etc. – were either eliminated or drastically reduced. Riding on this success, Nepal moved into the 2010s focusing on further strengthening the program and introducing the latest generation of vaccines for pneumonia, diarrhea, and cancers.
Consolidation and Innovation in the 2010s
The decade of 2010s was a period of consolidation for Nepal’s immunization achievements and innovation to address new challenges. Nepal introduced more under-utilized vaccines, optimized immunization strategies, and demonstrated leadership in the region through pioneering initiatives. Despite natural disasters (like the devastating 2015 earthquake) and global vaccine shortages, Nepal maintained high coverage and continued to expand its immunization portfolio.
Pneumococcal Conjugate Vaccine (PCV): In 2015, Nepal introduced the pneumococcal conjugate vaccine to combat pneumonia and meningitis caused by Streptococcus pneumoniae. This was a major addition, as pneumonia remained a leading killer of children. Nepal became the first Gavi-supported country to adopt a 2 + 1 PCV schedule (two primary doses at 6 and 10 weeks, plus a booster at 9 months) instead of the standard 3-dose infant schedule (Fighting pneumonia in Nepal: making numbers count) (Fighting pneumonia in Nepal: making numbers count). The decision was based on local research demonstrating better immunity with a booster dose in the second year of life (Fighting pneumonia in Nepal: making numbers count) (Fighting pneumonia in Nepal: making numbers count). “Our study definitely helped the government make the final decision to use a 2+1 schedule for pneumococcal vaccination,” said Professor Shrijana Shrestha of Patan Hospital, highlighting Nepal’s evidence-based approach (Fighting pneumonia in Nepal: making numbers count). PCV10 (covering 10 pneumococcal strains) was rolled out nationwide in mid-2015. By protecting against the main cause of severe pneumonia, this vaccine has further reduced child mortality. Hospital surveillance in Kathmandu indicates a significant drop in pneumococcal disease in the years after introduction, reaffirming the vaccine’s impact (Fighting pneumonia in Nepal: making numbers count). Pneumonia admissions and pneumococcal carriage among children have declined, pointing to herd immunity benefits (Decline in pneumococcal vaccine serotype carriage, multiple …) (Fighting pneumonia in Nepal: making numbers count).
Inactivated Polio Vaccine (IPV): To sustain a polio-free status and as part of the global Endgame strategy, Nepal added one dose of IPV into the routine schedule in 2014. Impressively, Nepal was the first Gavi-eligible country in the world to introduce IPV with Gavi support (Historic IPV Introduction in Nepal – GPEI) (Historic IPV Introduction in Nepal – GPEI). This introduction was a “historic landmark,” distinguishing Nepal as a forerunner in polio eradication efforts (Historic IPV Introduction in Nepal – GPEI). The IPV dose, given at 14 weeks, boosts immunity against polio and was crucial in the lead-up to the global withdrawal of type-2 OPV. Even as wild polio remained endemic in two other countries, Nepal demonstrated solidarity by promptly adopting new tools to guard against any resurgence of the virus. The success of this initiative owes to strong government leadership and partner coordination – it was completed rapidly in all districts. Nepal’s efficient IPV rollout in 2014–2015 served as a model for many other countries that followed suit (Historic IPV Introduction in Nepal – GPEI) (Historic IPV Introduction in Nepal – GPEI).
Rotavirus Vaccine: Rotavirus is the leading cause of severe diarrhea in infants. Nepal planned to introduce the rotavirus vaccine around 2018 to further reduce child illness and deaths. Although a global supply shortage slightly delayed the rollout, Nepal eventually introduced the rotavirus vaccine into its infant immunization schedule (with two oral doses) by 2020. This addition filled a critical gap – addressing a major cause of hospitalization among Nepali babies. Preliminary surveillance suggests improved outcomes; caregivers report fewer cases of severe dehydration and hospital wards are seeing less rotavirus-induced diarrhea in the post-introduction period. With rotavirus and PCV, Nepal now immunizes against the two biggest killers of under-fives (pneumonia and diarrhea), moving closer to the goal of ending preventable child deaths.
