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How can Sri Lanka benefit? Insights & Solutions…

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Vaccines against Covid-19:

By Dr LakKumar Fernando.

MD, DCH, MRCP(UK), MRCPCH (UK), FRCP (Lond), FSLCP

Background

It is almost one year since the world started battling the Covid-19 pandemic; there are over 80 million confirmed cases and 1.8 million deaths. WHO estimates that 10% of the world’s 7.8 billion population is already infected with Covid-19, and if that is the case the true case number is ten times higher. However, we are still without a proper treatment that can cure all the patients. Sri Lanka has recorded more than 200 Covid deaths and 40,000 cases by now. Fortunately, there is a light at the end of the tunnel with the positive news that several vaccines are getting lined up, shaping to end the pandemic before the end of 2021.

Vaccines have become the best solution against nearly all the important infections that threatened the human existence and Covid-19 is the most recent threat that demanded the biggest ever ‘vaccine solution’ in the history of mankind.

Normally, a vaccine takes 5-15 years of serious medical research before it is delivered for licensing and marketing. However, with all the tools ready with several vaccine makers to bring in a vaccine for similar infections, the race for Covid-19 vaccine became fast and efficient and researchers worked round the clock to fast track the solutions. The result is vaccinations against Covid-19 have started in several parts of the world already, even before the end of 2020.

With WHO declaring Covid-19 a global pandemic, close to 200 vaccine developers started research with huge investments and after completing pre-clinical animal studies, 44 vaccine candidates are currently in phase 1, 21 in phase 2, 18 are in phase 3. Five vaccines have approvals for limited use and three have emergency approval for full use., The fourth was approved on the 30th which can be a turning point with regard to cost and storage temperature of vaccines. About 85 vaccines are still in animal testing and just one vaccine was abandoned after the trials. Most Covid vaccines need two doses for complete immunity. However, trials have also shown significant immunity protection (70%) after a few weeks of the first dose itself. As a result, now the UK government is going to delay the second dose to 12 weeks instead of threeweeks so that more people could be vaccinated with the first dose protecting many while giving manufacturer more time to produce more doses.

Pfizer BioNTech’s BNT162b2 is the first vaccine against Covid-19 that got approval in most countries, that included the USA, Canada, the UK, and EU with more being added to the list almost daily. Moderna was the next that got approved in the USA and Canada. The Russian manufacturer Gamaley’s Sputnik V vaccine is in early use in Russia and it’s also approved in Belarus and Argentina. The Chinese vaccine Sinopharm Beijing is approved in the UAE and Bahrain and there is limited use in China too. CanSino and Sinovac are two other Chinese vaccines that are in limited use in China already.

The British-Swiss Oxford University combined Astra-Zeneca (AZ) vaccine AZD1222 which also has its biggest manufacturing site in the Serum Institute of our neighbouring India just got approval from the UK regulatory authority MHRA (Medicine and Health Regulatory Authority) and its possibly going to be the cheapest with cost being as low as two USD per dose with the storage capability of being within on 2-8 centigrade under normal refrigeration. Serum Institute also has over 50 million doses ready for dispatch after approval. AZ with about 30 manufacturing sites has the capacity to produce bigger quantities of the vaccine than most others.

Another Indian vaccine by Bharat Biotech is also in Phase 3 and will complete trials early next year.

With all these vaccines getting lined up and with more than a couple of million people in the world getting their doses already, Sri Lanka too should move fast to get the best use of the opportunity.

 

HOW CAN SRI LANKA GET THE VACCINE?

There is a group called COVAX set up with WHO’s help with funding from rich countries organized to give access for Covid-19 vaccines to populations in over 90 poorer countries. Covax has already ordered 2 billion of Covid vaccines from different manufacturers and they have already secured 1 billion doses from this order. It has agreed to give Sri Lanka too vaccines for 4.1 million or 20% of our population free.

No Covid vaccine is still intended for the under 16 age group as the trials were in populations older than this age limit. Fortunately, in this younger age group Covid has so far remained largely an asymptomatic disease with minimal deaths or need for hospitalisation.

 

WHEN CAN SRI LANKA GET THE VACCINE?

