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Covid-19 Vaccines:Some ethical dilemmas



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.

There is an unprecedented interest across the globe in the currently available vaccines against SARS-CoV-2 virus that causes COVID-19 disease. There are many factors to consider in this endeavour to vaccinate the general population. The primary considerations are the effectiveness and safety of the vaccines while the costs, the adequacy of the supplies of the vaccines, ethics of selection of priority groups for vaccination, logistics of transportation as well as fair and equitable distribution of vaccines to all corners of the world are also important. This article will discuss some of the pros and cons of a few that are relevant to Sri Lanka.

The effectiveness of the currently licensed vaccines is by now well established. They do very significantly protect us against more severe symptomatic disease and thereby reduce the needs for intensive treatment in hospitals and of course by virtue of that, reduce the associated mortality. This is of major importance as this little blot of a coronavirus has killed over 2.7 million people all over the world and in Sri Lanka it has taken the lives of around 550 people at the time of writing of this article. The initial premise on which the researchers worked on, as stipulated by even the World Health Organisation (WHO), is a committed effort towards reducing more severe disease and mortality. Generally, a vaccine is formulated to prevent anyone catching the disease. However, that was not the initial principle on which the research was targeted.

Yet for all this, now there seems to be some accumulating evidence that the vaccines do play a part in protecting at least some recipients against catching the disease and thereby reducing transmission from humans to humans. In some recipients of the vaccine who contracted the virus, significantly lower viral loads have also been seen. All of these do combine to provide a real bonus and would help a great deal in our fight to defeat the virus. However, it must be stressed that it does not provide universal one hundred percent protection against infection by the virus. Vaccinated individuals should not, I repeat., should not, abandon safe physical distancing, avoidance of gatherings, washing of hands and wearing of masks. If the vaccinated people happen to catch the virus, even if they are asymptomatic, they can still transmit it, at least to some people. So it is very important to follow all health guidelines.

The safety profile of the vaccine was quite stringently looked at during all the clinical trials in humans before these vaccines were licensed for general use. It must be remembered that all types of any vaccine against infective diseases have the risk of developing allergic or sensitivity reactions. Some of the recipients of the vaccine against COVID-19 are also liable to get chills or feeling cold, fever, muscle pains, some abdominal symptoms and fatigue. All of these are quite short-lived, just only for a couple of days. Some more serious side-effects have been noted in the human trials but these were extremely rare and not thought to be of grave significance. The latest problem that was publicised are disturbances in the clotting of blood in vaccine recipients in some Western countries. Clots were detected in deep veins and some detached clots had gone into the blood vessels of the lungs. A lot of fuss was made on this issue, particularly by the media, which even led to temporary suspension of at least one brand of the corona vaccines. However, deep venous thrombosis is a well-known problem in the West and a scrupulous assessment of a cause-and-effect nature, has not been able to establish the vaccine to be directly responsible for these problems. In fact, after firm assurance of the safety of the vaccine being provided by the European Medicines Agency (EMA), many of those countries have restarted their vaccination programme with the incriminated vaccine. It is important also to highlight that even after giving around 800,000 or so vaccinations in Sri Lanka, this problem has not been seen here to a really significant extent, up to now. From an ethical perspective, there is everything to be gained by administering the currently used Oxford-AstraZenica vaccine in Sri Lanka.

The real ethical dilemma in our country is how to organise the administration of the limited supplies of the vaccines to cover the most vulnerable groups of our citizens. The administration of the vaccine to front -line health workers and the forces personnel in the front-line went off quite well, except for a couple of hitches initially in the provision of the vaccine for health personnel in the private sector. After that, for a couple of days, an ill-advised ad hoc decision to vaccinate those between 30 and 59 years caused a profound degree of mayhem and chaos at vaccination centres. At the present time there seems to be some order where the over 60-year-olds are given the vaccine. It took a considerable number of adverse scathing reports in the media and intense pressure brought on by many people, for sanity to prevail. Ethically, it is imperative that the carefully formulated ‘Priority List’ of groups of people for administration of the vaccine is strictly adhered to. Queue-jumpers, thugs and those with connections should be very firmly dealt with.

