Opinion
Ivermectin and Covid: no time to lose and lives to save
By Prof. Saroj Jayasinghe,
MBBS, MD (Colombo), FRCP (London), MD (Bristol) PhD (Colombo), FCCP, FNASSL
Consultant to the Faculty of Medicine
Sabaragamuwa University of Sri Lanka.
Former Professor of Medicine, University of Colombo
It is with a degree of reluctance that I am stepping into the controversy relating to Ivermectin use in COVID. Unknown to many, the pros and cons of Ivermectin in COVID have been discussed in private forums of physicians, academia and doctors from 2020. It has been in the international media ever since laboratory studies in Australia showed that the drug inhibits the growth of the virus. However, the public in Sri Lanka became more aware of the controversy recently, when a confidential letter sent to an official of the Ministry of Health appeared in the social media. I had written this in June 2021 as an individual professional after several months of raging controversy among professionals. It was about treatment of COVID, and I firmly believe vaccination is the best option to prevent the illness. One reason for the very cautious approach of not approving the use of Ivermectin in the West could be because anti-vaccine groups are promoting it as an alternative. Sri Lanka has no such problems, and our population is willingly getting vaccinated.
Proposals to use Sri Lanka as a large study area as a clinical trial or as an observational study were made as far back as early 2021. I understand a clinical trial has begun in patients admitted with COVID, after considerable delays due to procedures related to clinical trials. Such studies are scrutinised by independent ethics committees, the drug must be approved by the National Medicinal Drugs Authority, and the study must be registered in an entity that makes is publicly available for anyone to read about it. This study will at least take another few weeks to months to yield results.
Most discussions in Sri Lanka Centre around the question whether the evidence to prescribe Ivermectin in COVID-19 is strong or inconclusive. One group says there is inconclusive evidence to use Ivermectin while another group says there IS sufficient evidence. As with many issues, this is not black or white but shades of grey, i.e. there are grades on the ‘strength of evidence’ from the field of Evidence Based Medicine (EBM). A parallel in the legal field is when we say that the evidence is ‘beyond reasonable doubt’ or there is ‘proof of the crime’, vs. circumstantial evidence.
Let us assume that using the principles of EBM we find that the evidence to use Ivermectin in COVID is ‘inconclusive’. Such a dilemma is very relevant to a situation where a decision is needed immediately, but the stakes are high. In other words, how would doctors decide to treat in a situation when the evidence for efficacy of a drug is inconclusive, but the stakes are high? Let me share an example.
Imagine a doctor who sees a very ill-looking patient with features of a serious infection (e.g. high fever, vomiting and body aches). She or he requests tests to identify the cause of the illness and the bacteria that may be causing the illness. In such an instance, should the doctor wait till the reports of the tests (e.g. culture reports) are available before treating? If a decision is made to treat immediately, the doctor does not have the ‘strength of evidence’ on the cause of the illness. However, if treatment is delayed until the reports arrive in two days the patient may be dead. This hypothetical example highlights a common dilemma: How do doctors balance between reliance on strength of evidence vs. taking an immediate decision when the evidence is inconclusive. This is best addressed by theories of decision-making and is a question very familiar to practicing doctors.
Now I will demonstrate the parallel with Ivermectin. In the case of ivermectin let us assume that the current evidence for its efficacy in COVID is inconclusive. However, the stakes are very high because COVID is currently raging, hundreds are dying, and there are no alternative drugs to treat early disease. Furthermore, Sri Lanka needs to bridge only a short vulnerable period of 4-6 weeks during which time our vaccination programme would become effective.
Let us assume that doctors begin to prescribe Ivermectin for treatment and prevention of COVID, for the next 4 to 6 weeks, despite the inconclusive evidence. There are two possible key outcomes:
Outcome 1: Future research confirms that it is effective, and it would contribute to saving many lives.