If we get ready with all logistical requirements, and communicate with COVAX and WHO efficiently and professionally, we can start having it from as early as next February itself but how many doses we can have and over what period of time will depend on many factors which also include the degree of our local effort and commitment.

 

WHOM SHOULD WE

VACCINATE FIRST?

We will have to have a priority order which should include our elderly population and those with co-existing illnesses like diabetes, heart and kidney disease and other chronic illnesses as well as the healthcare workers (HCW) and security forces involved in Covid control activities who are high risk groups to contact the disease.

Vaccinating healthcare workers are important for several reasons and they include…

1. We cannot afford to lose HCW having to isolate them or quarantine them with infection or exposure as they are needed in numbers to look after the Covid cases and other patients

2. Due to the fear of contacting Covid there is breakdown in the necessary routine medical and surgical care for patients in most healthcare institutions at present and this is responsible for most parallel deaths and morbidity even in non-Covid patients. Some of the Covid deaths specially home deaths are also a result of the malfunctioning of routine standard follow up and care for those with co-morbidities.

3. If the case numbers increase HCW will need more PPE for everyday use and we will not be able to face it if the situation escalate further.

 

WHAT ABOUT VACCINATING THE OTHERS? CAN WE AFFORD IT?

When it comes to immunisation coverage for routine vaccines, Sri Lanka is outstanding in the world where our strong public health set up and the infrastructure has beaten even many developed countries.

Our vaccination acceptance rates are remarkably high with the literacy rates and public health network, mass vaccination is nothing new to our setup. Being an island with secure borders and the limited population of only 21 million compared to eg. India’s 1.3 billion, we are a country where vaccinating the entire population is a realistic feasible option if you can find the money and the doses to cover the entire population. With about 25% (6 million) below 16 years of age, where there is no vaccine for this age group, we need vaccines only for less than 15 million people. Our over 65 population in the country is just about 10% (2 million). We will get at least 4 million doses free from COVAX. We must spend money only for 11 million doses.

 

If we buy at 2 USD per dose, (Indonesia is possibly getting the AZ vaccine from serum institute for USD 1.64 per dose) we will need less than Rs. 5-8 billion to buy the vaccine and there will be a little more logistical cost. This will also be over many months. Sri Lanka has already spent close to 10 billion rupees on PCR testing alone since March and compared to that the vaccine expenditure is a remarkably worthwhile investment. It is also not essential that we give the vaccine free to everybody.

With good motivation and awareness campaign there will be many who will not mind paying for their vaccine which can be as little as 500-800 rupees for both doses. We can start a public campaign to raise funding for the vaccine without overburdening the Treasury and if handled properly this can have an excellent response. We have 1.8 million Samurdhi recipients and it is believed that only about 1 million of them are in the extremely poor category. In this country we can also easily find over 1 million people who will not mind sponsoring a vaccine for someone else who is poor and cannot afford it. This is a time we have to get-together to face this pandemic.

No one should try to take political advantage of the situation. Together we can end up a proud nation that has vaccinated all its people ahead of many other countries. It is also essential that we strengthen the vaccination system by allowing the private sector too, to be very much a part of the vaccination program. This not only ease the burden to the government, it will also help to reduce unwanted unrest among people.

It is also worth noting that many rich countries have already placed orders far in excess of their true requirement. For example, UK has placed orders for 350 million doses though they need only 120 million doses for its less than 60 million eligible population. There are many examples like Canada pre-ordering almost 9 doses per person very much more than they need and countries needing more doses can take advantage of these situations, by being proactive. Its unlikely that the cost of the vaccines will go up or the availability of doses will become a huge issue. With time most will be solved. Already 18 vaccines are in phase 3, and they too will be competing in the market soon. The early successors have no room for monopoly and when vaccines like by Johnson & Johnson which is single dose also come into the market the competition will be even more. Serum Institute in India can produce 2 billion doses of AZ vaccine in 2021 and the Russian Gamaleya can produce 500 million more doses to be used outside Russia. WHO and NMRA will do the regulatory evaluations for each vaccine fast. However, if we do not actively look for avenues, we will be end up at the back end of waiting list.

