Opinion
Ivermectin and Covid: no time to lose and lives to save
By Prof. Saroj Jayasinghe,
MBBS, MD (Colombo), FRCP (London), MD (Bristol) PhD (Colombo), FCCP, FNASSL
Consultant to the Faculty of Medicine
Sabaragamuwa University of Sri Lanka.
Former Professor of Medicine, University of Colombo
It is with a degree of reluctance that I am stepping into the controversy relating to Ivermectin use in COVID. Unknown to many, the pros and cons of Ivermectin in COVID have been discussed in private forums of physicians, academia and doctors from 2020. It has been in the international media ever since laboratory studies in Australia showed that the drug inhibits the growth of the virus. However, the public in Sri Lanka became more aware of the controversy recently, when a confidential letter sent to an official of the Ministry of Health appeared in the social media. I had written this in June 2021 as an individual professional after several months of raging controversy among professionals. It was about treatment of COVID, and I firmly believe vaccination is the best option to prevent the illness. One reason for the very cautious approach of not approving the use of Ivermectin in the West could be because anti-vaccine groups are promoting it as an alternative. Sri Lanka has no such problems, and our population is willingly getting vaccinated.
Proposals to use Sri Lanka as a large study area as a clinical trial or as an observational study were made as far back as early 2021. I understand a clinical trial has begun in patients admitted with COVID, after considerable delays due to procedures related to clinical trials. Such studies are scrutinised by independent ethics committees, the drug must be approved by the National Medicinal Drugs Authority, and the study must be registered in an entity that makes is publicly available for anyone to read about it. This study will at least take another few weeks to months to yield results.
Most discussions in Sri Lanka Centre around the question whether the evidence to prescribe Ivermectin in COVID-19 is strong or inconclusive. One group says there is inconclusive evidence to use Ivermectin while another group says there IS sufficient evidence. As with many issues, this is not black or white but shades of grey, i.e. there are grades on the ‘strength of evidence’ from the field of Evidence Based Medicine (EBM). A parallel in the legal field is when we say that the evidence is ‘beyond reasonable doubt’ or there is ‘proof of the crime’, vs. circumstantial evidence.
Let us assume that using the principles of EBM we find that the evidence to use Ivermectin in COVID is ‘inconclusive’. Such a dilemma is very relevant to a situation where a decision is needed immediately, but the stakes are high. In other words, how would doctors decide to treat in a situation when the evidence for efficacy of a drug is inconclusive, but the stakes are high? Let me share an example.
Imagine a doctor who sees a very ill-looking patient with features of a serious infection (e.g. high fever, vomiting and body aches). She or he requests tests to identify the cause of the illness and the bacteria that may be causing the illness. In such an instance, should the doctor wait till the reports of the tests (e.g. culture reports) are available before treating? If a decision is made to treat immediately, the doctor does not have the ‘strength of evidence’ on the cause of the illness. However, if treatment is delayed until the reports arrive in two days the patient may be dead. This hypothetical example highlights a common dilemma: How do doctors balance between reliance on strength of evidence vs. taking an immediate decision when the evidence is inconclusive. This is best addressed by theories of decision-making and is a question very familiar to practicing doctors.
Now I will demonstrate the parallel with Ivermectin. In the case of ivermectin let us assume that the current evidence for its efficacy in COVID is inconclusive. However, the stakes are very high because COVID is currently raging, hundreds are dying, and there are no alternative drugs to treat early disease. Furthermore, Sri Lanka needs to bridge only a short vulnerable period of 4-6 weeks during which time our vaccination programme would become effective.
Let us assume that doctors begin to prescribe Ivermectin for treatment and prevention of COVID, for the next 4 to 6 weeks, despite the inconclusive evidence. There are two possible key outcomes:
Outcome 1: Future research confirms that it is effective, and it would contribute to saving many lives.
Outcome 2: Future research shows that it is ineffective, and we would have wasted money on the drug. Therefore, Ivermectin could either save lives or waste money. Even the money wasted is miniscule because the cost of a course of Ivermectin is less than Rs 200.00 (i.e. less than one US dollar)! Is it safe to use over the next 4 to 6 weeks? We know it is a very safe drug that has been used for almost 40 years. It is used in mass scale by the WHO to eliminate ‘River Blindness’ and is in their Essential Drug List.
