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A visa for bringing in expertise and expanding tourism

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In this article, I introduce an idea which is simple to implement but is powerful and helps with building technical skills, strengthening the country brand and creating international opportunities for Sri Lankans. Furthermore, it can diversify and extend the country’s tourism revenue streams.

The simple idea is to introduce a hassle-free visa for Internships, Volunteering, Expert Exchange Programs and Short-term Studies. For brevity, let me call it a Knowledge Transfer Visa or KTV. There are three important clarifications to make up-front. Firstly, this visa is not for those seeking paid employment in Sri Lanka. Secondly, the local partner needs to ensure that if any local permits or permissions are applicable, these are in place and cover any KTV holders. Thirdly, it is not a resident’s visa and tourist rates will have to be paid by KTV holders for their sightseeing.

It is also important to spell out up-front a critical requirement for success. This is that an applicant from a country who is entitled to obtain an online tourist visa quickly and easily should be able to obtain a KTV with the same ease and convenience. It would be reasonable for the Department of Immigration to have an additional information box in the visa application to ask for the name and contact details of the local partner (corporate or individual). But it should not be the role of the visa issuing officer in a Sri Lankan foreign mission or the Department of Immigration to examine paperwork to assess the credentials of the visitor and the local partner. This should be left to the applicant and local partner to assess each other. By analogy, a tourist is not asked to demonstrate that the hotel they have booked into is validly registered as a tourism business. Nor does the visa issuing process ask the hotel if they have vetted the tourist’s ability to pay. If the KTV is kept as simple as an online tourist visa, it will succeed, otherwise it will fail to deliver the potential benefits.

A reader may ask why this sort of visa is needed. The answer is that Sri Lanka is well positioned to benefit from activities covered in a knowledge transfer visa. However, such visits will only materialise if foreign nationals are reassured that they can arrive for such purposes with a visa where the purpose of their visit is explicitly recognised and they are confident that their visit is welcomed. Visitors on a KTV will bring in hard currency revenues in much the same way as ordinary tourists but importantly lead to other benefits such as the import of expertise, building international networks for local corporates and individuals and being potential repeat visitors. Let me explain by running through the various strands.

Internships

With the first strand, Internships, there is an overt intention that people want to work in a very structured manner and obtain useful work experience to help obtain paid employment back in their home country. Sri Lanka for various reasons, wishes to have tight controls over foreign workers and to limit foreign nationals on work visas. It is important to point out that facilitating internships need not conflict with this thinking. Incoming foreign interns are different to full-time foreign workers and caters to a younger demographic looking for a short period of work experience. If Sri Lanka restricts foreign internships to unpaid internships, this will limit the candidate pool to those interns who have parental financial support. Nevertheless, this is still a start and better than not opening the door at all.

In many sectors, Sri Lanka can offer meaningful summer internships of up to 3 months or longer. Two obvious examples are Tourism and Information Technology (IT). Sri Lankan companies cannot run viable business models by relying on a supply of foreign interns. Therefore, foreign interns do not in any way threaten the prospects for locals for employment. On the contrary, foreign interns from developed economies can benefit locals working with them in various ways. These could include improving language skills, and locals gaining exposure to skills such as time-management and project planning. Internships can also be used for foreign students to engage in undergraduate and postgraduate university projects with local academics.

To explain how foreign interns can be very useful, let me construct an example. It is a fact that Sri Lankan companies are writing the software for some of the most technologically advanced companies in the world. Imagine Sri Lankan IT companies actively pitch this to foreign universities in advanced economies and foreign undergraduates take up internships in Sri Lanka. Not only do they gain work experience of an equivalent standard to working in London or New York, but they will have a more exciting time in a tropical country. When they graduate, they will take up jobs in London, New York or wherever. When their employers are looking to outsource work, they may recommend the companies they worked with in Sri Lanka. Some of these foreign interns may even start their own companies in the future and look to outsource work to the Sri Lankan companies they worked with. If the new start-ups do well, there may be frequent business visits. When their former interns start families, they will visit Sri Lanka on visits which combine business meetings with a family holiday. Their children in turn will grow up with Sri Lanka being a place that was a regular holiday destination and, in the future, bring their own children on holiday. Internships in Sri Lanka to foreign students can grow future business revenues and also create a multi-generation chain of tourists.

