Features
Public scepticism regarding paediatric preventive interventions
A significant portion of the history of paediatrics is a triumph of prevention. From the simple act of washing hands to the miracle of vaccines, preventive strategies have been the unsung heroes, drastically lowering child mortality rates and setting the stage for healthier, longer lives across the globe. Simple measures like promoting personal hygiene, ensuring the proper use of toilets, and providing Vitamin K immediately after birth to prevent dangerous bleeding, have profound impacts. Advanced interventions like inhalers for asthma, robust trauma care systems, and even cutting-edge genetic manipulations are testament to the relentless and wonderful progress of paediatric science.
A shining beacon that has signified increased survival and marked reductions in mortality across the board in all paediatric age groups has been the development of various preventive strategies in the science of children’s health, from newborns to adolescents. The institution of such proven measures across the globe, has resulted in gains that are almost too good to be true. From a Sri Lankan perspective, these measures have contributed towards the unbelievable reduction of the under-5-year mortality rate from over 100 per 1000 live births in the 1960s to the seminal single-digit figure of 07 per 1000 live births in the 2020s.
Yet for all this, despite the overwhelming evidence of success, a most worrying trend is emerging. That is public scepticism and pessimism regarding these vital interventions. This doubt is not a benign phenomenon; it poses a real danger to the health of our children. At the heart of this challenge lies the potent, often insidious, spread of misinformation and disinformation.
The success of any preventive health strategy in paediatrics rests not just on its scientific efficacy, but on parental cooperation and commitment. When parents hesitate or refuse to follow recommended guidelines, the shield of prevention is compromised. Today, the most potent threat to this partnership is the flood of false information.
Misinformation is false information spread unintentionally. A well-meaning friend sharing a rumour about a vaccine side-effect they heard online is spreading misinformation.
Disinformation is false information deliberately created and disseminated to cause harm or sow doubt. This often comes from organised groups or individuals with vested interests; sometimes financial, sometimes ideological, who seek to undermine public trust in medical institutions and scientific consensus.
The digital age, particularly social media, has become the prime breeding ground for these falsehoods. Complex scientific data is reduced to emotionally charged, simplistic, and often sensationalist soundbites that travel faster and farther than the truth.
The most visible battleground is childhood vaccination. Decades of robust, high-quality research have confirmed vaccines as one of the most cost-effective and successful public health interventions ever conceived. Global vaccination efforts have saved an estimated 150 million lives in the past 50 years, eradicating or drastically controlling diseases like polio, measles, diphtheria, and tetanus.
However, a single, long-retracted, and scientifically debunked paper claiming a link between the Measles-Mumps-Rubella (MMR) vaccine and autism continues to be weaponised by disinformation campaigns. This persistent myth, despite being soundly disproven, taps into deep-seated fears about children’s development. Other common vaccine myths target ingredients such as trace amounts of aluminium or mercury, which are harmless in the quantities used and often less than what is naturally found in food or the idea that “natural immunity” from infection is superior, totally ignoring the fact that natural infection carries the devastating risk of severe complications, long-term disability, and even death. The tangible consequence of this doubt is the dropping of childhood vaccination rates in various communities, leading to the wholly unnecessary re-emergence of vaccine-preventable diseases like measles.
Scepticism is not limited to vaccines. It can touch any area of paediatric preventive care where an intervention might seem unnecessary, invasive, or have perceived risks. Routine screenings for speech disorders, motor skills, or mental health issues can sometimes be perceived as medicalising normal childhood variations or putting a “label” on a child. Parents may resist or delay screening, missing the critical window for early intervention of proven measures that are likely to help. Advice on managing childhood obesity, reducing screen time, or adopting a balanced diet can be viewed by some parents as intrusive or judgmental, leading to poor adherence to essential health-promoting behaviours.
The regular use of inhalers for asthma or other chronic conditions might be looked down upon due to the fear of “dependency”, “addiction”, or long-term side effects, despite medical consensus that these preventive measures keep conditions controlled and prevent life-threatening exacerbations.
The common thread is a lack of understanding of the risk-benefit ratio. Parents, bombarded by fear-mongering narratives, often overestimate the rare, mild risks of an intervention while catastrophically underestimating the severe and permanent risks of the disease or condition itself.
The power of paediatric preventive medicine is not in a single shot or pill, but in the consistent, committed partnership between healthcare providers and parents. Paediatric science, driven by rigorous evidence-based medicine, do continue to refine guidelines, conduct transparent research, and communicate its findings clearly. When guidelines are confusing or lack robust evidence, it naturally creates openings for doubt. The scientific community’s commitment to continuous quality improvement and accessibility is paramount.
