Opinion
Fork in the road: Will we protect medicines that protect us or deal with incurable diseases?
By SHOBHA SHUKLA – CNS
The spotlight is once again on preventing antimicrobial resistance that is not only devastating human health but also threatening the sustainability of our planet earth. Will we protect the medicines that protect us or lose them, resulting in diseases that become difficult or impossible to treat? “The answer my friend is blowing in the wind” as the legendary lyrics go.
What is antimicrobial resistance?
Antimicrobial resistance occurs when bacteria, viruses, fungi or parasites become resistant to, and hence no longer respond to the antimicrobials or drugs (antibiotics, antivirals, fungicides and parasiticides) used to treat the diseases caused by them. While antimicrobials are the backbone of modern medicine, their misuse and overuse in humans, animals and plants is driving the emergence and spread of antimicrobial resistance, making it difficult or even impossible to treat infections, increasing the risk of disease spread, severe illness and death.
Progress on all SDGs threatened by antimicrobial resistance
Antimicrobial resistance is not only causing a huge loss of human life (contributing to over 6 million deaths every year directly and indirectly) but also posing a crippling mountainous economic burden, said Dr Haileyesus Getahun, who is the Director, Global Coordination and Partnership on antimicrobial resistance, and also the Director, Quadripartite Joint Secretariat on antimicrobial resistance at the World Health Organization (WHO). Dr Getahun was the inaugural speaker at a recently concluded 2nd Annual Global Media Forum in lead up to 2022 World Antimicrobial Awareness Week.
According to a 2017 World Bank report, if no action is taken now, antimicrobial resistance is likely to cause an USD 1.2 trillion additional health expenditure per year by 2050, and push up to 24 million additional people (particularly in low-income countries) into extreme poverty by 2030. Dr Getahun warned that antimicrobial resistance can directly affect progress on at least 6 of the 17 UN Sustainable Development Goals and can be linked indirectly to the remaining 11 as well.
Inequity also ails antimicrobial resistance
As the burden of antimicrobial resistance is greatest in low-resource settings, particularly in sub-Saharan Africa, and South Asia, it is not only a global public health problem, but also an issue of health equity and socioeconomic development, says Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit at the World Health Organization (WHO). Along with ensuring a rational use of antibiotics “having access to clean water, sanitation, and hygiene, as well as good infection prevention and control measures, such as hand washing and vaccination, are vital in the fight against antimicrobial resistance,” he emphasises.
One Health approach is vital to address antimicrobial resistance
Humans, animals, plants and environment are continuously interacting and sharing with each other the microbials that have become resistant to drugs. So curbing antimicrobial resistance to protect human lives is not possible without protecting the health of our plants, animals and environment.
Jacqueline Álvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP), rightly points out that “Antimicrobial resistance is both, a cause and a consequence of the triple planetary crisis of climate change, biodiversity loss and pollution and chemicals.”
Dr Getahun calls for increased financing, political advocacy and coordinated global action to better respond to the converging threats of antimicrobial resistance and the climate crisis before it is too late.Scott Newman, Senior Animal Health and Production Officer for Asia and the Pacific at the Food and Agriculture Organization of the United Nations (FAO), stresses upon preserving antimicrobial efficacy while we sustain food and agriculture production.
“Loss of biodiversity and ecosystems, as well as of natural habitats for agriculture, has also led to an increase in antimicrobial use, and pathogen spread. We have to ensure that emergence and spread of antimicrobial resistance is slowed down across all food sectors (animal husbandry and agriculture). We need to switch to sustainable food production, by promoting climate-smart agriculture, agro-ecological approaches, nature-based solutions, and efficient and safe production methods biosecurity and disease prevention and control,” added Scott Newman.
