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Brain drain and future of medical education

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By Ramya Kumar

Healthcare is in crisis. Medical doctors, and other health professionals, are leaving the country in droves. The WHO (2010), in its Global Code of Practice on the International Recruitment of Health Personnel, while discouraging the active recruitment of health workers from “developing countries” (p. 7), urges source countries to “address the geographical misdistribution of health workers and to support their retention in underserved areas” (p.8). What is the government doing to stem the health brain drain, in particular, the en masse migration of medical doctors? This article draws attention to several government policies, and proposals, that are likely to accelerate medical migration, and suggests that radically different measures may be needed.

Urban-rural inequalities

The Northern Province, which covers 13.3% of the land area and is home to about 5% of the country’s population, receives about 5% of specialists and medical officers in the state sector. Although the province receives what seems to be a fair allocation according to population size, the large land mass means that they are spread far and wide, with rural folk having to travel great distances to access healthcare. On the other hand, Colombo, where 11.2% of the country’s population resides, receives more than double its fair share, accounting for over a quarter of medical doctors, to cover just 1.08% of the land mass. While this misdistribution exists in other health worker categories (see table), the numbers show that the health brain drain will likely affect people living in rural districts more than others.

Percentage distribution of specialists and medical officers in the public sector – 2019

What have other countries done in times of crisis? Thailand has in place several policies to retain health workers in rural areas, including medical doctors. Government bonds, in place since the 1960s, require all graduating doctors to serve in rural areas for a stipulated period or pay the bond. In addition, the ministries of public health and education recruit rural students who score somewhat lower marks on national exams, to medical programmes, with specified rural service requirements to be fulfilled on graduation. The latter comprise over 30% of medical graduates in Thailand and tend to remain in public service beyond the mandated period. While similar programmes are in place to retain other health workers, health professional curricula are rurally-oriented, emphasising primary care and public health, with practical training in rural settings, with many offered in the Thai language. In addition, the Thai government offers hardship allowances, overtime payments, and numerous career advancement opportunities to incentivize rural work. The overarching goal of these policies is to improve rural access to healthcare, not constrain health workers. By contrast, in Sri Lanka, government policy seems to promote medical migration. Indeed, recent budget proposals, if implemented, may weaken existing policies that support rural retention of medical personnel.

Promoting medical brain drain

For one, no bonds are in place for medical graduates who have benefited from free education. This means that junior doctors do not need to think twice about migrating to greener pastures, with most planning to face exams to be eligible to work as doctors in other countries. Second, the Postgraduate Institute of Medicine (PGIM) sustaines a colonial policy that requires specialists to spend a stipulated period abroad to fulfill “foreign training” requirements in (mostly) high-income countries to be board certified. While the Ministry of Health forks out a (bonded) stipend for this training, it could just as well be obtained at state-of-the-art training centres in the South East Asian region that may cost less and are less likely to be destinations for medical migration.

Third, the Accreditation Unit of the Sri Lanka Medical Council (SLMC) is presently working toward securing recognition from the World Federation for Medical Education (WFME), as its local accreditation agency. According to the Unit’s website, benefits to be accrued include MBBS holders from WFME-recognized institutions being able to register in postgraduate medical courses that recognize WFME accreditation and also seek employment in such countries. However, harmonising medical programmes in line with international requirements may neglect local needs. For instance, the SLMC’s Minimum Standards of Medical Education, gazetted in 2018, do not include requirements to complete clinical training in rural stations, despite most doctors being posted to such areas in their first appointments.

Recruitment to the state sector has halted, presumably under directives of the International Monetary Fund (IMF). While it is uncertain to what extent this policy will affect the health sector, the government should ensure that public sector employment is guaranteed to health workers in the future. By guaranteeing employment and retaining postgraduate education in the state sector, the Ministry of Health has been able to ensure the availability of specialists and doctors in the public sector. Despite politicization, in particular the influence of the Government Medical Officers’ Association (GMOA) on transfer lists, and many other ills, this system allows the government to fill vacant rural stations with new cohorts of doctors. If public sector recruitment is halted/restricted, the uncertainties around employment may result in mass medical migration.

Privatisation and rural retention

In Sri Lanka, medical education remains under the state’s purview, delivered by 12 faculties of medicine, 11 under the University Grants Commission (UGC) and one with the Ministry of Defence. For decades, successive governments have attempted to privatize medical education. In South Asian settings especially, where most parents would like their children to follow a career in medicine, MBBS degree programmes present lucrative business opportunities. Even so, privatisation has been resisted in Sri Lanka with the SAITM debacle still fresh in our memories.