Outcome 2: Future research shows that it is ineffective, and we would have wasted money on the drug. Therefore, Ivermectin could either save lives or waste money. Even the money wasted is miniscule because the cost of a course of Ivermectin is less than Rs 200.00 (i.e. less than one US dollar)! Is it safe to use over the next 4 to 6 weeks? We know it is a very safe drug that has been used for almost 40 years. It is used in mass scale by the WHO to eliminate ‘River Blindness’ and is in their Essential Drug List.
A combination of other factors add support to the decision to prescribe Ivermectin.
1. Evidence is evolving, and studies are in progress. Therefore, conclusive evidence may emerge to confirm its efficacy.
2. There is laboratory (in vitro) evidence that Ivermectin is active against the COVID-19 virus.
3. It’s easy to give (tablets and not injections).
4. Currently there are no effective drugs in Sri Lanka to treat early COVID or prevent it.
5. Certain regions in India and South American countries are using Ivermectin to treat and prevent COVID-19
Summary
Therefore, my humble question is, should doctors in Sri Lanka consider whether to use Ivermectin to treat or prevent COVID-19? We need this only for 4-6 weeks. During this period, rates of COVID are likely to increase due to the very rapid transmission of Delta variant. We have no time to lose, nothing to lose, and lives to save. There is no time for clinical trials. Those who wish to embark on trials to wet their thirst for more evidence are welcome to do so. By the time the results of a new trial are available the horse would have bolted, and hundreds would have died.
My suggestion is for patients to ask your doctors about Ivermectin. You have a right to do so. Doctors are divided on the issue because of their sincerity to the views they have about science, scientific evidence, and decision-making. Please do not assume that there is a conspiracy against the drug in Sri Lanka! I can vouch for the honesty of all the doctors who are having different views on the topic. This is a disagreement between professionals who have diverse views, and we seem to have dug into our lines of defence!
The Ministry of Health has allowed the use of Ivermectin under the direction of a doctor. A range of doses for treatment and prevention is available at BIRD-group.org a group working in the UK. The opinions I have stated here are my own independent views and not in any way linked to the institutions I am affiliated to.
Opinion
Developing the country by helping villages
Mr. R.M.Amerasekera’s recent article on how improving rural households and villages contributes to national development (Sunday Island Aug. 23) was interesting reading as I, during my long years in the public service, was privileged to be associated with projects to improve the living conditions of rural folk.
In this context, mention should be made of that down to earth politician, D.B.Wijetunga who as
Minister for Highways and Power & Energy focused much attention on uplifting the living standard of villagers with projects to improve their lot. As Minister for Highway he successfully pushed the Treasury to increase inadequate provision in the estimates to improve roads under Provincial and District Road Committees.
Having done so, he instructed area engineers to see that the full allocation was utilized giving top priority to improve minor roads. Foot paths were widened and made motorable and farmers who carried their produce to market on their heads or shoulders had tractors. School children had small vans or two-wheeled tractors to take them them to school. It should also said that the interest shown by the government inspired villagers themselves to organize shramadana activities that were guided by Area Engineers.
Then D.B.Wijetunga as Minister for Power & Energy was keen on providing electricity to villages. Finding there was no provisions in government estimates he consulted his Secretary to the Ministry, Prof. K.K.Y.W. Perera, who suggested that we approach Asian Development Bank (ADB). Thanks to Prof. Perera’s influence with the ADB a loan was arranged subject to the condition that only financially viable villages be connected.
To satisfy this condition, a survey had to be carried out. Special mention should be made of Engineer Maxie Tissera who devotedly with the assistance of Area Engineers, prepared a list of such villages and
work started with all enthusiasm. Members of Parliaments, seeing that some villages in their electorate had been not listed, provided funds from their Decentralized Budget to provide electricity to such villages. A recent news item says that almost the entire country has now been electrified.
I am happy that I was involved in these two projects during my public service career as an Assistant Secretary to the Ministries for Highways and Ministry for Power & Energy.
G.A.D.Sirimal, SLAS,
Rtd. Asst. Secretary,
Ministry for Power & Energy
Opinion
If Sri Lanka wants ‘real’ stability, only one way to achieve it, in a short time
by Sunil Abhayawardhana
After the economic crisis of 2022, and the IMF programme that followed, some are of the opinion that ‘stability’ was achieved, but followed by ‘not out of danger yet’. Where is the ‘stability’ then?