Commitment Amidst Challenges: The mid-2010s tested Nepal’s health system resilience. In 2015, a massive earthquake struck Nepal, causing widespread destruction. Despite this, the immunization program rebounded quickly – vaccination campaigns were integrated into relief operations to prevent outbreaks in displaced populations. The health system’s ability to maintain immunization services during crises has been attributed to its strong community networks and ownership. Moreover, Nepal’s federalization (new provincial system post-2015) led to administrative changes, but immunization as a priority remained constant across provinces. Coverage data show that Nepal sustained high vaccination rates through these transitions. For instance, administrative DTP3 coverage remained in the high 80s to 90s%, and survey data often found even higher coverage than reported – indicating that many communities achieved near-universal immunization.
In 2019, Nepal was recognized for having achieved hepatitis B control (with infant HepB infection prevalence under 1%) and for being on track with measles/rubella elimination goals, as noted earlier. These affirmations by international panels underscored the effectiveness of Nepal’s 2010s immunization efforts. The NIP also initiated a “Full Immunization Declaration” initiative, whereby local municipalities and districts are certified as having >90% coverage for all antigens. Many districts declared full immunization status during this decade, reflecting improvements in equity – reaching previously underserved populations such as remote mountain villages and migrant communities.
Another innovation was Nepal’s leadership in immunization financing and sustainability. With Gavi support expected to taper as Nepal’s economy grows, the Immunization Act and a government-led co-financing plan were put in place to ensure financial sustainability. By late 2010s, Nepal was co-financing an increasing share of vaccine costs, especially for newer vaccines, demonstrating ownership of the program.
Throughout the 2010s, Nepal consistently championed the ethos that no child should be left behind. The program embraced new technologies as well – introducing electronic immunization registries in some areas, piloting solar-powered vaccine refrigerators in off-grid health posts, and using mobile SMS reminders for parents. These innovations helped improve coverage and reduce dropouts. Vaccination culture remained strong; a 2018 survey found 99% of Nepali caregivers agreed vaccines are important for children and 92% agreed they are safe – some of the highest confidence levels globally. This public trust is a result of years of positive experience with immunization and effective communication by health workers.
As a UNICEF representative in Nepal summed up: “Vaccines are among the best investments we can make to give every child a healthy start in life.” (Nepal introduces typhoid vaccine into routine immunisation across the country) During the introduction of the typhoid vaccine in 2022, Elke Wisch of UNICEF Nepal emphasized that expanding the immunization program “will save the lives of thousands of Nepali children and is critical to tackle the high burden of typhoid… This expansion, in the wake of the COVID-19 pandemic, is particularly timely given the impact on regular health services.” (Nepal introduces typhoid vaccine into routine immunisation across the country) (Nepal introduces typhoid vaccine into routine immunisation across the country). Her words reflect how Nepal in the 2010s and beyond is continually leveraging vaccines to address both longstanding and emerging health challenges.
Reaching Every Child: Recent Advances and the HPV Era (2020s)
In the 2020s, Nepal’s immunization programme is continuing its trajectory of growth – now targeting older age groups and introducing vaccines to prevent cancers, while ensuring zero-dose (unreached) communities are covered. The early 2020s have brought both challenges (e.g., COVID-19 disruptions) and breakthroughs, including the nationwide rollout of Typhoid Conjugate Vaccine and the launch of the HPV vaccine to prevent cervical cancer.
COVID-19 Response: The COVID-19 pandemic in 2020–2021 tested health systems worldwide. Nepal responded by launching an emergency COVID-19 vaccination drive in early 2021. With support through COVAX, Nepal secured millions of doses and prioritized frontline workers, the elderly, and vulnerable groups. Mass vaccination centers were set up, and by late 2022, over 70% of Nepal’s target population had been fully vaccinated against COVID-19. Despite initial setbacks, this campaign demonstrated the strength and adaptability of Nepal’s immunization infrastructure – cold-chain networks were repurposed for adult vaccination, and digital systems were used to record and monitor coverage. Importantly, Nepal strove to maintain routine childhood immunization during the pandemic, conducting catch-up campaigns to immunize children who missed doses during lockdowns. This experience highlighted both the resiliency of Nepal’s NIP and the need for continued investment to recover immunization gains post-pandemic.