Antimicrobials cannot compensate animal husbandry practices
“Antimicrobials are also used to prevent infections in animals apart from their use in treating animal diseases. But we must note that antimicrobials used in animals to prevent infections, must not be done to compensate poor animal husbandry practices. Rather antimicrobials should only be used for infection prevention in animals, who are at risk of acquiring a specific infection or in a specific situation where infectious disease is likely to occur, if the drug is not administered,” cautioned Delfy Gochez, Data Management Officer, antimicrobial resistance, and Veterinary Products Department, World Organisation for Animal Health (WOAH).
Jane Lwoyero, Technical Officer on antimicrobial resistance at the WOAH shared that in Africa, and globally, WOAH (World Organisation for Animal Health)’s strategy is followed by them to promote prudent use of antimicrobials. “We have also disseminated farm biosecurity guidelines in Kenya and Ethiopia to curb antimicrobial resistance. We also helped pilot the information and alert system for substandard and falsified veterinary products (during October – December 2021)” said Jane. “WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans.”
Improve the basics to strengthen antimicrobial stewardship
“To contain antimicrobial resistance, we need better evidence, and evidence-backed actions; we need to improve diagnostic stewardship; we need to have good infection control practices in the hospitals and the community; and without these pillars – we cannot truly practice antimicrobial stewardship,” said Dr Kamini Walia, Senior scientist, Indian Council of Medical Research.
“Diagnostic stewardship and infection control – both are significant challenges in our country because we have sub-optimal investment in the healthcare system, and we do not have good diagnostic laboratories in secondary and primary healthcare services (and good laboratories are essentially limited to tertiary care health services). Being a tropical country, we have a significant burden of infectious diseases. This further leads to sanitation and hygiene problems, and most of the antimicrobials which are prescribed are to compensate for poor sanitation and hygiene – both in communities and in hospitals. So, if we really want to make progress on antimicrobial stewardship we have to improve the basics, such as improving diagnostics, infection control, and other necessary actions,” rightly added Dr Walia.
“Studies done in India show that almost half of all prescriptions audited in the study, were of antibiotics, and over 55% of antibiotic use was prescribed for uncomplicated respiratory symptoms. More alarmingly, less than 1% of these patients had any microbiological diagnosis done. Many of these prescriptions show the levels of inappropriate use or higher use of antibiotics. Also, over two-third of these drugs are available over the counter. We need to prevent over-the-counter dispensing of antimicrobials,” said Dr Prapti Gilada-Toshniwal, senior microbiologist and founder head of UniLabs.
“We need stronger and practical antimicrobial stewardship programme for our context and ground realities so that we can effectively promote the appropriate use of antimicrobials (including antibiotics), improve treatment outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms,” added Dr Prapti Gilada-Toshniwal. “We need to boost diagnostic capacities at all levels. Access to accurate, rapid, and point-of-care diagnostic facilities for different diseases and conditions, should be scaled up.”
Clock is ticking
All this points towards the urgency of tackling antimicrobial resistance through an integrated and comprehensive response involving all the sectors, what is now referred to as the One Health approach. In the words of Dr Getahun, “One Health approach is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.”Collaborative efforts are needed that involve public health, agriculture, animal husbandry and environment sectors, as well as whole of society approach, to effectively address the challenge of AMR and make economies resilient to its impacts.
Opinion
Why Sri Lanka needs a National Budget Performance and Evaluation Office
Sri Lanka is now grappling with the aftermath of the one of the gravest natural disasters in recent memory, as Cyclone Ditwah and the associated weather system continue to bring relentless rain, flash floods, and landslides across the country.
In view of the severe disaster situation, Speaker Jagath Wickramaratne had to amend the schedule for the Committee Stage debates on Budget 2026, which was subsequently passed by Parliament. There have been various interpretations of Budget 2026 by economists, the business community, academics, and civil society. Some analyses draw on economic expertise, others reflect social understanding, while certain groups read the budget through political ideology. But with the country now trying to manage a humanitarian and economic emergency, it is clear that fragmented interpretations will not suffice. This is a moment when Sri Lanka needs a unified, responsible, and collective “national reading” of the budget—one that rises above personal or political positions and focuses on safeguarding citizens, restoring stability, and guiding the nation toward recovery.