We know that the cause of the crisis was a lack of foreign exchange. However, the IMF programme focused on the fiscal aspects, not one that enhanced export earnings. So, we are once again in a situation, facing the same problem, with the ‘fiscal discipline’ thrust on us.
Therefore, it is clear that if we seriously want to achieve ‘real’ stability, we need to use our heads much more and get out of the ‘epistemic insularity’ that has been around for so long. (Epistemic insularity is a state where an individual or group becomes isolated from alternative perspectives, data, and frameworks of knowledge. It occurs when individuals, groups or communities construct a protective bubble around their beliefs, making them resistant to outside evidence or challenging viewpoints).
It applies also to guys who have recently got into the bubble and being taught Neo-liberal lessons.
Fixing targets for budget deficits and tax collection is ok if it is in relation to a development drive. If not, it would only increase the misery of a higher cost of living. That development drive is what is missing in Sri Lanka.
A development drive comes after formulating a development plan, which is not an instant production, takes much time and effort. Therefore, Sri Lanka needs right now an accelerated ‘urgent’ project, that would bring ‘real’ stability, in the shortest possible time. Once ‘real’ stability is achieved, the focus should shift towards a greater development plan.
The only way
The only way for Sri Lanka to achieve ‘real’ stability is by enhancing its export earnings by at least $ 20-25B. Most of the projects that are being thought of are not capable of bringing in earnings on the scale required, in the shortest possible time.
Over the years, tea, rubber and coconut was the first base of exports. Then there were many smaller products such as gems and petroleum products that were not developed, tough the potential was there, followed by garments and IT, which were small in scale.
Continuing on the same path, is not going to change the story. A radical change of stance is urgently needed. What is amazing is that it has not yet been realised.
A point to note is that a World Bank report issued a few years ago, highlighting the possibility of enhancing exports by the present exporters by as much as $10B, if provided with some assistance, was not even considered. However, this should be an ongoing programme, but conditions of the IMF programme may not be able to give the required support to these industries.
Historically, since Independence, the path chosen has not been able to bring the desired results. Should we then, not change our thinking, to be able to bring about the urgently required outcomes?
Widespread development is going to take time with the existing conditions. The governments programmes would at best, bring in an additional $5B by 2030 at best. Therefore, targeting one specific sector and industry, with total focus for about a year or two, has a better chance of success.
Even if total investment is around 10% of GDP and half of it is diverted to a single project capable of increasing export revenue by 100%, that bold decision should be taken. The shortfall in public investment for a short time should be tolerated.
Sri Lanka has never embarked on such a programme and is the only way it could achieve ‘real’ stability.
Therefore, after much research, the only single project, capable of enhancing export figures by as much as $20 -25B was identified as mentioned below.
Oil refinery in Trincomalee
This is a project that should have been started at the time of Independence in 1948, when the funds were available from the Sterling Balances Agreement. However, it did not materialise and the country paid a heavy price.
Now, to be able to generate $20-25B, a refinery with at least a 400,000 b/d refinery is urgently required to be set up in Trincomalee. India is planning to set up eight new refineries in the coming years. The world’s largest refinery is located in Jamnagar, India, with a capacity of around 1.6 million b/d, owned by Reliance Industries.
The funding of such a project has many options, Multi-lateral sources, Joint Ventures and many more. (However, for a country that could release $2-3B for vehicle imports, should be able to work that out).
An idea of the cost could be determined by the Chinese cost for a 200,000 b/d refinery, which works out to around $3.7B. Sourcing equipment from China is considerably lower, compared with other western sources.
Sourcing the correct equipment, from suppliers at a price that the project can afford becomes critical. Equipment from the west is highly inflated, while Chinese equipment is now available at a much lower price.
The shortest time a refinery has been established is one year, in South Korea, and Singapore’s first refinery, a little over a year. There are many hurdles that have to be got over and a government has the ability to do so, if it is really determined. Most of it is paperwork and environment issues, with site selection.