Yet, it is quite clear that the government is bent on establishing private medical schools.

Apart from the relentless attacks on student leaders, the SLMC’s Accreditation Unit welcomes applications for accreditation from all medical schools in the country; nowhere in the accreditation policy are state universities referenced. By placing accreditation in the hands of an “independent” unit, the government will be able to circumvent the UGC’s cumbersome administrative procedures, and invite foreign investment in medical education. These intentions are clear in the language used in the Minimum Standards of 2018:

“Every recognized university, or institution, within, or outside, Sri Lanka which grants or confers a medical qualification, alone or jointly with any Sri Lankan or foreign recognized university or institution under affiliation or under a twin medical programme shall ensure that the minimum standards set out in the Schedule hereto are adhere [sic] to and maintain [sic] by such recognized university or institution in the conduct of its medical education.”

Privatising medical education will shift the demographics of doctors in favour of the elite, who are far less likely to remain in the country. Contributing to these changes are the UGC’s renewed efforts to attract students with foreign qualifications, on a fee-levying basis, to local undergraduate programmes, including medicine. While a finite number of places are available at medical schools, increasing the number of students, with foreign qualifications, may see a parallel reduction in the number of local recruits within an already strained system. International medical students are even less likely to present a solution to the brain drain.

The Budget proposals for 2023 include plans to increase merit-based admissions from 40% to 50% in commerce, technology, science and mathematics A/L streams. This means that district quota based admissions to medicine from underserved districts, such as in the Vanni or Uva, will decline. While this move will deepen class-based inequalities in access to medical education, weakening the district quota system will mean that fewer rural students will enter medicine, although the latter are more likely to serve in their home districts.

Bleak future

Despite the crisis that faces the health sector, the government implements or is proposing to implement a number of short-sighted policies that are likely to accelerate medical brain drain. While the public healthcare system is in shambles, experiencing acute resource-constraints, massive changes are in the offing under World Bank-IMF pressures and what looks like a far right government. We must draw on lessons from other countries to demand the government to take measures to address the brain drain and support the retention of healthcare workers in underserved areas to avert a crisis in rural healthcare.

(Ramya Kumar is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna)

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies



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Twin personas; reaction long after the action

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I am pleasantly surprised and marvel too most times I read the editorial in The Island. Why? Because they are so very apt on the most current issue in the land. The editor has the clever knack of hitting the nail right on the head and is fearless even when the nail represents a VVIP.

Friday 25 November had the sharp, truth writing editor commenting on President Ranil W and his stunning metamorphosis from a peace promoting, democracy advocating politician to a persona that he himself says is Hitler like. And as the editor has written, one wondered if he and his immediate predecessor, Gotabaya Rajapaksa, had swapped bodies, for the former sounded just like the latter. Gota was expected to be a dictator; a monk called out to him to be Sri Lanka’s Hitler while his brother Basil bracketed him with the ‘Terminator’.

Ranil seems to hear cries for protection of human rights as a cover for violent protests. Gota, though an army man and later as a civilian, cosseted the army at great cost to the exchequer, did not threaten to bring the army out to quell protests. It was done once or twice: e. g at Rathupaswela and at an FTZ. These orders were not proven to be directly emanating from him nor directly connected to him. However, peace proclaiming Wickremesinghe with his new surname added on is outdoing the former army officer. He maintains the PTA and now says (probably in all truth and belief – scarce characteristics of politicians) that he will call out the army to quell protests, which have been and will be, mostly peaceful.

What this woman, a former teacher and counselor, opines with common sense and intuition is that he is going about it all wrong. He is inciting protest and lawlessness, even violence, since the youth of the country, with others, are utterly frustrated, angered, troubled and volcanic – waiting to erupt and so are the sideline catalysts: the terrorism promoting core politicized protesters of the IUSF, FSP and certain JVPers. Ranil should have been wiser and less outreaching, and negotiated with leaders of the groups mentioned, including trouble rousers like Stalin, and convinced them of the dire state the country is in. Negotiating with die-hard protesters may not be his cuppa; he shies away from direct contact with the hoi polloi. But talk to them he must. He should include persons like Guv CB to the negotiating table since Dr Nandalal Weerasinghe is one of the very few, if not the only high-up, that all respect. The rabble-rousers should be convinced, even threatened privately, that at this juncture what the country needs and the IMF promotes is encouraging money making projects, the surest and largest-inflow-of dollars earning tourism to resume and continue with peace prevailing in the country. With so many countries with so much to offer, why should tourists visit a near warring Sri Lanka? The reality of course is that this dot of an island has most to offer the tourist as pronounced by even Lonely Planet guides.

