The President of Sri Lanka had said that the only solution with any certainty to the Covid pandemic is vaccination. This is true because prevention is less effective when dealing with a highly infectious and elusive virus capable of mutating into more and more infections and deadly strains like the Covid-19 virus. On the other hand, a vaccine could prevent it more effectively or reduce its effects significantly. A country cannot be locked down for ever whether partially or totally, a way out has to be found and the only way is to vaccinate sufficient numbers to achieve herd immunity. However no vaccine gives 100% immunity but all of them that are being used at present are effective in preventing serious illness necessitating hospitalization and death which is a huge bonus to poor countries. This is not to suggest that preventive measures like face masks, washing hands, social distance and avoiding mass gathering are ineffective and unnecessary, on the contrary they are essential until sufficient numbers are immunized.
Importance and the effectiveness of the Covid vaccines cannot be down played. This is why countries like the US which were ravaged by the virus are going pell mell with their vaccination programmes and closing in on achieving herd immunity. Europe at present has 53 vaccine manufacturing sites and is planning to have more of them. They have delivered 100 million to member countries and plan to produce sufficient doses to immunize 70% of their population by end of July and 3 billion doses by end of the year. They are planning to have a near normal Summer. These countries know the value of vaccines. Herd immunity in relation to major infectious disease has not been achieved by the natural process of the infection but by vaccination. A good example is Measles.
However, there are practical problems with regard to adequate vaccination, such as insufficient availability, cost, logistical issues, people’s acceptance and even politics particularly in a country like Sri Lanka where any issue is maximally politicized by politicians of both sides of the divide. Global politics also could be a factor with world powers expecting hegemonic favours. Sri Lanka received a gift of vaccine from India at the beginning and started a roll out very efficiently but unfortunately it has run into snags as the supply of Indian vaccine is uncertain as India is engulfed in an unprecedented catastrophe due to the ruthless pandemic. It has also received Chinese vaccines but seems to be reluctant to use it until WHO approval is given.
Sri Lanka may also receive the Russian Sputnik vaccine which has been approved by the WHO. It plans to purchase about 13 million doses which would be sufficient to vaccinate about 3% of the population. According to experts like Christellu Liboudo MD at least 80-90% of the population (this figure varies according to the virus) has to be immunized either by previous infection or vaccination to reach herd immunity. This means we will need quite a lot of vaccine doses to come out of the mire. From where could we get them. India has to immunize its own population of one billion before it could think of giving it to others. Prime Minister Modi is unpopular for blundering in the management of the pandemic and will not want to make it worse by depriving the life saving vaccine to their own people. Other vaccine producing countries like the US, UK may not give us the vaccine, they are accused of hoarding the vaccine in excess of their own needs. Could you blame them, though WHO calls for equitable distribution of vaccine the citizens are priority in a struggle for survival.
The only vaccine producing country which has no urgent need for it is China. It has vaccinated 200 million of its people and is planning to vaccinate the rest at the rate of one million a day! It has about five vaccines which are ready for Stage 111 trials. None of them has received WHO approval. Two of these vaccines Sinopharm and Sinovac have entered the last phase to join the COVAX vaccine initiative of the WHO and a final decision is expected before 3rd of May 2021. WHO has pledged Sri Lanka to supply vaccines sufficient for 20% of our population through the COVAX programme. But due to lack of supplies it has not been possible to meet this commitment. However with the approval of the two Chinese vaccines hopefully these would be available in Sri Lanka sooner than later. China is increasing its vaccine producing capacity and would soon develop into be the largest producer.
Chinese vaccines are being used in 65 countries at present despite the fact that they are not approved by the WHO. These include 13 countries in Latin America, 25 in Africa, 22 in Asia and 5 in Europe. And they include countries like Indonesia, Malaysia and Thailand which are more developed than Sri Lanka. In the past week Thailand and Philippines received their 3rd batch of Chinese vaccines.
