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Possible resurgence of childhood measles; last thing we need

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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From stabilisation to transformation without delay

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At a symposium on reconciliation organised by the National Peace Council last week, more than 250 religious clergy, civic activists and political representatives from different communities gathered to discuss the country’s future. Speaking at the event, Minister Bimal Rathnayake explained the government’s approach to national reconciliation. He said the government viewed the country’s recovery in terms of a three stage process. The first stage was stabilisation, the second was development and the third was transformation. Reconciliation, he implied, would come in that final stage. The participation of Opposition Leader Sajith Premadasa at the same symposium, and the constructive nature of his comments, strengthens that hope.

When the present NPP government took office in 2024, the country was emerging from one of the gravest crises in its post Independence history. The economic collapse of 2022 had led to shortages of fuel, food, medicines and electricity. Inflation soared, foreign reserves disappeared and long queues became part of daily life. The political upheaval that followed culminated in the resignation of former President Gotabaya Rajapaksa after mass public protests under the banner of the Aragalaya movement. The country was then governed by a leadership that spoke the language of reform and reconciliation but was widely perceived as lacking a direct popular mandate.

Sri Lanka’s past experience suggests that stabilisation and transformation cannot be treated as entirely separate stages. Postponing reconciliation until some future moment risks repeating the failures of the past. If transformation is endlessly delayed until a supposedly perfect moment arrives, there will always be new crises and new reasons for postponement. Minister Rathnayake’s contention that the government’s immediate priority has necessarily been stabilisation flows from the government’s awareness of the precarious situation the country is. Over the past two years, the government has succeeded to a significant extent in restoring economic and political stability. Inflation has reduced, shortages have ended and public institutions have regained a degree of functionality.

Guaranteed Changes

On the other hand, the country’s development continues to face challenges due to adverse global conditions, including disruptions caused by conflict in the Middle East and extreme weather events that have affected tourism, trade and the cost of living. The danger is that reconciliation may be indefinitely postponed in the name of stabilisation. This danger can be reduced if the government works proactively with the opposition and civil society to commence practical measures of transformation now rather than later. The participation of Opposition Leader Sajith Premadasa at the symposium, and the constructive nature of his comments, has strengthened the sense that bipartisan engagement on reconciliation may now be possible.

The urgency of transformation came through strongly in the presentations made by representatives of the Sri Lanka Tamil and Malaiyaha Tamil communities. ITAK parliamentarian S.Shritharan spoke of the frustration caused by unresolved post war issues in the north and east. He referred to disputes regarding land occupied during the war years, including controversies linked to Buddhist temples and state sponsored settlement activity in areas claimed by local communities. He also pointed to the continuing large scale presence of the security forces in the north and east nearly two decades after the end of the war. These grievances have remained central to Tamil political discourse since the end of the armed conflict in 2009. Families displaced by war continue to seek the return of ancestral lands. Civil society organisations in the north have repeatedly called for greater civilian control over local administration and a reduction in military involvement in civilian life.

Academic research and practical work on the ground have shown that reconciliation cannot be separated from questions of dignity, equality and justice. Former minister Mano Ganesan, leader of the Democratic People’s Front, focused on the longstanding problems faced by the Malaiyaha Tamil community. He spoke passionately about continuing housing shortages, landlessness and economic marginalisation, issues that have persisted since Independence. He also highlighted the devastating impact of recent extreme weather events on estate communities that remain socially and economically vulnerable. The condition of the Malaiyaha Tamil community remains one of the enduring social justice issues in Sri Lanka.

After Independence in 1948, a large proportion of them were denied citizenship and voting rights through legislation that rendered them stateless. Though citizenship rights were eventually restored, the social and economic consequences of exclusion continue to be felt generations later.

Many families still lack secure housing and land ownership despite their immense contribution to the country’s plantation economy. Minister Rathnayake’s responses to both these concerns were politically significant. He argued that recent political developments, including the declining influence of narrow ethnic politics across communities, indicated a major shift in public attitudes. According to him, the political ground has changed in ways that make it increasingly difficult for politicians who rely primarily on ethnic division and communal insecurity to retain public support.

Inter-Connected

There is evidence to support the assessment about the changing political grounding which sees future prospects in the resolution of long standing problems. . The economic collapse of 2022 affected all communities alike and generated a new politics centred on governance, anti corruption, accountability and economic justice. The Aragalaya protests brought together Sinhalese, Tamils and Muslims in a common demand for political change. Although ethnic grievances have not disappeared, the crisis created space for a broader understanding that the country’s future depends on cooperation rather than division. Opposition Leader Premadasa’s comments at the symposium reflected this changing political climate. He emphasised that national reconciliation could not be separated from economic justice and the need to address disparities between regions and social classes.v He also mentioned the need for civil society organisations to take this message to the community. This wider understanding of reconciliation is important because ethnic inequality and economic inequality have often reinforced each other in Sri Lanka’s history.

Academic studies have identified the denial of citizenship rights after Independence as a historic injustice that set back the Malaiyaha community for decades. The challenge now is to ensure that transformation becomes part of the stabilisation and development process itself. Practical first steps are both possible and necessary. The release of civilian lands still under state control, greater devolution of administrative authority, reduction of military involvement in civilian affairs, language equality in public administration and accelerated housing and land ownership programmes in the plantation sector are all measures that can begin immediately without waiting for a final stage of transformation.

