Features
Ivermectin – A possible win-win situation
BY Dr. Sumedha S. Amarasekara
Ivermectin is a drug that has been increasingly occupying medical attention, following its possible role in the treatment and prevention of SARS-CoV-2 (Covid-19). A news item in the The Sunday Times of 05.09.2021 says, ‘Ivermectin divides doctors while NMRA gives waiver to import drug to stop black market sales’.
Ivermectin:
Ivermectin was discovered in 1975 and had come into medical use by 1981. It is an antiparasitic drug that has antiviral and anti-inflammatory properties. It is a well-known drug, approved as an antiparasitic agent by both the FDA (U.S. Food and Drug Administration) and the WHO (World Health Organization). It is on the list of the WHO’s Essential medicines. It is considered to be extremely safe in the recommended dose (0.2 to 0.4 mg/kg). Over the last 20 to 30 years the medical/scientific community has begun to investigate /appreciate its antiviral and anti-inflammatory properties (Kircik LH, Del Rosso JQ, Layton AM, Schauber J. Over 25 Years of Clinical Experience with Ivermectin: An Overview of Safety for an Increasing Number of Indications. J Drugs Dermatol. 2016 Mar;15(3):325-32. PMID: 26954318)
Ivermectin is also an extremely cheap drug. A 12mg tablet –the normal recommended dose for a 60 kg adult- is around US $ 0.03 -3 cents. The manufacturing cost is estimated at US $ 168 for 1 kilogram. Therefore, as one can work out, to manufacture 12 mg will cost: 168 divided by 1,000,000 and multiplied by 12 = US $ 0.002. Hence the bulk of the cost of the drug is in fact in converting the drug into tablets, packaging and distribution!
Evidence of the use of Ivermectin :
There is an increasing number of news items and journal publications showing the efficacy of Ivermectin’s role in reducing the mortality of Covid-19 and reducing the spread (prophylaxis) of Covid-19 among the population. A case-control study done at the All India Institute of Medical Sciences concluded that two-doses of Ivermectin prophylaxis at a dose of 300μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 (Covid-19) infection among health care workers for the following month (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886121/). A meta-analysis published in June this year shows a probable reduction of mortality (i.e. deaths) by 62%, when Ivermectin was used as a therapeutic agent and a possible reduction of spread by 86% when Ivermectin was used as a prophylactic agent(American Journal of Therapeutics 28, e434–e460 (2021).
In fact the control of Coivd-19 in the Northern states of India and across a number of other countries has been attributed to the use of Ivermectin. An increasing number of countries has stated that they are adding Ivermectin on to their arsenal in combating Covid-19 (https://www.youtube.com/c/WhiteboardDoctor/playlists- Ivermectin and Covid-19).
However, the NIH (National Institute of Health) maintains that there isn’t sufficient data to recommend Ivermectin for or against, in the treatment of Covid-19, which is the same stance that has been taken up by the National Medicines Regulatory Authority (NMRA) of this country as well. The WHO’s stand is still that, Ivermectin should not be used outside a clinical trial.
Conducting clinical trials:
To understand this apparent discrepancy between the results of the clinical trials and the stance of the NIH, WHO, etc., requires an insight into the interpretation of clinical trials. In today’s world conducting and interpreting clinical trials is almost a separate discipline on its own and is well beyond the scope of this article (and mine as well!).
However, an understanding of clinical trials and their interpretation is necessary to understand the clinical trials themselves and the decision-making process of these authorities. There is a variety of trials that could be done. The basis of all these trials is that one group of patients is given Ivermectin and the other group is not given Ivermectin. Following the trial, by comparing the mortality rates and spread of Covid-19 (the results) between the two groups, scientists would be able to say what effect Ivermectin has on the mortality and spread of Coivid-19. For the results to be valid, apart from the Ivermectin, everything else between these two groups needs to be the ‘same’, such as the male to female ratio of patients, other illnesses they have, other medication they take, smoking habits, alcohol consumption, etc. As one can see it is not easy to get two comparable groups. Thereafter, if one is treating for Covid -19, both groups need to have the same degree of sickness i.e. the average number of mild to moderate to severe cases should match up. If one is checking for prevention (prophylaxis) then their exposure to ‘known Covid-19 cases’ and ‘potential cases’ needs to match up as well. For example starting from, do they wear one or two masks, what type of masks, do they wear a face shield, do they maintain social distancing; all the time or some of the times, have they been exposed to any known Covid-19 patients, have they attended any weddings, funerals, parties, ‘get togethers’, do they live in apartments or individual houses, do they travel to work using public transport, do they shop on line or in person, etc… etc… As one can see this is even more complex than trying to match groups for treatment. This is what leads to the term Controlled. Thereafter, scientists need to make sure that every patient has an equal chance of either receiving the Ivermectin or not. In other words, there is no bias in who receives and who does not receive the drug. Because inadvertently one might be influenced by whom one gives the drug to i.e. the drug may be given to someone considered sick who needs the drug and not given to one with a milder disease. This process of randomly allocating the treatment leads to the term Randomised. From a patient’s point of view, they may feel psychologically let down by not having received the drug or psychologically boosted by receiving the drug. This can affect their response to the treatment. The doctors monitoring the patient can be influenced as well, if they know whether a patient is taking the drug or not. To eliminate this phenomenon everybody receives ‘the drug’- either the drug or the placebo –originating from the Latin phrase ‘I shall please’. Therefore only those who actually run the trial know, who gets what. So the person/s who gives the ‘drug’ and monitors the patients do not know what they are giving and neither do the patients know what they are receiving which is called a double blind. If all these elements are combined then we arrive at a randomised, double blind, controlled study which is considered as the golden standard.