A combination of other factors add support to the decision to prescribe Ivermectin.
1. Evidence is evolving, and studies are in progress. Therefore, conclusive evidence may emerge to confirm its efficacy.
2. There is laboratory (in vitro) evidence that Ivermectin is active against the COVID-19 virus.
3. It’s easy to give (tablets and not injections).
4. Currently there are no effective drugs in Sri Lanka to treat early COVID or prevent it.
5. Certain regions in India and South American countries are using Ivermectin to treat and prevent COVID-19
Summary
Therefore, my humble question is, should doctors in Sri Lanka consider whether to use Ivermectin to treat or prevent COVID-19? We need this only for 4-6 weeks. During this period, rates of COVID are likely to increase due to the very rapid transmission of Delta variant. We have no time to lose, nothing to lose, and lives to save. There is no time for clinical trials. Those who wish to embark on trials to wet their thirst for more evidence are welcome to do so. By the time the results of a new trial are available the horse would have bolted, and hundreds would have died.
My suggestion is for patients to ask your doctors about Ivermectin. You have a right to do so. Doctors are divided on the issue because of their sincerity to the views they have about science, scientific evidence, and decision-making. Please do not assume that there is a conspiracy against the drug in Sri Lanka! I can vouch for the honesty of all the doctors who are having different views on the topic. This is a disagreement between professionals who have diverse views, and we seem to have dug into our lines of defence!
The Ministry of Health has allowed the use of Ivermectin under the direction of a doctor. A range of doses for treatment and prevention is available at BIRD-group.org a group working in the UK. The opinions I have stated here are my own independent views and not in any way linked to the institutions I am affiliated to.
Opinion
Are we reading the sky wrong?
Rethinking climate prediction, disasters, and plantation economics in Sri Lanka
For decades, Sri Lanka has interpreted climate through a narrow lens. Rainfall totals, sunshine hours, and surface temperatures dominate forecasts, policy briefings, and disaster warnings. These indicators once served an agrarian island reasonably well. But in an era of intensifying extremes—flash floods, sudden landslides, prolonged dry spells within “normal” monsoons—the question can no longer be avoided: are we measuring the climate correctly, or merely measuring what is easiest to observe?
Across the world, climate science has quietly moved beyond a purely local view of weather. Researchers increasingly recognise that Earth’s climate system is not sealed off from the rest of the universe. Solar activity, upper-atmospheric dynamics, ocean–atmosphere coupling, and geomagnetic disturbances all influence how energy moves through the climate system. These forces do not create rain or drought by themselves, but they shape how weather behaves—its timing, intensity, and spatial concentration.
Sri Lanka’s forecasting framework, however, remains largely grounded in twentieth-century assumptions. It asks how much rain will fall, where it will fall, and over how many days. What it rarely asks is whether the rainfall will arrive as steady saturation or violent cloudbursts; whether soils are already at failure thresholds; or whether larger atmospheric energy patterns are priming the region for extremes. As a result, disasters are repeatedly described as “unexpected,” even when the conditions that produced them were slowly assembling.
This blind spot matters because Sri Lanka is unusually sensitive to climate volatility. The island sits at a crossroads of monsoon systems, bordered by the Indian Ocean and shaped by steep central highlands resting on deeply weathered soils. Its landscapes—especially in plantation regions—have been altered over centuries, reducing natural buffers against hydrological shock. In such a setting, small shifts in atmospheric behaviour can trigger outsized consequences. A few hours of intense rain can undo what months of average rainfall statistics suggest is “normal.”
Nowhere are these consequences more visible than in commercial perennial plantation agriculture. Tea, rubber, coconut, and spice crops are not annual ventures; they are long-term biological investments. A tea bush destroyed by a landslide cannot be replaced in a season. A rubber stand weakened by prolonged waterlogging or drought stress may take years to recover, if it recovers at all. Climate shocks therefore ripple through plantation economics long after floodwaters recede or drought declarations end.
From an investment perspective, this volatility directly undermines key financial metrics. Return on Investment (ROI) becomes unstable as yields fluctuate and recovery costs rise. Benefit–Cost Ratios (BCR) deteriorate when expenditures on drainage, replanting, disease control, and labour increase faster than output. Most critically, Internal Rates of Return (IRR) decline as cash flows become irregular and back-loaded, discouraging long-term capital and raising the cost of financing. Plantation agriculture begins to look less like a stable productive sector and more like a high-risk gamble.
