Opinion
Immunity Blackout: The Conundrum of ‘Immune Amnesia’ in Humans

Just visualise the scenario where you spend years of your life building up a defence team in your body that remembers every invading enemy it has fought, from chickenpox to the flu, from pneumonia to skin infections and many, many, more. The body then goes on to build up a robust armamentarium to fight them the next time they attempt to cause trouble. This is what usually happens with our natural defence systems of the human body. The memory of the attackers is the thing that leads to war being declared on them subsequently.
Now, imagine a setting where disaster strikes in the form of some intruder who breaks in and erases those memories, leaving your body exposed and unprotected. We now know for sure that this is not a scene from a science fiction movie. It is a real thing that takes place in the human body, called Immune Amnesia; the word amnesia being a glorified term for forgetting something. It is a situation where the body “disremembers” how to fight off diseases it once defeated. This kind of immune memory loss leaves the body wide open to catching infections that one was previously protected against. It is not merely about getting sick again. It is about becoming vulnerable to a whole list of diseases, some of them serious, or even deadly.
The human immune system is like an army that defends the body against harmful invaders like bacteria and viruses. It has two main parts. One is the Innate Immune System, the first line of defence, a quick response team that is inherent in humans, which attacks anything unfamiliar. Humans are born with the capacity to direct this Innate Immune System to respond unreservedly to any harmful agent that invades the body. The second line of resistance of the human defensive army is the Adaptive Immune System, which is the smarter component that specifically remembers past infections and builds explicit and precise weapons to fight them off more efficiently when the perpetrators try to attack the body a second time. These weapons include antibodies and immune memory cells. Thanks to this adaptive immune system, if you had chickenpox as a child, your body remembers how to fight it. That is why one does not usually get it again. The flip side of the coin is that vaccines also work by training this adaptive memory system without one having to go through the actual disease. They are like military drills: safe practice sessions that teach the immune system to recognise and destroy certain pathogens before they get in and cause disease.
Think of your immune system as a vast library filled with records of every infection you have ever encountered. Each record contains information about the specific pathogen and instructions on how to fight it off. When you get a disease or receive a vaccine, new records are added to this library, ensuring that your body is prepared for future encounters.
This phenomenon of Immune Amnesia can occur after certain infections, most famously after contracting the measles virus. In recent years, scientists have come to understand this strange and troubling side effect of an illness that many once believed was simply “a childhood rite of passage.” Measles is not just a fever followed by a rash. It is one of the most contagious diseases known to man, and it can have long-lasting effects on the immune system, even after recovery. Studies in the last decade have shown that measles can erase 20% to 70% of the immune system’s memory. In other words, if you’ve had 100 disease-fighting memory cells, measles might destroy even up to 70 of them. As to how measles does it? Scientists believe that the virus attacks Immune Memory B cells and Memory T cells; these being the two types of specialised immune cells in the body that remember how to fight past infections. Once these cells are damaged or destroyed, your body has to start over from scratch, relearning how to fight infections it already knew how to handle before the “wiping out” of the process.
The really creepy part is that Immune Amnesia does not make you feel sick right away. You may feel perfectly fine after recovering from measles or a similar infection. But your immune system is now more vulnerable. A child who gets measles might recover from the rash and fever. But in the months or years that follow, they could get pneumonia, ear infections, or diarrhoea far more easily than before. These secondary infections can be dangerous, even fatal. In fact, before widespread vaccination, measles did not just kill children through the measles virus itself. Many died from other infections they caught in the months after measles had wiped out their immune memory. That is the reason why countries that introduced the measles vaccine not only saw a drop in measles cases, but also a drop in deaths from other diseases. It turns out that protecting against measles was protecting against a whole range of infections by safeguarding the memory of the immune system.
While measles is the best-known cause of immune amnesia, some scientists are exploring whether other infections might cause similar problems. There’s growing curiosity about whether certain viruses, like the flu viruses or even COVID-19, might temporarily reduce immune memory or even cause immune “confusion”, the latter term referring to a confused immune system attacking normal human tissues or exhibiting less effective responses against disease-causing organisms. While the research is still in early stages, one thing is clear: our immune systems are delicate. Some infections do not just challenge the body, they even rearrange the entire system.
This is where the conversation comes full circle. Vaccination is not just about avoiding a rash or a few days of fever. It is about protecting the long-term memory of your immune system. If you prevent measles through vaccination, you do not just avoid one disease. You also prevent your immune system from being reset and losing its ability to fight off dozens of others. This is why experts emphasise the importance of the measles, mumps, and rubella (MMR) vaccine. Despite its safety and effectiveness, some specific communities and groups of anti-vaxxers have become hesitant or sceptical about vaccines, often due to misinformation and disinformation. But studies have shown that in communities where vaccination rates drop, not only does measles come back, but so do many other infections. It is just like pulling a thread and watching an entire sweater unravel and disintegrate.