Interpretation of clinical trials:
So the trial is done and the results are out. Now a complex issue remains as to how certain the scientists are that these results are due to Ivermectin and not due to a natural variation of events. To illustrate this we can look at a hypothetical situation of 10,000 Covid -19 patients that have an overall mortality of 2% i.e. 200 deaths. If we were to divide these patients into lots of 1000, it is extremely unlikely that these deaths would be distributed equally for every lot of 1000 patients. Some lots would have had more deaths, other lots would have had less, averaging out at 20 per group of 1000 i.e. 2%. Now let us assume that the two groups of patients selected of a 1000 each for the study, were to have 10 deaths in one group and 30 deaths in the other –averaging out at 2%. The critical issue to grasp is that, which group is which is not known. Assume Ivermectin was given to the group that was to have 30 deaths and as a result of Ivermectin the death rate was halved and ended up being 15 –a 50% reduction- this is 50% (5) more than that of the control group, so it could be erroneously concluded that Ivermectin does not work, when it actually does work. On the other hand Ivermectin may not actually work, but in this instance it was given to the group that was to have 10 deaths, so erroneously the conclusion is that Ivermectin does work, when in fact it doesn’t. If things were not as complex as it were, it is worthwhile to remember that this natural variation exists for all of the characteristics mentioned above between the two groups as well. This needs to be taken in to account.
So when scientists interpret data, these variations are taken into consideration and there are three main aspects that they consider. The first is the power of the study. That basically means, are there sufficient numbers of patients in the study for the scientists to be able to pick up a true difference that goes beyond the natural variation. The hypothetical study shown above, has very little power; as one could see that the results could not be interpreted due to the natural variation. Next is significance. That is a measure of allowing for chance to be involved in the result. For most studies the significance level, known commonly as a P value is set below 0.05 (P< 0.05). In this context it would mean that, there is less than a 5% chance that the decrease in mortality is, not due to Ivermectin i.e. the chance of Ivermectin causing the decrease in mortality is more than 95%. Thirdly, there is the concept of ‘a confidence interval’. Broadly speaking the narrower the confidence interval the more valid the results are.
Clinical interpretation and Ivermectin:
It is a deficiency of some of the above factors in the clinical trials so far conducted and their subsequent interpretation that have resulted in this stance of the various authorities. Therefore the vital aspect to understand in going forward is that the issue is not primarily to do with the results from all these trials (and other evidence) that have been conducted across the world; that have shown that Ivermectin does work. But, it is to do with the validity of these results. Therefore the view put forward by those who are guarded in their recommendation in the use of Ivermectin, is that the validity (certainty) of these trials is not strong enough for the use of Ivermectin to be recommended. Which of course is not the same as saying that Ivermectin does not work.
This view needs to be counterbalanced by the following facts. Firstly, there have been no significant adverse effects reported in any of the trials conducted using Ivermectin. Secondly, there is only an extremely limited number of drugs that have been recommended in the treatment of Covid-19 and none of these is ‘curative’ in the strictest sense of the word. Thirdly, though vaccination makes a significant difference to the outcome if one were to get Covid-19, it has not been as successful in preventing its spread.
Available options:
The WHO apart from the vaccines, has only recommended a few drugs to be used in the treatment of Covid-19. Remdesivir is one such drug. This is however, only to be used in the treatment of Covid-19 patients, essentially in a hospital environment. A vial of this drug costs over US $ 500. Not exactly a practical solution for us! Besides there are no clinical trials scheduled by the major pharmaceutical companies comparing Remdesivir (US $ 500) with Ivermectin (US $0.03) to be seen in the near horizon. Countries that have already used Ivermectin and are satisfied with its outcomes are not going to be conducting trials to assess a drug that they already find works.
One option is to evaluate all the existing evidence and start using Ivermectin. Prof. Saroj Jayasinghe (Faculty of Medicine, University of Colombo) a highly respected clinician has already written to the Ministry of Health recommending that Ivermectin should be used in the treatment of Covid-19.
