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How can Sri Lanka benefit? Insights & Solutions…

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Vaccines against Covid-19:

By Dr LakKumar Fernando.

MD, DCH, MRCP(UK), MRCPCH (UK), FRCP (Lond), FSLCP

Background

It is almost one year since the world started battling the Covid-19 pandemic; there are over 80 million confirmed cases and 1.8 million deaths. WHO estimates that 10% of the world’s 7.8 billion population is already infected with Covid-19, and if that is the case the true case number is ten times higher. However, we are still without a proper treatment that can cure all the patients. Sri Lanka has recorded more than 200 Covid deaths and 40,000 cases by now. Fortunately, there is a light at the end of the tunnel with the positive news that several vaccines are getting lined up, shaping to end the pandemic before the end of 2021.

Vaccines have become the best solution against nearly all the important infections that threatened the human existence and Covid-19 is the most recent threat that demanded the biggest ever ‘vaccine solution’ in the history of mankind.

Normally, a vaccine takes 5-15 years of serious medical research before it is delivered for licensing and marketing. However, with all the tools ready with several vaccine makers to bring in a vaccine for similar infections, the race for Covid-19 vaccine became fast and efficient and researchers worked round the clock to fast track the solutions. The result is vaccinations against Covid-19 have started in several parts of the world already, even before the end of 2020.

With WHO declaring Covid-19 a global pandemic, close to 200 vaccine developers started research with huge investments and after completing pre-clinical animal studies, 44 vaccine candidates are currently in phase 1, 21 in phase 2, 18 are in phase 3. Five vaccines have approvals for limited use and three have emergency approval for full use., The fourth was approved on the 30th which can be a turning point with regard to cost and storage temperature of vaccines. About 85 vaccines are still in animal testing and just one vaccine was abandoned after the trials. Most Covid vaccines need two doses for complete immunity. However, trials have also shown significant immunity protection (70%) after a few weeks of the first dose itself. As a result, now the UK government is going to delay the second dose to 12 weeks instead of threeweeks so that more people could be vaccinated with the first dose protecting many while giving manufacturer more time to produce more doses.

Pfizer BioNTech’s BNT162b2 is the first vaccine against Covid-19 that got approval in most countries, that included the USA, Canada, the UK, and EU with more being added to the list almost daily. Moderna was the next that got approved in the USA and Canada. The Russian manufacturer Gamaley’s Sputnik V vaccine is in early use in Russia and it’s also approved in Belarus and Argentina. The Chinese vaccine Sinopharm Beijing is approved in the UAE and Bahrain and there is limited use in China too. CanSino and Sinovac are two other Chinese vaccines that are in limited use in China already.

The British-Swiss Oxford University combined Astra-Zeneca (AZ) vaccine AZD1222 which also has its biggest manufacturing site in the Serum Institute of our neighbouring India just got approval from the UK regulatory authority MHRA (Medicine and Health Regulatory Authority) and its possibly going to be the cheapest with cost being as low as two USD per dose with the storage capability of being within on 2-8 centigrade under normal refrigeration. Serum Institute also has over 50 million doses ready for dispatch after approval. AZ with about 30 manufacturing sites has the capacity to produce bigger quantities of the vaccine than most others.

Another Indian vaccine by Bharat Biotech is also in Phase 3 and will complete trials early next year.

With all these vaccines getting lined up and with more than a couple of million people in the world getting their doses already, Sri Lanka too should move fast to get the best use of the opportunity.

 

HOW CAN SRI LANKA GET THE VACCINE?

There is a group called COVAX set up with WHO’s help with funding from rich countries organized to give access for Covid-19 vaccines to populations in over 90 poorer countries. Covax has already ordered 2 billion of Covid vaccines from different manufacturers and they have already secured 1 billion doses from this order. It has agreed to give Sri Lanka too vaccines for 4.1 million or 20% of our population free.

No Covid vaccine is still intended for the under 16 age group as the trials were in populations older than this age limit. Fortunately, in this younger age group Covid has so far remained largely an asymptomatic disease with minimal deaths or need for hospitalisation.

 

WHEN CAN SRI LANKA GET THE VACCINE?