It is claimed that Chinese vaccines are less effective particularly against variants of the Covid virus. The mutants would escape detection by antibodies but they would be mopped up by T Cell mechanism that has been boosted by the vaccine. This why most of the Chinese vaccines are effective against mutants found in the UK, South Africa and other countries (Global Times, 28.3.2021). In a trial conducted in Brazil 252 new cases were detected out of which 85 had been vaccinated with CoronaVac, a Chinese vaccine, while 167 had a placebo and none in the vaccinated group had to be hospitalized. The vaccine could have a role in preventing severe disease in every country says Paul Offit a vaccine scientist at the Children’s Hospital of Philadelphia in Pennsylvania (Nature, 15.01.2021).
China is Sri Lanka’s friend in need from the time of the Rice Rubber pact that rescued the country in 1952 when no other country would come to its assistance. It was not just a trade agreement but one that was favourable to Sri Lanka and Chinese magnanimity was evident in the agreement. And just last March again China came to the rescue of Sri Lanka at the UNHRC. Could we afford to be neutral and not aligned with a strong friend when we have so many ruthless enemies hovering above as shown at the UNHRC. And could we continue to be reluctant to use Chinese vaccines if we are serious about coming out of this abyss.
N.A.de S. Amaratunga
Geographical Information Maps for Covid-19 control
Around six months ago, the issue about lack of spatial information about the whereabouts of Covid-19 patients, came up, but, unfortunately, it has not been resolved yet. At that time the GMOA gave an ultimatum to the Ministry of Health that it will withdraw from the Technical Committee for Covid-19 control, if analyzed Geographical Information System (GIS) maps of Covid-19 patient-locations will not be made available. Although most don’t agree with the GMOA with some of their actions, on this matter I was more than 100% with them. The GMOA is an organization, which has many knowledgeable specialists in the areas of epidemiology, disease control and Information Technology, and I believe their knowledge, attitude and valuable inputs made it easy for the control teams to prevent the escalation of this epidemic.
The geographical maps are valuable tools to the MOHs, PHIs for their control work, and also to the general public to know of the locations of the patients, at least at the street level, so that they can avoid such areas. I think the Presidential Task Force also should be shown these maps, if they have not seen it yet, to make informed decisions. This week again, the President of the GMOA stated, over a private TV channel, that they, in fact, put up a GIS room next to the Director General of Health Services’ room, and that is a right move. He vented his frustrations when he came out with the difficulty in getting the maps done through the Epidemiology Unit to get this genre going. To fight a war there should be a central command and control room, and maps are a very important tool. Even 30 years ago, the officers in the field sent in the data about the spread of diseases, or they took samples, such as of stools of cholera patients, but they never got the analyzed reports, as someone was keeping them in the centre to write a paper to a journal.
Twenty years ago, when I was the Chief Medical Officer of Health of the CMC, realizing the value of GIS maps, I used them for dengue control in Colombo; and it provided great information to plan and implement control measures. We could see clusters of patients, and the gradual movement of the cluster into newer areas with time. My maps were used by at least the Peradeniya University to train Medical Officers in Health Mapping. I was also invited as the keynote speaker, by the Geographical Information Society. Many came to me from the Ministry of Health, KDU and other institutions to learn what we had done. Since then, the Ministry has trained some doctors who are now experts in GIS mapping, and they could be used to map the patient locations, show high, medium and low risk areas and also put in other information. The Public Health Department of CMC gave Geographical Position System-GPS training to Public Health Inspectors those days, to send in the information from the patient’s location to the GIS centre at the Town Hall, where all such information was collated. We then prepared the maps and sent them out to the MOHs and also discussed the situation at meetings.
I hope they have continued that work and, if so, they also should put out the maps of present patient locations in the CMC website, so that the people in Colombo will also know which areas in the city they should avoid. Colombo city was the centre of transmission of Covid-19 in the country a few months ago as nothing materialised. It is a pity that I can’t even get any information about Covid-19 patients in the CMC area, although I am the Chairman of the Standing Committee on Health and Sanitation at the CMC. The system I built up has come to a standstill, and sometimes even after eight months, I can’t get any answers to my questions given at Council meetings. Frustrated, I even wrote to the Epidemiology Unit asking for information about patient locations to better plan our prevention programmes, at least to prevent patients dying at home. But after listening to the GMOA President, yesterday, I now know it is a futile exercise. Information is power, but why not give it at a time of national crisis for the greater good of the people?