There are some other ethical aspects to the administration of the vaccine. There are some concerns regarding the second dose of the vaccine. In a previous article (The Island – 17th March 2021), I have explained the rationale for changing the timing of the second dose to three months after the first dose from the earlier recommended time period of one month from the first dose. So far around 800,000 or more first doses have been administered. It is imperative that we give the second dose to this cohort in three months or so from the first dose. The government must, I repeat MUST, ensure that sufficient stocks of the vaccine are kept for this group of people.

There have been some arguments put forward in certain quarters to say that we should use all available stocks to vaccinate as many people as possible with the first dose to provide even short-term immunity to as many people as possible. They make it out to be a human rights issue. This author believes that it is a more compelling question of human rights for ALL those who have already had the first dose to be given the second dose at the appropriate time, to provide them with the best possible and sustained protection. This contention would apply to even those between 30 and 59 years, who were given the first dose of the vaccine during those initial disordered days.

As far as ethics go, in view of the global shortage of vaccines, it is essential that the powers-that-be take steps to even get as many brands of the vaccines with PROVEN EFFICACY AND SAFETY RECORDS into the country. It really does not matter where these vaccines originate from. The only criteria that are of paramount importance are whether the vaccine is effective and whether it is safe.

As at present it is best to give both doses of the same vaccine to each recipient. However, when more scientific information is available, we may be able to mix vaccines if there is evidence that it would work equally well or even better when vaccines are mixed. All over the world, there are several scientific studies in progress to ascertain the usefulness of such a pathway. However, that decision should be a well-informed one, based on robust scientific evidence. It could only be made by the expert scientific medical community. It should not be made on economic, logistical or political grounds by non-medical people and most certainly not, by lay politicians, on their own accord.

The take home message for our people at the present time is that the authorities are trying their very best to provide the vaccines against this coronavirus that is running amok. The prioritised groups who are due to receive the vaccine should be reassured of the effectiveness and safety of this vaccination. Misinformation, especially through the social media, concocting of various stories of doubtful repute and spreading of false rumours, should not be allowed to scuttle the current vaccination procedures. A system of well-organised system of administration of the vaccines will go a long way towards ensuring success in this war against a tiny enemy that has the potential to bring all of us to our knees and make us sink to the lowest depths of despair.

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Rise of Dual Power amidst Covid 



We had so many kings in our Sinhala Balaya of many centuries. There were many questionable deals on succession by members of this royalty, and others who came to those realms. But we have yet to hear of any brother of a ruling monarch rushing abroad in the midst of what may have been a national crisis, moving to a disaster.This is the stuff of Sinhala Power in the 21st Century. It is a show of the Raja Keliya – the power game, where dual citizenship is the dominant factor. The Sri Lanka, Mawbima home, is of lesser importance than the Videsha mawbima, especially if one’s health has to be handled by foreign medical sources; even if the Videsha Mawbima is the biggest affected by the Covid pandemic.

The appointment of Task Forces to deal with important issues facing the country and the people is the substance of the current Saubhagyaye Dekma – Vision of Prosperity and Splendour. Appointing a brother to head task forces of key importance is the show of dominant family power that prevails in this country today. But brotherly feelings are certainly not important when a dual citizen thinks of the greater importance of the Videsha Mawbima. The tasks of Economic Growth, Eradicating Poverty and Assuring Food Supply, as well as the more recent Green Socio-Economy must all be pushed aside, when the call of the Videsha Mawbima for healthcare is the stuff that matters.

This is the brotherly Vision of Prosperity and Splendour, or the Sahodara Saubhabyaye Dekma.

The Covid pandemic has certainly brought much contradictory thinking, especially in the government, on how the health of the people in this country, non-dual citizens, could be assured. Minister Udaya Gammanpila, a Cabinet spokesman too, is certain that mixed vaccinations of different brands and qualities, is the means to protect the people. 