If we get ready with all logistical requirements, and communicate with COVAX and WHO efficiently and professionally, we can start having it from as early as next February itself but how many doses we can have and over what period of time will depend on many factors which also include the degree of our local effort and commitment.

 

WHOM SHOULD WE

VACCINATE FIRST?

We will have to have a priority order which should include our elderly population and those with co-existing illnesses like diabetes, heart and kidney disease and other chronic illnesses as well as the healthcare workers (HCW) and security forces involved in Covid control activities who are high risk groups to contact the disease.

Vaccinating healthcare workers are important for several reasons and they include…

1. We cannot afford to lose HCW having to isolate them or quarantine them with infection or exposure as they are needed in numbers to look after the Covid cases and other patients

2. Due to the fear of contacting Covid there is breakdown in the necessary routine medical and surgical care for patients in most healthcare institutions at present and this is responsible for most parallel deaths and morbidity even in non-Covid patients. Some of the Covid deaths specially home deaths are also a result of the malfunctioning of routine standard follow up and care for those with co-morbidities.

3. If the case numbers increase HCW will need more PPE for everyday use and we will not be able to face it if the situation escalate further.

 

WHAT ABOUT VACCINATING THE OTHERS? CAN WE AFFORD IT?

When it comes to immunisation coverage for routine vaccines, Sri Lanka is outstanding in the world where our strong public health set up and the infrastructure has beaten even many developed countries.

Our vaccination acceptance rates are remarkably high with the literacy rates and public health network, mass vaccination is nothing new to our setup. Being an island with secure borders and the limited population of only 21 million compared to eg. India’s 1.3 billion, we are a country where vaccinating the entire population is a realistic feasible option if you can find the money and the doses to cover the entire population. With about 25% (6 million) below 16 years of age, where there is no vaccine for this age group, we need vaccines only for less than 15 million people. Our over 65 population in the country is just about 10% (2 million). We will get at least 4 million doses free from COVAX. We must spend money only for 11 million doses.

 

If we buy at 2 USD per dose, (Indonesia is possibly getting the AZ vaccine from serum institute for USD 1.64 per dose) we will need less than Rs. 5-8 billion to buy the vaccine and there will be a little more logistical cost. This will also be over many months. Sri Lanka has already spent close to 10 billion rupees on PCR testing alone since March and compared to that the vaccine expenditure is a remarkably worthwhile investment. It is also not essential that we give the vaccine free to everybody.

With good motivation and awareness campaign there will be many who will not mind paying for their vaccine which can be as little as 500-800 rupees for both doses. We can start a public campaign to raise funding for the vaccine without overburdening the Treasury and if handled properly this can have an excellent response. We have 1.8 million Samurdhi recipients and it is believed that only about 1 million of them are in the extremely poor category. In this country we can also easily find over 1 million people who will not mind sponsoring a vaccine for someone else who is poor and cannot afford it. This is a time we have to get-together to face this pandemic.

No one should try to take political advantage of the situation. Together we can end up a proud nation that has vaccinated all its people ahead of many other countries. It is also essential that we strengthen the vaccination system by allowing the private sector too, to be very much a part of the vaccination program. This not only ease the burden to the government, it will also help to reduce unwanted unrest among people.

It is also worth noting that many rich countries have already placed orders far in excess of their true requirement. For example, UK has placed orders for 350 million doses though they need only 120 million doses for its less than 60 million eligible population. There are many examples like Canada pre-ordering almost 9 doses per person very much more than they need and countries needing more doses can take advantage of these situations, by being proactive. Its unlikely that the cost of the vaccines will go up or the availability of doses will become a huge issue. With time most will be solved. Already 18 vaccines are in phase 3, and they too will be competing in the market soon. The early successors have no room for monopoly and when vaccines like by Johnson & Johnson which is single dose also come into the market the competition will be even more. Serum Institute in India can produce 2 billion doses of AZ vaccine in 2021 and the Russian Gamaleya can produce 500 million more doses to be used outside Russia. WHO and NMRA will do the regulatory evaluations for each vaccine fast. However, if we do not actively look for avenues, we will be end up at the back end of waiting list.