However, as is always the case, the country pleases but men in it are vile and utterly stupid. The protestors do not realize their protests will not change things immediately. But they most certainly cost the country much. These fire breathing, loud mouthed protestors and so-called protectors of peace and human rights are at present the principal harmers of the land.If after sincere one-to-one negotiation, some remain recalcitrant, then the police should be called in to deal with them.

Bang shut empty stable door

Mentioned many times before by Cass and other writers, Sri Lankans in general suffer short memories: will vilify a person today and praise him tomorrow not only because they are turncoats but because the people have forgotten and of course forgiven yesterday’s sins of leaders. Another characteristic is shutting the stable door once the horse has bolted. The preliminaries of the flight of the horse are seen but no alarm is raised. Once the horse has bolted; then come forth loud hues and cries of damage done.This last character trait of the Sinhala race mostly, was exhibited and exposed in the news telecast on MTV 1 Channel on Sunday November 27.

Villagers of a certain forest area, with voices raised women to the forefront, confronted a man who was in a new built, multi roomed hut-like construction. He seemed settled down. The crowd that walked across a vast area of bare land accused that the forest that covered this area had been illegally decimated. They demanded evidence of his right to settle down there. He said the police and other officials had cleared him. Trespassing was not even mentioned. Cass’ wonder at this loud fracas was why the fuss now with land bare and a house built when the villagers surely heard if not saw trees being felled en masse. Why had they not informed authorities then? Why wait for the deforestation and illegal building to be completed before protesting? Had they been waiting all these past months for the TV cameras to arrive to act angry and national minded?

It was suspected, if not known for sure, that vociferous Diana Gamage was a dual citizenship holder or maybe even a citizen of another country visiting her home turf. She was up front for long and since being made a State Minister by Prez Wickremasinghe, his hand guided by a crow pulling strings from even thousands of miles to the west, became prominently vociferous with forex earning projects foundationed on fun and good times. She proposed the growing of ganja plants; creating a Disney theme park; making Mannar an international gambling den and what else Cass fails to recall. Now firmly in Parliament as an elected member she faces the public rising up and declaring she is not eligible to hold a Parliamentary seat since the passage of A21 or 22. The mare had bolted to the green pastures by the Diyawanne and now people are a-rising to close the door she galloped through. Confine her at home with no powers and privileges or deport her to turf in her adopted country?

Bandula Gunawardena, holding the portfolio of Minister of Trade, held forth on the subject he thinks he is omniscient in. He claims economics as his forte of intellectual knowledge; certification of this fact being he was a tuition master in the subject. He refers to himself as Doctor Bandula G; the doctorate coming to him from where we know not. In a pontification in Parliament on the Sunday, he waxed eloquent on mismanagement of the Central Bank and trotted out figures in billions and decimals thereof of printed money. He blamed past CB persons. Why was this economist considering himself on par with Amartya Sen, Paul Krugman and Maynard Keynes, silent then when Nivaard Cabral kept the printing machines in the CB turning day and night churning out 5000 rupee notes? (PS. Cass wonders very much whether he has heard of Krugman and knows Keynes was one of the Bloomsbury Group. Cass can wager her life that he does not know who this group was).

Speaking of this Mr Cabral, he was recently seen on TV at a press interview passing the buck adroitly and proclaiming he was obeying orders to print money. Was he a robot and of whom?

Short take

A very good move was mooted recently in Parliament and will soon be law. Cass refers to the stricture that university students will be allowed one extra year after their graduating date whether they fail the final exam and wish to repeat or when they dodge sitting the final exam. Here again the closing of the loophole after damage is done. Firebrand Wasantha is said to have been in the University of Sri Jayawardenapura for eight solid years. Wasn’t this truancy of sitting the finals seen earlier? Authorities too scared to report the fact; saving their scalps by ignoring anomalies. just as they turn blind eyes to filthy and dangerous ragging in universities?

This land of ours which is truly incomparable, is derogatively a land like no other when speaking of it with tongue in cheek.

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Maris Stella College in 1950s and 60s

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By George Braine

Maris Stella College, Negombo, is celebrating its centenary this year. These are my recollections of the years I spent there.Maris Stella had classes from Standard Two. For lower and upper kindergarten (as they were called those days), all boys attended Ave Maria Convent, along with girls, of course. One teacher I recall is Sr. Mary Imelda, diminutive but a formidable force. As she taught, her two dogs, spoiled rotten by the children, roamed the classroom.