Technology should be used in disease prevention as much as possible, especially in this case, but the people in top positions are scared to use newer technology mostly because they don’t know about such technologies, or do not know how to use them. When PCR testing was started, a few leading private firms wanted to donate the latest automated PCR machine, but it was turned down by the people who were to use it, as they wanted a machine that could be used manually. That was my personal experience. There are other interests involved, too. Now I believe only the Sri Jayewardenepura University has an Automated machine which is 4-5 times faster in giving results.
Similarly, through GIS mapping we can put together a lot of information in a short time, and the analyzed information can be made available to the people who make decisions, and those in the field. Seeing the ground situation with one’s own eyes, is better than seeing some numbers. I hope the President, the Ministers and the Presidential Task Force will seriously take note of this, as this is very valuable public information that can be used to control this epidemic, at this critical juncture. For example, the information through maps could be used at least to know whether we should lock down a city or a district, or a province, or a few of them, etc., to prevent further escalation of this Covid-19 epidemic. There could be even a working sub-committee set up to do this work. Please do not put away this information in cold storage as someone’s private property. Let saner counsel prevail.
Dr. PRADEEP KARIYAWASAM
Chairman, Standing Committee on Health/CMC
Minister Gamini Lokuge’s damage to people’s health
Two consecutive editorials, published in The Island on the 7 and 8 May, lambasted the despicable intervention of the Minister of Transport, Gamini Lokuge, for being instrumental in lifting the lockdown, in Piliyandala, against the advice of the health authorities.
A team of health officials, led by the MOH Piliyandala, backed by PHIs, and the DGHS, based on the recommendations of his officers, decided to lock down the Piliyandala town, as it had taken a turn for the worse, due to the rapid spread of the epidemic.
Minister Lokuge is reported to have admitted, at an interview with Hiru News, that he influenced the lifting of the lockdown in Piliyandala, and The Island, of May 10, highlighted the circumstances that led him to influence the lifting of the lockdown. The Minister accepted that he influenced the lifting of the lockdown for the sake of the daily wage earners, a claim which has to be taken with a pinch of salt.
Close on the heels of the Minister’s arrogant countermand, a cluster of 138 patients was detected from the Piliyandala market.
A vendor collapsed in the market itself and his post-mortem proved that he was afflicted with the coronavirus.
The female MOH, who deserves to be praised for the adroit manner in which she has been performing duties in Piliyandala, said over the television that the cluster could have been averted, if the lockdown had not been lifted.
Hence, the Minister’s overzealous attempt to look after the livelihood of the daily wage earner, is certainly humbug, which cannot be condoned under any circumstances.
Readers would remember that the High Courts of Madras and Calcutta lambasted the Election Commission of India for their failure to ensure the recommended protocol meant for Covid-19, and openly said the ECI should be put on murder charges.
Could we reasonably expect that the authorities institute murder charges against the Minister, in the resplendent island, so that legislators, with bloated egos, could be reined in this hour of calamity.
Undoubtedly, idiotic action on the part of the Minister has endangered the precious lives of the people living in the Piliyandala area.
The childish manner in which the Minister responded to the questions, as reported by The Island correspondent, raises a number of issues. The foremost issue is whether he, as a senior Minister of the government, is capable of running an important Ministry, as he has messed up a vital epidemic issue, involving his own constituents.
Secondly, he has caused much embarrassment to the Commander of the Army and Head of the Presidential Task Force who has undertaking an arduous operation.
His argument that if the lifting of the lockdown was wrong then it should have been imposed again, is ridiculous.
All in all, what I could say is that the Minister’s high-handed intervention has left a bad taste in many a mouth, and it has caused an irrparable damage to the government at a time when its popularity is plummeting at a rapid pace.
