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Possible resurgence of childhood measles; last thing we need

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Dr B.J.C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

The disease measles, also known as rubeola and morbilli, is an extremely contagious infective viral illness in children, characterised by fever and a skin rash, with the potential to cause diarrhoea, respiratory complications, like pneumonia, ear infections and inflammation of the brain. It has a very characteristic clinical picture, and the diagnosis is clinically quite obvious to those doctors who have seen it before. Currently, there are sophisticated antibody and viral isolation tests that could be used to confirm a definitive diagnosis of a measles infection.

Measles, though often recognised as a usual childhood illness and, perhaps, as just a part of growing up, was, however, well known to be a killer of some affected children, right up to about the middle of the 1980s. The younger the affected child, the more the likelihood of the occurrence of complications; infants under one year are the most vulnerable. Many children succumbed to the development of intractable respiratory infections and acute brain inflammation. This author, who saw loads of measles cases in his medical student days, early career and consultant stages, can vouch for what is documented here.

Of course, in many affected children, it was a rather mild disease. Yet for all that, in some, it caused very many problems. The crux of the matter was that it was not at all possible to predict which of those affected by the virus was likely to develop major complications. The acute involvement of the brain in the form of inflammatory encephalitis could kill or leave the child with permanent brain damage. There is no treatment or anti-viral drugs to treat this condition.

Even more importantly, measles was recognised in the late 1960s to be the cause of delayed onset brain damage known by the technical term Sub-acute Sclerosing Panencephalitis (SSPE). In that condition, known as a ‘slow-virus’ infection, the virus remains in the brain and slowly eats into the tissues of the brain over months and years. It is a slow but relentlessly progressive terrible complication of measles and is characterised by disturbances of motor functions with uncontrollable jerky movements of the head, trunk or limbs, overt convulsions or fits, progressive cognitive and higher brain function deterioration, changes in behaviour and even blindness.

In the advanced stages of the disease, individuals may lose the ability to walk as their muscles stiffen or spasm. There is progressive deterioration to a comatose state, and then to a persistent vegetative brain-dead state. Death is inevitable as there is no effective curative treatment. It kills and the diagnosis is a very definitive death certificate. Even if one child gets SSPE, it is one too many as there is no known treatment. It is a terrible complication of measles and doctors are entirely helpless in treating it.

This scenario completely changed, totally for the better, when Sri Lanka started an island-wide immunisation programme against measles in 1984. Later, we used the Measles-Rubella (MR) vaccine from 2001 and then we started using the Measles-Mumps-Rubella (MMR) vaccine from 2011. This author was the Consultant Paediatrician in Badulla when the measles vaccination was started and then he was transferred to the General Hospital, Ratnapura, in January 1985. In both these institutions, we saw a dramatic reduction in measles cases and later on in cases of SSPE.

From then onwards, over the years, there were a few catch-up campaigns of vaccination to vaccinate those who had missed. There was practically 100 percent coverage of all children through our Expanded Programme of Immunisation with fantastic results. The World Health Organisation (WHO) certified Sri Lanka as a measles-free country in 2016.

Having been put through the mill over the years, and through many a natural as well as man-made catastrophe in the not-too-distant past, we need a resurgence of measles, just like a hole in the head. We have got more than our fair share of problems to worry about without having to deal with the resurrection of an awfully contagious viral disease, like measles.

However, there are very loud alarm bells being sounded this year. Around the middle or so of May 2023, there was a diagnosed case of measles in a 23-year-old admitted to the National Hospital in Colombo. Then there were confirmed cases being reported from the Lady Ridgeway Hospital for Children and also from other areas of the country. Up to the time of writing this article, close to 50 cases have been reported, mostly from Colombo and the suburbs of Colombo, and some sporadic cases from several other areas of the country.

One thing was a common denominator for all these cases. THEY HAVE ALL NOT BEEN PROPERLY AND COMPLETELY VACCINATED AGAINST MEASLES. Eighty-seven percent were not given even one dose of the vaccine, and 17% had only one dose. None of those with measles had both doses of the vaccine. It was all due to vaccine hesitancy and vaccine refusal on the part of the parents. The vast majority of the patients were from one ethnic group.

