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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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Credibility in governance through elections and not security forces

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Ranil Wickremesinghe

By Jehan Perera

President Ranil Wickremesinghe’s warning that he is prepared to declare a state of national emergency and use the military to suppress any public protests for change of government would reflect the pressures he is under. The manner in which he has used the security forces to deal with the protest movement has been unexpected. His words and deeds are contradictory to what he has previously stood for as a five-time former prime minister. This is especially true in the case of the ethnic and religious minorities who have consistently voted for him and his party at elections. They have felt safer and more secure under his governments which always sought to reduce the heavy hand of state oppression in which national security is given pride of place. He has always promised them much though he has been unable to deliver on much of what he promised.

Notwithstanding the unfortunate rhetoric and actions of the present time the belief still persists that President Wickremesinghe is the best of the available options. Recent pronouncements of the president have reignited hope that he will address the problems of the religious and ethnic minorities. He has stated that he does not want to leave this problem to the next generation. He has said that he wants to resolve this intractable national problem by the country’s 75th independence anniversary on February 4 next year. The hope that the president will make a fresh effort to resolve their problems has led the main Tamil party, the TNA, to desist from voting against the budget which passed with a relatively small majority. Their spokesperson, M A Sumanthiran said in Parliament that due to the president reaching out to them, stretching out his hand, they did not vote against the budget although they disagreed with it.

It is not only in words that the president has reached out to the ethnic and religious minorities. Reports from the north and east indicate that the Maveer (Heroes) Day commemorations this year took place without incident. During the past two years scores of people were arrested and a massive presence of security forces blocked the people from participating in public events. On this occasion the security forces did not get involved in any attempt to stop the commemorations. University students distributed sweets and even cut a birthday cake to celebrate slain LTTE leader Velupillai Prabhakaran’s birthday. The analogy that the president drew to himself being seen as a Hitler who exterminated ethnic and religious minorities is misplaced. The release of those held under the Prevention of Terrorism Act for engaging in similar acts in the past would further contribute to the reconciliation process.

WORSENING CRISIS

In this context, the president’s use of militaristic rhetoric can only be understood in relation to the growing economic crisis that shows no sign of abating. The anticipated IMF bailout package is at risk of getting indefinitely delayed. It was initially anticipated to come in September then in November but now January is being targeted. Japan’s top brokerage and investment bank, Nomura Holdings Inc, has warned that seven countries – Egypt, Romania, Sri Lanka, Turkey, Czech Republic, Pakistan and Hungary – are now at a high risk of currency crises. Sri Lanka is in third place on the table of risk. The next devaluation of the rupee could see another spike in inflation that will make the cost of living even more unbearable to the masses of people.

The president is on record as having said that the economic crisis will get worse before it improves. Both anecdotal and statistical evidence indicates that it is indeed worsening. University teachers at the University of Sabaragamuwa reported that attendance in their classes was down by at least a quarter. Students who come from other parts of the country are unable to afford the cost of meals and so they stay at home. A study by the Institute of Policy Studies has shown that about four percent of primary, 20 percent of secondary and 26 percent of collegiate students had dropped out of school in the estate sector, which is the worst affected. The future costs to the country of a less well educated population is incalculable and inhumane.

As it is the situation is a dire one for large swathes of the population. Research from the University of Peradeniya has revealed that close to half of Sri Lanka’s population, 42 percent (up from 14 percent in 2019) are living under the poverty line. Professor of Economics Wasantha Athukorala has said there is a dramatic increase in the poverty level of over three-hold across the past three years. In 2019, nearly 3 million people lived below the poverty line, but that number has increased to 9.6 million in October 2022. In these adverse circumstances stability in a polity can be ensured either through legitimacy or through force. It would be tragic if the latter is the choice that is made.