With above explained feasibility and reality, Sri Lankan can be one of the first countries in this part of the world to vaccinate its entire population. It is never an impossible task. This will place us in a unique situation, with our ability to fully open the country where factories and tourism and our economy can jump ahead of many others, making Sri Lanka one of the safest countries in the world to travel and to deal with. We being a smaller country with a smaller population, it’s best that we take advantage of our unique circumstances. For the best out come extreme efficiency is a must and we will need top officials with a proven track record handing our vaccine effort.

WHAT ARE THE VACCINES WE CAN BUY OR GET?

With the huge global demand, it is unlikely that any country(possible exception of Singapore and Canada) can vaccinate the entire population with only one type of vaccine. We will have to keep shopping for different vaccines, while the COVAX also will be giving the countries their free quota from different makes. They have already offered as 200,000 doses of Pfizer vaccine to Sri Lanka last week through a proposal, as they believe, Sri Lanka is an ideal example in this part of the world to successfully execute distribution of an ultra-cold vaccine to a limited population like the healthcare workers. Though -70C appeared not practical at the beginning Pfizer has already found good transport solution where vaccine doses can be taken in a separate storage unit filled with dry ice (liquid carbon dioxide), and there are reputed local logistics companies (eg. Akbar Brothers) that can handle it up to the delivery to the hospital. The Pfizer’s storage units can maintain ultra-cold temperature for 10 days if unopened and can be kept for 30 days if re-filled with dry ice every 5 days. Once taken out of these storage unit the vaccine can be kept in normal refrigerator temperature of 2-8C up to a further 5 days. If we commit to take this free offer, (has to be a firm commitment done fast enough in time) we can vaccinate our HCW front liners incredibly early, and the same Pfizer vaccine can be made available also for the private sector later in the future. Our preparedness to complete our vaccinations using different vaccines for Covid will be the best way to achieve the ‘not-impossible target’ of vaccinating our entire population early.

 

WHAT ABOUT SIDE EFFECTS OF THE VACCINE AND DURATION OF IMMUNITY? WHAT ABOUT NEW STRAINS THAT WILL APPEAR?

Any vaccine or drug can have side effects, like allergy in people known for severe allergy. With over millions of vaccinations now completed after recent approval the safety of the approved vaccines appear very good and comparable to the vaccines we have already taken from childhood. This has been systematically tested in phase 2 and 3 of the trials.

About efficacy and long-lasting immunity, we can be only be hopeful as compared to influenza virus that fast mutate, SARS Covid-2 is a relatively stable virus where mutations are slower, and indications are that even the new variant of Covid-19 that emerged in UK and South Africa will still be prevented by the vaccine. There are interesting reports about the survivors of 2002- 2004 SARS epidemic infected by SARS Covid-01 still showing protection against the current Covid-2. If the immunity does not last long a booster will be needed. Initially like children we will have few exclusions for vaccinations like for any new vaccine for eg. pregnancy. Vaccinating a large number will bring in a major change into our lifestyle and take us towards herd immunity. With so many restrictions affecting our day-to-day life the vaccine option is THE best available solution we have now.

In summary we need to use a multi-pronged effort to vaccinate everybody which will be a noticeably big useful investment towards economic development, even more than a health solution. We will have to secure and use

1. The free vaccine we will get from COVAX for 20% of our population

2. Negotiate with various sources, and countries to obtain or buy more doses to cover the balance population.

3. Permit the private sector also to import, distribute and vaccinate, with state monitoring to facilitate effective coverage of the population who could afford the vaccine privately.

 



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The Paradox of Coercion: US strategy and the global re-emergence of Iran

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Iranians vowing resistance at a mass funeral of the victims of US-Israeli airstrikes

(A sequel to the two-part article, War with Iran and unravelling of the global order, published in The Island on April 8 and 9.)

The unfolding developments in the US-Israeli coordinated military attack against Iran reveal a striking paradox at contemporary geopolitics: efforts to weaken a state through coercion may, under certain conditions, contribute to its structural elevation within the international system. What appears as short-term tactical success can generate long-term strategic consequences that are neither anticipated nor easily reversible. In this context, the policies associated with Donald Trump and Benjamin Netanyahu, marked by unilateralism and the willingness to use force, risk producing precisely such an unintended outcome. Rather than marginalising Iran, their actions may be accelerating its re-emergence, not merely as a regional actor in the Middle East, but as a consequential player in the global geopolitics and the wider architecture of international supply chains of energy economy.