Many things worry all of us in situations like this. From experience, this could just be the start of an epidemic as we know to our cost that this is how such things start. This is particularly so because we have an extremely vulnerable cohort of 6- to 9-month-old babies who have not been vaccinated and who do not have natural immunity transferred from the mother. Originally, it was decided to give the first dose of the vaccine at nine months of age because the immunity in the mothers as a result of acquiring the natural disease during their childhood, had sufficient antibodies to be transferred to the babies which lasted up to around nine months of age.

However, once the disease was wiped out, the current set of mothers have immunity against measles only through two doses of the vaccine that they have had during their childhood rather than through natural measles infection. Research work done internationally and in Sri Lanka has very clearly shown that the babies of those mothers have very little, if any, antibodies against measles from six months of age. They belong to the lot of an extremely susceptible and defenceless group in whom the disease could spread like wildfire. By their age, they are also a group of children in whom the propensity to develop all complications of the disease is sky high.

The Epidemiology Unit and the Family Health Bureau of the Ministry of Health have responded ever so promptly to the current situation by instituting certain measures. To their eternal credit, no stone has remained unmoved in a dedicated quest towards thwarting the development of an epidemic of measles.

However, there is a limit to what they could do. The success of it all depends on public cooperation and reinvigorating a sense of public-spiritedness and intense responsibility on the part of all Sri Lankan parents. All these vaccine-avoider parents may have their reasons for taking such a course of action and on closer scrutiny, all of them are based on myths. None of those reasons stand up to scientific scrutiny and as I said before, any death from measles, EITHER IN THE ACUTE PHASE OR YEARS LATER DUE TO SSPE, IS A DEATH THAT IS ONE DEATH TOO MANY.

All parents in our country, irrespective of age, caste, creed, religion, or ethnicity, simply owe it to our nation to put their collective shoulder to the wheel to prevent a dismal and disastrous calamity of a measles epidemic in our country. This writer has fought many valiant battles in the past to protect our children from infectious diseases. He has even crossed swords with the Health authorities for the sake of the children of our Motherland. All he is asking now is unstinted cooperation from the parents. If you have the slightest regard for what I say, PLEASE, PLEASE, VACCINATE ALL CHILDREN. Let none of them be left behind.

I have said this before, even very recently at that, and I will say it again, even ad nauseam…, even to ad infinitum…., VACCINATION SAVES LIVES!



Features

Cyclones, greed and philosophy for a new world order

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Floods caused by Cyclone Ditwah in Sri Lanka

Further to my earlier letter titled, “Psychology of Greed and Philosophy for a New World Order” (The Island 26.11.2025) it may not be far-fetched to say that the cause of the devastating cyclones that hit Sri Lanka and Indonesia last week could be traced back to human greed. Cyclones of this magnitude are said to be unusual in the equatorial region but, according to experts, the raised sea surface temperatures created the conditions for their occurrence. This is directly due to global warming which is caused by excessive emission of Greenhouse gases due to burning of fossil fuels and other activities. These activities cannot be brought under control as the rich, greedy Western powers do not want to abide by the terms and conditions agreed upon at the Paris Agreement of 2015, as was seen at the COP30 meeting in Brazil recently. Is there hope for third world countries? This is why the Global South must develop a New World Order. For this purpose, the proposed contentment/sufficiency philosophy based on morals like dhana, seela, bhavana, may provide the necessary foundation.

Further, such a philosophy need not be parochial and isolationist. It may not be  necessary to adopt systems that existed in the past that suited the times but develop a system that would be practical and also pragmatic in the context of the modern world.