ELECTORAL SOLUTION

President Wickremesinghe has been stressing the importance of political stability to achieve economic development. His recent statement that the security forces will be used to negate any unauthorised protest is a sign that the government expects the conditions of economic hardship to escalate. The general public who are experiencing extreme economic hardship are appalled at the manner in which those who committed acts of corruption and violence in the past are being overlooked because they belong to the ruling party and its cliques. The IMF has made anti-corruption a prerequisite to qualify for a bailout, calling for “Reducing corruption vulnerabilities through improving fiscal transparency and public financial management, introducing a stronger anti-corruption legal framework, and conducting an in-depth governance diagnostic, supported by IMF technical assistance.”

It is morally unacceptable even if politically pragmatic that the president is failing to take action against the wrongdoers because he needs their votes in parliament. As a start, the president needs to appoint a credible and independent national procurement committee to ensure that major economic contracts are undertaken without corruption. Second, the president needs to bite the bullet on elections. The country’s burning issues would be better accepted by the country and world at large if they are being dealt with by a statesman than by a dictator. Government that is based on the people’s consent constitutes the sum and substance of democracy. This consent is manifested through free and fair elections that are regularly held. Local government elections have been postponed for a year and are reaching their legal maximum in terms of postponement. These elections need to be held before March next year.

Elections will enable the people to express their views in a democratic manner to elect their representatives for the present. This would provide the government with guidance in terms of the decisions it is being called to take to revive the economy and place the burden in a manner that will be acceptable to the people. The provincial council elections have been postponed since 2018. Democratically elected provincial councils share in the burdens of governance. The devolution of power that took place under the 13th Amendment was meant to promote ethnic harmony in the country. The president who has taken the position that he is for a solution to the ethnic conflict should seriously consider conducting the provincial council elections together with the local government elections se their financial costs. By doing so he will also gain legitimacy as a democratic statesman and not a dictator.

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WEDNESDAY – Movie Review

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The Addams Family is back with a new tale to tell! Originally created by Charles Addams as a comic strip published in The New Yorker, it offered readers a sarcastic take on the ‘typical nuclear family’ by substituting it with a more macabre bunch of strange and eerie individuals. Since then the titular family has been adapted on to the big screen many times, from live action movies to animated versions, the Addams Family has gained many fans throughout the years. Created by Alfred Gough and Miles Millar, with Tim Burton working on four episodes of the eight-part series, Wednesday is a welcoming tale for young fans, but unfortunately fails to think outside the box and remains anchored to the floor with a messy storyline.

Dead-eyed Wednesday Addams (Jenna Ortega) is a stubborn, independent and intelligent teenager in this new series. Her penchant for attracting trouble wherever she goes alarms her parents, Morticia (Catherine Zeta-Jones) and Gomez (Luis Guzmán). With an already strained relationship with her parents (specifically her mother), Wednesday is enrolled at Nevermore, an academy for outcasts like herself. Having attended the academy themselves, Morticia and Gomez are hopeful that their daughter will ‘fit right in’. Caught between trying to build her own identity and other teenage complexities, Wednesday soon finds herself in the middle of a twisted mystery.

This is the first time audiences are introduced to a teenage Wednesday, which allowed the creators to build a new world on their own terms, but while keeping true to the original nature of the character. The creators do a fair amount of world building by introducing other outcasts like the Fangs (vampires), Stoners (Gorgons), Scales (sirens) and Furs (werewolves), among others. Nevermore Academy itself is beautiful and comes with the classic package of creepy crypts, hidden rooms and secret societies. The series also offers a decent amount of gore, although they could have added more given Wednesday’s proclivity for gore-related activities. The series deals with classic young-adult tropes which includes teenage crushes, bullies, relationships and even prom, among other things. The series navigates through Wednesday’s journey of self-discovery, which is a new avenue for both the character and the fans. From understanding and displaying her emotions to discovering her identity and understanding her peers, the series takes a deep dive into heavy material.