Immune amnesia also has consequences for entire populations, not just individuals. When a community is mostly vaccinated, herd immunity kicks in. This means that even people who cannot get vaccinated, like little babies or those with weak immune systems, are protected because the disease has nowhere to spread. But when vaccination rates fall and diseases like measles spread, immune amnesia weakens the immune systems of those who get infected. This creates a ripple effect where many other infections spread more easily, even to people who never had measles. In other words, immune amnesia can help fuel epidemics of other diseases. That is a very heavy price to pay for skipping a simple vaccine.
Immune amnesia is not just a curious biological fact. It is not just another strange scientific fact that might just blow away. It has very serious implications for public health. It could explain why some people get sick more often after recovering from certain infections, and it adds weight to the importance of vaccinations.
The good news is, immune amnesia can be prevented, and the solution is quite a bit straightforward. ONE CLEAR POSITIVE STEP IS TO GET VACCINATED AGAINST DISEASES, PARTICULARLY THOSE THAT ARE KNOWN TO INDUCE IMMUNE AMNESIA. This is particularly important against measles. We need to educate the general public, and this article is a committed attempt to do just that. The society at large should intensely support the public health measures undertaken to facilitate satisfactory vaccination initiatives. If the general public has some concerns regarding vaccines and vaccination, they should promptly ask relevant questions from the proper authorities. It would be most unwise to be guided by portals such as social media.
The World Health Organisation (WHO) recently reported that measles cases in the European region more than doubled from 2023 to 2024, reaching about 127,000, the highest number since 1997. The increase has been linked to a lack of vaccination coverage. It is estimated that half a million children across some parts of the world, which comprises 53 countries in Europe and Central Asia, missed their first dose of the measles vaccine in 2023. Children aged 5 years or younger accounted for about 2 out of 5 cases of the highly transmissible infectious virus.
Immune amnesia is a powerful reminder of how interconnected our health profile really is. One little bug can undo years of carefully crafted immune protection, making the body forget how to fight off old foes. Measles is the best-known example, but scientists are watching for other culprits. The takeaway message is very clear: diseases like measles are not harmless childhood illnesses. They can cause long-term damage, even after the obvious symptoms are gone. Vaccines protect us not just from the disease, but from its deeper and widespread consequences, including Immune Amnesia. So, the next time you think of measles as just a spotty rash, remember that it also can wipe the slate clean, leaving your immune system defenceless and your body at woeful risk.
BY Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child HealthSection Editor, Ceylon Medical Journal
Opinion
Dhammam Saranam

It may hurt our pride, but we must admit that our Buddhist education has failed. It adheres to the tradition of memorizing, especially post canonical poetry and commentaries while discouraging critical thinking. The current sorry state of social institutions is living evidence of that failure. Solutions to chronic problems of this nature will take time to bear results, but there is no better time to act than now. We must teach the future generations, using terms they understand, that Dhamma is a way to see the reality of nature and our place in it, and knowing it with wisdom will allow us to live a happy and successful life here and now. We must stress the fact, and be proud of it, that Dhamma is not only compatible with science, but it is also ahead of our times, a unique feature. Future generations of Sangha must be trained to critically evaluate the utility of prevailing practices that Buddha had rejected. Understanding Dhamma does not have to wait for the arrival of a Buddha who is not even mentioned in the Pali Canon. Let us teach future generations, in their language, that Dhammam Saranam means is to ‘Face life armed with the wisdom of Dhamma, free of baseless beliefs and futile rituals.’
(The first part of this article appeared yesterday)
A third characteristic derived from this first principle has to do with human knowledge, or the way they know about their world. Dhamma describes the cognitive process, or the way humans become aware of their world, using the formula referred to as the Five Aggregates (Pancakkhanda). Dhamma ascribes knowledge to what is acquired through the sense organs consisting of eye, ear, nose, tongue, and the body, and deliberations by mind, which is the sixth sense faculty. The stimuli received by the sense organs (Vedana) are received by the brain in the form of electrochemical signals (Sanna), where that data is interpreted and assembled into mental formations (Sankhara).