Some foreign interns can also work in a three-way collaboration between their university, a local university and a private sector company. Take for example, a hotel that has placed camera traps on its property to study wildlife. If they do it on their own, it may simply be for marketing the hotel. If they can partner with a local academic or conservation NGO, it could be elevated into a formal study, perhaps even a long-term study. For both the local academic and the hotel, it would be useful if any work they do is part of a long-term study with a foreign university. International collaborations like this are also more useful to the hotel in their efforts for international publicity. For the local academic or conservation NGO, the international collaboration could also open opportunities for funding and recognition and invitations to present in international conferences. A win for all.

If Sri Lanka companies open up to foreign interns, it may result in them realising the value of well-structured internship programs and the dialogue with overseas interns and their academic supervisors may lead to good internship programs being set up for both local and foreign applicants. This can only help young resident Sri Lankans who at present are frustrated by the paucity of structured internship programs even amongst Sri Lanka’s leading companies.

Before I continue to the next two strands, it is useful to reiterate why a knowledge transfer visa is important. The above-mentioned benefits can only arise if potential foreign interns and volunteers have a mechanism of a special visa to reassure them that the purpose of their visit is properly disclosed and that their activity in Sri Lanka is welcomed and completely above-board within the stated purpose of the visa.

The same will apply, with voluntourism, which is a form of commercial tourism activity. Overseas companies that have a business model of arranging voluntourism abroad are more likely to add Sri Lanka as a destination if a KTV existed.

Volunteering

The second strand is Volunteering and here I define it narrowly to cases where a volunteer is not volunteering to build out their CV to help them gain paid employment in their home country. If they are doing so, it is covered under the Internship category. Under this definition, volunteers are people who fall into two broad categories. They may be volunteering for recreational purposes, coupled with wanting to do something that is societally useful. Or they may be people who are retired and on a comfortable retirement income who now have time and money to give something back to society. For example, a person in a highly paid job may come and volunteer for two weeks on a science (e.g. biodiversity surveys) or an arts project (e.g. cataloguing temple art). They may do this because they enjoy doing something different from their day job which is related to their personal interests and societally useful. This type of volunteering has become a significant form of tourism, known as voluntourism.

For the second type of volunteering an example would be a retired wildlife reserve manager from overseas who is happy to work for free with a Sri Lankan hotel or game lodge to train guides and provide practical help in rewilding the grounds of the property. They may enjoy mentoring and want to share their experience with others who are happy to learn from them. To take another example, it could be a retired museum curator who is happy to volunteer at a government museum to train local staff and inject fresh thinking into how exhibitions are curated.

The host country receives free expertise and valuable time from such volunteers. The volunteers are also paying tourists.

In G20 countries, volunteering is highly organised and has resulted in businesses that provide on-line platforms to match volunteers with recipient organisations. Sri Lanka can benefit from making it easy for people to volunteer and to come over, whether it is to paint hospital wards, help in beach clean-ups, or to help at a literary, music or cultural festival or to train local wildlife guides. Many volunteers will also look to add on a holiday extension to their volunteering stay. It is not just free people-hours of work and spending as foreign visitors: Carefully chosen good volunteers also bring in ideas, know-how, enthusiasm and energy.

Expert Exchange

The third strand in the knowledge transfer visa is for Expert Exchange. This is for people who are established in their discipline and looking to diversify their experience and build an international network by engaging in short term unpaid assignments overseas. For example, let’s assume a senior academic would like to spend a month working with local counterparts. Perhaps it is someone from a Management Science faculty who is interested in South Asian trade and wishes to work with local counterparts in a Sri Lankan professional institution or the Management Science faculty of a university. Or, perhaps it is an academic with an interest in contemporary Asian art. In such situations, a mutually useful arrangement between the foreign visitor and any local counterparts would be for the visitor to be provided a desk and some working space in the local faculty. Perhaps the visiting academic or professional can even undertake to give a certain number of lectures to Sri Lankan students. Relationships established in this way could lead to reciprocal invitations for Sri Lankan academics to attend foreign conferences and workshops and possibly help with Sri Lankan students receiving guidance and support with doing a PhD overseas. The visiting academic or expert is not being paid by the local partners in Sri Lanka and will continue to be on the payroll of their employer in their home country. Again, such visitors need to be reassured that what they are doing is deemed above -board and welcomed. They would not wish to come to Sri Lanka on a standard tourist visa for an engagement of this kind.