Budget 2026 is unique for several reasons. To understand it properly, we must “read” it through the lens of Sri Lanka’s current economic realities as well as the fiscal consolidation pathway outlined under the International Monetary Fund programme. Some argue that this Budget reflects a liberal policy orientation, citing several key allocations that support this view: strong investment in human capital, an infrastructure-led growth strategy, targeted support for private enterprise and MSMEs, and an emphasis on fiscal discipline and transparency.
Anyway, it can be argued that it is still too early to categorise the 2026 budget as a fully liberal budget approach, especially when considering the structural realities that continue to shape Sri Lanka’s economy. Still some sectors in Sri Lanka restricted private-sector space, with state dominance. And also, we can witness a weak performance-based management system with no strong KPI-linked monitoring or institutional performance cells. Moreover, the country still maintains a broad subsidy orientation, where extensive welfare transfers may constrain productivity unless they shift toward targeted and time-bound mechanisms. Even though we can see improved tax administration in the recent past, there is a need to have proper tax rationalisation, requiring significant simplification to become broad-based and globally competitive. These factors collectively indicate that, despite certain reform signals, it may be premature to label Budget 2026 as fully liberal in nature.
Overall, Sri Lanka needs to have proper monitoring mechanisms for the budget. Even if it is a liberal type, development, or any type of budget, we need to see how we can have a budget monitoring system.
Establishing a National Budget Performance and Evaluation Office
Whatever the budgets presented during the last seven decades, the implementation of budget proposals can always be mostly considered as around 30-50 %. Sri Lanka needs to have proper budget monitoring mechanisms. This is not only important for the budget but also for all other activities in Sri Lanka. Most of the countries in the world have this, and we can learn many best practices from them.
Establishing a National Budget Performance and Evaluation Office is essential for strengthening Sri Lanka’s fiscal governance and ensuring that public spending delivers measurable value. Such an office would provide an independent, data-driven mechanism to track budget implementation, monitor programme outcomes, and evaluate whether ministries achieve their intended results. Drawing from global best practices—including India’s PFMS-enabled monitoring and OECD programme-based budgeting frameworks—the office would develop clear KPIs, performance scorecards, and annual evaluation reports linked to national priorities. By integrating financial data, output metrics, and policy outcomes, this institution would enable evidence-based decision-making, improve budget credibility, reduce wastage, and foster greater transparency and accountability across the public sector. Ultimately, this would help shift Sri Lanka’s budgeting process from input-focused allocations toward performance-oriented results.
There is an urgent need for a paradigm shift in Sri Lanka’s economy, where export diversification, strengthened governance, and institutional efficiency become essential pillars of reform. Establishing a National Budget Performance and Evaluation Office is a critical step that can help the country address many long-standing challenges related to governance, fiscal discipline, and evidence-based decision-making. Such an institution would create the mechanisms required for transparency, accountability, and performance-focused budgeting. Ultimately, for Sri Lanka to gain greater global recognition and move toward a more stable, credible economic future, every stakeholder must be equipped with the right knowledge, tools, and systems that support disciplined financial management and a respected national identity.
by Prof. Nalin Abeysekera ✍️
Opinion
Comfort for some, death for others: The reality of climate change
The recent Cyclone Ditwah struck South and Southeast Asia in an unprecedented way, causing floods, landslides, deaths, displacement of thousands, and severe soil degradation. For many in Sri Lanka, the disaster is seen as a natural event that the government should have anticipated. Yet, the reality is that small countries like ours have little power to prevent disasters of this scale. Despite contributing minimally to global carbon emissions, we are forced to bear the consequences of ecological harm caused largely by wealthier nations. Excessive consumption and profit-driven production in capitalist economies fuel climate change, while the Global South suffers the resulting losses in lives, homes, and livelihoods. The dead, the disappeared, and the displaced from Cyclone Ditwah demand climate justice—a justice that addresses structural inequality, exploitation of nature for profit, and the failure of global powers to take responsibility.