Non-science used as science
I have read with interest the article on “Science, Non-science and Nonsense” written by Dr. Sarath Gamini De Silva in “The Island” of 11.3.2021. In this article “Dr. Sarath Gamini”, as he is popularly known in the medical circles, refers to me (without mentioning my name) and my research and a lecture given by me to the Sri Lanka Medical Association. This is my response to him, particularly, on the issue of glyphosate pesticide.
I take strong issue with Dr. Sarath Gamini’s erroneous characterisation of my research, related to glyphosates, and the categorization of the government decisions and policies related to the glyphosate pesticide. For clarity, let me reproduce the paragraph on glyphosate in toto from Dr. Sarath Gamini’s article, highlighting the area where he refers to me and my research:
“The campaign conducted blaming the weed killer glyphosate as a cause of the epidemic of chronic kidney disease of unknown origin in the farming areas, mainly in the North Central province, was one burning issue then. There was no scientific evidence to prove this, despite the efforts of some professors in the medical field to find some. However, the importation of the chemical was banned mostly due to political expediency. One is not aware of any other country in the world doing so. When a visiting Sri Lankan expatriate doctor claiming to be a researcher in the field was asked, he could name only a small country, still contemplating doing so. He was lost for words to answer probing questions on the matter. His research has since been discredited in the USA. How the ban adversely affected the productivity in the agricultural sector in Sri Lanka has never been assessed or discussed.”
I am an American Board-Certified Occupational Medicine physician, and I have worked as a tenured full professor for over 34 years in the California State University, Long Beach, which is one of the largest and most respected university systems in the United States. Second, I have published more than a dozen peer reviewed scientific articles, and have given over 50 public lectures in relation to the toxic effects of glyphosate pesticide. Except for an unsigned petition sent by some disgruntled supporters of pesticides (the contents of which were found to be completely false) my research has never been discredited in the United States, or anywhere else. In fact, I won several awards for my research, including the Research Accomplishment of the Year award from my university, the prestigious “International Award” from the Occupational Health and Safety Section of the American Public Health Association, and the Scientific Freedom and Responsibility (SFR) Award from the American Association for the Advancement of Science (an award that I shared with Prof. Channa Jayasumana). By the same token. As far as I know, Dr. Sarath Gamini does not have a single publication related to the toxicity of glyphosate pesticide. I raise this issue because one of the conditions that Dr. Sarath Gamini has stipulated, throughout his article, is that one has to be knowledgeable and competent in order to be able to make comments on any issue, within medicine or any other scientific field. Does that apply to Dr. Sarath Gamini, on the issue of Glyphosate as well?
Now, to get on to the content, throughout the paragraph on glyphosate, Dr. Sarath Gamini makes an assertion that the ban on glyphosate pesticide was made without any scientific evidence and “mostly due to political expediency” and he says, “One is not aware of any other country in the world doing so (the ban)”. These statements clearly demonstrate Dr. Sarath Gamin’s ignorance on the subject. Let me state the following facts for his knowledge, as well as that of the general public.
Hundreds of scientific research studies have linked glyphosate not only to Chronic Kidney Disease but also to many other health conditions, including autism, birth defects, inflammatory bowel syndrome and liver diseases. The World Health Organization’s International Agency for Research on Cancer reviewed the scientific evidence in a 2015 report and classified glyphosate as “probably carcinogenic to humans.” Glyphosate – brand name Roundup – is primarily associated with Non-Hodgkin Lymphoma (NHL), a cancer in the immune system. Following this determination, in October 2015, the first Roundup (Glyphosate) product liability lawsuit was filed against Monsanto in San Francisco District courts. In August 2018, a jury awarded $289 million in damages to the plaintiff – Dewayne Johnson – who is a former school groundskeeper for a California county school system when he developed NHL after spraying glyphosate regularly for several years. This amount was later reduced, during the appeals process. During this trial, evidence released by lawyers for the plaintiff tells an alarming story of ghostwriting, scientific manipulation, collusion with the United States Environmental Protection Agency (EPA), and previously undisclosed information about how the human body absorbs glyphosate. These documents provide a deeper understanding of the serious public health consequences of glyphosate, and the false advertising related to Monsanto’s conduct in marketing glyphosate.