Iran not merely a state

Iran is not merely a state, but a civilisation with a distinctive political trajectory. At the heart of the present transformation lies its asymmetric strategy, rooted in the strategic exploitation of geography. Few states possess the capacity to shape the global system through geography alone. Iran’s proximity to the Strait of Hormuz, a narrow maritime passage through which a substantial share of the world’s oil and liquefied natural gas flows, endows it with a latent structural power that transcends conventional measures of national capability.

In periods of stability, this position translates into economic opportunity; in moments of crisis, it becomes a lever of systemic disruption. Recent tensions have demonstrated that even limited instability in this corridor can reverberate across global markets, triggering sharp increases in energy prices, disrupting supply chains, and amplifying inflationary pressures worldwide. Should Iran consolidate its capacity to influence or control this chokepoint, whether through military deterrence, asymmetric instruments, or diplomatic maneuvering, it would shift from being a participant in global energy markets to a pivotal arbiter of their functioning.

Energy-embedded global economy

The contemporary global economy is not merely energy-dependent; it is deeply energy-embedded. Hydrocarbons underpin not only transportation and electricity generation but also the production of petrochemicals, fertilisers, and a wide range of industrial inputs essential to modern manufacturing and food systems. Disruptions linked to Iran have already illustrated how shocks in the energy sector cascade through interconnected supply chains, affecting everything from agricultural output to high-technology industries. In this sense, Iran’s leverage is no longer confined to the traditional realm of resource geopolitics. It increasingly operates within a networked global system in which control over a single critical node can generate disproportionate influence across multiple sectors. This form of power, diffuse, indirect, and systemic, marks a departure from the more linear dynamics of twentieth-century oil politics.

The implications of such a shift are profound for the structure of the international order. For decades, the global system has been underpinned by a set of institutions, norms, and economic arrangements often described as the so-called liberal international order. Sanctions, financial controls, and diplomatic isolation have been key instruments through which dominant powers have sought to discipline states that challenge this order. However, Iran’s prolonged exposure to sanctions has compelled it to develop adaptive strategies: alternative trade networks, informal financial channels, and closer ties with non-Western partners. A crisis-induced re-entry into global markets would therefore not signify reintegration into the existing order, but rather the expansion of parallel systems that operate alongside, and sometimes in opposition to, it. In this context, Iran’s rise would contribute to the gradual fragmentation of the global economy, accelerating trends toward decoupling, regionalization, and the erosion of established institutional authority.

Decline of global order based on US hegemony

This process of fragmentation is closely linked to declining global order based on U.S. hegemony. A more globally consequential Iran would inevitably become a focal point in the strategic player in emerging multipolar world. For China, whose economic growth remains heavily dependent on secure energy supplies, deeper engagement with Iran would serve both economic and geopolitical objectives, reinforcing its presence in the broader Middle East and insulating it from vulnerabilities associated with maritime chokepoints. Russia, already positioned as a major energy exporter and a challenger to Western dominance, may find in Iran a complementary partner in reshaping global energy markets and contesting sanctions regimes. Meanwhile, countries across the Global South, including major importers such as India, would face a more complex strategic environment, characterized by heightened exposure to supply disruptions and increased pressure to navigate between competing power centers. In this emerging landscape, Iran would function less as an isolated actor and more as a pivotal node within a reconfigured network of global alignments.

Dynamics enhancing Iran’s strategic importance

Paradoxically, the very dynamics that enhance Iran’s strategic importance may also accelerate efforts to reduce dependence on the conditions that enable its influence. Recurrent energy shocks tend to catalyze policy responses aimed at diversification and resilience. States are likely to expand strategic reserves, invest in alternative supply routes, and accelerate transitions toward renewable energy and nuclear power. Over the longer term, such measures could diminish the centrality of fossil fuel chokepoints, thereby constraining Iran’s leverage. However, this transition will be uneven and contested. Advanced economies may possess the resources to adapt more rapidly, while developing countries remain structurally dependent on affordable hydrocarbons. In the interim, the global system may experience a prolonged period in which dependence on Iranian-linked energy flows coexists with attempts to transcend it—a duality that adds further complexity to the evolving geopolitical landscape.