It must be reiterated that without controlling the force of collective greed the present destructive socioeconomic system cannot be changed. Hence the need for a philosophy that incorporates the means of controlling greed. Dhana, seela, bhavana may suit Sri Lanka and most of the East which, as mentioned in my earlier letter, share a similar philosophical heritage. The rest of the world also may have to adopt a contentment / sufficiency philosophy with  strong and effective tenets that suit their culture, to bring under control the evil of greed. If not, there is no hope for the existence of the world. Global warming will destroy it with cyclones, forest fires, droughts, floods, crop failure and famine.

Leading economists had commented on the damaging effect of greed on the economy while philosophers, ancient as well as modern, had spoken about its degenerating influence on the inborn human morals. Ancient philosophers like Plato, Aristotle, and Epicurus all spoke about greed, viewing it as a destructive force that hindered a good life. They believed greed was rooted in personal immorality and prevented individuals from achieving true happiness by focusing on endless material accumulation rather than the limited wealth needed for natural needs.

Jeffry Sachs argues that greed is a destructive force that undermines social and environmental well-being, citing it as a major driver of climate change and economic inequality, referencing the ideas of Adam Smith, John Maynard Keynes, etc. Joseph Stiglitz, a Nobel Laureate economist, has criticised neoliberal ideology in similar terms.

In my earlier letter, I have discussed how contentment / sufficiency philosophy could effectively transform the socioeconomic system to one that prioritises collective well-being and sufficiency over rampant consumerism and greed, potentially leading to more sustainable economic models.

Obviously, these changes cannot be brought about without a change of attitude, morals and commitment of the rulers and the government. This cannot be achieved without a mass movement; people must realise the need for change. Such a movement would need  leadership. In this regard a critical responsibility lies with the educated middle class. It is they who must give leadership to the movement that would have the goal of getting rid of the evil of excessive greed. It is they who must educate the entire nation about the need for these changes.

The middle class would be the vanguard of change. It is the middle class that has the capacity to bring about change. It is the middle class that perform as a vibrant component of the society for political stability. It is the group which supplies political philosophy, ideology, movements, guidance and leaders for the rest of the society. The poor, who are the majority, need the political wisdom and leadership of the middle class.

Further, the middle class is the font of culture, creativity, literature, art and music. Thinkers, writers, artistes, musicians are fostered by the middle class. Cultural activity of the middle class could pervade down to the poor groups and have an effect on their cultural development as well. Similarly, education of a country depends on how educated the middle class is. It is the responsibility of the middle class to provide education to the poor people.

Most importantly, the morals of a society are imbued in the middle class and it is they who foster them. As morals are crucial in the battle against  greed, the middle class assume greater credentials to spearhead the movement against greed and bring in sustainable development and growth. Contentment sufficiency philosophy, based on morals, would form the strong foundation necessary for achieving the goal of a new world order. Thus, it is seen that the middle class is eminently suitable to be the vehicle that could adopt and disseminate a contentment/ sufficiency philosophy and lead the movement against the evil neo-liberal system that is destroying the world.

The Global South, which comprises the majority of the world’s poor, may have to realise, before it is too late, that it is they who are the most vulnerable to climate change though they may not be the greatest offenders who cause it. Yet, if they are to survive, they must get together and help each other to achieve self-sufficiency in the essential needs, like food, energy and medicine. Trade must not be via exploitative and weaponised currency but by means of a barter system, based on purchase power parity (PPP). The union of these countries could be an expansion of organisations,like BRICS, ASEAN, SCO, AU, etc., which already have the trade and financial arrangements though in a rudimentary state but with great potential, if only they could sort out their bilateral issues and work towards a Global South which is neither rich nor poor but sufficient, contented and safe, a lesson to the Global North. China, India and South Africa must play the lead role in this venture. They would need the support of a strong philosophy that has the capacity to fight the evil of greed, for they cannot achieve these goals if fettered by greed. The proposed contentment / sufficient philosophy would form a strong philosophical foundation for the Global South, to unite, fight greed and develop a new world order which, above all, will make it safe for life.

by Prof. N. A. de S. Amaratunga 
PHD, DSc, DLITT

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SINHARAJA: The Living Cathedral of Sri Lanka’s Rainforest Heritage

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Damp and thick undergrowth

When Senior biodiversity scientist Vimukthi Weeratunga speaks of Sinharaja, his voice carries the weight of four decades spent beneath its dripping emerald canopy. To him, Sri Lanka’s last great rainforest is not merely a protected area—it is “a cathedral of life,” a sanctuary where evolution whispers through every leaf, stream and shadow.