The Ceylon Petroleum Corporation has been in existence and operating the 50,000 b/d refinery from the late 1960s and should be able to handle such a project, if not outside help would have to be deployed.
Most governments do not see the long- term benefits of such a project, due to the normal long- time frame to commence such a project. However, this is where ‘urgency’ has to be understood. As the CPC is the only institution involved, apart from the state bureaucracy, there is no reason for delay. If there is a strong will, there would always be a way of getting it off the ground, in the shortest possible time.
The discussions already commenced regarding the UAE, India, SL project, could be beneficial. A joint venture with India, is a strong possibility. The pipeline distribution would reduce delivery costs. However, total dependence on the Indian market would not be a good strategic or business decision.
The second refinery
China offered to establish a 200,000 b/d refinery in Hambantota, three years ago. Obviously, the government is under tremendous external pressure on this. This is where diplomacy at its best is required.
Sri Lanka had this ability in the 1960s and early 70s and later in the 1990s and early 2000s. This ability does not seem to be around at present, but needs to be revived.
I remember in the early 1970s during the Bangladesh war, Pakistan requested permission to fly via Colombo to East Pakistan. No one expected Sri Lanka to grant permission. But it was granted, keeping the relationship with India intact.
The proportion to be released to the local market and tax concession, should be worked out with the best interests of the country in mind. Even though the original percentage to be released to the local market was 20%, a further 20% would reduce the export earnings, but would save importing that amount, as SL imports around 100.000 b/d of refined petroleum.
Tax concessions face obstacles with the IMF programme, which could be solved via negotiations, that convince the IMF of the greater benefits to the country, but requires skill, as mentioned earlier.
A project of this nature, which brings immediate results, has never been seen in SL and lacks the confidence needed, but has to be built up to take bold decisions. It would face many obstacles, but as mentioned earlier, if there is a will, it could be done.
The Hambantota refinery could easily add another $10-15B to the aggregate earnings from petroleum exports, which would total around $ 35-40B in total.
Would that not bring ‘real stability’ to the economy?
No other project or projects could bring in the foreign exchange on the scale that these two could. In fact, expanding the refinery capacity in Trincomalee and Hambantota, could be considered later.
Other possibilities
While aiming for ‘real’ stability, it should not be forgotten to bring ‘real’ stability to the farming community in the country.
The mistakes of the past in relation to agriculture development needs to be corrected by the farmer being the ultimate beneficiary from agriculture development. It is ridiculous in an under developed economy like Sri Lanka, where the farmer toils so hard, while the big millers get the ultimate benefit.
Therefore, the thinking should change, where the farmer sells rice, with milling by farmer coops and linking the farmer to the rice market.
Once stability has been achieved and a sizeable reserve built up via earning as against borrowings, Sri Lanka should set its sights on development and not stop at stability. Listed below are a few projects that could be initiated.
* An iron and Steel mill for export in Trincomalee- which could bring in around $10-15B.
* Develop Colombo as The Gem and Jewelry center of the World $ 5-10B.
* R+D into graphene if could be used for semiconductors
* Aircraft repair and maintenance facilities to service the huge fleet in India
* Local IT companies registered in SL, operating out of Jaffna
* R+D to be incentivised in various fields
Opinion
Navigating Sri Lanka’s Israeli Dilemma
Sovereignty, Tourism, and the Law:
by Sasanka Perera
(The writer is on X as @sasmester)
On 28 October 2024, I wrote in this column an essay, titled ‘Israelis in Sri Lanka and the Advent of a ‘Neo’ Colonialism.’ My concern then was the disruption long-term Israeli tourists, often over-staying tourist visas, were causing particularly in the Eastern Province. Government intervention was mostly visible through relative inaction. Over the past year, Sri Lanka’s pristine coastal enclaves, from Hikkaduwa and Weligama in the west to Arugam Bay in the East, have found themselves at the centre of a complex and needless geopolitically-inflected controversy. As I explained in my earlier essay, too, the rapid growth of Israeli tourism has brought to light serious concerns regarding regulatory oversight, economic fairness, and national sovereignty. The latest controversy erupted in August 2026, in Hiriketiya, near Dickwella, in the country’s south. Unlike in the east, where the protesters were mostly from Muslim communities, in Hiriketiya, the protests were led by Buddhists, including monks.