Beyond material considerations, Iran’s potential re-emergence also signals a deeper transformation of the existing global order. Traditional metrics—military strength, economic size, technological capacity—remain somewhat important, but they are increasingly complemented by the ability to influence critical nodes within global networks. The capacity to disrupt, delay, or redirect flows of energy, goods, and capital can generate strategic effects that rival, or even surpass, those achieved through direct military confrontation. In this sense, Iran exemplifies a broader shift from territorial geopolitics to what might be termed network geopolitics. Control over chokepoints, supply chains, and infrastructural linkages become a central determinant of influence, enabling states with relatively limited ‘conventional’ capabilities to exert outsized impact on the international system.

Iran’s trajectory may be understood as a transition through several distinct phases: from a regional challenger seeking to assert influence within the Middle East, to a strategic disruptor capable of unsettling global markets, and ultimately to a systemic actor whose decisions carry worldwide consequences. This evolution is neither inevitable nor linear; it depends on a complex interplay of domestic resilience, external pressures, and the responses of other global actors. Nevertheless, the possibility itself underscores the unintended consequences of policies that prioritize short-term coercion over long-term strategic foresight.

Transition shaped by paradoxes

In historical perspective, moments of systemic transition are often shaped by such paradoxes. Actions taken to preserve an existing order can, under certain conditions, accelerate its transformation. The current crisis involving Iran may represent one such moment. By elevating the strategic significance of energy chokepoints, exposing the vulnerabilities of interconnected supply chains, and encouraging the development of alternative economic networks, it contributes to a broader reconfiguration of global power. In this emerging context, Iran’s re-emergence as a global actor would not simply reflect its own capabilities or ambitions; it would also embody the structural shifts reshaping the international system itself. What began as an effort to constrain Iran may ultimately facilitate its transformation into a decisive player in the global energy economy and supply chain architecture. The implications of this shift extend far beyond the Middle East, touching upon the stability of markets, the cohesion of international institutions, and the evolving nature of power in the twenty-first century.

The war with Iran is best understood not as a discrete regional conflict, but as a structural moment in the transformation of the international system. It reveals a growing disjuncture between the continued reliance on coercive statecraft and the realities of an interdependent global order in which power increasingly derives from control over critical economic and infrastructural nodes. Rather than achieving strategic containment, the conflict has underscored the capacity of a relatively constrained actor to generate systemic effects through geoeconomic leverage. In doing so, it highlights a broader shift from military-centric conceptions of power toward forms of influence embedded in networks of energy, trade, and supply chains.

This is not merely a redistribution of power, but a redefinition of how power operates. At the systemic level, the war accelerates the erosion of the post-Cold War order, reinforcing tendencies toward fragmentation, parallel economic arrangements, and multipolar competition. Iran’s potential re-emergence as a global actor should therefore be seen less as an isolated outcome than as a manifestation of these deeper structural changes. In this sense, the strategic significance of the war lies in its unintended consequences: it exposes the limits of coercive hegemony while simultaneously amplifying the importance of those actors positioned to exploit the vulnerabilities of an interconnected world.

by Gamini Keerawella ✍️

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The dawn of smart help for little ones

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How Artificial Intelligence is breaking barriers in Autism Diagnosis and Care

For any parent, the early years are a most valuable countdown of “firsts” of his or her precious child: the first step, the first clear word, the first beautiful smile, and quite a few other firsts as well. Yet for all that, for some families, that joy is overshadowed by a growing, quiet, but disturbing intuition that something is even a little bit different. Perhaps a child is not responding to his or her name, or the little one seems to be more interested in the spinning wheels of a toy than a game of peek-a-boo, or even avoids normal social responses.

In many countries, especially in the developing world, the road from that first “gut feeling” that there is something wrong, to a formal diagnosis of Autism Spectrum Disorder (ASD) is often a long and exhausting journey. While doctors can often identify autism in children as young as 12 to 18 months, the average age of diagnosis in our communities still hovers around four years. In these critical years, when a child’s brain is most like a machine ready to learn and adapt, time is of the essence and is the most valuable resource a family has.