With above explained feasibility and reality, Sri Lankan can be one of the first countries in this part of the world to vaccinate its entire population. It is never an impossible task. This will place us in a unique situation, with our ability to fully open the country where factories and tourism and our economy can jump ahead of many others, making Sri Lanka one of the safest countries in the world to travel and to deal with. We being a smaller country with a smaller population, it’s best that we take advantage of our unique circumstances. For the best out come extreme efficiency is a must and we will need top officials with a proven track record handing our vaccine effort.

WHAT ARE THE VACCINES WE CAN BUY OR GET?

With the huge global demand, it is unlikely that any country(possible exception of Singapore and Canada) can vaccinate the entire population with only one type of vaccine. We will have to keep shopping for different vaccines, while the COVAX also will be giving the countries their free quota from different makes. They have already offered as 200,000 doses of Pfizer vaccine to Sri Lanka last week through a proposal, as they believe, Sri Lanka is an ideal example in this part of the world to successfully execute distribution of an ultra-cold vaccine to a limited population like the healthcare workers. Though -70C appeared not practical at the beginning Pfizer has already found good transport solution where vaccine doses can be taken in a separate storage unit filled with dry ice (liquid carbon dioxide), and there are reputed local logistics companies (eg. Akbar Brothers) that can handle it up to the delivery to the hospital. The Pfizer’s storage units can maintain ultra-cold temperature for 10 days if unopened and can be kept for 30 days if re-filled with dry ice every 5 days. Once taken out of these storage unit the vaccine can be kept in normal refrigerator temperature of 2-8C up to a further 5 days. If we commit to take this free offer, (has to be a firm commitment done fast enough in time) we can vaccinate our HCW front liners incredibly early, and the same Pfizer vaccine can be made available also for the private sector later in the future. Our preparedness to complete our vaccinations using different vaccines for Covid will be the best way to achieve the ‘not-impossible target’ of vaccinating our entire population early.

 

WHAT ABOUT SIDE EFFECTS OF THE VACCINE AND DURATION OF IMMUNITY? WHAT ABOUT NEW STRAINS THAT WILL APPEAR?

Any vaccine or drug can have side effects, like allergy in people known for severe allergy. With over millions of vaccinations now completed after recent approval the safety of the approved vaccines appear very good and comparable to the vaccines we have already taken from childhood. This has been systematically tested in phase 2 and 3 of the trials.

About efficacy and long-lasting immunity, we can be only be hopeful as compared to influenza virus that fast mutate, SARS Covid-2 is a relatively stable virus where mutations are slower, and indications are that even the new variant of Covid-19 that emerged in UK and South Africa will still be prevented by the vaccine. There are interesting reports about the survivors of 2002- 2004 SARS epidemic infected by SARS Covid-01 still showing protection against the current Covid-2. If the immunity does not last long a booster will be needed. Initially like children we will have few exclusions for vaccinations like for any new vaccine for eg. pregnancy. Vaccinating a large number will bring in a major change into our lifestyle and take us towards herd immunity. With so many restrictions affecting our day-to-day life the vaccine option is THE best available solution we have now.

In summary we need to use a multi-pronged effort to vaccinate everybody which will be a noticeably big useful investment towards economic development, even more than a health solution. We will have to secure and use

1. The free vaccine we will get from COVAX for 20% of our population

2. Negotiate with various sources, and countries to obtain or buy more doses to cover the balance population.

3. Permit the private sector also to import, distribute and vaccinate, with state monitoring to facilitate effective coverage of the population who could afford the vaccine privately.

 

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Govt.’s choice is dialogue over confrontation

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By Jehan Perera

Preparing for the forthcoming UN Human Rights Council cannot be easy for a government elected on a nationalist platform that was very critical of international intervention. When the government declared its intention to withdraw from Sri Lanka’s co-sponsorship of the October 2015 resolution No. 30/1 last February, it may have been hoping that this would be the end of the matter. However, this is not to be. The UN Human Rights High Commissioner’s report that will be taken up at the forthcoming UNHRC session in March contains a slate of proposals that are severely punitive in nature and will need to be mitigated. These include targeted economic sanctions, travel bans and even the involvement of the International Criminal Court.