Short-term Study

The final strand of the knowledge transfer visa is for Short-term Study. Sri Lanka already has the skilled teachers and education infrastructure to offer undergraduate degrees from several foreign universities. It also runs accredited courses for professional qualifications from organisations that are based in G20 countries, whether it is in Accountancy or Marketing or IT. This capability can be expanded to provide ‘summer schools’ where foreign students arrive for a combination of classroom and field teaching. Local educational institutions can use their business initiative to develop curricula in consultation with foreign universities to meet the coursework credit requirements. If it is simple and easy to obtain a visa to attend such a course in Sri Lanka, this becomes a tempting offer for foreign students. In areas spanning from medicine, tourism, and the biological sciences, Sri Lanka can become an exciting destination for classroom and field work.

Conclusion

The results won’t be seen immediately as it takes years for local counterparts and foreign counterparts to respond and adapt to the benefits of such a visa. But slowly and steadily, we will see benefits accruing to the country. We also need to keep in mind that with anything that involves people, sometimes things don’t work out. A few foreign visitors or the Sri Lankan partners may not fulfil their obligations properly. We should not allow misguided fears of a few bad apples to block the massive potential for Sri Lanka to benefit from a simple but powerful idea that is easy to implement. It would benefit the private sector, state institutions, the universities, and many other sectors to encourage the government to introduce such a visa.

To conclude, if a knowledge transfer visa (KTV) is created which is as simple and quick to obtain as an online tourist visa, it will create a comforting and reassuring environment to encourage foreign visitors who are looking for something more than a short holiday. This will result in hard currency revenues in multiple ways as with ordinary tourism. However, there are potentially significant additional benefits from the bringing in of know-how, skilled people-hours of work, the scope for new types of businesses to develop, and allow Sri Lankan individuals, corporates and institutions to have doors opened for them for international business and academic opportunities. Furthermore, there is a huge Sri Lankan diaspora out there whose children and grandchildren do not have dual nationality but could be encouraged to bring their money and know-how for a longer length of time in Sri Lanka through a knowledge transfer visa.

by Gehan de Silva Wijeyeratne



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Is Tax a Responsibility or a Burden? Part II

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A critical policy misstep by the administration of President Gotabaya Rajapaksa was the substantial reduction in tax rates in late 2019, which significantly eroded government revenue. This drastic contraction in the fiscal base severely undermined public finance sustainability and contributed to Sri Lanka’s deepening fiscal and economic crisis in the years that followed.

The intended purpose of these series of major tax cuts aimed at boosting the economy, including slashing the VAT rate from 15% to 8% and reducing corporate and personal income taxes. Several other taxes—such as the PAYE tax, Nation Building Tax, Economic Service Charge, and Withholding Tax—were also abolished. While these measures were intended to encourage investment and ease the tax burden, they led to a sharp drop in government revenue, with total tax income falling by nearly 50% in 2020. Experts estimate that the country lost between Rs. 560 billion to Rs. 700 billion due to these cuts, severely weakening the government’s ability to fund public services and manage the economy.

Speechless NPP/JVP/AKD

Fortunately, the current government did not follow through on its election promise to remove taxes on essential goods such as food, medicine, and education-related items. Upon assuming office, they appear to have realised—albeit belatedly—that such a policy is neither fiscally practical nor compatible with the country’s economic realities. Moreover, adherence to International Monetary Fund (IMF) commitments and fiscal consolidation targets has likely influenced this course correction, reinforcing the need to maintain at least a minimal tax base on essential commodities.

Even the stalwarts of the National People’s Power (NPP), led by the JVP, are often left speechless when questioned by journalists about the feasibility of their campaign promises, particularly those lacking fiscal credibility. Similar to their eventual admission of responsibility for the 1988/89 insurrection and related violence, they now lack the courage to acknowledge their latest failure. After coming to power, they realised that the promises they made were neither practical nor sustainable—but instead of admitting their mistake, they continue to avoid accountability.