Today, a new “algorithmic dawn” is offering a shortcut to really cut that delay. Artificial Intelligence (AI), the very same smart technology that helps us navigate traffic, suggest a new song, or help people with ChatGPT, is moving out of the lab and into the children’s nursery. By acting as a digital “magnifying glass”, specifically designed AI tools can now spot subtle patterns in a child’s gaze, some little quirks in the rhythm of their babbling, or the way they move, often much faster than the human eye can. Then the machine can issue a warning signal and indicate that further action and a proper evaluation are necessary. This is most certainly not about replacing the brain, the heart and the expertise of a paediatrician; it is about providing “Smart Help” that can be accessed from a smartphone in a family living room. For millions of “little ones on the spectrum”, most notably in the developing world, this technology is turning a journey once defined by waiting, uncertainty and even tears, into one of proactive care and even brighter horizons. The time gained is most certainly a very valuable window of opportunity.

What is the “Spectrum,” and Why Does Time Matter?

Autism is described as a “spectrum” because it affects many children somewhat differently and to varying degrees. Some children may have advanced technical skills but struggle to hold a conversation; others may be non-verbal or have intense sensory sensitivities. It can be very mild or very severe, and perhaps everywhere in between as well.

The common thread is that the brain develops differently in these affected children. This is why Early Intervention is the gold-standard goal. During the toddler years, a child’s brain is incredibly “plastic”, meaning that it is a highly adaptable and ready to learn type of organ. Starting therapy and management strategies during this valuable period of opportunity can fundamentally change a child’s future life path.

The problem, to a certain extent, is that traditional diagnosis of ASD is a slow, manual process. It requires intensively trained experts to watch a child play for hours and fill out complex checklists. In many countries, including Sri Lanka, where there is a massive shortage of these highly qualified specialists, the waiting list for a consultation alone can take months or even years. These doyens are rather thin on the ground and even when available, are heavily overworked.

Enter the AI Revolution: Seeing the Unseen

AI certainly does NOT replace doctors, but it acts like a high-powered magnifying glass. By using “Machine Learning”, computers can analyse massive amounts of data to find tiny patterns that the human eye might miss. Here is how it is changing the game:

1. Tracking Gaze and Smiles

One of the earliest signs of autism is how a child looks at the world. AI “Computer Vision” can analyse a simple video of a child playing. It can track exactly where the child is looking. Does the child look at a person’s eyes when they speak, or are they drawn to the spinning wheels of a toy in the corner? AI can quantify these “social attention” patterns in seconds and add them to a cache of things that ring warning bells.

2. The Sound of a Voice

Did you know that the “music” of a child’s speech can hold clues? AI can listen to the pitch and rhythm (called prosody) of a child’s voice. Children on the spectrum sometimes have a “flat” or monotonic way of speaking. AI algorithms can measure these vocal biomarkers with incredible precision, helping to flag concerns long before a child is old enough for a full conversation.

3. Movement and Play

Repetitive behaviour, like hand-flapping or rocking, are core traits of ASD. Sensors in smartphones or simple video analysis can now categorise these movements objectively. Instead of a parent trying to describe how often a behaviour happens, the application or ‘app’ provides a clear, data-driven report for the doctor.

Innovation at Home: India’s Digital Solutions

The most exciting part of this technology is that it does not require a million-dollar lab. In India, where smartphone use is booming, several “homegrown” apps are bringing specialist-level screening to rural and urban homes alike.

Apps like CogniAble, which give parents a step-by-step intervention plan based on the child’s specific needs, or START, a tablet-based tool used by local health workers in areas like Delhi slums to spot risks via simple games, or LEEZA.APP, which offers free AI screening to remove the “money barrier” that keeps many families from seeking help, or AutismBASICS, which provides thousands of activities and a milestone tracker to help parents manage daily therapy at home, are just a few of the programs in use at present. These tools are “democratising” healthcare. A mother in a remote village with a basic smartphone can now access the same level of screening logic that was once only available in a major city hospital.

Beyond the Diagnosis: A Robot Tutor?