The economic consequences do not stop at balance sheets. Plantation systems are labour-intensive by nature, and when financial margins tighten, wage pressure is the first stress point. Living wage commitments become framed as “unaffordable,” workdays are lost during climate disruptions, and productivity-linked wage models collapse under erratic output. In effect, climate misprediction translates into wage instability, quietly eroding livelihoods without ever appearing in meteorological reports.
This is not an argument for abandoning traditional climate indicators. Rainfall and sunshine still matter. But they are no longer sufficient on their own. Climate today is a system, not a statistic. It is shaped by interactions between the Sun, the atmosphere, the oceans, the land, and the ways humans have modified all three. Ignoring these interactions does not make them disappear; it simply shifts their costs onto farmers, workers, investors, and the public purse.
Sri Lanka’s repeated cycle of surprise disasters, post-event compensation, and stalled reform suggests a deeper problem than bad luck. It points to an outdated model of climate intelligence. Until forecasting frameworks expand beyond local rainfall totals to incorporate broader atmospheric and oceanic drivers—and until those insights are translated into agricultural and economic planning—plantation regions will remain exposed, and wage debates will remain disconnected from their true root causes.
The future of Sri Lanka’s plantations, and the dignity of the workforce that sustains them, depends on a simple shift in perspective: from measuring weather, to understanding systems. Climate is no longer just what falls from the sky. It is what moves through the universe, settles into soils, shapes returns on investment, and ultimately determines whether growth is shared or fragile.
The Way Forward
Sustaining plantation agriculture under today’s climate volatility demands an urgent policy reset. The government must mandate real-world investment appraisals—NPV, IRR, and BCR—through crop research institutes, replacing outdated historical assumptions with current climate, cost, and risk realities. Satellite-based, farm-specific real-time weather stations should be rapidly deployed across plantation regions and integrated with a central server at the Department of Meteorology, enabling precision forecasting, early warnings, and estate-level decision support. Globally proven-to-fail monocropping systems must be phased out through a time-bound transition, replacing them with diversified, mixed-root systems that combine deep-rooted and shallow-rooted species, improving soil structure, water buffering, slope stability, and resilience against prolonged droughts and extreme rainfall.
In parallel, a national plantation insurance framework, linked to green and climate-finance institutions and regulated by the Insurance Regulatory Commission, is essential to protect small and medium perennial growers from systemic climate risk. A Virtual Plantation Bank must be operationalized without delay to finance climate-resilient plantation designs, agroforestry transitions, and productivity gains aligned with national yield targets. The state should set minimum yield and profit benchmarks per hectare, formally recognize 10–50 acre growers as Proprietary Planters, and enable scale through long-term (up to 99-year) leases where state lands are sub-leased to proven operators. Finally, achieving a 4% GDP contribution from plantations requires making modern HRM practices mandatory across the sector, replacing outdated labour systems with people-centric, productivity-linked models that attract, retain, and fairly reward a skilled workforce—because sustainable competitive advantage begins with the right people.
by Dammike Kobbekaduwe
(www.vivonta.lk & www.planters.lk ✍️
Opinion
Disasters do not destroy nations; the refusal to change does
Sri Lanka has endured both kinds of catastrophe that a nation can face, those caused by nature and those created by human hands. A thirty-year civil war tore apart the social fabric, deepening mistrust between communities and leaving lasting psychological wounds, particularly among those who lived through displacement, loss, and fear. The 2004 tsunami, by contrast, arrived without warning, erasing entire coastal communities within minutes and reminding us of our vulnerability to forces beyond human control.
These two disasters posed the same question in different forms: did we learn, and did we change? After the war ended, did we invest seriously in repairing relationships between Sinhalese and Tamil communities, or did we equate peace with silence and infrastructure alone? Were collective efforts made to heal trauma and restore dignity, or were psychological wounds left to be carried privately, generation after generation? After the tsunami, did we fundamentally rethink how and where we build, how we plan settlements, and how we prepare for future risks, or did we rebuild quickly, gratefully, and then forget?
Years later, as Sri Lanka confronts economic collapse and climate-driven disasters, the uncomfortable truth emerges. we survived these catastrophes, but we did not allow them to transform us. Survival became the goal; change was postponed.