However, to take a national stance on a drug not approved by the WHO could be considered ‘irresponsible’ and may jeopardise our future with regard to health and safety issues on an international forum.
Therefore, another option would be to follow the guidelines of the WHO and conduct a clinical trial. The issue that would now cross one’s mind is given in this discussion; conducting a trial that would give valid results would be an extremely complex and arduous undertaking. How does one organise these matching groups etc..?
The solution:
An islandwide clinical trial with the use of Ivermectin.
With regard to an islandwide clinical trial, the numbers will be huge running into millions. This leads to an enormous power and thereby an incredible validity of the study. It also ironically means that the amount of extra data that one needs to record, to make sure that one has matching groups, etc., becomes minimal as well. As a point of illustration, if we were to have a randomised clinical trial–blind or not-across the 14,022 Grama Niladhari Wasams involving around 22 million adults and children, where half are given Ivermectin; the outcome would be dependent on the use of Ivermectin, as the chance of another confounding factor or natural variation affecting one group-of roughly 11 million- and not the other would be almost nonexistent!
Let us not forget that we are probably one of the few countries in the world where countrywide elections are held and the results are given within a day or so.
The WHO will/should give its blessing and if need be, provide help with the necessary expertise (and resources?) to conduct this trial.
This is essentially a win, win
and win situation
An acceptable clinical trial is required to provide the definitive answers-what the WHO, the NIH and our NMRA need. The medical sector would be happy to get the findings they require with a ‘controlled opening of the country’. The country needs to be opened in some manner to assess the prophylactic role of Ivermectin and the ‘government’ would find it feasible and more than willing to do so for economic reasons. The people would be happy to get ‘a drug that would/could work’ and more importantly an easily affordable one in their hour of need.
The advantage of an island wide clinical trial:
There are a number of important points that are extremely favourable in terms of conducting an islandwide clinical trial with Ivermectin.
1. Ivermectin is an extremely safe drug at the prescribed doses. It can be given to children as well, leading to a comprehensive island\wide clinical trial. This is particularly important as we still do not have a proper handle on vaccination when it comes to children.
Given that Ivermectin is already used as an antiparasitic agent and given to children, it can be used separately in an islandwide clinical trial to re-open the schools.
2. Ivermectin is an extremely cheap drug. This is most relevant to us in our current economic predicament. The cost of treating an adult with Covid-19 and /or using Ivermectin as a prophylactic drug (the loading dose and the required tablets for three months) on average will be less than Rs. 500 per person. As the dose is based on body weight, the cost will be less for children.
3. When used as a prophylactic drug, it has an extremely simple dosing schedule – a loading dose administered a couple of days apart then a maintenance dose once a week or at a prescribed interval.
4. The existing trials show a considerable impact from this drug. Based on the existing trials, if Ivermectin were to work, we should be expecting at least a 50% reduction of mortality and at least the same reduction in the spread of the disease, or there about. Therefore the effects of using this drug would be extremely easy to monitor.
5. A very important point, the prevention (i.e. prophylactic) aspect of Ivermectin, starts once the drug has got absorbed into the system – pretty much immediately. When one considers the vaccine, the first dose needs to be given, then a period of at least four weeks has to pass for the body to generate a sufficient immune response for the second dose to be given. Thereafter, a further two to three weeks need to elapse before one is considered to be immune i. e. close upon almost two months. With Ivermectin, if one takes the tablet at night, by morning one is ‘good to go’.
6. Finally, another significant and interesting aspect is that we would be able to evaluate the relative efficacy and interactions between Ivermectin and our vaccines. How does Ivermectin impact on those who have completed both vaccine doses or only had one or have not been vaccinated at all? Looking to the future, how does Ivermectin-given that it has therapeutic as well as prophylactic properties- compare with Vaccination?
The country still faces a dilemma of opening the country vs having an uncontrolled spread of Covid-19. The reality is that we will need to ‘reopen the country’. This is the best time while the country is in a lock down to organise an islandwide clinical trial. Plan what type of trial/trials we want to execute, formulate the primary and secondary questions that need to be answered, identify the significant sub groups, determine what monitoring processes are required, etc. Make necessary plans to reopen the country systematically with an islandwide clinical trial in place.
Hopefully, we shall see the light at the end of the tunnel.
Features
Management of a contingency
by Premananda Atapattu
nandaata@gmail.com
A retired Senior Police Officer has reported and cautioned that there might be an attempt to disrupt the conduct of the presidential elections. It is a statutory obligation of the Executive to facilitate the smooth conduct of the polls and subsequent statutory events. However, to my knowledge even today the Sri Lankan government does not have a contingency plan to meet with such a situation.