Maris Stella sits on the road that extends from Colombo to Chilaw, and beyond to Puttalam and Anuradhapura. Despite the heavy traffic on the road, the school displays a somewhat serene ambience because of the large, well maintained playground, and the lovely main building set some distance from the road. Two storied, with a lengthy Italianesque facade, the main building is reached along two narrow roadways lined by long, single storied classrooms. In the center, shaded by massive mara trees, is a smaller playing field – for soccer, softball cricket and gymnastics- in the 50s and 60s. These buildings, the trees, and the playing field, now a lush green, have been well preserved.

My father recalled that, during World War II, when Allied troops were stationed at the school, these mara trees were covered with camouflage nets to hide the anti-aircraft guns mounted below.

Teachers and students

My father had been at Maris Stella in the 1930s and 40s, and when I entered in 1957, some of his teachers were still there. Elias, dark, wizened, and with a tousle of grey hair, taught me in Standard 2. Capt. Jayamanne, a big man, tough as nails, had been the cadet platoon commander during my father’s time, and still was. Bro. Jonas had been in charge of sports for years. Obris, who taught English, had become the vice-principal. My father also recalled Bros. Nizier, Valentine, and Xavier, a Spaniard. Mahaboob, physical training instructor and Bro. Gerard had been his classmates. Undoubtedly, the most unusual teacher was Johannes, who taught Sinhala. The only teacher who wore a sarong to school, worn high up on the waist and held up with a broad belt, he had an owlish, scholarly air; our textbooks on Sinhala had been authored by him. Ms. Wallace, lustily playing the piano, taught us singing. Two younger teachers were Dabarera and Kurera.

One hilarious memory is that of Bro. Jonas, coaching the football team even during matches, running up and down the sidelines, grey hair and cassock flying. He was strict, liberal with the cane and slaps. Another is of Mahaboob, the PTI, in his impeccable polo shirt, pants, and tennis shoes, all in spotless white, taking us through various drills on the playground.

The principals during my time were Bros. Stanislaus and Peter, and the headmasters Bros. Nizier and Gerard.We were living near Ave Maria Convent when I joined Maris Stella, which meant a walk of more than a mile, crossing a railway track and walking along Main Street till I reached Copra Junction along the Colombo – Chilaw road. The street is chock-a-block with shops now, but, in those days, I only passed houses with well-maintained gardens, a couple of boutiques, a dispensary and a dental clinic. A well-off classmate was driven to school and passed me on the way, but never offered me a lift.

Most students walked to school or rode bicycles, in wave after wave. Others came by train or bus. The only person who drove was a senior student named Jayakody from Dankotuwa. This was extraordinary, when no teacher owned a car, and some rode rickety bicycles. His Peugeot 203 was parked under a mara tree while he attended classes and later stayed for football practice.

At Maris Stella, a Catholic school, most students were Catholic. But, ethnically, we were an eclectic band, marked by the Bharatha community and Burghers. The family names of schoolmates I can recall is evidence of this: Siriwardena, Jayawardena, Abeysekera, Swaminathan, Bolonghe, Salgado, Leitan, Tissera, Hettiaarachi, Jayamanne, Franke, Croos-Dabarera, Dabarera, Jayamaha, Coonghe, Aserappa, Rodrigo, Fernando, Pereira, Costa, Gomez, Mirando. Ives Swaminathan had immigrated from Mauritius, and sang French songs in a lovely voice.

After my brother entered Maris Stella, we were five cousins there: Roy and Lloyd Chelvaratnam, George Wambeck, George and Roy Braine. Roy C and Lloyd were in the Tamil stream. Two Georges and two Roys.Latin was compulsory from the Junior School Certificate (JSC) class. All that memorizations were intimidating, so I was relieved when the requirement was taken off when I reached the JSC class. But, Latin prevailed in the daily mass conducted at the chapel, and in the hymns sung there. I recited prayers and sang those hymns, without any idea of what was being said or sung.

Sports

Mention Maris Stella and sports during my time, and the name that springs to mind is Melvin Mallawaratchi. Tall and good looking, with a ready smile that lit up his face, Melvin was already legendary when I entered school. Our age gap was more than 10 years, so I had no opportunity to know him personally. All I knew was that, whenever he batted, he lit up the cricket field. I, along with other schoolmates, simply hero worshipped him.