Ortega’s performance as the titular character plays a major role in keeping audiences glued to the screen. This is also the first time viewers are shown a teenage Wednesday Addams, which works to Ortega’s benefit as she depicts more dimensions to the ghoulish, morose character many are associated with based on previous renditions. Her facial expressions and ability to deliver on seriously emotional moments strengthens her role as the lead. The rest of the Addams Family, even with limited screen time, lack the eccentricities their characters should have. Hopeless romantics Morticia and Gomez seem incompatible in this version and Uncle Fester is far less crazy than he ought to be. The only member worth mentioning is the Thing—a severed hand— who brought more character and spirit to the series acting alongside Ortega. With barely any room to develop a majority of the characters are prosaic and tedious, even though they remain vital to the plot.

Apart from Ortega, Gwendoline Christie and Emma Myers deserve honorable mentions for their roles as Nevermore’s head teacher, Larissa Weems and the peppy Enid Sinclair respectively. Enid quickly became a fan favorite as the character was the polar opposite to Wednesday. Her character is vital to Wednesday’s character development and their journey to find common ground as mismatched individuals is amusing.

Christina Ricci who played Wednesday in the 90s returns as ‘normie’ teacher, Miss Thornhill and unfortunately barely stands out and this in large part due to the messy storyline. The series is bogged down with numerous subplots and overlapping tropes and the characters with potential for growth are completely overlooked. With love triangles, bullies and killer monsters on the loose, the series self-destructs and the climax sinks into disappointment.

At the end of the day, Wednesday plays to the beat of the new generation and touches on new themes, which is welcoming seeing as the character should grow up at some point. While not everyone may relate to Wednesday’s teenage perils, it is interesting to witness her growth and her journey as an ‘outcast’ or ‘weirdo’. And while Wednesday doesn’t exactly offer a distinctly unique story, it gives audiences a small taste of what Jenna Ortega’s Wednesday is capable of. Creating a story around a well-established franchise is a difficult task, and in this case the creators fail to add value to their visions. If the series continues, the creators will have the opportunity to think further outside the box and push the limits to Wednesday’s character and give audiences a bone-chilling experience. Wednesday is currently streaming on Netflix.

 

 

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Stage set for… AWESOME FRIDAY

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The past few weeks have been a very busy period for the new-look Mirage outfit…preparing themselves for their big night – Friday, December 2nd – when they would perform, on stage, for the very first time, as Donald Pieries (leader/vocals/drums), Benjy (bass), Niro Wattaladeniya (guitar), Viraj Cooray (guitar/vocals), Asangi Wickramasinghe (keyboard/vocals), along with their two frontline female vocalist, Sharon (Lulu) and Christine.

They have thoroughly immersed themselves in their practice sessions as they are very keen to surprise their fans, music lovers, and well-wishers, on opening night…at the Peacock, Berjaya Hotel, in Mount Lavinia.

Action starts at 8.00 pm and, thereafter, it will be five hours of great music, along with EFFEX DJs Widhara and Damien, interspersed with fun and excitement…for the whole family!

Yes, opening night is for the whole family, so you don’t need to keep some of your family members at home – kids, especially.

Working on their repertoire for Friday, bassist Benjy says “what we will dish out will be extra special, with lots of action on stage.”

It would be interesting to see Sharon (Lulu) doing her thing with Mirage, after her early days with the Gypsies, and, I’m told, a dynamic performance from Sharon is what is in store for all those who make it to the Peacock this Friday

Edward (Eddy) Joseph (centre) with Donald and Benjy

While the band was at one of their practice sessions, last week, they had a surprise visitor – Edward (Eddy) Joseph, a former member of the group Steelers, who is now based in Germany.

Eddy is here on a short visit and is scheduled to return to Germany, tomorrow (30).

He spent an hour with Mirage, at their practice session, and says he is disappointed that he would not be around for the group’s opening night.

However, there is a possibility of several well-known personalities, in the showbiz scene, turning up, on Friday night, to experience the sounds of the new-look Mirage, including Sohan Weerasinghe and Joey Lewis (from London).

Rajiv Sebastian, too, says he is keen to be a part of the fun-filled evening.

You could contact Benjy, on 0777356356, if you need to double check…their plans for AWESOME FRIDAY!

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