Dr. Sudarshani Fernandopulle, State Minister on the subject, thinks differently, on the lines of the WHO specialists, who have stressed there is no evidence so far to authorize mixed vaccinations. The other minister of health and vaccination issues is somewhat silent on this confusion in official thinking. Is a new pandemic syrup to be promoted by the power handlers?

Thank heavens that the Cabinet Minister of Health, Pavithra Wanniarachchi, is so far silent on this matter. She could come up with a new Sri Lankan Deshamanya scientific solution, such as throwing some of the Sinopharm and Sputnik (Chinese and Russian) into the nearby river, and using the mixed and river blended vaccine for people of the related province. She is sure to obtain the support of Ministers Udaya Gammanpila and Prasanna Ranatunga for such a crafty thinking of science, just as they shared her belief in the Charmed Pot Game or Mantara Kala Keliya to fight the Covid-19.

  We are now in the midst of what is known as a Lockdown. It is not a “Vasaa thabeema” in Sinhala, but a limit on travel – a ‘Sancharana Seemava’. The Police are very clear that anyone who breaks the lockdown rules will be arrested and brought to justice. We have seen the great joy that policemen showed in carrying non-mask wearers and other violaters of Covid safety guidelines, to be shoved into buses. How much more of such delights would follow when Covid increases its hold on Sri Lanka? What was the related Task Force, and its ceremonial uniformed head doing, when Indians were brought to Sri Lankan hotels for quarantine before travel to some Middle Easter countries? What foreigner from the Covid battered India was carried or courteously conducted to a place where lawbreakers are detained?

As we keep wearing our masks and distancing ourselves from others, there is much cause for concern, even beyond the Covid pandemic, on how persons arrested and detained by the police are killed by or in the presence of the  police. Two suspected and arrested persons have been killed while in police custody this week.  They are Melon Mabula or ‘Uru Juva’ and Tharaka Perera Wijesekera or ‘Kosgoda Tharaka’ These are persons with records of major crimes, possibly with much strong evidence, but not presented in court and any punishment order through the judicial process.

The police spokesperson, a person with a legal background, too, tells the people the details of all the terrible crimes these persons are supposed to be guilty of. It is a contemptible move to get public support for the killings. The Bar Association has raised concerns about these departures from justice. There must be much more protests, even with the Covid dangers.

One gets the impression that the prevailing dangerous situation due to Covid, is being used to carry out increasing violations of the law and the judicial process. This is certainly a major step back to the earlier years of Rajapaksa Power, when many such suspects were killed in Colombo and elsewhere, showing off police escape power. It also brings back memories of the killing and attacks on journalists by similar police and official forces of crooked power.

Are we moving to a new sense of Dual Power — where the judiciary is ignored and official power is the Rule of the Day? Is the power of Dual Citizenry to be the dominant force once Covid puts down the people’s power?

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Should ASEAN Free Trade Area be considered model for SAFTA?



By Dr. Srimal Fernando

Economic integration is more important today than it has ever been for South Asia’s development. When comparing the impact of South Asian Association for Regional Cooperation (SAARC)s South Asian Free Trade Area (SAFTA) and the Association of Southeast Asian Nations (ASEAN ) Free Trade Area (AFTA) in promoting trade amongst its member states, AFTA has been more effective in integrating the economies of its member states. SAFTA , on the other hand, has yet to make significant contributions to the integration of the economies of SAARC member states. The Success of ASEAN’s economic integration can be attributed to the willingness of Southeast Asian countries to embrace the tenets of regional integration. In contrast, SAARC’s model has failed to create a secure regional environment that is conducive for economic growth since its formation.

The Association of Southeast Asian Nations (ASEAN ) member states signed the AFTA agreement on 28 January 1992. After the establishment of AFTA, the member states of ASEAN succeeded in signing trading protocols within the organization. The ASEAN model succeeded in creating one of the most successful free trade areas in Asia as well as globally. The establishment of AFTA has been an important milestone in Southeast Asia as a factor that facilitated the economic integration of ASEAN member states.