Home games were thronged with enthusiastic spectators. When Melvin came to bat and took his stance, a collective hush fell on the ground.  Soon, we were cheering wildly as the ball sailed over our heads, over trees, onto the main road, or sped along to the boundary in a flash. In his stride, Melvin was unstoppable.

In one game against St. Anthony’s College, Wattala, I watched as he scored a blistering 96 in the second innings, having scored an unbeaten century in the first.  In 1957, playing Ibbagamuwa Central, Melvin had scored 96 in only 20 minutes, which included two sixers and 18 fours.

Melvin’s flamboyance did not stop at cricket. He was also a champion sprinter. Maris Stella’s rival school in Negombo, St. Mary’s, had a champion sprinter named Mello. At every meet where they met, he dueled it out with Melvin in the 100-yards sprint, running neck to neck. We stood near the finish line to see Melvin triumph every time.

Eddie and Rukmani

By 1958, we had moved to a house across the road from Maris Stella; 120 Colombo Road, if memory serves. Now, I only had a 5-minute walk to school. It also meant that we went to Sunday service at the Maris Stella college chapel.

Eddie Jayamanne and Rukmani Devi, husband and wife, were at the peak of their popularity. She was the reigning queen of Sinhala cinema, and the nightingale of Sinhala music. Eddie was less flamboyant, somewhat short, with curly hair and spectacles.  He was a comedian. Even to a mere schoolboy, Rukmani’s luminous beauty and grace was overwhelming.

So, on Sunday morning, a two-toned Buick convertible would drive up regally, passing those majestic mara trees, Eddie at the wheel, and the couple would walk up to the chapel. They did not put on airs, and behaved just like the rest of us, sitting on the benches, singing hymns, and walking up to the altar and kneeling to receive communion. After the service, they mingled and chatted. And nobody asked for autographs!

I think Eddie and Rukmani were fond of Maris Stella. They attended fund raising events, like the Maris Mela carnival and a football match, which I recall vividly. Their nephew, Gamini Jayamanne, was my classmate.

Scouting, and a school take-over

Cousin George Wambeck and I were Cub Scouts, Wolf Cubs as they were called those days. The chip-a-job weeks were the best, because we got to roam all over Negombo and beyond, with no adult supervision. Most people treated us kindly, giving 50 cents or even a generous rupee for the odd “job” we did, and also a snack and a soft drink into the bargain.

One day, cousin George and I, along with another friend, visited a relative’s house in search of a “job”. He had been drinking, and was stretched out on a hansiputuwa when we dropped-in. Thinking of having some fun with us, he assumed the role of a drill sergeant, lined us up, and put us through military “maneuvers”: attention, right turn, quick march, left turn, halt. Scouting doesn’t teach marching, and we were mere 8-year olds anyway. Our female cousins were watching from behind curtains, and we could hear the giggles. But, the man did reward us well, and also insisted that we have a meal before letting us go.On another day, we walked down Temple Road to Jaya-Ruk, the residence of Eddie and Rukmani. But they weren’t home.

Perhaps the most memorable event was planned take-over of schools by the government, in 1960. The Catholic church was opposed to the move. The conflict escalated, and, as a final resort, parents of students occupied some classrooms, bringing mats and pots and pans. They cooked, ate, and slept there. They came to “defend” the school, but from whom wasn’t certain. From a new principal appointed by the government, from the police, the army?

Classes were suspended, and we enjoyed loitering around the school, waiting for the confrontation to take place. Eventually, the matter was resolved, but, in Negombo, only Maris Stella and Ave Maria Convent remain as private fee-levying schools.

When my father moved to Nattandiya for work, my brother and I travelled to school from there, by steam train. We wore khaki pith hats and carried our books and lunch in little, cardboard suitcases. Every day was an adventure. Later, when father moved to Madampe, we were boarded at Maris Stella.

What I recall most from the boarding is the constant hunger. We didn’t have much pocket money, so gouging at the tuck shop was not an option. On Sundays, a long line of boarders was taken for a walk, most often to the beach. Going through town, the aroma from the thosai boutiques was irresistible. Despite Bro. Raphael, an Italian, keeping a sharp eye, boys would take turns to dart into the boutiques and buying up the vadais. Our pockets would be stuffed and we salivated at the feast to come.

In 1962, my last year at Maris Stella, my brother and I were boarded at a home on Temple Road. Bertram Fernando, a pioneer comedian of Sinhala cinema, also lived there. Every Sunday, a game of bridge went on for hours on the verandah around a round table. A regular attendee was Eddie Jayamanne, who drove up in his Buick convertible.