They also boast that they didn’t fail in six months as critics had predicted, but the truth is they would have undoubtedly collapsed had they kept the promises they made during the election. Their survival today is largely due to adopting centre-right economic policies—ironically, a complete departure from their own political ideology.

How Are Taxes Collected and Who’s Responsible?

The main agency responsible for collecting taxes in Sri Lanka is the Inland Revenue Department (IRD). They handle everything from registering taxpayers, to processing tax returns, and making sure that tax payments are made on time. The IRD also educates the public on how to comply with tax laws.

Alongside the IRD, other departments like Customs and Excise collect taxes on imported goods, fuel, alcohol, and tobacco products. These agencies work together to ensure the government receives revenue from different sources.

If you earn an income from an employment, rental properties, interest from fixed income earning securities such as fixed deposits/government bonds or run a business, it’s mandatory to register as a taxpayer. This involves submitting personal or business details to the IRD and receiving a tax identification number (TIN). Once registered, taxpayers must file returns (details of revenue and expenses) regularly, reporting their income and calculating the tax they owe.

However, many people find this process confusing, which is why the IRD runs educational programmes to help. For example, “Tax Week” is a special initiative where seminars, tax clinics, and registration drives are held to guide taxpayers through the process.

Challenges in Tax Collection

Collecting taxes isn’t always easy. Some taxpayers don’t fully understand their obligations, while others try to avoid paying taxes illegally. The IRD faces the difficult job of encouraging voluntary compliance while also enforcing penalties on defaulters.

To improve tax collection, authorities are investing in technology like online filing systems and digital payment options. These tools make it easier and faster for taxpayers to meet their obligations.

Efficient tax collection ensures that the government has the funds needed to deliver services and invest in development projects. When taxes are collected fairly and effectively, it builds trust between the public and the government.

Costs, Benefits, and Challenges of Collecting Taxes

It is very important to balance between spending money on tax collection and the revenue it generates. Collecting taxes might seem like a simple process — you pay, the government gets money. But behind the scenes, tax collection is a complex and costly operation. we’ll see how much it costs to collect taxes, why it’s worth it, and the challenges that come with the job.

Running a tax system isn’t free. The government spends money on staff, offices, technology, and systems to register taxpayers, process returns and enforce laws. There are also costs related to educating the public, handling disputes, and tracking down people who try to avoid taxes.

For instance, the Inland Revenue Department (IRD) of Sri Lanka has invested in digital platforms aimed at simplifying tax filing and minimising errors. Although these technological upgrades require significant upfront expenditure, they are intended to streamline processes and generate long-term cost savings. However, the full benefits of these investments have yet to materialise.

Balancing Cost of Administration/Tax Collection and Tax Revenue

A key challenge for tax authorities is balancing the cost of collecting taxes with the amount of revenue brought in. If it costs too much to collect taxes, it can reduce the net benefit to the government and society.

In some advanced countries like New Zealand, the tax collection system is known for its efficiency. The New Zealand Inland Revenue Department uses a mix of technology, clear communication, and fairness to keep costs low while maximizing revenue.

Despite the costs, effective tax collection is essential. It funds everything from hospitals and schools to roads and social welfare. More importantly, when people see taxes are collected fairly and efficiently, they are more likely to comply voluntarily. This voluntary compliance reduces enforcement costs and helps build trust between the government and citizens.

Tax authorities face ongoing challenges such as tax evasion, avoidance, and the complexity of tax laws. Educating taxpayers and simplifying tax processes are crucial steps in overcoming these problems. Not only is the transparency and fairness of tax law essential, but equally important is the way these principles are manifested in practice, as both are crucial for fostering taxpayer compliance and public trust. Therefore, we’ll look at recent cases of tax evasion and what they mean for Sri Lanka.

Why Fairness Matters

When it comes to taxes, fairness is one of the most important concerns for citizens. People want to know that everyone pays their fair share — and that the rules apply equally to all. But what exactly does fairness mean in taxation, and why does it matter?

A tax system is fair when it treats taxpayers equally and applies the law consistently. Fairness builds trust between the public and the government. When people believe the tax system is fair, they are more willing to pay their taxes voluntarily. On the other hand, if they think others are cheating or getting special treatment, compliance drops, and the government loses revenue.