The brain is isolated from the outside world and relies solely on the information sent by the sense organs to construct an image of the object or phenomenon that caused the stimulus. There is a major shortcoming in this process. That is, there is no way humans can know how accurately the mind interprets the information in constructing mental images. Humans think they see, hear, taste, smell and feel things, but they only become aware of things. Awareness and reality are not the same, and we have no way of knowing how close the former represents the latter. Furthermore, the sense organs, brain, and its activities, as well as all phenomena the sense organs encounter are in flux. Human sense organs have not evolved to see reality, yet we become aware of our world through this process and get attached to them. Dhamma describes this process, the Five Aggregates, as the human condition, or Dukkha in Pali (Sankittena pancupadanakkhanda dukkha).
These limitations of the human cognitive system that the Buddha described two and half millennia ago, have been confirmed by modern science. Dhamma describes this as a state of ignorance (Avijja). That means humans have no way of knowing how closely the mental construct of their world represents reality. This is a subject of quantum physics as well. Einstein described this condition as an illusion, and he said that the purpose of any religion should be to help humans overcome this condition. That is exactly what Dhamma is about: it considers life, the condition in which humans must deal with things that are in flux and beyond control, while not knowing reality is unsatisfactory. It describes this condition as Dukkha. That does not mean life is misery; there is nothing good or bad about life, life is what it is.
Dhamma does not stop there, it also explains the arising (Samudaya), cessation (Nirodha), and the way to cessation (Magga) of this condition. Teaching describes the cause and condition for human condition as ignorance, and the way to eliminate it is to develop the mind to be able to see things as they really are (yathabutha nanadassana). To know that without doubt, one must experience it, know it without names and labels; and the way to accomplish it is described in the Noble Eight-fold Path, also known as the Middle Path (Majjima Patipada).
In essence, Dhamma can be described as nature, truth, law, and the way things are. That is, the purpose of Dhamma is to see the reality of nature and human’s place in it. There is no mysticism or beliefs involved. What is the significance of understanding the position of humans in nature? The one who knows the way will not go astray!
Since everything is in flux, everything is interconnected. As such, human life depends on everything else in nature, and humans must take that into account in all their actions, talking, and even thinking. The science behind how thinking matters is another fascinating aspect to explore. This is where the Buddhist ethics come into play. Buddhist ethics are not decrees of a superpower, they are a set of guidance or conventions that are in harmony with nature’s way. They allow humans to live a happy, harmonious, and prosperous life here and now and make the planet a safe place for all beings. Look at our country; it is disregarding the ethical behavior that has caused the failure of socio-economic institutions of the country.
Now, we can turn to the second part of the question, what is the meaning of Saranam? Even though it is implied in the goal of Dhamma, it must be clarified whether this constitutes an appeal to an authority to bestow its blessings upon those in need, or if it represents a directive. The Pali-English dictionary translates Saranam as Refuge, Protection, Salvation, and Nirvana. A Pali-Sanskrit scholar who analyses the etymology of the word Saranam explains it as to mean defence, shield, not running away from, and providing protection in a fight (Whelan 2022). This explanation gives a sense of active participation or being the agent of the action instead of being the passive beneficiary of a power, as opposed to what is conveyed by dictionary translations.
Dhammam Saranam Gacchami does not mean passively waiting for some blessing to be bestowed upon us. To reap the benefits of Dhamma, one must understand it and live accordingly. Memorising it or listening to recitations in a now extinct language does not serve the purpose. There is no mystery or higher powers involved. Therefore, this phrase can be interpreted as ‘I face the human condition armed with the wisdom of Dhamma.’
A brief investigation of the reasons for the failure of Buddhist education is warranted here. When the Sangha prioritised learning and memorisation of Dhamma over practice, they did the right thing: Dhamma is preserved and safe. Unfortunately, to fill the void created by lack of interpretation and practice, our ancestors have adopted beliefs, practices, and rituals from other cultures that exist on the island, and it is those complex set of practices developed over centuries that the Westerners labeled as Buddhism. Most alarmingly, the process of adding new rituals continues to date.
Theravada is one tradition, or a school, among thirteen or so existing such traditions. To Sri Lankans, it is of paramount importance; not only that it has become an integral part of our large culture, but it is also the system that ensured the perpetuation of Dhamma and made it available to the world. However, we must have the wisdom and courage to see that the Dhamma and Buddhism are two different things, for Dhamma has no ‘ism’ in it. We must appreciate the origin and purpose of those practices and continue to protect and preserve those that have practical utility but critically evaluate and reject those that are utterly meaningless. The time has come to use the treasure that generations sacrificed blood and sweat to protect, and that is the best way to preserve it.