Ultimately, the success of prevention rests with the parents. Parenting, as a vital form of preventive care, includes all activities that raise happy, healthy, and capable children. The simple, non-medical steps mentioned in the introduction, proper handwashing, good sanitation, and encouraging exercise, are all forms of parental preventive intervention.
For more complex interventions, parental commitment requires several actions. They need to seek and trust the guidance provided by qualified healthcare professionals over anonymous, unsubstantiated online claims. They need to engage in an open dialogue by asking relevant questions and expressing concerns to doctors in an open, non-confrontational manner. A good healthcare provider will use this as an opportunity to educate and build trust, and not a portal to simply dismiss concerns. Then, of course, there is the spectre of adherence to various protocols and actions by the parents. These include consistently following recommended schedules, whether for well-child checkups, vaccinations, or daily medication protocols.
Addressing public scepticism requires a multi-pronged, collaborative strategy. It is not just about correcting false facts (debunking), but about building resilience against future falsehoods (prebunking). The single most influential voice in a parent’s decision-making process is their paediatrician or primary care provider. Clinicians must move beyond simply reciting facts. They need to use empathetic communication techniques, like Motivational Interviewing (MI), which focuses on active listening, validating parental concerns, and then collaboratively guiding them toward evidence-based decisions. For example, responding with, “I hear you’re worried about the side-effects you read about. Can I share what we know from decades of safety monitoring?” Being open about common, minor side effects such as a short-lasting fever after a vaccine pre-empts the shock and distrust that occurs when an expected, yet unmentioned, reaction happens.
Public health campaigns must go on the offensive, not just a defensive fact-checking spree. Teaching the general public how disinformation works, the use of “fake experts”, selective cherry-picked data, and conspiracy theories all add up to a most powerful form of inoculation (prebunking) against future exposure. Health institutions must simplify their communications and make verified, high-quality information easily accessible on platforms where parents are already looking.
Parents often trust their peers as much as their doctors. Engaging local community leaders, faith leaders, and even trusted social media influencers to share accurate, positive messages about paediatric health can shift the public narrative at a grassroots level. While protecting privacy, sharing aggregate data and stories about the dramatic decline in childhood diseases thanks to prevention can re-emphasise the collective good.
The battle against child mortality and morbidity has been one of the great human achievements, a testament to scientific ingenuity and collective effort. Today, the greatest threat to maintaining these gains is not a new virus, but a breakdown of trust fuelled by unchecked falsehoods.
Paediatric preventive interventions, from a cake of soap and a proper toilet to the most sophisticated genetic therapies, are the foundation of a healthy future for every child. To secure this future, the scientific community must remain transparent, the healthcare system must lead with empathy, and the public must commit to informed, critical thinking. By rejecting the noise of disinformation and embracing the clear, evidence-based consensus of science, we can ensure that every child continues to benefit from the life-saving progress that defines modern paediatrics. The well-being of the next generation demands nothing less than this renewed commitment.
Little children are not in a position to make abiding decisions regarding their health, especially regarding preventive strategies in health. It is ultimately the crucial decisions made by responsible parents regarding the health of their children that really matter. As doctors, our commitment is never to leave any child behind.
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.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
Features
The Division Bell Mystery
Tales of Mystery and Suspense 3
The murder, in a private dining room in the house, is of a financier with whom the government was negotiating a loan. When this seemed difficult the Minister of Home Affairs agreed to lead discussions, since he had known Mr Oissel the financier when they were young. Hence the private dinner, but when the Minister stepped out for a vote, Oissel was shot just as the Division Bell rang.
The Brahms and Simon detective novels, the first of which I wrote about last week, were amongst several books by the pair that Robert Scoble gave me when I was in Australia towards the end of last year. Amongst them was another thriller of a very different sort, though that too was written and set between the wars.
Called The Division Bell Mystery, it was set in the House of Commons, the first such book I believe, and was by Ellen Wilkinson, a Labour MP who became Minister of Education in Attlee’s government after the war, having served previously as Parliamentary Private Secretary to several ministers. Her hero Robert West is also a PPS, but a conservative, and his Minister, of Home Affairs, is an old style aristocrat, not much loved by the less orthodox Prime Minister, who nevertheless needs his support on many occasions.
The murder, in a private dining room in the house, is of a financier with whom the government was negotiating a loan. When this seemed difficult the Minister of Home Affairs agreed to lead discussions, since he had known Mr Oissel the financier when they were young. Hence the private dinner, but when the Minister stepped out for a vote, Oissel was shot just as the Division Bell rang.
West was just outside the door when the shot was heard, and when he opened it saw only the dead body with a revolver beside it. The assumption that this was suicide was however challenged by Oissel’s grand-daughter Annette, who was his heir, on the grounds that he would never have killed himself. But her view was given greater credence by the Inspector put in charge of the case who said there were no burn marks on the body which would have been the case had Oissel fired the pistol himself.