In the case of the SAARC, the signing of free trade protocols under the SAFTA agreement has been faced with several tariff and non-tariff barriers. Although both SASRC and ASEAN member states face unique challenges that affect trading within these organizations, it can be said that, unlike the SAARC, the ASEAN economic integration model has been far successful in promoting trade amongst its member states. For the SAARC, the liberalization of the economies of SAFTA signatories has been a crucial challenge. On the other hand, ASEAN has made notable progress with regards to trade liberalization, policy alignments, and intra-regional trade among Southeast Asian nations.

The specific trade liberalization challenges faced by the SAARC member states include concerns over SAFTA revenue allocation from member states, restrictive rules of origin, and negative sensitive lists. The sensitive lists adopted by SAARC member states have proven to be a significant hurdle to exportation amongst SAARC member states. This has particularly made it difficult for exports from small member states of the SAARC to enter into large markets such as India and Pakistan. Having failed to grant the application of  most favored nation (MFN) status that would have seen a significant reduction in the sensitive lists maintained by both countries, trade between these two regional powers has been problematic over the years. Notably, the trading commodities that are in the sensitive lists of a majority of the SAFTA member states have high export potential. Despite the various commitments made by SAFTA member states, countries continue to maintain long sensitive lists hence the dismal performance of SAFTA. 

In the case of ASEAN, the establishment of the AFTA agreement has provided ASEAN member states with a platform to exploit their export potential. The AFTA agreement has boosted the economies of ASEAN countries through its trade liberalization policies. AFTA has also entered into several free trade agreements with regional powers such as Australia, China, South Korea, India, and Japan. The ASEAN countries are now focused on creating an Economic Community for their member states. Notably, several countries have shown interest in being a part of the proposed ASEAN Economic Community.

It should however be noted that the massive success achieved by ASEAN’S AFTA as opposed to SAARC’s SAFTA is not flawless. For example, although ASEAN has made significant steps in eliminating tariff barriers amongst AFTA member states, Non-tariff barriers are still a key challenge to the AFTA agreement. However, when analyzing the progress made by ASEAN’s AFTA since its formation, the achievements and evolution are undeniable. ASEAN was formed in an era when interstate relations amongst Southeast Asian countries were characterized by political mistrust and strained interstate relations. Years later, the organization has succeeded in unifying its member states for a common course, an aspect that the SAARC still struggles with. 

Way Forward

If SAFTA is to become more effective and emulate AFTA’s success, the myriad of issues mentioned above needs to be addressed. First, downsizing the sensitive lists of countries in a time-bound manner will be necessary. Secondly, the issue of para tariffs needs to be squarely addressed. A starting point could be to reduce and accelerate the elimination of para tariffs on items not on sensitive lists and include para tariffs in SAFTA negotiations. Also, the non-tariff barriers to trade facing SAFTA member states need to be equally addressed like the tariff barriers. Finally, strengthening economic relations can be used to reinforce improving political relations in the region, particularly between India and Pakistan. To an extent, the success of ASEAN in achieving effective economic integration and its experience can be used as an external driver of SAARC and its SAFTA agreement.

About the author:

Dr. Srimal Fernando received his PhD in the area of International Affairs. He was the recipient of the prestigious O.P. Jindal Doctoral Fellowship and SAU Scholarship under the SAARC umbrella. He is also an Advisor/Global Editor of Diplomatic Society for South Africa in partnership with Diplomatic World Institute (Brussels). He has received accolades such as 2018/2019 ‘Best Journalist of the Year’ in South Africa, (GCA) Media Award for 2016 and the Indian Council of World Affairs (ICWA) accolade. He is the author of ‘Politics, Economics and Connectivity: In Search of South Asian Union’

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Ramazan spirit endures amid pandemic



This will be a sombre Ramazan, indeed, with the country under a lockdown. But the spirit of Ramazan lives on in all Muslims. Ramadan, also referred to as Ramazan, Ramzan, or Ramadhan, in some countries, is the ninth month of the Islamic calendar, and Muslims the world over dedicate this holy month for fasting, prayer, reflection and community.