The Role of Excessive Consumption
The environmental crisis is driven by excessive consumption, particularly in developed countries. Cars, electronics, clothing, and other consumer goods require immense energy to produce, much of it from fossil fuels such as coal, gas, and oil. The transportation of raw materials and finished products adds further emissions, while waste from overconsumption ends up in landfills, releasing methane, a potent greenhouse gas. This cycle of consumption, production, and waste underscores a systemic problem: climate change is not merely an environmental issue, but a symptom of an economic system built on profit, not sustainability.
Market-Based “Solutions” and Greenwashing
Neoliberal economies are not silent in the face of climate change—they perform “sustainability” while offering superficial solutions. Many corporations engage in green branding to appear environmentally responsible, even as their practices remain unchanged. Carbon trading, for example, allows companies to buy and sell the right to emit CO₂ under a capped system. While intended to reduce emissions, it often commodifies pollution rather than eliminating it, enabling wealthy actors to continue environmentally harmful practices. Since many developing countries do not strictly enforce carbon caps, wealthy corporations often relocate their factories to these regions. Meanwhile, the burden of “reductions” is shifted to marginalised communities, turning these areas into pollution havens that endure the worst effects of climate disasters despite contributing the least to the problem. Market-based solutions, therefore, frequently reinforce existing inequalities rather than addressing the structural causes of climate change.
International Agreements and Structural Limitations
The global community has reached multiple climate agreements, including the UNFCCC (1992), the Kyoto Protocol (1997), and the Paris Agreement (2015). Yet these agreements remain constrained by capitalist agendas and weak enforcement mechanisms. Most rely on voluntary national commitments, peer pressure, and reporting transparency rather than legally binding obligations. Countries can submit inadequate Nationally Determined Contributions (NDCs) and remain technically compliant, rendering the agreements more symbolic than transformative. While not entirely ineffective, international agreements often prioritise narrative performance over real structural change, allowing wealthy nations to avoid meaningful responsibility for emissions and ecological harm.
Climate Justice and Social Inequalities
Climate change is inseparable from social injustice. Marginalised communities—those affected by poverty, colonial histories, racial discrimination, or gender inequality—face the greatest risks from environmental disasters. These populations generally lack safe housing, and even when warned to evacuate, they have few resources or means to recover from disasters. General climate policies, which have been influcned by capitalist agendas, that focus solely on emissions reduction or “green” initiatives fail to address these deeper inequalities. True climate action must empower communities, redistribute wealth, and integrate social justice with environmental sustainability. Only by tackling the structural drivers of both inequality and ecological harm can we move toward genuine climate justice.
Conclusion
Cyclone Ditwah and other climate disasters are reminders that the effects of environmental degradation are unevenly distributed. The Global South pays a heavy price for the consumption patterns and industrial practices of the Global North. Market-based solutions, superficial sustainability initiatives, and weak international agreements are insufficient to address the systemic roots of climate change. Achieving climate justice requires a fundamental rethinking of economic priorities, social structures, and global responsibility—placing people and the planet above profit.
The author is a postdoctoral fellow at Harvard Divinity School.
by Anushka Kahandagamage ✍️
Opinion
Ditwah wake-up call demands a national volunteer community service for rebuilding Sri Lanka
The Tsunami of 2004 struck our coasts, but the recent Cyclone Ditwah has delivered an unprecedented blow, devastating and traumatising the entire country. President Anura Kumara Dissanayake rightly called it the “largest and most challenging natural disaster” in Sri Lanka’s history.