The law enforcement authorities in Sri Lanka were not prepared to meet the contingencies which arose in the country begining from the 1971 insurrection. It has always been a recovery attempt made, in each case, except for the 1962 coup to overthrow the government, which came to light at the last minute, accidentally.
State outfits tasked with collecting and analysing the likely threats to national security have failed in their role during the last five decades. There was no central intelligence agency at the highest executive level of the State to collect, collate and analyse every piece of information relating to the national security and disseminate appropriately, timely, under acknowledgement; and create a preventive programme and have feedback obtained. This position should be regularised by stipulating as statutory obligations of each individual authority and appropriate records be maintained.
In a policing environment, it is an executive function that operates above the umbrella organisation in managing natural disasters and environmental hazards. Peace and safety of life and property of citizens is a priority. A policy framework needs to be identified as to how the State should manage its functions and policies in the context of the changing regional and global situation affecting National Security. Roles of the Executive; Armed forces and the Police should be stipulated as statutory obligations. It includes a coup to overthrow the government; jail breaks; hijacking of a VIP or an Aircraft and many other similar possibilities. In order for a police organization to draft a contingency plan, it must recognise a deficiency in the organis ation’s ability to operate efficiently and effectively in a crisis situation and there exists a need for a plan to put into action within the shortest possible time frame.
Therefore, it has to be in conformity with the National Security policy framework already in place and should receive the approval of the Executive. An action plan specifying how the policing function should be undertaken in a contingency situation has to be developed with the participation of the security forces and the police and all other state agencies executing and providing logistical support. Final product should identify a programme of action, which shall be a statutory obligation.
Man-made emergencies: While Law Enforcement agencies are responsible for dealing with the man-made emergencies, crisis situations and disasters, such incidents can be prevented or loss of life and property and the damage caused could be prevented or minimised, if carefully monitored in an intelligence gathering mechanism and included in a well-prepared prevention programme
Developing a Contingency plan.
The Objective of a Disaster Management Plan: Identifying threats to national security; public peace and the well-being of the citizens and implementing suitable plans to achieve and safeguard these objectives. Reducing the vulnerability and the effects of human induced hazards to a manageable level by identifying risk factors. Developing programmes to reduce the risks that can be envisaged and develop the capacity of the disaster management systems; response and recovery management systems at all levels to restore normalcy.
A contingency plan of the State:
A contingency plan of the State is a programme of actions prepared by the government aiming to respond to hazards and crisis situations that may occur in the country. The plan will provide the basis for rapid appropriate action. It has to identify all possibilities or vulnerabilities and how to respond to each of them effectively and take preventive and risk reduction measures. It has to identify clear policies, procedures and guidelines for action in response to early warnings. Each Ministry, responsible for providing essential services is required to take necessary measures to keep the country alive and function smoothly. It also has to prepare its own plans for meeting any contingency or a crisis situation that may occur. This includes supply of essentials like food and water; medicine; energy and power; public transport and many other essential services like health care utilization required to keep the citizens alive and secure civic conveniences as the nature and scale of the crisis may seriously affect people’s access to them. These include environmental hazards, flood; droughts; cyclones; epidemics and other likely hazards. “…To be effective, disaster management should be implemented as a comprehensive and continuous activity, and not as a periodic reaction to individual disaster circumstances…” (William, Vice President ADB, 1992.)
National Development and Disaster Management Policy:
First, most major departments within Government have a tangible and practical connection with disaster management. They have clearly defined roles and responsibilities throughout the total process of prevention, mitigation, preparedness, response, and recovery (especially in these last three segments). These roles and responsibilities are formally laid down in the relevant counter disaster plans…” (. Disaster management: A Disaster manager’s handbook. Carter, W. Nick., Asian Development Bank, 2008.)
Under Sec: 10. (1) of the Disaster Management Act, “It shall be the duty of every Ministry; Government Department to prepare its own plan to meet an impending disaster”. However, even after two decades of passing the above noted Act, the Ministry in charge of Defence or the Department of Police and other agencies providing essential services to the nation, do not have such a plan of action which makes the destiny of citizens uncertain. Therefore, it is essential that the government should prepare a statutory framework to normalise a crisis situation and an action plan to restore the peaceful living of the citizens.
Maritime safety:
Sri Lanka also does not have a contingency plan for the safety of Maritime zones. This Plan should have the operational ability to operate throughout the Maritime Zones of Sri Lanka. It should identify all vulnerabilities like smuggling of arms and weapons of destruction and prohibited goods; robbery and all other illegal activities in territorial waters; acts causing environmental damage and pollution; oil spills or chemical spills etc. The role of each agency in normal situations and in a contingency should be identified. It includes the specific role of the Ministry of Foreign affairs; Ports authority; SL Navy; SL Air Force, and the agencies responsible for Policing including prosecution and all other agencies providing logistical support in a crisis situation.