The role of AI does not stop once a diagnosis is made. It is also becoming a tireless “co-therapist.”

For many children with autism, the human world can be unpredictable and overwhelming. AI-powered “Social Robots” or interactive apps provide a safe, predictable environment. These “Robo-Therapists” do not get tired, they do not get frustrated, and they can repeat a social lesson even 100 times until the child feels comfortable.

Furthermore, for children who are nonverbal, AI-powered communication apps serve as a “voice”. These apps use smart technology to predict what a child wants to say, allowing and facilitating them to express their needs and feelings to their parents, even for the very first time.

The Human Element: Proceed with Care

As bright as this dawn is, experts warn that we must move forward carefully and most intelligently.

= Privacy: Because these apps collect sensitive videos and data about children, keeping that information secure is a top priority.

= Cultural Differences: An AI trained on children in the US or Europe might not perfectly understand a child in Sri Lanka. We need “diverse local data” to ensure the algorithms understand our local languages, gestures, and social norms. Many of these programs need to be home-grown or baked at home in Sri Lanka.

= The Human Touch: Most importantly, we need to always remember that AI is a tool, not a replacement. A computer can spot a pattern, but it cannot give a hug, provide emotional support to a struggling parent, or celebrate a breakthrough with the same joy as a human therapist.

A Brighter Future

We are moving toward a world where “waiting and seeing” is no longer, and quite definitely, not the only option for parents. By combining the heart of a parent and the expertise of a doctor with the speed of an algorithm, we can ensure that no child is left behind because of where they live or how much money they have.

The “Algorithmic Dawn” is not just about code and data. It is about giving every child the best possible start in life. It is the main principle on which Hippocrates, the Father of Medicine, all those centuries ago, based all his postulations on how physicians should work.

 The “Red Flag” Checklist: 18 to 24 Months

The American Academy of Pediatrics recommends screening all children at 18 and 24 months. If you notice several of these signs, it is time to use an AI screening app or consult your paediatrician.

Communication and Social Cues

= The Name Test: Does your child consistently fail to turn around or look at you when you call his or her name?

= The Pointing Test: By 18 months, most toddlers point at things they want (like a biscuit) or things they find interesting (like a dog). Is your child using your hand as a “tool” to get things instead of pointing?

= The Eye Contact Test: Does your child avoid looking at your face during social interactions or during play or when being fed?

= The Shared Smile: Does your child rarely smile back when you smile at him or her?

Behaviour and Play

= The Toy Test: Does your child play with toys in “unusual” ways? (e.g., instead of rolling a car, they spend 20 minutes just spinning one wheel or lining them up in a perfect, rigid line).

= The Routine Rule: Do they have an extreme “meltdown” over tiny changes, like taking a different route to the park or using a different coloured cup?

= Repetitive Motions: Do you notice frequent hand-flapping, rocking, or spinning in circles, especially when they are excited or upset?

The “Golden Rule” of Regression

Finally, an extremely important rule for concerned parents to follow.

If your little one had words (like “Mama” or “Dada” or “Amma” or “Thaththa” or Thaii/Amma or Appa) or social skills (like waving “Bye-Bye”) and a beautiful social smile etc, and then SUDDENLY STOPS USING THEM, that could be a most significant red flag. In such situations, the standard advice would be: Please consult a doctor immediately.

by Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics),
MRCP(UK), FRCP(Edin), FRCP(Lond), 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.

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Governance, growth and our regional moment:Why Sri Lanka must choose wisely

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The recent disclosure of a substantial internal fraud at National Development Bank has understandably unsettled the financial community. What began as a relatively contained incident has since been revised upwards, revealing a scheme that operated over an extended period within a specific operational area. To their credit, both the bank and the Central Bank of Sri Lanka responded with speed. Staff were suspended, arrests followed, an independent forensic review was commissioned, and clear assurances were given that customer funds remained secure. The institution’s capital and liquidity positions continue to meet regulatory requirements, and day to day operations have not been disrupted.

Yet it would be a mistake to view this as an isolated operational error at a single respected institution. When a fraud of this magnitude, equivalent to more than a year’s profit for the bank, emerges within one of our most established listed companies, the implications extend well beyond the banking sector. It prompts a necessary and uncomfortable question. Are we truly strengthening the foundations of our economy so that every part of our society can operate with the integrity and confidence that sustainable progress demands?

