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Covid-19 vaccination: Is it the proverbial ‘Silver Bullet’?

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Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

In this emerald isle, people take to any form of vaccination, like the legendary ducks take to water. Offer them a vaccine against anything and they will take it; at least most of them would do so. The vaccine antagonists and anti-vaxxers are extremely few and far between, so as to be almost a virtual non-entity. With a very high literacy rate, and a population that is prepared to take heed to the hilt, the axiom that dictates ‘prevention is better than cure’, it is the absolute dream of the experts in the public health scenario that there is unmitigated abiding interest on the part of our populace to get vaccinated against COVID-19. It has been said that vaccines do not save lives but vaccination most definitely does. Vaccines have to be given to people for them to produce the optimal effects. A receptive population to such a notion is indeed, a much-fancied reverie of all health service providers.

In such a background, it is most laudable that Sri Lanka is going pell-mell, even in an impetuous rush, to vaccinate her population against COVID-19, at what could best be described as at break-neck speed. Even given the spectacle of an insufficiency of adequate stocks of the coronavirus vaccines to freely vaccinate the population, the authorities are making the very best of the situation. We must, of course clearly appreciate the steps taken by the Government and the Ministry of Health in this initiative. The tri-forces, the Army in particular, have to be congratulated, in playing the lead role in organising a scheme of things to administer the vaccines in an orderly fashion. TAKE A BOW; ALL OF YOU, you are indeed giving the very best of yourselves in this endeavour.

Well, the goal is to somehow secure a high enough herd-immunity to defeat the virus; most definitely a commendable final goal. The currently prevalent mantra is to vaccinate, vaccinate, and vaccinate even more. Yet for all that there is much misinformation and an infodemic doing the rounds, especially on social media, about widespread speculations on loss of sexual prowess, impotence, subfertility and infertility, as undesirable effects of the COVID-19 vaccines. THERE IS ABSOLUTELY NO SCIENTIFIC BASIS FOR ANY OF THESE IMPLICATIONS. NONE OF THE CURRENTLY AVAILABLE COVID-19 VACCINES DO ANY OF THIS. It is just stupid covidiocy on the part of a few anti-vaxxers. It has induced a lot of young people to refuse the vaccine. This is a crime against humanity to spread such falsehoods. It is absolutely crucial to realise that the current vaccination drive is just a very important one of quite a few things we can do to try and keep the coronavirus at bay.

We have seen the fantastic results of immunisations against ‘child-killer diseases’ in paediatric healthcare. This author, as a young junior doctor, was witness to the ravages of the much-feared childhood diseases that killed or maimed scores of young children even in the second half of the last century. Those diseases such as tetanus, diphtheria, whooping cough, polio, measles, Japanese encephalitis; just to mention a few that took scores of young lives of yore, are a thing of the past now. Adequate vaccination has completely wiped them out. The last case of childhood polio in Sri Lanka was seen just around a quarter of a century ago. The young junior doctors of today and the current lot of medical students have not seen any of these dreaded diseases.

In the child healthcare scenario, vaccination has become the panacea for all ills in the above-mentioned diseases. In the same vein, it is quite reasonable to expect the coronavirus vaccines to provide a similar end-result. However, is it really so? It is a most lamentable fact that it is perhaps not quite so.

There is a well-recognised fundamental difference between all the vaccines that are used to prevent the much-feared childhood diseases of the past and the currently available vaccines against the coronavirus that is causing the current pandemic. The vaccines against all those childhood diseases COMPLETELY PREVENT children getting the disease!!!, period. Well, if the recipients are protected against getting the infection, it is the end of the story; a definitive conclusion of the matter in hand.

However, right up to just a few days ago, none of the currently available vaccines against COVID-19, were thought to be able to COMPLETELY PREVENT anyone getting the disease to any appreciable degree. How they work is by reducing the severity of the disease and by preventing the deaths. So…, the basic end-result characteristics of all the currently available COVID-19 vaccines were thought to be quite different to the standard vaccines against all other infective diseases. One could still get the disease in spite of being vaccinated against COVID-19 and would still be able to spread the illness to others.