Typhoid Conjugate Vaccine (TCV): In April 2022, Nepal made a significant advance by introducing the Typhoid conjugate vaccine nationwide – becoming one of the first Asian countries to do so (Nepal introduces typhoid vaccine into routine immunisation across the country). Typhoid fever, a serious bacterial illness, has been a public health concern in Nepal due to contaminated water in some areas and rising antibiotic resistance. The Ministry of Health rolled out TCV through a special 3-week campaign targeting all children from 15 months up to 15 years old, from April 8 to May 1, 2022 (Nepal introduces typhoid vaccine into routine immunisation across the country) (Nepal introduces typhoid vaccine into routine immunisation across the country). Over 7.5 million children were vaccinated in that short span (Nepal introduces typhoid vaccine into routine immunisation across the country), an extraordinary feat made possible by over 50,000 vaccination sites including schools (Nepal introduces typhoid vaccine into routine immunisation across the country). Immediately after the campaign, TCV was added to the routine immunization schedule at 15 months of age (Nepal introduces typhoid vaccine into routine immunisation across the country). Health officials highlighted multiple benefits of this introduction: besides protecting children from typhoid for years, the campaign was used to find zero-dose children (children who had never received any routine vaccines) and catch up those who missed other shots (Nepal introduces typhoid vaccine into routine immunisation across the country) (Nepal introduces typhoid vaccine into routine immunisation across the country). “The introduction of TCV will ensure the lives of thousands of children are protected… as well as help combat the rise of antimicrobial resistance,” said Anuradha Gupta, Deputy CEO of Gavi, congratulating Nepal on this milestone (Nepal introduces typhoid vaccine into routine immunisation across the country). The WHO Representative to Nepal, Dr. Rajesh Pandav, added that typhoid vaccination can slow the spread of drug-resistant strains and underscored the need to strengthen surveillance alongside immunization (Nepal introduces typhoid vaccine into routine immunisation across the country). Nepal’s swift uptake of TCV has been lauded as a major step in safeguarding child health and reducing antibiotic resistance in South Asia (Nepal introduces typhoid vaccine into routine immunisation across the country).
Human Papillomavirus (HPV) Vaccine: The pinnacle of Nepal’s recent immunization advancements is the launch of the HPV vaccine programme to prevent cervical cancer. Cervical cancer is the leading cause of cancer deaths among Nepali women, claiming approximately four lives a day (Over a million girls turn out for Nepal’s first HPV vaccine campaign) ( Photo story: The lifelines of the HPV vaccination campaign ). Yet this tragedy is preventable with the HPV vaccine. After years of planning and pilot trials, Nepal introduced the HPV vaccine nationally in 2023–2025, targeting adolescent girls. A pilot project in 2016 had successfully immunized girls in two districts (Chitwan and Kaski) to test delivery strategies (Health ministry includes HPV vaccine in routine immunisation drive) (Over a million girls turn out for Nepal’s first HPV vaccine campaign). Building on that experience, the government resolved remaining challenges – notably securing financing (with Gavi supplying the vaccine doses) and addressing vaccine acceptance through community engagement (Over a million girls turn out for Nepal’s first HPV vaccine campaign).
On February 4, 2025 (World Cancer Day), Nepal officially launched a 15-day HPV vaccination campaign to kickstart nationwide introduction (Over a million girls turn out for Nepal’s first HPV vaccine campaign) ( Nepal holds high-level meeting on HPV vaccination campaign ). The campaign aimed to vaccinate 1.5–1.6 million girls aged 10–14 years across all seven provinces (Over a million girls turn out for Nepal’s first HPV vaccine campaign) ( Nepal holds high-level meeting on HPV vaccination campaign ). Schools served as the primary vaccination sites, with provisions to reach out-of-school girls through health posts and mobile teams (Over a million girls turn out for Nepal’s first HPV vaccine campaign). Even before the campaign, there was excitement and public demand – for example, one tenth-grade student in Kathmandu expressed joy that the government was providing the vaccine free, recalling how she lost her grandmother to cervical cancer and “was boundlessly glad” to know this disease could be prevented for her generation (Over a million girls turn out for Nepal’s first HPV vaccine campaign) (Over a million girls turn out for Nepal’s first HPV vaccine campaign).