In a second case, the jury awarded a staggering $2 billion in damages to a couple – Alva and Alberta Pilliod. In court proceedings, the Pilliods testified to using Roundup regularly, starting in 1982. The couple used the consumer version of the weedkiller, whose label lacked any warnings about covering skin or wearing protective masks. Following these successes in courts, more than 18000 cases have been filed by people who developed cancer after regularly spraying glyphosate. According to some legal reports, Bayer – the German company that bought Monsanto in 2016 – has formally submitted a $8 billion for a global settlement. In March 2020, Monsanto also agreed to pay $39.5 million as a settlement for falsely advertising Roundup is “safe” for people and pets. The settlement, which was filed in federal court in Kansas City, Missouri, resolves allegations brought by several plaintiffs who claimed Monsanto failed to warn consumers about the health risks of glyphosate.
Following the lawsuits and the expert epidemiological evidence that was presented in courts, more than 20 countries have now banned, or restricted, the use of glyphosate. Although Monsanto’s new owner, Bayer, is fighting hard to limit these restrictions, the list is growing day by day. Some of these countries include Belgium, Denmark, France, Thailand, Vietnam, Saudi Arabia, Oman, Bahrain, and Mexico. There are many cities and institutions in the U.S., including, New York, Key West, Los Angeles, the Universities of California and Miami who have now regulations to restrict the use of Glyphosate-based pesticides. (For a complete list of these restrictions please see Where is Glyphosate Banned? | Baum Hedlund Aristei & Goldman (baumhedlundlaw.com)
In his article, Dr. Sarath Gamini describes the revocation of the ban on glyphosate for the use in tea and coconut cultivation as a “fortunate” one. In my mind, this was one of the most “unfortunate” Cabinet decisions for several reasons: First, this policy decision was taken without much scientific advice. There was an Expert Committee that was appointed to provide advice on this matter. I was invited as an expert to testify. However, two weeks before the hearings were scheduled, the Cabinet paper was approved hastily. The main argument put forward was that there was not enough of a labour force for the removal of weeds, manually. However, many weeds have now developed resistance to glyphosate, so that one has to use manual labour to complete the process of weed removal. Second, there is no tracking and post-marketing monitoring process available in Sri Lanka to ensure that this toxic pesticide does not end up in the hands of fruit and vegetable growers and in our food. Third, the regulatory costs of protective equipment, biomonitoring and the certification of the tea and coconut products to ensure that their glyphosate levels are within acceptable limits is costly – a cost that outweighs the benefits. By now it should be clear to the reader that I have a completely opposing view on glyphosate to that of Dr. Sarath Gamini De Silva.
Furthermore, in this article Dr. Sarath Gamini describes how, over the past few years, we have seen many untruths, hypocrisy and myths being propagated by professionals misleading the ignorant public and creating social unrest and even violence. As examples, the author describes, among others, several recent incidents, including the alleged sterilization of women without consent in Kurunegala, the propagation of a questionable local medicine that was touted as a cure for Covid-19, and the issue of compulsory cremation of deaths due to Covid. I will not comment on any of these issues for two reasons: First, I was not present in the country when most of these incidents took place; Second, I have not studied the social and political dynamics, surrounding these incidents, and the policies.
Therefore, in conclusion, I would like to say this to Dr. Sarath Gamini De Silva: Now that you have talked about glyphosate, please “walk the walk” and demonstrate that you have the expertise on the subject and that you know what the “established knowledge” is. Dr. Sarath Gemini’s view of the established knowledge on glyphosate is completely antithetical to that of mine. Therefore, I would like to invite Dr. Sarath Gamini De Silva to a public debate about the toxicity of glyphosate and the appropriateness of using the pesticide in Sri Lanka agriculture.
Dr. SARATH GUNATILAKE
Professor, California State University, Long Beach, California
Diplomate, American Board of Occupational Medicine
Email – email@example.com )
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