Tax Evasion vs. Tax Avoidance

Many people confuse tax evasion with tax avoidance. Tax evasion is illegal — it means deliberately hiding income or falsifying information to pay less tax. Tax avoidance, on the other hand, uses legal methods to reduce tax liability, often by exploiting loopholes, treated as a legal way of “tax avoidance”, unethical though.

Until recently, Sri Lanka considered tax avoidance legal, while evasion was punishable by law. However, countries like New Zealand never treated aggressive tax avoidance as legal, closing loopholes through laws like the General Anti-Avoidance Rule (GAAR) to ensure fairness.

Recent Cases Highlighting the Importance of Fairness

Sri Lanka has witnessed a rise in high-profile tax evasion cases, underscoring the need for stronger enforcement mechanisms and clear legal frameworks to uphold fairness and protect compliant taxpayers. Notable cases include Randeniya Distilleries, fined Rs. 1.35 billion for deliberate tax avoidance, and W.M. Mendis & Co. Ltd., held liable for Rs. 3.55 billion in unpaid taxes, highlighting institutional efforts to curb evasion. However, the current campaign lacks robust enforcement strategies, risking reduced credibility if legal consequences are not consistently applied.

In contrast, New Zealand’s Inland Revenue Department exemplifies a balanced approach by integrating education with data-driven enforcement. Key legal precedents, such as Frucor Suntory (2022) and Penny and Hooper (2011), reaffirm the courts’ stance against tax avoidance schemes that undermine the intent of tax law. These cases demonstrate how transparent laws, and credible enforcement can foster compliance and trust in the tax system.

These cases illustrate New Zealand’s robust legal framework that deters tax avoidance through clear jurisprudence and the application of General Anti-Avoidance Rules (GAAR).

Learning from New Zealand

New Zealand’s tax system is often praised for its transparent, fair approach. The Inland Revenue Department takes a firm stance against both evasion and aggressive avoidance. Public education and consistent enforcement have helped maintain a high level of compliance and trust.

To improve tax fairness, Sri Lanka needs to update laws, increase transparency, and enhance taxpayer education. Fair application of tax law not only boosts revenue but also strengthens public confidence in the system.

The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or position of the institution he works for. He can be contacted at saliya.a@slit.lk and www.researcher.com)

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A glimpse into future cholesterol control: A time without daily pills perhaps?

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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

For millions of people worldwide, the daily ritual of taking a statin or other drugs to manage cholesterol levels is a fact of life. These powerful medications have dramatically reduced the risk of heart attacks and strokes, thereby transforming cardiovascular healthcare. However, the hassle of having to take these medicines every day is a cumbersome infringement on life itself.

Now, imagine a future where the burden of daily pills for this purpose could be replaced by a single, or at most, a few injections per year. This is NOT science fiction; it is the audacious goal of a new frontier in medicine, with revolutionary drugs currently undergoing rigorous clinical trials. These cutting-edge therapies are designed to act directly in the liver, targeting the very genetic instructions or enzymes responsible for producing “bad” cholesterol, potentially offering a more profound and long-lasting solution than ever before.

This appears to be the dawn of a new era with medicines that employ gene-silencing and enzyme-neutralisation techniques. The excitement surrounding these new treatments stems from their innovative approaches. Unlike traditional statins, which work by blocking an enzyme involved in cholesterol production, these newer drugs go further upstream, interfering with the body’s internal machinery that regulates cholesterol at a more fundamental level.

Two primary classes of these emerging therapies are making waves at present:

1. PCSK9 Inhibitors: A Deeper Dive

There are a few currently approved drugs that inhibit PCSK9 gene. But they require injections every two to four weeks. These antibody-based drugs work by binding to and neutralising a protein called PCSK9 (Proprotein Convertase Subtilisin/Kexin type 9), which acts like a “destroyer” of LDL receptors on the surface of liver cells. These LDL receptors are crucial for grabbing “bad” LDL cholesterol from the bloodstream and bringing it into the liver for processing and removal. By blocking PCSK9, these inhibitors allow more LDL receptors to remain active on liver cells, significantly boosting the liver’s capacity to clear LDL cholesterol from the blood.

The truly groundbreaking development now is a group of medicines that aim to permanently or durably turn off the PCSK9 gene itself. Instead of needing regular injections to block the protein, a single treatment could, in theory, silence the gene that produces it, offering a lifelong reduction in cholesterol.