History offers rare moments when societies stand at a crossroads, able either to restore what was lost or to reimagine what could be built on stronger foundations. One such moment occurred in Lisbon in 1755. On 1 November 1755, Lisbon-one of the most prosperous cities in the world, was almost completely erased. A massive earthquake, estimated between magnitude 8.5 and 9.0, was followed by a tsunami and raging fires. Churches collapsed during Mass, tens of thousands died, and the royal court was left stunned. Clergy quickly declared the catastrophe a punishment from God, urging repentance rather than reconstruction.
One man refused to accept paralysis as destiny. Sebastião José de Carvalho e Melo, later known as the Marquês de Pombal, responded with cold clarity. His famous instruction, “Bury the dead and feed the living,” was not heartless; it was revolutionary. While others searched for divine meaning, Pombal focused on human responsibility. Relief efforts were organised immediately, disease was prevented, and plans for rebuilding began almost at once.
Pombal did not seek to restore medieval Lisbon. He saw its narrow streets and crumbling buildings as symbols of an outdated order. Under his leadership, Lisbon was rebuilt with wide avenues, rational urban planning, and some of the world’s earliest earthquake-resistant architecture. Moreover, his vision extended far beyond stone and mortar. He reformed trade, reduced dependence on colonial wealth, encouraged local industries, modernised education, and challenged the long-standing dominance of aristocracy and the Church. Lisbon became a living expression of Enlightenment values, reason, science, and progress.
Back in Sri Lanka, this failure is no longer a matter of opinion. it is documented evidence. An initial assessment by the United Nations Development Programme (UNDP) following Cyclone Ditwah revealed that more than half of those affected by flooding were already living in households facing multiple vulnerabilities before the cyclone struck, including unstable incomes, high debt, and limited capacity to cope with disasters (UNDP, 2025). The disaster did not create poverty; it magnified it. Physical damage was only the visible layer. Beneath it lay deep social and economic fragility, ensuring that for many communities, recovery would be slow, uneven, and uncertain.
The world today offers Sri Lanka another lesson Lisbon understood centuries ago: risk is systemic, and resilience cannot be improvised, it must be planned. Modern climate science shows that weather systems are deeply interconnected; rising ocean temperatures, changing wind patterns, and global emissions influence extreme weather far beyond their points of origin. Floods, landslides, and cyclones affecting Sri Lanka are no longer isolated events, but part of a broader climatic shift. Rebuilding without adapting construction methods, land-use planning, and infrastructure to these realities is not resilience, it is denial. In this context, resilience also depends on Sri Lanka’s willingness to learn from other countries, adopt proven technologies, and collaborate across borders, recognising that effective solutions to global risks cannot be developed in isolation.
A deeper problem is how we respond to disasters: we often explain destruction without seriously asking why it happened or how it could have been prevented. Time and again, devastation is framed through religion, fate, karma, or divine will. While faith can bring comfort in moments of loss, it cannot replace responsibility, foresight, or reform. After major disasters, public attention often focuses on stories of isolated religious statues or buildings that remain undamaged, interpreted as signs of protection or blessing, while far less attention is paid to understanding environmental exposure, construction quality, and settlement planning, the factors that determine survival. Similarly, when a single house survives a landslide, it is often described as a miracle rather than an opportunity to study soil conditions, building practices, and land-use decisions. While such interpretations may provide emotional reassurance, they risk obscuring the scientific understanding needed to reduce future loss.
The lesson from Lisbon is clear: rebuilding a nation requires the courage to question tradition, the discipline to act rationally, and leadership willing to choose long-term progress over short-term comfort. Until Sri Lanka learns to rebuild not only roads and buildings, but relationships, institutions, and ways of thinking, we will remain a country trapped in recovery, never truly reborn.
by Darshika Thejani Bulathwatta
Psychologist and Researcher
Opinion
A wise Christmas
Important events in the Christian calendar are to be regurlarly reviewed if they are to impact on the lives of people and communities. This is certainly true of Christmas.