Public alert system: In all contingency situations, it is the duty of the State to make the public aware that there is an impending disaster or a crisis situation or a crisis already occurred. Issue of public warnings and alert systems will be required, depending on the likely situation, may be amber or red alert system and the public will be ready to meet the crisis. The losses incurred could be reduced and the public will co-operate with the authorities and co-ordination of activities among authorities will also be achieved gainfully. This cause of action will ensure the public will not be panicky and daily routines and essential services will be carried out. In order to prevent each mass media broadcasting misinformation or different stories; versions, authorities should take full control of any situation.
Disaster mitigation and prevention: Disaster prevention and mitigation principles should be incorporated into all contingency plans.
A contingency Plan for the Police Department: Police department did not have a contingency plan in the year 1983 to prevent ethnic riots in the country or to execute at the time of attack on catholic churches in April 2019 or attack on peaceful demonstrators in Galle Face ground and Island wide attacks on the houses of ruling party politicians in May 2022 and the incidents that made the Head of the state to resign.
Attacks by Islamic terrorists in 2019:
Police department suffered the worst black mark on 21 April 2019,
by its failure to prevent attacks by Muslim terrorists in five locations in the country. Police department failed in their role to take action to prevent these incidents, although the Executive Head of the country, Secretary to the Ministry of Defence and the Head of the Police department and those at the periphery level had sufficient and clear information about a planned attack which was conveyed to the appropriate authorities well in advance.
Defining the role of police and their powers: Drawbacks with the existing statutory provisions.
Existing statutory provisions in Sri Lanka do not address the statutory obligations and the role of the Police, Secretary and the Executive Head of the country adequately in the context of socio – economic and infrastructure and constitutional developments that had taken place since independence and in varied contingencies that may arise in different situations. The need for a such a plan was felt since the 1971 insurrection with the incidents disturbing the peace and in restoration of the public confidence and stability of the country.
Vulnerability assessment and profiling the risk factors: national security.
Absence of a sound Economic development strategy and a Policy framework to uplift living standards: With the change of every government, development policies had been changed since 1952 to date. Policy decisions have not been identified to preserve and develop the domestic industries, including manufacturing industries. Natural resources were not gainfully utilised. Developing global economic trends were not carefully followed in order to structure the economy to meet the actual challenges.
‘…A recent World Bank Group (WBG)study of road safety investment in South Asia revealed a crisis that has been exacerbated by the rapid growth in vehicle ownership and diversity of motorized and non-motorized traffic of varying sizes and speeds, without adequate protection for the most vulnerable. Vehicle ownership in Sri Lanka is already high by regional standards and grew by 67 percent between 2011 and 2018. If this trend continues, as expected, crash fatalities and injuries will steadily climb unless urgently required measures are implemented…”.
Absence of a permanent Foreign policy: In the absence of a permanent balanced foreign policy, the county suffers the risk of facing pressure to become a victim of global superpowers.
Demand for a power sharing mechanism:
It is essential that the Sri Lankan NATION should reach a settlement acceptable to both parties in order to ensure that the population in the Northern province and as well as their kinsmen in other provinces should not be denied their legitimate rights and to ensure that entire country will achieve benefits of a long lasting peace which will enable the saving of costs incurred in maintaining of national security.
Development of Jihadist movement and other extremist Muslim organizations:
Development of terrorist cells within the Muslim community also creates a major threat to national security. Adequate protection to prevent the spread of such cells within the country should be taken. Law enforcement agencies should be trained to collect and analyse all such forms of threats. Immigration department should be adequately trained to prevent unlawful force entry into the county which is not being done at present. “…Since Sri Lanka’s Easter Sunday massacre, the world’s worst terrorist attack in 2019, every Sri Lankan should understand that the next attack is in the making. To prevent a possible next attack, the recommendations of the Parliamentary Select Committee should be implemented…”. (Prof. Gunaratne.2022) In his book titled Sri Lanka’s Easter Sunday Massacre. Lessons for the international community he makes suggestions in detail, under the title “shaping the domain” 2023, as to how the Islamic space could be regulated, it should essentially draw the attention of Administrators dealing with the subject of Defence.
Interference of the NGOO in internal affairs of the country. Non-governmental Organizations (NGOO) operating here continues to accelerate their interference in the internal matters of the country, in the absence of an effective immigration control system and a statutory framework to control their sabotage activities.
The global superpowers are continuing with their undue interference in the internal affairs of the country as rivalry in the region continues to grow.
Overcrowding of Prisons and possible break away of a Jail. Overcrowding of prisons is a major threat and should find solutions to detain remand prisoners and convicts in separate prisons to prevent the formation of any heretical, subversive gangs and train the staff to counter a riot and jailbreak.