The toll is staggering: Over 600 people were confirmed dead, with hundreds still missing. More than 2 million citizens – nearly one in ten people—have been affected. 41,000 to 86,000 houses are damaged or completely destroyed. The damage is widespread, with 22 of the island’s 25 districts declared disaster-affected areas. A provisional economic damage estimate reaching up to USD 7 billion—a figure that instantly consumes about 7% of our national GDP. This was not merely a natural disaster; it was a crisis amplified by systemic failure, culminating in a catastrophe that now demands a radical, long-term policy response.
Unlike the Tsunami, the destruction to our vital inland infrastructure—roads, bridges, railway lines, and power networks—has been colossal, crippling the nation’s ability to recover. Over 25,000 members of the tri-forces have been mobilised, and the nation rightly hails their courageous and relentless efforts in rescue and relief. They should now be graduated from ‘Rana Viruvo’ to RUN VIRUVO considering the efforts they are still putting into the relief operations in this unprecedented calamity. But the scale of the rebuilding effort requires a permanently sustained unified national mechanism, perhaps learning from their rich experiences.
Why did devastation reach this cataclysmic level?
Unlike a sudden earthquake/Tsunami, a cyclone’s path is largely traceable. Yet, the “post-mortem” on Ditwah reveals a horrifying truth: the storm’s devastation was amplified by our own institutional failures.
The India Meteorological Department (IMD) which runs the Regional Specialised Meteorological Centre (RMSC) monitors the oceans in this region and issues alerts for cyclones. It serves all the regional countries — Bangladesh, Maldives, Myanmar, Oman, Pakistan, Sri Lanka and Thailand. The RMSC first predicted the formation of a depression as early as November 13 and issued an alert over the possibility of a cyclone forming on November 20. From November 23 onwards, IMD/RMSC had been routinely sharing frequent weather updates with Sri Lanka.
Robust models from the India Meteorological Department and the RMSC provided ample warnings of the depression and subsequent cyclonic intensification. Some of these predictions by the RMC and even the BBC forecasted rainfall over 300- 400 mm which could go up to even half a meter per day. True to their forecasts, Matale tragically received unprecedented rainfall of around 520 mm, triggering fatal landslides. Ditwah’s impact was worsened by its unusually slow movement over the island which sustained heavy rainfall over several days.
The Governance Gap
The critical breakdown occurred between the scientific prediction and the state’s executive arm. Warnings, if not taken seriously or acted upon, become meaningless data points. The core issue is a fragmented disaster management system that lacks the “unified command structure” required for real-time data sharing and rapid deployment. As one analyst noted, the disaster delivered a hard lesson: we entered one of our worst natural disasters in decades without a functioning national strategy and with a severe deficit in “adaptive capacity.
Scientific forecasts were not translated into an appropriate, urgent disaster preparedness program by the Sri Lankan state apparatus. Public reports indicate that national preparedness was woefully short of what was needed. The warnings failed to translate into a coherent, proactive response into an appropriate disaster preparedness action program on the island. This failure points directly to long-standing institutional deficits.
The Strategic Imperative: Dedicated Workforce for a $7B Recovery
President Anura Kumara Dissanayake rightly emphasised that restoring public life requires a unified operational mechanism that goes beyond normal state administration. To tackle this immense task, the Government has established a ‘Rebuilding Sri Lanka Fund’ to finance the medium- and long-term recovery, including essential infrastructure and public health issues.
This newly established ‘Rebuilding Sri Lanka Fund’ addresses the financial cost, but it does not solve the fundamental manpower crisis which is a key bottleneck in retarding the progress of this formidable undertaking. Rebuilding 247 kilometers of impacted roads, restoring two-thirds of unusable railway lines, clearing hundreds of landslides, and repairing crucial irrigation systems demands a sustained, disciplined, and massive workforce that normal state administration simply cannot provide. Furthermore, with the changing climate, events of this nature and magnitude may be more frequent in the future.