 “Sinharaja is the largest and most precious tropical rainforest we have,” Weeratunga said.

“Sixty to seventy percent of the plants and animals found here exist nowhere else on Earth. This forest is the heart of endemic biodiversity in Sri Lanka.”

A Magnet for the World’s Naturalists

Sinharaja’s allure lies not in charismatic megafauna but in the world of the small and extraordinary—tiny, jewel-toned frogs; iridescent butterflies; shy serpents; and canopy birds whose songs drift like threads of silver through the mist.

“You must walk slowly in Sinharaja,” Weeratunga smiled.

“Its beauty reveals itself only to those who are patient and observant.”

For global travellers fascinated by natural history, Sinharaja remains a top draw. Nearly 90% of nature-focused visitors to Sri Lanka place Sinharaja at the top of their itinerary, generating a deep economic pulse for surrounding communities.

A Forest Etched in History

Centuries before conservationists championed its cause, Sinharaja captured the imagination of explorers and scholars. British and Dutch botanists, venturing into the island’s interior from the 17th century onward, mapped streams, documented rare orchids, and penned some of the earliest scientific records of Sri Lanka’s natural heritage.

Smallest cat

These chronicles now form the backbone of our understanding of the island’s unique ecology.

The Great Forest War: Saving Sinharaja

But Sinharaja nearly vanished.

In the 1970s, the government—guided by a timber-driven development mindset—greenlit a Canadian-assisted logging project. Forests around Sinharaja fell first; then, the chainsaws approached the ancient core.

 “There was very little scientific data to counter the felling,” Weeratunga recalled.

“But people knew instinctively this was a national treasure.”

The public responded with one of the greatest environmental uprisings in Sri Lankan history. Conservation icons Thilo Hoffmann and Neluwe Gunananda Thera led a national movement. After seven tense years, the new government of 1977 halted the project.

What followed was a scientific renaissance. Leading researchers—including Prof. Savithri Gunathilake and Prof. Nimal Gunathilaka, Prof. Sarath Kottagama, and others—descended into the depths of Sinharaja, documenting every possible facet of its biodiversity.

Thilak

 “Those studies paved the way for Sinharaja to become Sri Lanka’s very first natural World Heritage Site,” Weeratunga noted proudly.

A Book Woven From 30 Years of Field Wisdom

For Weeratunga, Sinharaja is more than academic terrain—it is home. Since joining the Forest Department in 1985 as a young researcher, he has trekked, photographed, documented and celebrated its secrets.

Now, decades later, he joins Dr. Thilak Jayaratne, the late Dr. Janaka Gallangoda, and Nadika Hapuarachchi in producing, what he calls, the most comprehensive book ever written on Sinharaja.

 “This will be the first major publication on Sinharaja since the early 1980s,” he said.

“It covers ecology, history, flora, fauna—and includes rare photographs taken over nearly 30 years.”

Some images were captured after weeks of waiting. Others after years—like the mysterious mass-flowering episodes where clusters of forest giants bloom in synchrony, or the delicate jewels of the understory: tiny jumping spiders, elusive amphibians, and canopy dwellers glimpsed only once in a lifetime.

The book even includes underwater photography from Sinharaja’s crystal-clear streams—worlds unseen by most visitors.

A Tribute to a Departed Friend

Halfway through the project, tragedy struck: co-author Dr. Janaka Gallangoda passed away.

 “We stopped the project for a while,” Weeratunga said quietly.

“But Dr. Thilak Jayaratne reminded us that Janaka lived for this forest. So we completed the book in his memory. One of our authors now watches over Sinharaja from above.”