Identifying likely threats, creating buffers; developing strategies to prevent and meet them: The possibility of occurrence of actions such as the following and other possible situations should be considered and plans should be developed to prevent and meet these vulnerable situations by regular training of the Armed Forces and the respective authorities. Coup to overthrow the government; Abduction of a VIP; Hijacking of a VIP boarded Aircraft, etc.
Meeting a contingency: development of a national contingency plan.
Ultimate objective of a contingency plan: The ultimate objective of the measures identified should be to ensure that the citizens will feel that they are safe in any part of the country during all hours of the day and they are able to get on with their normal day to day affairs in a peaceful environment.
Response to a contingency: Establishing a Level of Response and identifying duties of all stakeholders: “…. Modern disaster management goes beyond post-disaster assistance. It now includes pre-disaster planning and preparedness activities, organizational planning, training, information management, public relations and many other fields. “…There are several options for dividing a plan into components or parts, such as: The main plan* usually contains the primary parts of the plan, such as the statement of mission, definition of the threat, legislative authority, policy matters, relationship to other emergency plans, organizational and operational implementation, warning mechanism, resources, request for assistance etc…”(Nick 2008)
Main components that should be accommodated in a DM plan. Plans prepared should identify the following roles of the police and the umbrella Ministry.
All types of risks and vulnerabilities to national security envisaged, likely threats to peace and stability, including man-made disasters.”…While it is recognized that no single emergency plan can reflect the full scope of the jurisdictional and emergency response complexities of a modern society, society can be served well by the sum total of several well-designed and focused agent-specific contingency plans, if these plans take care to focus on the jurisdiction and expertise of the agency assigned the specific task, and take advantage of the authority and expertise available in other quarters and through other contingency plans without unnecessary duplication of effort…” Guidelines for the Development of a National Environmental Contingency Plan” Peter G. Belling,. United Nations Environment Programme,2017.
The plan should also be made flexible enough to accommodate moderate political and structural changes to government departments without the need to make structural changes to the plan or significant revisions to the plan’s main elements. Such changes are usually subject to complex and time-consuming approvals processes…”. (Nick 2008)
Contingency plan for the Divisional Commands: It should be made the obligation of the Range DIGG and OICC Divisions to develop a separate contingency plan for each police Administrative Division, based on the vulnerabilities in each Division. Special attention should be given to safeguarding the State properties. Sacred places; Reservoirs; Electrical installations and water supply etc. A plan of action that should be taken to prevent / reduce and mitigate them.
Strategy to meet with a contingency after an incident; Recovery procedure; short and long term; Plan of action to mitigate them and the judicial procedure should be stipulated.
(The Writer is the author of the book, Crime Prevention Efforts in National Planning in Sri Lanka (2015). Second edition of this book contains a chapter on the above subject.)
Features
The Outside World
The frenzy of the Sri Lankan presidential election is gradually decelerating itself. The outward frenzy fizzled out as Wednesday ended with the cessation of electioneering. We hope the frenzy will not simmer in the more violent of party members. What we earnestly hope for is a peaceful polling day, quiet when results come streaming in and peace to be absolute when the winner is announced.
Hence Cass decided to cast her jaundiced eye out across the oceans to comment on the week’s happenings. She is also weary of all the election meetings shown on television and strongly desires a change. She was faced with devastating floods in Poland; fires in Portugal, worse death causing retaliation by Israel in Lebanon. She chooses however to first dwell on the latest far out narrative concerning Trump.
Sniper attempt
On Monday 16 September, BBC News had the story breaking that Trump had been targeted the previous day by a lone gun-toting interloper in his Trump International Golf Club in West Palm Beach, Florida, near his 126-room palatial resort, Mar-a Lago. Trump was on the course golfing and a secret service agent spotted the barrel of a gun and shot at the bush it emerged from. The man escaped but was apprehended – name announced and fact he was an activist for Ukraine. No need to go into him and his explanation as those facts will be fully unraveled by the time you read this.
When the news broke on BBC News, Cassandra’s first thought in her doubting mind was that it was staged; considered in Trump’s or his advisors’ strategy as an effective weapon to discredit Harris and the Democrats and show Trump off as targeted but bravely continuing his run for presidency and campaigning, not giving up even his routines of golf. Any gimmick, however cheap or rotten, is possible with this man.
Trump spoke with Fox News Digital on Monday, the day after the attempted shooting, indirectly accusing the Democrats. He said the would-be assassin believed all that was said by his political rivals. “He believed the rhetoric of Biden and Harris, and he acted on it” was what 78-year-old Trump said. “Their rhetoric is causing me to be shot at, when I am the one who is going to save the country and they are the ones that are destroying the country – both from inside and out. They say I am anti-democratic; they have brought cases against me. And, I am the one who will save you.”