As such, there is a moral call to a strategic imperative. The immediate, ad-hoc spontaneous public volunteerism is commendable, but the scale of the task ahead requires a permanent, non-partisan national investment in human resources. The time for piecemeal recovery programs is over. Ditwah has forced the issue of structural accountability and national capacity onto the policy agenda.
A Call for Mandatory National Service
One of the most responsible paths forward is to utilise this crisis to institutionalise a robust National Service System, transforming a generation of youth into a standing army for climate resilience and nation-building. To fail to do so would be to guarantee that the next storm will bring an even higher price.
Sri Lanka cannot afford to be unprepared again. The solution is to immediately mobilise and, for the long term, institutionalise the patriotic energy of our youth into a robust, structured National Service System. This service should be more than just disaster relief; it is a long-term investment that will:
i) Build the Nation: Provide a rapid-response labour force for future disasters, infrastructure projects, and conservation efforts.
ii) Forge Character: Instill essential skills like discipline, leadership, accountability, and responsibility in our youth, thereby contributing to lower rates of substance abuse and crime.
iii) Strengthen Unity: Promote social cohesion and reinforce national identity by having youth from all backgrounds work together for a common cause.
The legal framework for such a move already exists. The Mobilisation and Supplementary Forces Act, No. 40 of 1985, already gives the government the powers to issue a National Service Order to enlist people in a National Armed Reserve. This mechanism can be adapted to establish a non-military, civilian-focused service.
Sri Lanka already has a government supported National Volunteer Service affiliated to her Social Services Department. It coordinates volunteers, develops management systems, and works with partners like the UN volunteers. This service can be improved and upgraded to tackle challenges in natural and/or human induced disasters which are going to be more frequent with greater intensity, at times.
In the immediate term, the large number of existing volunteers dispersed all over the island need to be engaged as understudy groups, working directly alongside the armed forces and government departments in the recovery process which is already happening in a number of instances.
Ditwah is our wake-up call for longer-term strategic planning and policy reforms. Alongside reacting to catastrophes in a piecemeal manner in the short-term, we must systematically start building a resilient nation with a vision for the future. Investing in a structured, mandatory Civilian National Service is the only way to safeguard our future against the inevitable challenges of climate change and to truly rebuild Sri Lanka.
Globally over 60 countries have national service portfolios mostly of military nature. Both Germany and France have recently reintroduced their national services to meet their own specific needs. In the US, the National Community Service centers around the Corporation for National and Community Service (CNCS), a federal agency that runs programs like AmeriCorps and Senior Corps, mobilising millions of Americans in service to address needs in education, disaster relief, environment, and more, fostering civic duty and offering educational awards for service.
Incorporate National Service into Educational Reforms
We must mobilize our youthful energy into a national service portfolio unique to our own needs giving due recognition to our history, geography and culture. As a long-term investment, this should be initiated while children are still in school, preparing them mentally and physically to contribute to nation-building.
A well-designed National Volunteer Community Service would instill discipline and foster essential skills like leadership, responsibility, and mutual respect, while contributing at the same time to national development. We can tailor this service to tackle our unique challenges in public safety, disaster relief, and environment conservation.
Existing school programmes like scouting and cadeting can be innovatively transformed to lay a sound foundation for this life-changing National Service for all schoolchildren. According to the initial estimates of UNICEF, over 275,000 children are among the 1.4 million people affected both physically and mentally who need careful rehabilitation.
The current educational reforms are an ideal platform to impart crucial values in patriotism and introduce essential skills like time management, discipline, and accountability. This system could not only build successful individuals but also help decrease social issues like substance abuse and crime among youth.
In the immediate future, to meet the demands of the recovery effort now, currently available volunteers should be engaged as understudy groups, working alongside the armed forces and government departments involved in the rebuilding process. The long-term investment in a Mandatory National Service, on the other hand, will strengthen our national identity and contribute to the “unified operational mechanism” the President has called for.
The author can be contacted at nimsavg@gmail.com
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