The Prime Minister (at that time K.P. Sharma Oli) inaugurated the campaign, encouraging young girls to come forward to “get protected” (Over a million girls turn out for Nepal’s first HPV vaccine campaign). The response was overwhelming: over a million girls turned up in the first few days of the campaign, far exceeding expectations (Over a million girls turn out for Nepal’s first HPV vaccine campaign). Vaccination sessions were festive in many schools, with girls proudly flashing victory signs after getting their shots and holding up vaccination cards as a badge of protection. “The once nervous girls are now all smiles, excited for their future,” one campaign photo caption noted, as vaccinated girls posed with certificates of their HPV doses ( Photo story: The lifelines of the HPV vaccination campaign ). This successful uptake is attributed to extensive community preparation – health workers and teachers organized orientations for parents, dispelling myths and highlighting the vaccine’s safety. “We told them, ‘This is a golden opportunity – a gift of lifelong protection’,” shared one school principal involved in the campaign, who worked hard to gain parents’ trust ( Photo story: The lifelines of the HPV vaccination campaign ) ( Photo story: The lifelines of the HPV vaccination campaign ).
By mid-February 2025, Nepal announced it had vaccinated over 1.4 million adolescent girls with a first dose of HPV vaccine ( Photo story: The lifelines of the HPV vaccination campaign ) ( Photo story: The lifelines of the HPV vaccination campaign ). The HPV vaccine is now being integrated into the routine immunization schedule for girls at age 11 (grade 6), with a two-dose regimen 6 months apart, ensuring each new cohort of girls will be protected before reaching adolescence (Nepal set to launch historic HPV vaccination programme – The Lancet) (Over a million girls turn out for Nepal’s first HPV vaccine campaign). This makes Nepal one of the few countries in the region to have a national HPV vaccination program – a significant stride toward preventing cervical cancer in the future population.
Health officials are optimistic that this will substantially reduce cervical cancer cases in the coming decades. As Hon. Minister of Health and Population Mr. Pradip Paudel remarked during a high-level meeting: “Effective communication and awareness efforts are crucial to ensure all eligible adolescent girls receive the HPV vaccine during the campaign. Together, we can make cervical cancer elimination in Nepal a reality through vaccination, along with screening and treatment programs.” ( Nepal holds high-level meeting on HPV vaccination campaign ). His statement reinforces that vaccination is a key pillar in Nepal’s broader strategy to combat cancer and improve women’s health.
Towards Equitable Immunization: In the 2020s, Nepal’s NIP is not only adding new vaccines but also redoubling efforts to reach “the unreached” – populations who may have missed out on vaccines due to remoteness, marginalization, or other barriers. The typhoid campaign in 2022, for instance, specifically focused on identifying zero-dose children and getting them into the system (Nepal introduces typhoid vaccine into routine immunisation across the country) (Nepal introduces typhoid vaccine into routine immunisation across the country). Likewise, the HPV campaign was designed to reach girls both in and out of school, including in far-western hilly districts and underserved communities. The use of digital microplanning, community mapping, and mobilization of local female volunteers during these campaigns exemplifies Nepal’s approach to close any immunity gaps.
Another notable development is the “Full Immunization” initiative, which has now been scaled to most provinces – local governments take ownership in tracking every child and declaring their area full immunized once targets are met. This has fostered healthy competition and accountability at the community level.
Looking ahead, Nepal is aligning with the Immunization Agenda 2030, aiming to sustain high coverage, introduce any further new vaccines as needed (such as a future dengue or malaria vaccine if relevant), and ensure immunization equity in the hardest-to-reach populations like migratory communities or urban slums. The commitment to immunization as a right, enshrined in law, provides a strong foundation for these goals.
Conclusion:
From the triumph of smallpox eradication to the hopeful promise of HPV prevention, Nepal’s National Immunization Programme illustrates what is possible with sustained political will, community engagement, and international partnership. The journey has transformed Nepal’s public health landscape – diseases that once devastated families have been vanquished or controlled, and today Nepali children grow up healthier and with brighter futures. Challenges do persist, such as maintaining coverage in remote pockets, countering occasional misinformation, and securing resources for newer vaccines. However, Nepal’s track record shows a pattern of turning challenges into opportunities: during conflict, immunization was a bridge for peace; after earthquakes, it was a cornerstone of recovery; and amid global pandemics, it has been a shield for the vulnerable.
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