Yet for all this, there seems to be a little bit of light at the end of the tunnel. In a most recent scientific publication in the New England Journal of Medicine, released as recently as 22nd September 2021, an interim analysis of a large study conducted in 99 centres of the USA has shown significant protection against CONTRACTING THE DISEASE as well as AGAINST MORE SEVERE DISEASE AND DEATH by the mRNA-1273 (Moderna/Spikevax) vaccine, administered as two doses 28 days apart. Vaccine efficacy in preventing Covid-19 illness was 93.2%, the effectiveness in preventing severe disease was 98.2% and the efficacy in preventing asymptomatic infection, starting 14 days after the second injection, was 63.0%. Vaccine efficacy was consistent across ethnic and racial groups, age groups, and participants with coexisting conditions. No safety concerns were identified.

Be that as it may, added to all our problems, now there is the daunting spectacle of the various types of variants and mutants, ranging from Alpha through delta, even to Epsilon and most recently to a particularly nasty strain called ‘Mu’, of the coronavirus which could cause problems even in the fully vaccinated. We still do not understand completely the potential impact of these more virulent strains in vaccinated people.

However, a case in point in relationship to these facts is the presently dominant situation in Israel. That country, one of the fastest in vaccination and most-vaccinated nations in the world, in spite of almost the entire population being vaccinated, is having some problems at the present time. By mid-March 2021, Israelis were partying as lockdowns ended and by April, masks had more or less vanished, turning the tiny country into a tantalising glimpse of a post-pandemic future. However, the crafty blight of a coronavirus seems to have come back with a vengeance. From a few dozen daily cases in early June 2021, even zero on June 9, new daily COVID infections twice hovered near 6,000 very recently, the highest daily rate in six months. Having won early access to supplies of the BioNTech/Pfizer jab in exchange for sharing nationwide data on how mass vaccination drives affect the pandemic, Israel is a closely watched indicator of a country where well-inoculated developed economies are heading.

As new infections soared, so did the long tail of hospitalisations in Israel. Even though the unvaccinated were five to six times as likely to end up seriously ill, the vaccine’s protection was waning fastest for the oldest; the most vulnerable, who got their first jabs as early as December 2020. At this rate, health officials predicted at least 5,000 people would need hospital beds by early September, half of them with serious medical needs, twice as many as Israel is equipped to handle. The current Prime Minister of Israel was honest with Israelis when he announced a new measure just a couple of weeks ago, whereby the government was trying to cushion the blow. On August 1, it had started offering people, over 60, a third shot of the Pfizer vaccine, embarking on its own public health experiment as it tumbled into an unpredictable fourth wave. So far, 775,000 people have taken their third shot and doctors say they can see antibody counts rising measurably within days of the third jab.

For Israelis, the booster shots are a reminder that they are still on the frontier of Covid-19 vaccinations. They celebrated when they were the first to get jabbed, cheering Pfizer as lockdowns ended in March 2021. Now, they are the first to experience the limits of the vaccine and the first to accept a long-whispered inevitability: the need to give regular booster shots to stay protected.

All these facts tend to bring into sharp focus, again and AGAIN, the undoubted importance of time-tested manoeuvres of avoiding crowds, maintaining a social distance of at least one to two metres, wearing suitable and effective masks; even double-masking, and repeated washing of hands, as our own personal weapons against this dastardly blight. Vaccination against COVID-19 will probably not be the panacea for all ills in combating this pandemic, although it would be a very powerful tool in the hands of the authorities in their quest towards victory over this disease. It will certainly not be the ultimate ‘SILVER BULLET’ against the disease.

If there is a lesson to be learnt from Israel today, it is this: corona, in fact, is not over; perhaps not for quite a while. This summer was just an intermission. Next may come winter., sadly perhaps, a winter of discontent. We do hope to high heaven that it may not be so for this beautiful and much-treasured Motherland of ours.