The Buddha recognised that the goals of the monastics and the laity are different, and he provided different sets of guidance accordingly. Monastics, free of household impediments, strive to reach the highest goal of Dhamma, whereas the laity must endeavor for a happy and prosperous life while fulfilling their responsibilities to the family, society, and Sasana at the same time. Since it has been the monastics who had been the purveyors of Dhamma, those aspects relevant to laity and their life here and now have been overlooked. The entire focus has shifted to the wellbeing in the hereafter at the expense of life here and now. The socio-economic breakdown we struggle with is a direct result of this misguided belief. This is not what the Buddha had advised; his teaching has utility whether one believes in continuity (samsara) or not (Kalama sutta). If we live an ethical and moral life, the benefits will result here and now as well as here after. Sadly, misguided, we have ruined both.
The other reason is giving priority to “the higher doctrine” or Buddhist philosophy in attempts to understand Dhamma. This led modern scholars to analyse Buddhist philosophy from the perspective of Western philosophy in hopes of discovering its empiricism (Tilakaratne 2021). Efforts in this direction have produced great scholarly work that allows the students of higher studies to analyse Dhamma, but they do not help the laypeople to bridge the gap in education. Instead of exegesis, we must rely on Buddha’s teaching itself.
Finally, the language is a major obstacle. We must not overlook the fact that the language and the style of the Pali Canon were meant for the iron age society. The scholarship is valuable only if it results in new thinking or interpretations, but that does not appear to be happening in recent times. We must recognise the value of the language of science as an invaluable tool in this respect. It may not work for all ages, but that is the way to get the message across to technology savvy future generations. What other better way to teach complex concepts like pancakkhanda, the human cognitive process than using science? Once they see the practicality of this approach, the students will embrace their proud heritage for being ahead of time and will turn into explore more complex concepts such as rebecoming (punabbhava) and continuity (samsara), which also can be explained based on scientific observations.
It may hurt our pride, but we must admit that our Buddhist education has failed. It adheres to the tradition of memorizing, especially post canonical poetry and commentaries while discouraging critical thinking. The current sorry state of social institutions is living evidence of that failure. Solutions to chronic problems of this nature will take time to bear results, but there is no better time to act than now. We must teach the future generations, using terms they understand, that Dhamma is a way to see the reality of nature and our place in it, and knowing it with wisdom will allow us to live a happy and successful life here and now. We must stress the fact, and be proud of it, that Dhamma is not only compatible with science, but it is also ahead of our times, a unique feature. Future generations of Sangha must be trained to critically evaluate the utility of prevailing practices that Buddha had rejected. Understanding Dhamma does not have to wait for the arrival of a Buddha who is not even mentioned in the Pali Canon. Let us teach future generations, in their language, that Dhammam Saranam means is to ‘Face life armed with the wisdom of Dhamma, free of baseless beliefs and futile rituals.’
(Concluded)
by Geewananda Gunawardana, Ph.D.
Opinion
Drs. Navaratnam’s consultation fee three rupees NOT Rs. 300

Thank you for publishing the article written by Mr Arjuna Hulugalle on my British Empire Medal award. I appreciate the prominence you have given the accolade, but I just wanted to bring to your notice that there was an incorrect reference to charges for patient consultations made by my late parents Dr and Dr Mrs Navaratnam.
I believe it was a type written error and it should read “to every patient the consultation fee was rupees three (NOT Rs 300.00” as stated in the article). My parents did not believe in taking money from their patients as theirs was a service to humanity, but if they did charge patients it was a nominal fee of three rupees or more often than not free of charge.
I hope you will publish this correction on my behalf as my late parents left a tremendous legacy of humanity, kindness and compassion and this does not reflect what they stood for.
Preshanthi Navaratnam
Opinion
81st Birth Anniversary of Dr. (Mrs.) Dulcie de Silva – A tribute

“In the end, it is not the years in your life that count. It is the life in your years.” — a quote from Abraham Lincoln that offers me a unique perspective to reflect on the life and work of Dr Mrs. Dulcie de Silva, whose 81st birthday falls on May 12, 2025. She is fondly addressed as Dulcie. Her life so far has been full of loving relationships, intellectual curiosity, a strong commitment to helping others, and an interesting career in public health with a focus on training primary healthcare workers. These qualities have made her one of Sri Lanka’s most memorable public health figures in recent times.
Dr de Silva’s move to the Institute of Hygiene Kalutara (now the National Institute of Health Sciences – NIHS) in 1976 as a Medical Officer was a defining moment in her life. That was when she truly embraced public health as her lifelong path. Later, she became part of the faculty, training primary healthcare workers, and stood out as one of its pioneers. She had the good fortune to be mentored by the late Dr Godwin Fernando, who took on the role of Chief Medical Officer of Health Kalutara in 1972. She also worked alongside a passionate group of co-workers from various health fields.