Since UN Secretary General Ban Ki-Moon’s visit in May 2009 just a few days after the three-decade long war came to its bloody termination, Sri Lanka has been a regular part of the UNHRC’s formal discussion and sometimes even taking the centre stage. Three resolutions were passed on Sri Lanka under acrimonious circumstances, with Sri Lanka winning the very first one, but losing the next two. As the country became internationally known for its opposition to revisiting the past, sanctions and hostile propaganda against it began to mount. It was only after the then Sri Lankan government in 2015 agreed to co-sponsor a fresh resolution did the clouds begin to dispel.

Clearly in preparation for the forthcoming UNHRC session in Geneva in March, the government has finally delivered on a promise it made a year ago at the same venue. In February 2020 Foreign Minister Dinesh Gunawardena sought to prepare the ground for Sri Lanka’s withdrawal from co-sponsorship of UN Human Rights Council resolution No 30/1 of 2015. His speech in Geneva highlighted two important issues. The first, and most important to Sri Lanka’s future, was that the government did not wish to break its relationships with the UN system and its mechanisms. He said, “Sri Lanka will continue to remain engaged with, and seek as required, the assistance of the UN and its agencies including the regular human rights mandates/bodies and mechanisms in capacity building and technical assistance, in keeping with domestic priorities and policies.”

Second, the Foreign Minister concluding his speech at the UNHRC session in Geneva saying “No one has the well-being of the multi-ethnic, multi-lingual, multi-religious and multi-cultural people of Sri Lanka closer to their heart, than the Government of Sri Lanka. It is this motivation that guides our commitment and resolve to move towards comprehensive reconciliation and an era of stable peace and prosperity for our people.” On that occasion the government pledged to set up a commission of inquiry to inquire into the findings of previous commissions of inquiry. The government’s action of appointing a sitting Supreme Court judge as the chairperson of a three-member presidential commission of inquiry into the findings and recommendations of earlier commissions and official bodies can be seen as the start point of its response to the UNHRC.

 

 

NEGATIVE RESPONSE

 

The government’s setting up of a Commission of Inquiry has yet to find a positive response from the international and national human rights community and may not find it at all. The national legal commentator Kishali Pinto Jayawardene has written that “the tasks encompassed within its mandate have already been performed by the Lessons Learnt and Reconciliation Commission (LLRC, 2011) under the term of this President’s brother, himself the country’s Executive President at the time, Mahinda Rajapaksa.” Amnesty International has stated that “Sri Lanka has a litany of such failed COIs that Amnesty International has extensively documented.” It goes on to quote from the UN High Commissioner for Human Rights that “Domestic processes have consistently failed to deliver accountability in the past and I am not convinced the appointment of yet another Commission of Inquiry will advance this agenda. As a result, victims remain denied justice and Sri Lankans from all communities have no guarantee that past patterns of human rights violations will not recur.”

It appears that the government intends its appointment of the COI to meet the demand for accountability in regard to past human rights violations. Its mandate includes to “Find out whether preceding Commissions of Inquiry and Committees which have been appointed to investigate into human rights violations, have revealed any human rights violations, serious violations of the international humanitarian law and other such serious offences.” In the past the government has not been prepared to accept that such violations took place in a way that is deserving of so much of international scrutiny. Time and again the point has been made in Sri Lanka that there are no clean wars fought anywhere in the world.

International organisations that stands for the principles of international human rights will necessarily be acting according to their mandates. These include seeking the intervention of international judicial mechanisms or seeking to promote hybrid international and national joint mechanisms within countries in which the legal structures have not been successful in ensuring justice. The latter was on the cards in regard to Resolution 30/1 from which the government withdrew its co-sponsorship. The previous government leaders who agreed to this resolution had to publicly deny any such intention in view of overwhelming political and public opposition to such a hybrid mechanism. The present government has made it clear that it will not accept international or hybrid mechanisms.