Matters are complicated by the fact that Oissel’s flat had been burgled while he was at dinner, and Jenks the policeman allocated to him, who had served the Home Secretary and seemed more acceptable to Oissel than someone from the Security Service, had been killed. Matters get even more complicated when Annette says her grand-father’s notebook in which he wrote his secrets in cipher was missing.
That was found in Jenks’ pocket, and then a photographer came to West to say he had been asked by Jenks to photograph this. More worryingly for West, he finds in the Home Secretary’s drawer a few pages from the notebook with what appears to be an interpretation of the cipher.
Overwhelmed by all this he confides in a recently created peer who knows all about the business world, who insists that they leave the house party at which they had met over dinner and discuss the matter with the Prime Minister who promptly summons the Home Secretary.
But the Home Secretary had gone to Scotland to launch a ship over the weekend, so the meeting could take place only on the morning of the Monday, when difficult questions were expected on the adjournment motion. He admits at the meeting that he had got Jenks to take the notebook, and also that he knew the code since it had been created by him and Oissel when they were young.
He thought he should resign, and even contemplated suicide, but the Prime Minister told him that that would be even worse for the government, and that he should go home to bed. The Prime Minister said that he himself would handle the question, which he did with aplomb, insisting that confidentiality was needed until the inquest. What had happened would be made clear then, he declared, leaving West and Inspector Blackit and Lord Dalbeattie what seemed the impossible task of solving the murder.
Dalbeattie had suggested that West ask a female Labour MP who was very fond of him to get what information she could from the staff. That there was some involvement there had become clear when West, going back late one night to collect a briefcase he had left in a dining room, found someone lurking in the dark in the corridor outside the private rooms. Room J, where the murder had happened, was meant to be guarded throughout by a policeman, but he had left the room having felt dizzy, and it seemed that his coffee had been drugged. West’s sudden appearance however had prevented anyone else getting into the room.
Dalbeattie decides to recreate the scene of the murder and has a dinner party in Room J on the Tuesday night, inviting West and Annette and the society hostess at whose house he had met, and also Patrick Kinnaird, an MP who was engaged to Annette, as well as the Permanent Secretary to the Home Ministry.
After coffee Inspector Blackit comes in with Grace, the Labour MP who had got the confidence of the staff, and a journalist who had also been helpful, and just as they say they think they are on the track the division bell rings. Grace jumps up and tells the Inspector that that provides the solution and they get a ladder, and sure enough find the revolver in the space where the bell is. Directed at the place where Oissel had sat, it had been primed to go off with the ringing of the bell. The waiter who had helped to set things up made clear who the murderer had been.
The reason for the murder and the confused motives of all those involved made for a fascinatingly intricate mix. But also impressive in the book were the descriptions of the isolation possible in the crowded premises of the house, the forceful characterization of the members – Grace based on the writer, the society hostess based on Nancy Astor, the first female MP – and the laid back nature of senior politicians which West realized had to change in the brave new world of high finance.
Features
The challenge of keeping value-based politics alive
The current outbreak of anti-immigrant protests in Durban, South Africa is bound to have taken many a subscriber to value-based politics or political idealism quite by surprise. After all, this is evidence that despite the historic accomplishments of nation-builders of the stature of the late President Nelson Mandela it cannot be taken for granted that identity politics, including racism in its worst forms, is no more in South Africa.
At the time of this writing details are scarce on the substantive root causes of the protests but it could very well be that economic grievances, particularly on the part of the majority community in South Africa, are contributing considerably to the disaffection. Shrinking employment and material prospects are likely to figure majorly among the factors igniting the unrest.
Fortunately, the local authorities in Durban are losing no time in calling for peaceful co-existence among the relevant communities and are pointing to the vital importance of stepping-up national integration processes. Apparently, immigrants in sizable numbers from neighbouring countries are present in Durban. However, international TV footage of the protests quoted some local authorities as saying that the majority of the immigrants in some centres that housed them were not illegal migrants and had the documents that entitle them to be in Durban.
In the Durban protests the world has fresh proof of the socially divisive consequences of the gathering globe-wide economic disaffection, touched off particularly by the continuing crisis in West Asia. Going ahead, the world would need to brace for increasing identity-based unrest of the kind it is just witnessing in South Africa.
Considering that the material lot of ordinary people everywhere could only aggravate progressively, with the US and Iran showing no signs of negotiating an end to their confrontation any time soon, it will be left to the more democratic and progressive sections of the world community to initiate positive measures collectively to bring a measure of relief to the discontented.
The swiftness with which such relief will be provided would depend crucially on the importance those sections taking up these undertakings attach to value-based politics as opposed to Realpolitik of power politics.