Although most non-Muslims associate Ramazan, solely with fasting, it is believed to bring Muslims closer to God and inculcate in them qualities such as patience, spirituality, and humility. Those of the Islamic faith believe that fasting redirects one away from worldly activities, cleanses the inner soul and free it from harm. It also teaches self-discipline, self-control, sacrifice, and empathy for those who are less fortunate and encourage actions of generosity and charity. It is a time of self-examination and increased religious devotion.

Ramazan is a commemoration of Prophet Muhammad’s first revelation, and the annual observance of Ramazan is regarded as one of the Five Pillars of Islam. The Five Pillars are basic acts, considered mandatory by Muslims, namely Muslim life, prayer, concern for the needy, self-purification, and the pilgrimage. Prophet Muhammad’s first revelation is believed to have taken place in 610 AD, in a cave called Hira, located near Mecca, where Muhammad was visited by the angel Jibrīl, who revealed to him the beginnings of what would later become the Qur’an. The visitation occurred on Ramazan.

Ramazan lasts from one sighting of the crescent moon to the next and the local religious authority is tasked with announcing the date. The Colombo Grand Mosque announced on Wednesday (12) that Sri Lankan Muslims will celebrate Ramazan on Friday (14). Because the Muslims follow a lunar calendar, the start of Ramazan moves backwards by about 11 days, each year, in the Gregorian calendar. Fasting from dawn to sunset is considered fard (obligatory) for all adult Muslims who are not acutely, or chronically, ill, travelling, elderly, breastfeeding, diabetic, or menstruating.

During this month, Muslims refrain not only from partaking of meals, but also tobacco products, sexual relations, and sinful behaviour, devoting themselves to prayer or salat and recitation of the Quran. The pre-dawn meal is referred to as suhur, and the nightly feast that breaks fast is referred to as iftar. During Ramazan, Muslims wake up well before dawn to eat the pre-dawn meal. This is considered the most important meal, during Ramazan, since it has to sustain one until sunset. This means eating lots of high-protein food and drinking as much water as possible, right up until dawn, after which one cannot eat or drink anything. The day of fasting ends at sunset, the exact minute of which is signalled by the fourth call to prayer, at dusk.

It is believed that spiritual rewards, or thawab, of fasting multiply during Ramazan. Muslims do not Fast on Eid, but Sri Lankan Muslims believe that observing the six days of optional fasting, that follows Eid, multiplies spiritual rewards.

Eid-Ul-Fitr is the Festival of Breaking the Fast, also simply referred to as Eid, and marks the end of the month-long dawn-to-sunset fasting of Ramadan, as well as the return to a more natural disposition of eating, drinking, and marital intimacy. In Sri Lanka, this Festival of Breaking the Fast is also referred to, colloquially, as Ramazan. Eid begins at sunset, on the night of the first sighting of the crescent moon. Muslims hand out money, to the poor and needy, as an obligatory act of charity, before performing the Eid prayer.

Globally, the Eid prayer is generally performed in open areas, like fields, community centres, or mosques in congregation. In Sri Lanka, the prayer is performed annually in Galle Face Green and mosques. The Eid prayer is followed by the sermon and then a supplication asking for Allah’s forgiveness, mercy, peace and blessings for all living beings across the world. The sermon encourages Muslims to engage in the rituals of Eid, such as zakat, almsgiving to other fellow Muslims. After the prayers, Muslims visit relatives, friends, and acquaintances, or hold large communal celebrations.

After prayer, Muslims celebrate Eid, with food being the central theme. Sri Lankans celebrate Ramazan with watalappam, falooda, samosa, gulab jamun and other national and regional dishes. The festivals were said to have initiated in Medina, after the migration of Muhammad from Mecca.

This year, as well as last year, Sri Lankan Muslims will have to forgo the custom of communal prayers, and celebrations, due to the ongoing pandemic, and will have to settle for private prayers and celebrations of Ramazan during this period of curfew. While these preventive measures are in place, during this year’s Ramazan, the principles of this holy month remain the same. Devout Muslims all over the world, will still be honouring this pillar of Islam, albeit from the security of their homes.

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