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Features

Encouraging signs, indeed!

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Derek and Manilal

Local entertainers can now breathe a sigh of relief…as the showbiz scene is showing signs of improving

Yes, it’s good to see Manilal Perera, the legendary singer, and Derek Wikramanayake, teaming up, as a duo, to oblige music lovers…during this pandemic era.

They will be seen in action, every Friday, at the Irish Pub, and on Sundays at the Cinnamon Grand Lobby.

The Irish Pub scene will be from 7.00 pm onwards, while at the Cinnamon Grand Lobby, action will also be from 7.00 pm onwards.

On November 1st, they are scheduled to do the roof top (25th floor) of the Movenpik hotel, in Colpetty, and, thereafter, at the same venue, every Saturday evening.

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Constructive dialogue beyond international community

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by Jehan Perera

Even as the country appears to be getting embroiled in more and more conflict, internally, where dialogue has broken down or not taken place at all, there has been the appearance of success, internationally. President Gotabaya Rajapaksa will be leading a delegation this week to Scotland to attend the UN Climate Change Conference (COP26). Both the President, at the UN General Assembly in New York, and Foreign Minister Prof G L Peiris, at the UN Human Rights Council, in Geneva seem to have made positive impacts on their audiences and, especially amongst the diplomatic community, with speeches that gave importance to national reconciliation, based on dialogue and international norms.

In a recent interview to the media Prof Peiris affirmed the value of dialogue in rebuilding international relations that have soured. He said, “The core message is that we believe in engagement at all times. There may be areas of disagreement from time to time. That is natural in bilateral relations, but our effort should always be to ascertain the areas of consensus and agreement. There are always areas where we could collaborate to the mutual advantage of both countries. And even if there are reservations with regard to particular methods, there are still abundant opportunities that are available for the enhancement of trade relations for investment opportunities, tourism, all of this. And I think this is succeeding because we are establishing a rapport and there is reciprocity. Countries are reaching out to us.”

Prof Peiris also said that upon his return from London, the President would engage in talks locally with opposition parties, the TNA and NGOs. He spoke positively about this dialogue, saying “The NGOs can certainly make a contribution. We like to benefit from their ideas. We will speak to opposition political parties. President Gotabaya Rajapaksa is going to meet the Tamil National Alliance on his return from COP26, which we will attend at the invitation of the British Prime Minister. So be it the NGO community or the foreign diaspora or the parliamentary opposition in Sri Lanka. We want to engage with all of them and that is very much the way forward”

INTERNAL FRAGMENTATION

The concept of a whole-of-government approach is indicative of a more cohesive approach to governance by government ministries, the public administration and state apparatus in general to deal with problems. It suggests that the government should not be acting in one way with the international community and another way with the national community when it seeks to resolve problems. It is consistency that builds trust and the international community will trust the government to the extent that the national community trusts it. Dialogue may slow down decision making at a time when the country is facing major problems and is in a hurry to overcome them. However, the failure to engage in dialogue can cause further delays due to misunderstanding and a refusal to cooperate by those who are being sidelined.

There are signs of fragmentation within the government as a result of failure to dialogue within it. A senior minister, Susil Premajayantha, has been openly critical of the ongoing constitutional reform process. He has compared it to the past process undertaken by the previous government in which there was consultations at multiple levels. There is a need to change the present constitutional framework which is overly centralised and unsuitable to a multi ethnic, multi religious and plural society. More than four decades have passed since the present constitution was enacted. But the two major attempts that were made in the period 1997-2000 and again in 2016-2019 failed.

President Rajapaksa, who has confidence in his ability to stick to his goals despite all obstacles, has announced that a new constitution will be in place next year. The President is well situated to obtain success in his endeavours but he needs to be take the rest of his government along with him. Apart from being determined to achieve his goals, the President has won the trust of most people, and continues to have it, though it is getting eroded by the multiple problems that are facing the country and not seeing a resolution. The teachers’ strike, which is affecting hundreds of thousands of schoolchildren, is now in its fourth month, with no sign of resolution. The crisis over the halting of the import of chemical fertiliser is undermining the position of farmers and consumers at the present time.