The government’s recent commitment that provincial council elections will finally be held this year is therefore significant. These elections have been repeatedly postponed by successive governments. Holding them would not solve the ethnic conflict by itself. But it would signal a willingness to restore democratic institutions and share power in a meaningful way.

Sri Lanka has repeatedly postponed difficult reforms in the hope that a more convenient political moment would eventually arrive. But opportunities are invariably created and fought for instead of being provided as a gift by a benevolent government.

The present moment, shaped by the economic crisis and public demand for accountable government, offers a rare opportunity to move simultaneously towards stability, development and reconciliation. Provincial council elections can be the first meaningful step. But they must not be the last.

by Jehan Perera

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Researchers to shape new environmental policy framework

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Some of the researchers at the meeting

In a significant move aimed at steering Sri Lanka’s environmental governance towards a more science-based and evidence-driven path, the Ministry of Environment has initiated a new collaborative mechanism to integrate leading researchers into national policy formulation and conservation planning.

The initiative was discussed at a high-level meeting chaired by Dr. Dammika Patabendi at the Ministry of Environment on Tuesday, where top environmental scientists, wildlife experts and researchers were invited to contribute towards what officials described as a “strategic transition” in the country’s environmental management framework.

The discussions focused on strengthening the scientific basis of environmental conservation programmes and national policy decisions while creating a more research-friendly environment for academics and field scientists engaged in biodiversity and ecological studies.

Particular attention was paid to long-standing concerns raised by researchers regarding procedural and operational difficulties encountered when conducting studies in collaboration with the Department of Wildlife Conservation and the Forest Department.

Minister Patabendi stressed the need for environmental policies to be guided by credible scientific data rather than ad hoc administrative decisions, ministry sources said.

Among the key proposals discussed was the establishment of a streamlined mechanism that would reduce bureaucratic obstacles faced by researchers in obtaining approvals, accessing field sites and sharing scientific findings with state institutions.

The Minister highlighted the importance of building stronger partnerships between policymakers and the scientific community at a time when Sri Lanka is grappling with escalating environmental challenges including deforestation, biodiversity loss, human-elephant conflict, climate-related disasters and ecosystem degradation.

Environmentalists attending the meeting had also highlighted the urgent necessity of incorporating empirical research into national decision-making processes to ensure long-term ecological sustainability and better resource management.

The meeting brought together several of Sri Lanka’s leading environmental researchers and academics including Rohan Pethiyagoda, Saminda Fernando, Sewwandi Jayakody, Samantha Gunasekara, Dinidu Devapura, Himesh Jayasinghe, Manoj Prasanna, Mendis Wickramasinghe and Suranjan Karunarathna.

Director General of Wildlife Conservation Ranjan Marasinghe also participated in the deliberations.

Officials said the proposed framework is expected to pave the way for a more transparent, data-oriented and scientifically credible environmental governance structure capable of addressing emerging conservation challenges more effectively.

The government expects the new mechanism to support the implementation of practical and scientifically robust programmes aimed at safeguarding Sri Lanka’s ecological future while enhancing cooperation between state agencies and the country’s growing community of environmental researchers.

 

By Ifham Nizam

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Back home … for a special occasion

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Seven Notes: Sri Lankans based in Dubai – with Niluk (second from left)

Niluk Uswaththa, of Seven Notes fame, based in Dubai, surprised many when he and his wife Apeksha, turned up in Colombo, last week … unannounced.

Yes, they had a purpose in their surprise visit … to wish Apeksha’s mum for her birthday, which was on Monday, 18th May, and what a surprise it turned out to be!

In an exclusive chit-chat with The Island, Niluk said that the scene in Dubai is improving and Seven Notes do have work coming their way.

Since the members of Seven Notes are all employed (doing day jobs), they operate only on Saturdays and Sundays.

Niluk: Didn’t come prepared to perform, but obliged
friends in Galle

In fact, to get to Colombo for the birthday surprise (on Monday, 18th May), the band had to skip their 17th May, Sunday gig.

“Although it’s a short vacation, my wife and I are enjoying the setup here,” said Niluk, adding that they spent two days in Galle and that their next destination is Anuradhapura.”

Niluk didn’t come prepared to perform, but he obliged the crowd present, at a friend’s birthday celebrations, in Galle, singing and playing guitar.

They are scheduled to leave for their home, in Dubai, in the first week of June.

Seven Notes is an outfit made up of Sri Lankans and the band has been around for almost nine years.

Niluk came into their scene nearly seven years ago.

“When I went to Dubai, I had offers coming my way but it was Seven Notes that impressed me because of their acoustic style.”

The Dubai’s entertainment scene is showing clear signs of bouncing back and even levelling up in the next few months.

Niluk and Apeksha: Enjoying their short vacation

After a slowdown earlier this year due to regional tensions, shows and festivals are back on the calendar, and organisers say late 2026 could be the busiest concert season in years.

Time Out Dubai says “the 2026 concert calendar is filling up nicely” and “the city is ready to party once again” after some reschedules.

Dubai Summer Surprises in July brings retail activations, comedy nights, and indoor art exhibitions.

Organisers point to a backlog of postponed events that are being rescheduled for late 2026 and early 2027.

Yes, Dubai is calm on the surface but on alert. Life is mostly normal in the city, but there’s a “balancing act” as people watch for escalation.

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