Community integrity
Years ago a modest rural community did exactly this, urging a pre-Christmas probe of the events around Jesus’ birth. From the outset, the wisemen aroused curiosity. Who were these visitors? Were they Jews? No. were they Christians? Of course not. As they probed the text, the representative character of those around the baby, became starkly clear. Apart from family, the local shepherds and the stabled animals, the only others present that first Christmas, were sages from distant religious cultures.
With time, the celebration of Christmas saw a sharp reversal. The church claimed exclusive ownership of an inclusive gift and deftly excluded ‘outsiders’ from full participation.
But the Biblical version of the ‘wise outsiders’ remained. It affirmed that the birth of Jesus inspired the wise to initiate a meeting space for diverse religious cultures, notwithstanding the long and ardous journey such initiatives entail. Far from exclusion, Jesus’ birth narratives, announced the real presence of the ‘outsider’ when the ‘Word became Flesh’.
The wise recognise the gift of life as an invitation to integrate sincere explanations of life; true religion. Religion gone bad, stalls these values and distorts history.
There is more to the visit of these sages.
Empire- When Jesus was born, Palestine was forcefully occcupied by the Roman empire. Then as now, empire did not take kindly to other persons or forces that promised dignity and well being. So, when rumours of a coming Kingdom of truth, justice and peace, associated with the new born baby reached the local empire agent, a self appointed king; he had to deliver. Information on the wherabouts of the baby would be diplomatically gleaned from the visiting sages.
But the sages did not only read the stars. They also read the signs of the times. Unlike the local religious authorities who cultivated dubious relations with a brutal regime hated by the people, the wise outsiders by-pass the waiting king.
The boycott of empire; refusal to co-operate with those who take what it wills, eliminate those it dislikes and dare those bullied to retaliate, is characteristic of the wise.
Gifts of the earth
A largely unanswered question has to do with the gifts offered by the wise. What happened to these gifts of the earth? Silent records allow context and reason to speak.
News of impending threats to the most vulnerable in the family received the urgent attention of his anxious parent-carers. Then as it is now, chances of survival under oppressive regimes, lay beyond borders. As if by anticipation, resources for the journey for asylum in neighbouring Egypt, had been provided by the wise. The parent-carers quietly out smart empire and save the saviour to be.
Wise carers consider the gifts of the earth as resources for life; its protection and nourishment. But, when plundered and hoarded, resources for all, become ‘wealth’ for a few; a condition that attempts to own the seas and the stars.
Wise choices
A wise christmas requires that the sages be brought into the centre of the discourse. This is how it was meant to be. These visitors did not turn up by chance. They were sent by the wisdom of the ages to highlight wise choices.
At the centre, the sages facilitate a preview of the prophetic wisdom of the man the baby becomes.The choice to appropriate this prophetic wisdom has ever since summed up Christmas for those unable to remain neutral when neighbour and nature are violated.
Wise carers
The wisdom of the sages also throws light on the life of our nation, hard pressed by the dual crises of debt repayment and post cyclonic reconstruction. In such unrelenting circumstances, those in civil governance take on an additional role as national carers.
The most humane priority of the national carer is to ensure the protection and dignity of the most vulnerable among us, immersed in crisis before the crises. Better opportunities, monitored and sustained through conversations are to gradually enhance the humanity of these equal citizens.
Nations in economic crises are nevertheless compelled to turn to global organisations like the IMF for direction and reconstruction. Since most who have been there, seldom stand on their own feet, wise national carers may not approach the negotiating table, uncritically. The suspicion, that such organisations eventually ‘grow’ ailing nations into feeder forces for empire economics, is not unfounded.
The recent cyclone gave us a nasty taste of these realities. Repeatedly declared a natural disaster, this is not the whole truth. Empire economics which indiscriminately vandalise our earth, had already set the stage for the ravage of our land and the loss of loved ones and possessions. As always, those affected first and most, were the least among us.
Unless we learn to manouvre our dealings for recovery wisely; mindful of our responsibilities by those relegated to the margins as well as the relentles violence and greed of empire, we are likely to end up drafted collaborators of the relentless havoc against neighbour and nature.
If on the other hand the recent and previous disasters are properly assessed by competent persons, reconstruction will be seen as yet another opportunity for stabilising content and integrated life styles for all Lankans, in some harmony with what is left of our dangerously threatened eco-system. We might then even stand up to empire and its wily agents, present everywhere. Who knows?
With peace and blessings to all!
Bishop Duleep de Chickera
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