EARLY WARNING

An immediate cause for the complaints against the government is the lack of dialogue and consultation on all the burning issues that confront the country. This problem is accentuated by the appointment of persons with military experience to decision-making positions. The ethos of the military is to take decisions fast and to issue orders which have to be carried out by subordinates. The President’s early assertion that his spoken words should be taken as written circulars reflects this ethos. However, democratic governance is about getting the views of the people who are not subordinates but equals. When Minister Premajayantha lamented that he did not know about the direction of constitutional change, he was not alone as neither does the general public or academicians which is evidenced by the complete absence of discussion on the subject in the mass media.

The past two attempts at constitutional reform focused on the resolution of the ethnic conflict and assuaging the discontent of the ethnic and religious minorities. The constitutional change of 1997-2000 was for the purpose of providing a political solution that could end the war. The constitutional change of 2016-19 was to ensure that a war should not happen again. Constitutional reform is important to people as they believe that it will impact on how they are governed, their place within society and their equality as citizens. The ethnic and religious minorities will tend to prefer decentralised government as it will give them more power in those parts of the country in which they are predominant. On the other hand, that very fact can cause apprehension in the minds of the ethnic and religious majority that their place in the country will be undermined.

Unless the general public is brought aboard on the issue of constitutional change, it is unlikely they will support it. We all need to know what the main purpose of the proposed constitutional reform is. If the confidence of the different ethnic and religious communities is not obtained, the political support for constitutional change will also not be forthcoming as politicians tend to stand for causes that win them votes. Minister Premajayantha has usefully lit an early warning light when he said that politicians are not like lamp posts to agree to anything that the government puts before them. Even though the government has a 2/3 majority, this cannot be taken for granted. There needs to be buy in for constitutional reform from elected politicians and the general public, both from the majority community and minorities, if President Rajapaksa is to succeed where previous leaders failed.

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Features

JAYASRI twins…in action in Europe

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The world over, the music scene has been pretty quiet, and we all know why. This pandemic has created untold hardships for, practically, everyone, and, the disturbing news is that, this kind of scene has been predicted for a good part of 2022, as well,

 

The band JAYASRI, however, based in Europe, and fronted by the brothers Rohitha and Rohan, say they are fortunate to find work coming their way.

Over the past few months, they have been performing at some of the festivals, held in Europe, during the summer season.

Says Rohitha: “As usual, we did one of the biggest African festivals in Europe, AfrikaTage, and some other summer events, from July up to now. Some were not that big, as they used to be, due to the pandemic, health precautions, etc.”

For the month of October, JAYASRI did some concerts in Italy, with shows in the city of Verona, Napoli, Rome, Padova and Milano.

The twins with the
late Sunil Perera

On November, 12th, the JAYASRI twins, Rohitha and Rohan, will be at EXPO Dubai 2020 and will be performing live in Dubai.

Rohitha also indicated that they have released their new single ‘SARANGANA,’ describing it as a Roots Reggae song, in audio form, to all download platforms, and as a music video to their YouTube channel – www.youtube.com/user/jayasri

According to Rohitha, this song will be featured in an action drama.

The lyrics for ‘SARANGANA,’ were created by Thushani Bulumulle, music by JAYASRI, and video direction by Chamara Janaraj Pieris.

There will be two audio versions, says Rohitha – a Radio Mix and a DUB Mix by Parvez.

The JAYASRI twins Rohitha and Rohan

After their Italian tour, Rohitha and Rohan are planning to come to Sri Lanka, to oblige their many fans, and they are hoping that the showbiz scene would keep on improving so that music lovers could experience a whole lot of entertainment, during the forthcoming festive season.

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