At the centre of latest public debate is the establishment of a ‘Chabad House’, essentially a Jewish community and religious centre, catering to Israeli travellers. One of the primary demands the protesters made, was to investigate if this religious entity was established legally and if the activities of Israeli residents, including running businesses, were legal. In the context of the earlier controversy, Prime Minister Harini Amarasuriya is on record for clarifying in Parliament on 8 January, 2025, that neither the Ministry of Buddhasasana, Religious and Cultural Affairs nor any other government institution had granted official permission for the establishment of Israeli religious sites. In other words, what existed was illegal.
Chabad Houses as private business entities
Representatives of the local Chabad Houses, of which there are about six at present, claim they operate as registered private business entities. However, operating public religious and communal hubs on standard tourist or corporate permits violates local town planning and immigration guidelines. Besides, despite the claim, it is very unclear even if standard business licenses were issued in the first place. If religious entities were run under temporary business licenses, then, that itself is a clear violation of Sri Lankan law showing scant disregard to both the legal system in the country and its socio-political sensitivities.
This setup stands in stark contrast to how Sri Lanka’s own religious presence is managed in Israel. In Tel Aviv, a Sri Lankan Buddhist temple was established in 2013 to serve thousands of Sri Lankan migrant workers. The effort was facilitated by the Sri Lankan Embassy in the Israeli capital. To respect local Israeli laws and urban regulations, that temple operates discreetly inside a private apartment complex rather than as a prominent, independent public centre with an overt public religious personality as is usually the case with Buddhist temples globally. The Chief Incumbent of the temple, at the time it opened in 2013, Ven. Karavilakotuwe Dhammathilaka, is on record for stating very clearly that in keeping with the religious sensitivities in Israel, the inaugural ceremony itself was also held on a low scale without much publicity. This makes sense given the fact that Israel is one of the most religiously intolerant societies in the world as its track record amply demonstrates. This is more so in the last few years. What is important in the context of the opening of the Buddhist temple in Tel Aviv is, no laws were violated, the temple was meant for long term-residents, and respected local laws and sensitivities. It was also an effort formally facilitated by the Sri Lankan Embassy.
The comparison raises a fundamental question of parity: why should foreign nationals in Sri Lanka, including Israelis, establish public religious and cultural centres without municipal or government authorisation, while Sri Lankans abroad strictly abide by local constraints, as the nondescript Sri Lankan Buddhist temple in Tel Aviv clearly demonstrates?
The debate and anxieties around the Israeli presence in Sri Lanka occurs alongside another pressing concern. That is, the relatively precarious position of thousands of Sri Lankan workers in Israel who are mostly in the construction, agriculture and caregiving sectors. Recently, thousands of Sri Lankan migrant workers faced deportation from Israel due to job category violations, after switching from agriculture or caregiving to unauthorised sectors. The Sri Lankan Foreign Ministry reportedly actively intervened with Israeli authorities to negotiate regularisations and protect these workers. In my view, Illegality is illegality everywhere. If Sri Lankans violated Israeli law, that country had every right to deport them, and we should not have intervened. But I do understand the government’s position, too, as it relates to employment of citizens. Then, there should be a system where such regularisations are managed via the facilitation of the Sri Lankan Embassy, and if citizens do not make use of such a facility, they should clearly face the consequences of Israeli law.
Troubling double standard
Whichever way one looks at it, this highlights a very troubling double standard. That is, while Sri Lankan workers and the government have to cautiously navigate strict Israeli labour and visa laws, Israeli visitors in Sri Lanka frequently evade local visa laws without consequence. This mostly occurs as a result of the institutionalised spinelessness of our law enforcement when it comes to foreigners, and particularly seemingly ‘white’ foreigners. But surely, over 78 years after Independence, spineless meekness on our part must have clear limits. There needs to be clear reciprocity. Besides, Israelis are not here to work as the Sri Lankans in Israel are. They are supposed to be tourists. They should neither work nor establish religious edifices as they feel fit violating our laws and sensitivities as a matter of routine. This is why the ongoing Israeli activities reek of settler-colonialism.