Opposed to all these exaggerations and bluster, both Biden and Harris expressed their shock and great relief that he was not harmed. They definitely sounded sincere. Not for them turmoil in the country with the election so close at hand and also so close in competitiveness. No one else but Trump will suspect it was a Party or, to be exact, Harris’ manoeuver to eliminate him and thus assure a Democratic presidency. Her success is sure even now, to admirers of Harris like Cassandra. Trump’s diatribe is so juvenile; like the ranting of a child who has been punched by a co-primary student: puerile like the man himself.
Sleaze
Sir W S Gilbert, English poet, dramatist and journalist said that “It’s Love that makes the world go round.” It is true since among very many other reasons, most literatures – English undoubtedly – revolves around the theme of love, whether it be poetry, prose or drama. History from before the time of Adam and Eve is dotted with love stories. Love did cause writing, painting, songs and drama. Now the world seems to be revolving around money and looming large among the revolving impetuses is sex and sleaze.
BBC News broadcast much on one of its longest serving, highest paid news anchors, Huw Edwards; who pleaded guilty in July this year that he was involved in receiving from December 2020 onwards pornography of the illicit kind with children featured in them–something definitely criminal. His supplier of indecent images was Alex William, a 25-year-old convicted paedophile who pleaded guilty to possessing and distributing prohibited images of children. He was sentenced to a suspended one year’s conviction.
What Edwards was charged with was “making indecent images of children”. Cass further read what ‘indecent’ means in this context. It is archaic legalese for depictions of abuse. The trial was conducted in a London Court and he was given a suspended six-month sentence. So, he need not go to jail but he will be on the Sex Offender Register for seven years; has to follow a 40-day Sex Offender Treatment Programme and 25 related sessions. His light sentence was because he admitted to being severely mentally troubled for a long time.
There were calls between the supplier of the horrible sleaze and Huw but a fee as such was not paid. Rather was £ 200 gifted by Edwards to Williams for a pair of Nike trainers and again around one thousand five hundred which paid for Williams’ entry to university.
This case is not written about by Cass merely because it is of a BBC high status employee who now is sent out of the Corporation and has to give back salaries paid to him while the case was going on. It is relevant to us in Sri Lanka since corruption is rampant in this fair isle and sleaze and sex crimes cannot be out of the picture.
That US rapper, Sean ‘Diddy’ Combs, is in trouble for his being mired in sex dirt. I quote: “Combs was arrested by federal agents in New York on 16 Sept, charged with alleged sex trafficking and racketeering conspiracy. He was caught off guard by federal authorities at the Park Hyatt Hotel in Manhattan.” Personally, Cass has never ever listened to this man’s singing, if you can call what he does for money, singing.
Most shocking and notorious was the Jeffrey Epstein case with his famous friends like Prince Edward, who was relieved of all royal duties which means his position in the inner Brit Royal Family is kaput now. Epstein offered underage girls to his customers known as friends. Listening to a video interview with Melinda Gates, Cass was shocked to hear that one reason she was forced to divorce Bill after 27 years of so successful a life together of immense social work for humanity, so to say, was his friendship with Epstein. It emerged she had been patient on many issues, even allowed with grace his demand to meet an ex-girlfriend once every month. But maybe the inevitable men’s seven-year itch or more likely mid-life crisis hit Bill Gates.
Epstein reportedly committed suicide by hanging himself while in prison and before his case was called. Many disbelieved the verdict of suicide. It was rumoured he was killed due to the names he could divulge. At a poll conducted soon after, 16% respondents believed he committed suicide, 45% believed he was murdered and 39% were unsure. Natural justice prevailed; his bad karma manifested itself in this life itself.
What about our country and our men? Lily white? Particularly those clad in pristine white kapati suits. Tell Cass another; don’t anger her beyond measure.
Why this second part of her Cry this Friday just prior to a pivotal point in the history of our land? One because she is tired of election talk. Two because of what she hears about political high-ups. Many should be in prison or rehabilitation camps or offender treatment programmes! Particularly relevant to know punishments are meted out in other countries with no impunity and subverting the rule of law. In Cass’ opinion SL is well in the sickness of sleaze and sleazy behaviour. Can a woman walk a crowded street or travel in a crowded bus without being harassed? With system change promised by most of the presidential candidates and sworn to by the Big Three, shivers may be running along spines of offenders. We may see a better, cleaner, less rotten bunch of bigwigs being chosen to govern us by the new President. He is just days away!
Features
International Day of Democracy posers for the South
September 15th marked International Day of Democracy and the aptness of reflecting on the future of democracy could not be stressed more at this juncture. The urgency of addressing this question is underscored by no less an incident of grave import than the recent second attempt, within just a few months, on the life of US presidential hopeful Donald Trump, besides other developments.