In the early 1970s, public health started going through a major transformation, especially in how front-line health workers were trained. This shift really kicked off when Dr Godwin Fernando became Chief Medical Officer of Health.
The transformation was not easy. It was a tough journey driven by Dr Fernando’s strategies, in partnership with his team — with Dr de Silva playing a key role. There was careful planning and structured roll-outs aimed at addressing the country’s health training needs more effectively. Getting approval from the ministry and cabinet was a major hurdle. Dr Fernando and his team had to navigate uncertainty and challenges to get NIHS recognized as a decentralized unit of the Ministry of Health. He had the willpower and skills to face whatever came his way. “Si vis pacem, para bellum” (If you want peace, prepare for war). Dr Fernando had a rare ability to anticipate the future. He was incredibly resilient — able to adapt, recover, and continue. With these strengths, he led an effort to persuade, negotiate, defend, and compromise in the interest of what became a nationally recognized achievement.
This entire journey gave Dr de Silva the experience to equip herself with future-ready skills and long-term success. She believed that “a vision is not enough; it must be combined with venture. It is not enough to stare up the steps; one must also step upstairs.” She believed bringing new life to your life requires focus, dedication, and emotional energy. She was driven by purpose and eventually became the fifth Director of NIHS in 1997 serving until her retirement in 2004.
The golden years of NIHS began with its full autonomy as a decentralized body under the Ministry of Health. This stage involved major developments in human resources, infrastructure and curriculum redesign, to mention but a few.
From the early 1980s, NIHS took new steps in its training programs. A notable example was the community development project in Adikarigoda, a small village near Kalutara, which became a “community school” offering direct training and research opportunities. Dr Halfdan T. Mahler, then Director-General of the World Health Organization, visited both NIHS and this village in the mid-1980s. He was deeply moved by the sense of unity and spirit there. In appreciation, Dr Mahler made a personal donation to restart a preschool project that had stalled for years. Dr Mahler is known for launching the “Health for All by the Year 2000” strategy.
Dr de Silva had a talent for managing problems. She was a moral compass who made steady, thoughtful decisions. Her leadership style was marked by calm strength, confidence, and consistency. She was known for doing ordinary things in extraordinary ways and following the principle: “Never impose on others what you would not choose for yourself.”
She was an erudite person with immense potential and experience in teaching and learning — providing a dynamic environment that nurtured intellectual curiosity, critical thinking, and ethical leadership. She believed in lifelong learning. “Ancora imparo” (Still, I am learning) — the Italian quote fits her perfectly.
Dr de Silva’s family and social life were filled with joyful moments and admirable qualities. She was always kind-hearted, cheerful, and modest — someone who lived with grace and grit. I remember the birthday parties of our sons and daughters back in the 1970s when we lived in the NIHS quarters. Today, you have your elder sons, daughter, grandchildren, and Mr. Andrew de Silva — once Secretary of Education close to you in your senior years.
You now lead a virtuous family life deeply rooted in religious and spiritual pursuits. “A virtuous wife was one who led the good life. A good laywoman endowed with religious devotion, moral virtues, and openness as well as wisdom and learning and gifting to charity makes success of her life in this very existence.” (Samyutta Nikaya)
Dr de Silva returned to public life though in a limited way after ten years of retirement, as a co-founder of the NIHS Pensioners’ Association, formed in December 2014. She served as its president for nine consecutive years. The association’s mission is to support the health, social, and spiritual needs of its members, while also showing continued loyalty to NIHS. One of its major achievements was naming the NIHS Auditorium as “Dr Godwin Fernando Memorial Auditorium” — a lasting tribute to a public health pioneer. The association celebrated its 10th anniversary in December 2024, marking a significant milestone.
On aging, Dr de Silva believes that with the right attitude and healthy spirit, aging can bring joy and new rewards. She feels positive aging is about being confident, staying active, and living fully.
She has answered some of life’s deepest questions: How should I live my life? For what should I aim? What values should I live by? These are what some call “Socrates questions.”
Dr de Silva has lived a psychologically rich life — never boring, always full of new experiences. She is a rare blend of qualities in one person. She lived authentically and gracefully and is undoubtedly a true legend of our time. Her contributions to public health are clear and lasting.
As she continues her retirement journey, I wish her good health and much joy in the years ahead.
The wonderful memories we share are priceless.
A.K. Seneviratne
A Former Senior Tutor, Public Health
NIHS Kalutara
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