Going by these yardsticks, Italy could be considered to be moving in the right direction. Recently Italy came to the fore in initiating the collective named, ‘Rome Coalition for Food Security and Access to Fertilizer’, which has as one of its aims the swift provision of fertilizer to economically weak African countries.
In a recent statement Italian Minister of Foreign Affairs and International Cooperation, Antonio Tajani, said that a principal aim of the project was to ensure that the farmers of Africa gained easy access to fertilizer, considering that food security is a growing concern among some of Africa’s economically vulnerable countries.
The statement went on to mention that some 30 countries hailing from the Mediterranean region, the Middle East, the Balkans as well as the FAO had been invited to join the coalition. The venture is far-seeing in that food security is main among the reasons for social discontent which in turn could degenerate into endemic political turmoil and bloodshed. Separatist violence and geographical fragmentation of countries wouldn’t be too far behind these developments, as Africa itself has often proved.
It is hoped that more G7 countries would take the cue from Italy and do what they could to ease the hardships of economically distressed countries, particularly of the global South. In these efforts they would need to break rank with the US, which is today brutally indifferent to the consequences of its policy of making ‘America First’, come what may.
Going by current developments, the Trump administration seems to be blithely oblivious to the wider, deleterious effects of its policy course in West Asia. Besides rendering Iran militarily and otherwise impotent nothing else seems to matter to Washington, as regards West Asia. This is policy short-sightedness of an extreme kind. After all, right now West Asia could be said to be sitting on the proverbial powder keg.
On the other hand, Iran is not giving the world the impression that it is doing anything constructive to get out of the policy straitjacket that it wove for itself decades ago. Rather than enter into a policy of ‘live and let live’ in relation to Israel in particular and initiate a process of reconciliation with the latter, it has chosen to operate within policy parameters that continue to damn Israel. This has put Israel always on the ‘defensive’ so to speak and prevented the opening up of space for meaningful dialogue.
That said, Israel is obliged to explore the possibilities of entering into a negotiatory process with the Arab-Islamic world that could lead to a de-escalation of tensions and bloodshed. It cannot continue to look at its neighbours through lenses that distort them as archetypal enemies who should be ‘wiped off completely from the face of the earth.’
In other words, the need is urgent for Realpolitik to give way to value-based politicks. Italy is beginning to prove that the latter approach could be pursued with some success. May be the EU and the UK could throw their weight behind these initiatives as well and establish that international politics could be refashioned on the basis of humane, civilized norms. The UN would need to be fully supportive of these moves and prove an organizational nucleus of the operations that follow.
In fact the time is ripe for people of conscience to collectively stand up on the side of peace and say ‘No’ to war and violence. Organizations such as the ICRC, the WHO and Medicines Sans Frontiers have already taken up this call. Referring to the widespread destruction of health facilities and their dehumanizing results these organizations have said, among other things, that ‘This is not a failure of the law. It is a failure of political will.’
True, ‘failure of political will’ among those powers that matter accounts for the runaway, uncontrollable nature of war and destruction in contemporary times, but more fundamentally it is a failure of the human conscience. It could very well be that the phenomenal levels to which violence and war have been unleashed today have had the effect of deadening consciences. This is a matter for urgent study and wide discussion.
Features
Vesak celebrations … with Cuteefly
I would describe Indunil Kaushalya Dissanayaka as innovative and creative, and she operates under the name of Cuteefly.
Indunil always comes up with something novel to celebrate special occasions, and she does it with candles … and that’s her profession.
She was in the spotlight when she created a happening scene, with candles, for Christmas, Sinhala and Tamil New Year, and Valentine’s Day.
As lanterns light up Sri Lanka for Vesak, the Colombo-based candle maker is quietly turning wax and wick into little pieces of the festival.

Candles reflecting Vesak themes
Her candles reflect Vesak themes – light, peace, remembrance, giving, etc., to enable you to fill your Vesak celebration with devotion and beauty.
Among her Vesak creations is a lotus-shaped soy candle, scented with sandalwood, lavender, etc., meant to burn during this Vesak Poya Day.

Indunil Kaushalya Dissanayaka: Customers
praise her for her creativity
These handcrafted Vesak candles are perfect for offering at the temple, she says.
What makes her creations so novel is that they come in different shapes, scents, themes, and all are handmade.
What’s more, her customers have heaped praise on her for her creativity.
According to Indunil, her creations are perfect as a thoughtful gift … to bring beauty, unity, and light into every moment.
Says Indunil: “Our beautifully handcrafted Unity candles are designed with premium detail and love, making them perfect for celebrations, gifts, and meaningful occasions.”
Cuteefly, says Indunil, is available online.
Readers could contact Indunil on 0778506066 for more details.
He Facebook Page is: Cuteefly.

Handmade with love
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