Jumping spide

An Invitation to the Public

A special exhibition, showcasing highlights from the book, will be held on 13–14 December, 2025, in Colombo.

“We cannot show Sinharaja in one gallery,” he laughed.

“But we can show a single drop of its beauty—enough to spark curiosity.”

A Forest That Must Endure

What makes the book special, he emphasises, is its accessibility.

“We wrote it in simple, clear language—no heavy jargon—so that everyone can understand why Sinharaja is irreplaceable,” Weeratunga said.

“If people know its value, they will protect it.”

To him, Sinharaja is more than a rainforest.

It is Sri Lanka’s living heritage.

A sanctuary of evolution.

A sacred, breathing cathedral that must endure for generations to come.

By Ifham Nizam

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How Knuckles was sold out

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Knuckles range

Leaked RTI Files Reveal Conflicting Approvals, Missing Assessments, and Silent Officials

“This Was Not Mismanagement — It Was a Structured Failure”— CEJ’s Dilena Pathragoda

An investigation, backed by newly released Right to Information (RTI) files, exposes a troubling sequence of events in which multiple state agencies appear to have enabled — or quietly tolerated — unauthorised road construction inside the Knuckles Conservation Forest, a UNESCO World Heritage site.

At the centre of the unfolding scandal is a trail of contradictory letters, unexplained delays, unsigned inspection reports, and sudden reversals by key government offices.

“What these documents show is not confusion or oversight. It is a structured failure,” said Dilena Pathragoda, Executive Director of the Centre for Environmental Justice (CEJ), who has been analysing the leaked records.

“Officials knew the legal requirements. They ignored them. They knew the ecological risks. They dismissed them. The evidence points to a deliberate weakening of safeguards meant to protect one of Sri Lanka’s most fragile ecosystems.”

A Paper Trail of Contradictions

RTI disclosures obtained by activists reveal:

Approvals issued before mandatory field inspections were carried out

Three departments claiming they “did not authorise” the same section of the road

A suspiciously backdated letter clearing a segment already under construction

Internal memos flagging “missing evaluation data” that were never addressed

“No-objection” notes do not hold any legal weight for work inside protected areas, experts say.

One senior officer’s signature appears on two letters with opposing conclusions, sent just three weeks apart — a discrepancy that has raised serious questions within the conservation community.

“This is the kind of documentation that usually surfaces only after damage is done,” Pathragoda said. “It shows a chain of administrative behaviour designed to delay scrutiny until the bulldozers moved in.”

The Silence of the Agencies

Perhaps, more alarming is the behaviour of the regulatory bodies.

Multiple departments — including those legally mandated to halt unauthorised work — acknowledged concerns in internal exchanges but issued no public warnings, took no enforcement action, and allowed machinery to continue operating.

“That silence is the real red flag,” Pathragoda noted.

“Silence is rarely accidental in cases like this. Silence protects someone.”

On the Ground: Damage Already Visible

Independent field teams report:

Fresh erosion scars on steep slopes

Sediment-laden water in downstream streams

Disturbed buffer zones

Workers claiming that they were instructed to “complete the section quickly”

Satellite images from the past two months show accelerated clearing around the contested route.

Environmental experts warn that once the hydrology of the Knuckles slopes is altered, the consequences could be irreversible.

CEJ: “Name Every Official Involved”

CEJ is preparing a formal complaint demanding a multi-agency investigation.

Pathragoda insists that responsibility must be traced along the entire chain — from field officers to approving authorities.

“Every signature, every omission, every backdated approval must be examined,” she said.

“If laws were violated, then prosecutions must follow. Not warnings. Not transfers. Prosecutions.”

A Scandal Still Unfolding

More RTI documents are expected to come out next week, including internal audits and communication logs that could deepen the crisis for several agencies.

As the paper trail widens, one thing is increasingly clear: what happened in Knuckles is not an isolated act — it is an institutional failure, executed quietly, and revealed only because citizens insisted on answers.

by Ifham Nizam

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