All our teachers named earlier have long departed. One by one, former classmates are also passing away. When I drive by Maris Stella now, the memories come flooding back. For some, the past is a foreign country. Not for me. Even after 60 years, the school anthem that we sang so robustly is fresh in my mind.

“All ye lads of Maris Stella proudly sing

May your voices boldly ring

Face life’s trials bravely

Act upon your motto gravely

Iter para tutum”

GEORGE BRAINE

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China’s Covid Trap

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by Gwynne Dyer

“Our COVID-19 policy is the most scientifically effective, the most economical, and yields the best result,” insisted the ‘People’s Daily’ newspaper in China after mass public protests against the government’s ‘zero covid’ policy last weekend. If President Xi Jinping believes that, he is in for a lot more trouble.

The protests were unprecedented in their scale and daring. They broke out spontaneously in twelve cities all across China after ten lockdown-related deaths in the remote province of Xinjiang. All sorts of people took part, from students to workers to pensioners. A few even called for the dethroning of Xi and the Communist Party.

That doesn’t mean the regime is on the brink of collapse. Public anger at the endless lockdowns and resulting loss of income is strong, but the regime’s surveillance technology is excellent. There was relatively little official violence last weekend, but many of the protesters will have an unpleasant visit by the police in the coming days.

Xi’s problem is that the protests will probably recur and may well escalate, because over-long mass quarantines and lockdowns are a non-political issue that can unite almost everybody against the government’s policy. Or rather, against Xi’s personal policy, for he has deliberately chosen to portray zero-covid as the greatest achievement of his time in office.

That made sense in the first year of the pandemic, for China’s relentless lockdowns and mass testing campaigns saved a great many lives then. Total covid-related deaths in China have been around 5,000 out of a population of 1.4 billion. The United States, with less than a quarter of China’s population, had more than a million covid deaths.

Xi and his propagandists naturally used this contrast as evidence that both Chinese medicine and the Chinese political system were superior to their Western equivalents. Was he even aware that the zero-covid policy could only be a stopgap measure until effective vaccines were developed, never a lasting solution?

His scientists must have tried to tell him that, but, somehow, he didn’t take the message on board. There was a vaccination programe, but not a very rigorous one – and Xi kept chasing the fantasy of completely eliminating the covid virus. He is caught in a trap, but he built it himself.

“Lockdowns should always be a temporary phenomenon, not a long-term strategy,” explained Dr Anthony Fauci, now President Joe Biden’s chief medical adviser. Continuing them for almost three years “without any seeming purpose or endgame” is sheer folly. Moreover, Xi seemed unaware that the covid virus was growing more infectious with time.

The latest versions of the omicron variant, which first appeared a year ago, are estimated to be up to ten times more infectious than the original virus that appeared in Wuhan in late 2020.

Those versions haven’t reached China yet, due to drastic curbs on travel into and out of the country, but the Chinese population is so poorly protected that the only alternatives if they arrive would be semi-permanent nationwide lockdowns or nationwide carnage.

Chinese-made vaccines are only 70% effective against earlier variants of the virus, and may be wholly ineffective against the later omicron versions. The elderly are particularly vulnerable: only 40% of the over-80s have had even a single booster shot.

An article published in Nature Medicine last March estimated that ending the covid-zero lockdowns and quarantines in current circumstances could overwhelm hospitals, with 15 times more people needing hospital beds than those currently available. It predicted around 1.5 million deaths.

That would still be a far better outcome than the US record, but arriving all at once so late in the game, when the rest of the world is long past lockdowns and mass deaths, it could spell political disaster for Xi Jinping. Perhaps even for the Communist regime.There is a way out. First, Xi has to eat humble pie and import several billion doses of the highly effective mRNA vaccines. Let’s say six months for that.

Then he has to control the rising infections with the hated lockdowns and quarantines as best he can, containing popular anger as much as possible, until a high enough portion of the population is properly vaccinated – say another six to twelve months.

Then, sometime in 2024, he can relax the restrictions and let the Chinese rejoin the rest of the world. That strategy worked for the Australians and New Zealanders, who ended similar mass lockdowns as soon as most people got their (imported) mRNA vaccines.If Xi can’t bear the humiliation of doing that, he could gamble that an effective Chinese-made mRNA vaccine will become available soon. Several are under development, and one is allegedly about to enter Phase 3 clinical trials.But if he bets on that and it’s not ready soon, his newly acquired status of de facto president-for-life will become a nightmare. Covid infections are rising fast.

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