The apparent repeat attempt on the life of Trump by a lone gunman should ideally have the effect of alerting supporters of democracy the world over to the need to continually strengthen the values, processes and institutions that would ensure the continuance of this unique governance system. To begin with, globe-wide forces of democracy need to come together to unitedly voice a strong ‘No’ to the use of political violence within and outside democracies.
This is a matter that should not be treated as merely pertaining to the domestic politics of the US. If an attempt is being made to stymie democratic processes within the world’s ‘mightiest democracy’ through the use of murderous violence, the observer could not be faulted for taking the position that no state professing to be democratic could rest assured that it is free of the scourge of lurking, anti-systemic violence.
Since Sri Lanka will be conducting yet another presidential poll come September 21, it would need to take notable cognizance of the multiple dangers confronting democracy. As this is being written, reports have surfaced of a political killing and other forms of lawlessness in the country’s provinces, although the latter are of a sporadic nature currently. This ought to be a reminder that, although Sri Lanka is seen in some quarters as a successful democracy, it is a very fragile one. Democratic processes within it are in constant need of strengthening and consolidation.
Needless to say, Sri Lanka has been time and again witness to ‘nation-breaking’ violence. The 30-year, humanly highly costly ‘anti-LTTE’ war was one of these manifestations of runaway violence that could have torn the country apart. Yet, the totality of causes that led to the war remains apparently unrecognized by governments and sections of the public, rendering Sri Lanka’s democracy several-fold more fragile.
If Lankan governments are seeking a durable answer to ‘nation-breaking’ violence, there are specific democratic measures that could be taken by them to effectively manage such disruptions. One of these is substantive power devolution to the country’s North-East. Despite Sri Lanka arriving at what is considered a landmark presidential poll, this need is yet to be addressed notably.
The security forces’ military victory over the LTTE in 2009 has bred a sense of complacency among Sri Lanka’s power and social elites, which fosters the belief that the country is free of separatist violence forever, but this could prove a dangerous illusion in the absence of a durable political solution to the ethnic conflict. This state of mind is fraught with risks, considering that the roots of the conflict are remaining unaddressed.
In the case of the second attempt on Trump’s life, the world is confronted with a disquieting irony. This is on account of the fact that no less a political actor than Trump himself encouraged anarchic tendencies within the US by initially turning a blind eye on them and by even inciting his supporters to seize control of the Capitol Building on January 6, 2021, subsequent to his defeat at the hands of Joe Biden at the last presidential election. For example, he is on record as telling the US public that the ‘election had been stolen from him.’
This amounts to a gross subversion of the democratic process and to date Trump evinces no signs of his deeply regretting his supporters’ anarchic violence, although he went back on some of his initial pronouncements. Thus has democracy been undermined by a US President himself.
Besides making the democratic system of governance a laughing stock of authoritarian states, such as Russia and China, Trump has given anti-democratic forces the world over a huge fillip by failing to unreservedly accept the result of the last US presidential poll, which was seen by the relevant authorities as free of blemish.
However, the damage to democracy stemming from Trump’s incitement of anarchic violence, could be considered as already having been done in the case of the weaker democracies of the South. The admirers of Trump are far and wide and there is no doubt that they would be already seeing the violent overthrow of a democratically-constituted state as legitimate.
The appeal of populist and authoritarian political personalities, such as Donald Trump, within Southern polities should be considered quite extensive in view of the fact that the majority of the latter states are prone to personalism; that is, the irrational glorification of political leaders by the masses.
This could be seen as a Fatal Cleopatra of democratically-deficient Southern states. To the extent to which they uncritically acclaim populist political leaders in particular, to the same extent do they weaken their democratic institutions and associated value systems. The answer to this is the growth of a vibrant democratic culture which is a long-gestation project that needs to be nourished over decades.
The induction of technocratic elites into governance is not necessarily the solution to this deep-seated problem in the South. These elites could help in the economic growth process to a degree, but the fostering of democratic cultures could be made possible by only those visionary leaders who place at the heart of their development schemes social and economic equity in the truest sense. Thus far, with the exception of Mahatma Gandhi of India, it is difficult to identify any Southern leader in post-independence times who could be considered as having been a catalyst in substantive democratic development; which is essentially all about combining growth with equity.
Hopefully, these Southern polities would think deeply on these matters, going forward. A broad-based, deeply humanistic and secular education could be considered as essential to the building of Gandhi-type visionary leaders with broad sympathies. This undertaking could no longer be postponed by Southern states desirous of fostering democratic governance.
The issue is; could Sri Lanka be considered as equal to this challenge? Unfortunately, the answer at the moment is ‘No’. None of its ‘leaders’ vying for the presidency, for instance, has conceived of development for their country in strictly the above terms. We need to begin with humanity or ‘Reverence for Life’ and there don’t seem to be takers for this among Sri Lanka’s ‘leaders’.
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