One such investigational drug is VERVE-102, developed by Verve Therapeutics. This is designed to be a single-course treatment. It uses a modified technology to make a precise “edit” to the PCSK9 gene in liver cells, effectively switching it off. Early data from clinical trials have shown promising results, with participants achieving significant reductions in LDL cholesterol. For instance, in one cohort, a mean LDL-C reduction of 53% was observed, with a maximum reduction of 69% in a single participant. The long-term durability of this effect is what truly excites researchers, with the hope that such a treatment could eliminate the need for ongoing regular daily medication.

2. ANGPTL3 Inhibitors: A Different Angle

Another fascinating target is the angiopoietin-like protein 3 (ANGPTL3). This protein, primarily secreted by the liver, acts as an inhibitor of two key enzymes: lipoprotein lipase (LPL) and endothelial lipase (EL). These lipases are essential for breaking down triglycerides and processing lipoproteins, including LDL cholesterol. When ANGPTL3 is inhibited, LPL and EL become more active, leading to a reduction in triglycerides, LDL cholesterol, and even HDL cholesterol.

A monoclonal antibody drug called Evinacumab (Evkeeza) is an example of an ANGPTL3 inhibitor already approved for a rare genetic condition called homozygous familial hypercholesterolemia (HoFH), requiring monthly intravenous infusions. However, research is ongoing into one-time or infrequent dose ANGPTL3-targeting therapies, potentially using gene-silencing technologies similar to those for PCSK9. Some of these medicines have shown significant reductions in ANGPTL3 and various atherogenic lipoproteins in preclinical and early human studies with a single dose.

It is absolutely vital to reiterate that these revolutionary treatments are still in various stages of clinical trials. These trials are meticulously structured processes designed to ensure that any new medication is both safe and effective before it can be made available to the public. Before human trials begin, new treatments are extensively tested in laboratories and on animals to assess their basic safety and potential efficacy. Then come Phase 1 Trials, which are the first human tests, typically involving a small group of healthy volunteers (around 20-100 people) or patients with the condition. The primary goal is to assess the drug’s safety, determine a safe dosage range, and identify common side effects. For gene-editing therapies, these initial phases are particularly critical to monitor for any unintended genetic changes or off-target effects.

Then, Phase 2 Trials follow. If a drug proves to be safe in Phase 1, it moves to Phase 2, involving a larger group of patients (typically 100-300) who have the specific condition the drug aims to treat. The focus here is to evaluate the drug’s effectiveness and continue monitoring for side effects. Researchers fine-tune dosages and study how the drug impacts the disease.

Then it graduates to Phase 3 Trial. This is the most extensive and crucial phase, involving hundreds to thousands of patients over several years, often across multiple international sites. In Phase 3, the new treatment is compared against existing standard-of-care treatments or a placebo (an inactive substance) to confirm its efficacy and safety on a larger scale. This phase generates the robust data needed for regulatory approval.

The final stage are Phase 4 Trials. Even after a drug receives approval and enters the market, Phase 4 trials continue. These are post-marketing surveillance studies that monitor the drug’s long-term effects, identify any rare side effects that may not have appeared in smaller trials, and explore new uses or populations.

For gene-editing therapies like VERVE-102, the journey through these phases is even more closely scrutinised due to the permanent nature of the genetic changes they induce. While early results are exciting, only successful completion of large-scale Phase 3 trials and ongoing Phase 4 monitoring will fully confirm their long-term safety and effectiveness. Companies like Verve Therapeutics are planning to move into Phase 2 trials for VERVE-102 in the second half of 2025, a significant step forward.

Will all these new developments lead to an “Economic Earthquake” and a Shake-Up for the Pharmaceutical Industry? The potential advent of one-time or very infrequent cholesterol treatments carries enormous implications, not just for patients but also for the multi-billion-dollar pharmaceutical industry.

Statins have been one of the most successful drug classes in history, generating immense revenues for pharmaceutical companies over decades, the so-called Statin Empire.. They are widely prescribed, often for life, creating a consistent market. The prospect of a single-dose cure could, in the long run, significantly shrink this market.