 

 

SEQUENTIAL IMPLEMENATION

 

In the preamble to the establishment of the COI the government has made some very constructive statements that open up the space for dialogue on issues of accountability, human rights and reconciliation. It states that “the policy of the Government of Sri Lanka is to continue to work with the United Nations and its Agencies to achieve accountability and human resource development for achieving sustainable peace and reconciliation, even though Sri Lanka withdrew from the co-sponsorship of the aforesaid resolutions” and further goes on to say that “the Government of Sri Lanka is committed to ensure that, other issues remain to be resolved through democratic and legal processes and to make institutional reforms where necessary to ensure justice and reconciliation.”

As the representative of a sovereign state, the government cannot be compelled to either accept international mechanisms or to prosecute those it does not wish to prosecute. At the same time its willingness to discuss the issues of accountability, justice and reconciliation as outlined in the preamble can be considered positively. The concept of transitional justice on which Resolution No 30/1 was built consists of the four pillars of truth, accountability, reparations and institutional reform. There is international debate on whether these four pillars should be implemented simultaneously or whether it is acceptable that they be implemented sequentially depending on the country context.

The government has already commenced the reparations process by establishing the Office for Reparations and to allocate a monthly sum of Rs 6000 to all those who have obtained Certificates of Absence (of their relatives) from the Office of Missing Persons. This process of compensation can be speeded up, widened and improved. It is also reported that the government is willing to consider the plight of suspected members of the LTTE who have been in detention without trial, and in some cases without even being indicted, for more than 10 years. The sooner action is taken the better. The government can also seek the assistance of the international community, and India in particular, to develop the war affected parts of the country on the lines of the Marshall Plan that the United States utilized to rebuild war destroyed parts of Europe. Member countries of the UNHRC need to be convinced that the government’s actions will take forward the national reconciliation process to vote to close the chapter on UNHRC resolution 30/1 in March 2021.

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Album to celebrate 30 years

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Rajiv Sebastian had mega plans to celebrate 30 years, in showbiz, and the plans included concerts, both local and foreign. But, with the pandemic, the singer had to put everything on hold.

However, in order to remember this great occasion, the singer has done an album, made up of 12 songs, featuring several well known artistes, including Sunil of the Gypsies.

All the songs have been composed, very specially for this album.

Among the highlights will be a duet, featuring Rajiv and the Derena DreamStar winner, Andrea Fallen.

Andrea, I’m told, will also be featured, doing a solo spot, on the album.

Rajiv and his band The Clan handle the Friday night scene at The Cinnamon Grand Breeze Bar, from 07.30 pm, onwards.

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LET’S DO IT … in the new normal

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The local showbiz scene is certainly brightening up – of course, in the ‘new normal’ format (and we hope so!)

Going back to the old format would be disastrous, especially as the country is experiencing a surge in Covid-19 cases, and the Western Province is said to be high on the list of new cases.

But…life has to go on, and with the necessary precautions taken, we can certainly enjoy what the ‘new normal’ has to offer us…by way of entertainment.

Bassist Benjy, who leads the band Aquarius, is happy that is hard work is finally bringing the band the desired results – where work is concerned.

Although new to the entertainment scene, Aquarius had lots of good things coming their way, but the pandemic ruined it all – not only for Aquarius but also for everyone connected with showbiz.

However, there are positive signs, on the horizon, and Benjy indicated to us that he is enthusiastically looking forward to making it a happening scene – wherever they perform.

And, this Friday night (January 29th), Aquarius will be doing their thing at The Show By O, Mount Lavinia – a beach front venue.

Benjy says he is planning out something extra special for this particular night.

“This is our very first outing, as a band, at The Show By O, so we want to make it memorable for all those who turn up this Friday.”

The legendary bassist, who lights up the stage, whenever he booms into action, is looking forward to seeing music lovers, and all those who missed out on being entertained for quite a while, at the Mount Lavinia venue, this Friday.

“I assure you, it will be a night to be remembered.”

Benjy and Aquarius will also be doing their thing, every Saturday evening, at the Darley rd. Pub & Restaurant, Colombo 10.

In fact, they were featured at this particular venue, late last year, but the second wave of Covid-19 ended their gigs.

Also new to the scene – very new, I would say – is Ishini and her band, The Branch.

Of course, Ishini is a singer of repute, having performed with Mirage, but as Ishini and The Branch, they are brand new!

Nevertheless, they were featured at certain five-star venues, during the past few weeks…of their existence.

 

 

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