Also, it is not only a matter of Israeli intransigence and official and public Sri Lankan apathy. The latter becomes possible when locals, who rent buildings to visa facilitate in running illegal Israeli businesses depriving their own citizens of legitimate incomes, are not even prosecuted by local law enforcement and judicial systems. As often is the case, foreign arrogance is built upon local meekness and lack of even the most basic sense of national pride. Of course, this does not apply to anyone, including Israelis who are operating a business in Sri Lanka legally, based on legitimate licenses issued by the government.
The proliferation of unlicensed, foreign-run businesses poses severe economic challenges to Sri Lanka’s local tourism industry. Many Israeli visitors enter this country on standard tourist visas but illegally set up guesthouses, surf camps, and cafes. Often operating exclusively in Hebrew, these businesses transact via informal channels or foreign accounts. When foreign visitors, including Israelis, run unregistered businesses, there are numerous local fallouts. For one thing, Sri Lanka loses substantial corporate, local government, and value-added tax revenues. Secondly, these activities severely undercut local livelihoods. Local vendors, tour guides, and small hoteliers are excluded by closed-loop and illegal Israeli operators. One of the common complaints where illegal Chabad Houses have been established is that they provide accommodation and meals to Israeli tourists, seriously disadvantaging local tourism-related businesses.
Adverse economic impact
Much of the income earned from these closed illegal operations, hardly comes to Sri Lanka in any way except for payment for supplies and rentals. Finally, since properties lease informally at inflated long-term rates to these operators, it drives up costs for Sri Lankan entrepreneurs and small business owners. But all this has become possible and so entrenched because of the established track record of relative inactivity of the Sri Lankan government in general as well as local governments and law enforcement in particular.
This brings to my mind the Israeli feature film, Arugam Bay. Directed by Marco Carmel and shot on location in Sri Lanka, including Ella and Arugam Bay. The film follows former Israeli soldiers using Sri Lanka’s coastal towns to process military combat trauma. The production received formal clearances for filming from the Sri Lanka Tourism Promotion Bureau in so far as publicly available information indicates. However, its narrative — framing Sri Lankan beach towns as retreats for Israeli military veterans — with blood in their hands and massive human rights violations to their credit, reaffirms local concerns about the island being used as a backdrop for Israeli human rights violations against Palestinians without sufficient regard for local perspectives.
It is precisely this kind of narrative, through word of mouth as well as social media, that creates an image of Sri Lanka as meek and trouble-free destination for Israelis intent on illegal activities. Do the Sri Lankan government or Sri Lankans want such a label attached to the country? I certainly don’t. It is quite shocking that the Sri Lanka Tourism Promotion Bureau gave permission for a such film to be shot locally. It shows both the Authority’s sorry view of what tourism is and scant disregard for ethical tourism.
Pushback mischaracterised as anti-Jewish sentiment
Public pushback against these illegal activities has sometimes been described by local as well as Israel supporters as anti-Jewish sentiment. But this completely mischaracterises the issue. Global condemnation of Israel’s military actions in Gaza and beyond and massive rights violations of entire Palestinian communities is rooted in international humanitarian law — not antisemitism. Differentiating between opposition towards violating state policies and hostility toward Jewish people is critical. Sri Lankans standing against Israeli military aggression or localised law-breaking are asserting human rights and national law as well as decent and legal behaviour by foreigners in our own country. This is not engaging in discrimination. That is, Israelis must be treated here as our people are treated in Israel. By law and by the book.
Sri Lanka must remain a welcoming host to international tourists. However, hospitality must not replace accountability. The government must strictly enforce visa restrictions, shut down unauthorised commercial and communal spaces, and protect local businesses. By upholding the rule of law uniformly, Sri Lanka can safeguard its economy, preserve its national sovereignty, and maintain harmony along its shores.
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