Developing gene-editing therapies and complex biologic drugs like these new cholesterol treatments is incredibly expensive, requiring massive investments in research, development, and clinical trials. To recoup these costs and generate profit, these drugs are expected to command extremely high prices, at least initially. Existing PCSK9 inhibitors, for example, were initially priced around $14,000 per year, though costs have since decreased. A one-time gene-editing therapy could potentially run into hundreds of thousands of dollars per patient.

Healthcare systems and insurance providers will face a monumental challenge in determining how to pay for such expensive, high-impact treatments. While a one-time treatment might be cost-effective over a patient’s lifetime compared to decades of daily pills, the upfront cost can be a major barrier. This could lead to intense negotiations between pharmaceutical companies and payers, and potentially restricted access for patients.

Pharmaceutical companies that have historically relied on chronic, daily medications might need to undertake a pivotal change in their business strategies. The focus could shift from high-volume sales of inexpensive pills to lower-volume, high-value, transformative gene therapies. This requires different manufacturing capabilities, distribution networks, and marketing approaches and most importantly, are likely to be very expensive.

Beyond the economics, the high cost raises significant ethical questions about equitable access. Will these life-changing therapies only be available to those with comprehensive insurance or significant financial resources, creating a two-tiered system of care? This is a critical societal discussion that will undoubtedly unfold as these drugs get closer to the perennial drug market.

Epilogue

This author believes that our attitude to all these promulgations will need to be one of “Hope on the Horizon, Caution in the Present”. The research into one-time cholesterol-lowering injections is undeniably thrilling. The idea of a treatment that could potentially offer lifelong protection against cardiovascular disease with minimal ongoing effort is a medical dream. They would represent a paradigm shift in how we approach chronic diseases, moving from symptom management to root-cause intervention through genetic or enzymatic targeting.

However, it is paramount and absolutely vital for the public to understand that this future is not here, not as yet. These drugs are still experimental, undergoing rigorous scrutiny in clinical trials to ensure their safety and efficacy over the long term. While the early data is highly encouraging, the full picture of their benefits, potential risks, and accessibility will only become clear in the coming years.

For now, the message remains consistent. Work closely with your healthcare provider to manage your cholesterol, using established, approved therapies and healthy lifestyle choices. But keep an eye on the horizon: the landscape of cholesterol treatment is on the cusp of a truly revolutionary transformation.

This article was written with some

assistance from Artificial Intelligence.

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)

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UN’s challenge of selective accountability without international equity

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Volker Türk

Despite the prevalence of double standards in international practice, it remains in Sri Lanka’s national interest to support the principles and implementation of international law. The existence of international law, however weak, offers some level of protection that smaller countries have when faced with the predatory behaviour of more powerful states. For this reason, the Sri Lankan government must do all it can to uphold its prior commitments to the UN Human Rights Council and implement the promises it has made to the fullest extent possible.

The visit of UN High Commissioner for Human Rights, Volker Türk, later this month may possibly be overshadowed by the eruption of hostilities in the Middle East following Israel’s attack on Iran. The High Commissioner’s visit to Sri Lanka relates to the series of resolutions passed by the UN Human Rights Council over the past sixteen years since the end of the war. It will highlight the contradiction in the rules-based international order when geopolitical interests override legal commitments. These resolutions highlight the importance of protecting human rights during times of conflict and ensuring accountability for war crimes. They are part of the enduring legacy of international human rights and humanitarian law, as exemplified by the Geneva Conventions and the global post-war consensus that atrocity crimes should not go unpunished.

The High Commissioner’s visit is likely to provoke criticism that the United Nations is pursuing Sri Lanka’s adherence to international norms with greater zeal than it shows toward violations by more powerful countries. There appears to be acquiescence, indeed even tacit approval, by influential states in response to Israel’s military actions in both Iran and Gaza on the grounds of existential threats to Israel. Similar military actions were taken in 2003 by the US and the UK governments, among other international powers, to destroy weapons of mass destruction alleged to be in Iraq. One of the central arguments made by critics of the UN’s engagement in Sri Lanka is that double standards are at play. These critics contend that the United Nations disproportionately targets weaker countries, thereby reinforcing an international system that turns a blind eye to powerful countries and, in doing so, undermines the credibility and coherence of global human rights standards.