Banking sits at the heart of any modern economy. It channels savings into investment, supports enterprise, and underpins household security. When even a leading institution reveals weaknesses in internal controls, risk oversight or governance culture, the signal to international observers is difficult to ignore. It suggests that the financial system upon which growth depends may not yet possess the resilience we aspire to project. If institutions that have undergone significant reform since 2022 can still experience such failures, what assurance can investors reasonably expect in other sectors of our economy? At a time when Sri Lanka needs to demonstrate strength and reliability, perceptions of fragility carry a heavy cost.

This matters profoundly because a genuine window of opportunity is now opening. Geopolitical shifts in the Middle East and beyond are prompting global investors and entrepreneurs to seek stable, well governed destinations for capital and talent. Sri Lanka possesses distinct advantages. Our geographical position offers natural connectivity. We have invested in critical infrastructure, including two major ports, international airports and strategic energy reserves. In an era where businesses prioritise rule of law, institutional predictability and sound fundamentals, our potential alignment with these criteria is significant. However, high profile governance failures at this precise moment risk undermining that narrative before it can gain meaningful traction.

The stakes are equally significant for initiatives such as the Port City Colombo. With substantial projects now approved, foreign investment commitments secured and early construction underway, this endeavour is moving from concept to delivery. Yet persistent concerns about governance standards in our established companies can act as a drag on investor sentiment. The confidence required to attract high value international tenants and long- term capital depends not only on physical infrastructure but on the perceived strength of our institutions and the consistency of our regulatory environment.

For decades, Sri Lanka has experienced growth averaging around four to five per cent per year. While this is not insignificant, it falls short of our potential, particularly when measured against the progress of our regional neighbours. India, for example, has sustained growth at roughly twice our rate for more than twenty years, driven by consistent policy execution and strengthening institutional credibility. Our own trajectory has been held back not by a lack of ideas or ambition, but by recurring shortcomings in how our major institutions are governed and held to account. The result is a cycle of unrealised potential, where promising openings are not fully converted into lasting advancement.

The current situation, though challenging, can serve as a catalyst for meaningful change. Boards of listed companies must move beyond procedural compliance to foster a genuine culture of ethical leadership, proactive risk management and zero tolerance for control failures. Regulators have an opportunity to undertake a comprehensive review of fraud prevention frameworks, whistle-blower protections and monitoring standards across the financial sector, with lessons applied to other key industries. Greater transparency in reporting material incidents and more timely forensic follow through will help rebuild trust with both domestic and international stakeholders.

Crucially, the government must tread carefully as it responds. Short term fixes or reactive measures may address immediate concerns but will not deliver the enduring stability that investors seek. What is required is a coherent long-term strategy that balances the imperative for rapid economic development with the equally vital need to conserve our natural environment and strengthen regional cooperation. Our neighbours in South Asia and Southeast Asia offer not only markets for trade and investment but also partners in shared challenges such as climate resilience, sustainable infrastructure and digital connectivity. By deepening these relationships through practical collaboration, Sri Lanka can position itself as a reliable and forward-looking partner in a dynamic region.

Sri Lanka stands at a pivotal moment. Global realignments are creating rare opportunities for capital inflows, technology transfer and new economic partnerships. Yet these opportunities will flow most readily to nations that demonstrate they can protect investor interests, uphold the rule of law and operate with predictability and transparency. If we allow governance weaknesses in our flagship institutions to persist, we risk once again watching potential pass us by.

This is a defining moment, and our response must be equally purposeful. We can treat the recent events as an unfortunate but isolated incident and return to established patterns. Or we can seize this moment as a timely reminder to strengthen every pillar of our economy, with particular attention to environmental stewardship and regional collaboration. Only by getting our house in order, with patience, consistency and a clear-eyed commitment to long term goals, can we convert today’s challenges into tomorrow’s competitive advantage. The path to sustained prosperity demands nothing less.

by Professor Chanaka Jayawardhena
Professor of Marketing
University of Surrey
Chanaka.j@gmail.com

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