The arrival of the High Commissioner is also likely to reignite internal debate in Sri Lanka about the purpose and legitimacy of UN involvement in the country. The question is whether international standards effectively contribute to national transformation, or do they risk being reduced to symbolic gestures that satisfy external scrutiny without generating substantive change. There will be those who regard international engagement as a necessary corrective to domestic failings, and others who see it as an infringement on national sovereignty. The question of accountability for war crimes committed during the three-decade-long civil war remains a deeply divisive and sensitive issue. Sri Lanka, with its own complex and painful history, has the opportunity to lead by example by reckoning with the past unlike many other countries who justify their atrocities under the veil of national security.

International Breakdown

The modern international system emerged in the wake of two catastrophic world wars and the recognised failure of early twentieth-century diplomacy to prevent mass violence. At its core was a collective pledge to establish a rules-based international order that could maintain peace through law, institutional cooperation, and multilateral governance. The development of international human rights and humanitarian law was most pronounced in the aftermath of the mass atrocities and immense human suffering of World War II. The powerful nations of the time resolved to lead a new global order in which such horrors would never be repeated.

This vision of a rules-based international order as a safeguard against a return to the law of the jungle, where power alone determined justice was institutionalised through the United Nations, the Geneva Conventions, and the establishment of international courts such as the International Court of Justice and the International Criminal Court. However, this international system has come under increasing strain in recent decades. Recent events show that it no longer functions as originally envisioned. In practice, the consistent application of international law, regardless of the status or power of a state, is frequently compromised. The selective enforcement of legal norms, particularly by powerful countries, has eroded the legitimacy of the system and calls into question the universalism at the heart of international law.

At present, at least three major international conflicts taking place in Ukraine, Gaza, and now the confrontation between Israel and Iran, illustrate a sustained breakdown in the enforcement of international legal norms. These conflicts involve powerful states that openly defy legal obligations, with the international community, especially its more influential members, often remaining conspicuously silent. Only a handful of countries, such as South Africa, have chosen to raise issues of international law violations in these conflicts. The broader silence or selective rationalisation by powerful countries has only reinforced the perception that international law is subject to political convenience, and that its authority can be subordinated to geopolitical calculation. Earlier examples would include the ruination of prosperous countries such as Iraq, Libya and Syria.

Uphold Consistency

The Sri Lankan situation illustrates the importance of preserving an international legal system with mechanisms for credible and impartial accountability. Sri Lanka, so far, has been unable to address the issues of accountability for serious war-time human rights violations through internal mechanisms. However, the broader lesson from Sri Lanka’s experience is that international norms ought not to be applied selectively. If global institutions aspire to uphold justice by holding smaller or less powerful countries accountable, they must apply the same standards to powerful states, including Israel, Russia, and the United States. Failing to do so risks creating the perception that the international legal system is an instrument of coercion and selective punishment rather than a foundation for equitable global justice.

Despite the prevalence of double standards in international practice, it remains in Sri Lanka’s national interest to support the principles and implementation of international law. The existence of international law, however weak, offers some level of protection that smaller countries have when faced with the predatory behaviour of more powerful states. For this reason, the Sri Lankan government must do all it can to uphold its prior commitments to the UN Human Rights Council and implement the promises it has made to the fullest extent possible. In multilateral forums, including the UN, Sri Lanka must reassert these commitments as strategic assets that help to defend its sovereignty and legitimacy. At the same time, Sri Lanka needs to take up the challenge of using these international platforms to highlight the problem of selective enforcement. Sri Lanka can contribute to the broader call for a more principled and consistent application of international law by demonstrating its seriousness in protecting vulnerable populations and position itself as a responsible and principled actor in the international community.

Engaging with the past in accordance with international standards is also essential for Sri Lanka’s internal reconciliation and social cohesion. The principles of transitional justice—truth, accountability, reparations, and institutional reform—are not only universally applicable but also critical to the long-term development of any post-conflict society. These principles apply across all contexts and periods. If Sri Lanka is to evolve into a united, stable, and prosperous country, it must undertake this process, regardless of what other countries do or fail to do. Only by acknowledging and addressing its own past can Sri Lanka build a future in which its multi-ethnic and multi-religious character becomes a source of strength rather than weakness.

 

by Jehan Perera

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