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Ivermectin and Covid: no time to lose and lives to save

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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.



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Opinion

Sovereignty without Governance is a hollow shield

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Globalisation exposes weakness and failed governance; and invites intervention – A message to all inept governments everywhere

The government of Burkina Faso has shattered the illusion of party politics, dissolving every political party in the nation. Its justification is blunt: parties divide the people, fracture sovereignty, and allow corrupt elites to hijack the sacred powers that belong to the citizenry.

This is not an aberration. It is the recurring disease of fragile states. Haiti, Somalia, Sudan, Venezuela, Sri Lanka—their governments collapse under the weight of incompetence, leaving their people abandoned and their sovereignty hollow. These failed states do not merely fail themselves; they burden the world. Their chaos spills across borders, draining the strength of nations that still stand.

Globalisation does not forgive weakness. It exposes it. And as global opinion hardens, a new world order is taking shape—one that no longer tolerates decay. The moment of rupture came when US President Donald Trump seized Nicolás Maduro from his Venezuelan hideout and dragged him to face justice in America.

Predictably, the chorus of populists cried “oil!” They shouted about imperialism while ignoring the rot of Maduro’s failed government and his collapse in legitimacy. But the truth is unavoidable: if Venezuela had been competently governed, Trump would never have had the opening to topple its leadership. Weakness invited conquest. Failure opened the door.

Singapore offers the perfect counterexample. It is perhaps the best-governed nation on earth, and for that reason it is untouchable. Strong governance is the only true shield of sovereignty. Without it, sovereignty is a brittle shell, a flag waving over ruins.

Trump’s precedent will echo across continents. China, Russia, India—regional powers are watching, calculating, preparing. The message is unmistakable: Sovereignty is conditional. It is not guaranteed by history or by law. It is guaranteed only by strength, by competence, by the will to govern effectively.

This is the revolutionary truth: nations that fail to govern themselves will be governed by others. The age of excuses is over. The age of accountability has begun. Weak governments will fall. Strong governments will endure. And the people, sovereign and indivisible, will demand leaders who can protect their destiny—or see them replaced by those who can.

By Brigadier (Rtd) Ranjan de Silva
rpcdesilva@gmail.com

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Opinion

CORRECTION

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In the article, “Let My Country Awake…” published yesterday, it was erroneously said that Sri Lanka was celebrating 77 years of Independence. It should be corrected as 78 years of Independence. The error is regretted.

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Opinion

“Let My Country Awake …”

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Where the mind is without fear, and the head is held high;

Where knowledge is free;

Where the world has not been broken up into fragments by narrow domestic walls;

Where words come out from the depth of truth;

Where tireless striving stretches its arms towards perfection;

Where the clear stream of reason has not lost its way into the dreary desert sand of dead habit;

Where the mind is led forward by thee into ever-widening thought and action

Into that heaven of freedom, my Father, let my country awake.

– Rabindranath Tagore, Gitanjali, 35

As Sri Lanka marks seventy-seven years of independence, this moment demands more than flags, ceremonies, or familiar slogans. It demands memory, honesty, and moral courage. Once spoken of with affection and hope as Mother Lanka, the nation today increasingly resembles a wounded child—carried again and again across fragile hanging bridges, suspended between survival and collapse. This image is not new to our cultural consciousness. Long before today’s crises, Sri Lankans encountered it through literature and radio, most memorably in Henry Jayasena’s Hunuwataye Kathawa (1967), the Sinhala radio drama adaptation of Bertolt Brecht’s The Caucasian Chalk Circle, written during World War II (WWII), broadcast by Radio Ceylon and later staged across the island. Heard in village homes and city neighborhoods, the story quietly shaped a moral imagination we now seem to have forgotten.

In Hunuwataye Kathawa, a child is placed at the center of a chalk circle, claimed by two women. One is Natella, the biological mother who abandons the child during a moment of danger and later returns—not out of love, but driven by entitlement, inheritance, and power. The other is Grusha, a poor servant who risks everything to protect the child, feeding her, carrying her across perilous terrain, and choosing care over comfort. When ordered by the judge to pull the child out of the circle, Grusha refuses. She would rather let go than injure the child. Justice, the story teaches, belongs not to those who claim ownership most loudly, but to those who practice responsibility and restraint. For generations of Sri Lankans, this lesson entered the heart not through policy or economics, but through art.

Beneath Sri Lanka’s recurring failures lies a deeper wound: collective forgetfulness. It is indeed incredible how a nation colonised by foreign powers for over four centuries, battered by people’s insurrections and national struggles ever since, divided by a 30-year-long ethnic war, shaken by a Tsunami, inflamed by Easter Bombings 2019, hit by Covid-19 shutdown, and bankrupt by economic crisis, just to mention a few before the devastating Cyclone Ditwah that rocked the entire nation not many weeks ago, could be so forgetful of its tragedies. This insight was articulated with striking clarity by Dr. Arvind Subramanian, the former Chief Economic Advisor to the Government of India, speaking at an event organised by The Examiner in Colombo on Jan 21, 2026. Subramanian observed the nation’s troubling tendency to forget its own history—its tragedies, hard-earned lessons, and warnings—and to embrace uncritically whatever is new in a pattern-line manner. This historical amnesia traps Sri Lanka in vicious cycles of debt, dependency, and unscientific thinking. When memory fails, every crisis feels unprecedented; when learning fails, every mistake is repeated.

Consequently, after seventy-eight years of independence from the last colonial rule, Sri Lanka still stands inside that chalk circle. Mother Lanka, once admired for free education, public health, and social mobility, has over the decades been reduced to a wounded child carried across unstable political, economic, and environmental bridges. Different governments, armed with different ideologies and promises, have taken turns holding her. Some carried her carefully; others dropped her midway; still others claimed her loudly while burdening her with unsustainable debt, weakened institutions, superstitious demeanors, and short-term fixes that mortgaged the future. This mother-made-child nation was perpetually oscillating between collapse and recovery. Yet instead of healing her wounds, with every passing Independence Day, we repeatedly celebrated and argued over who owned her.

This long post-independence journey reveals two recurring patterns. There have been many Natella-like approaches—entitlement without responsibility, nationalism without sacrifice, populism without prudence. These abandon the child in moments of crisis, only to return when power, contracts, or prestige are at stake. Alongside them, however, there have also been Grusha-like moments—imperfect, painful, often unpopular, yet rooted in reform, discipline, and care. These moments prioritise institutions over personalities, education over spectacle, sustainability over extraction, science over superstitions, and responsibility over applause. They are the moments that keep the child alive. The thorough cleaning that the whole nation recently experienced with Cyclone Ditwah also reminds us, among many other lessons, about the power and the need of these Grusha-like moments. It reminds us that the real celebration of freedom requires not slogans but breaking free from Natella-like approaches and, after the immersion that she just experienced, that it is only possible in and through at least three kinds of voluntary and ongoing immersions (3P Immersions)—disciplines that reshape not only policy but also personal and national character—Immersion of Poverty, Immersion of Plurality, and Immersion of Prudence.

The immersion of poverty, both spiritual and material, is deeply rooted in Buddhist teaching of tanhaā and āśā—the restless craving for more than one truly needs or can sustain. It is that which enables us to be constantly mindful of ourselves, not only who we really were, who we actually are, and what we continue to become, but also what we are really in need of. Nationally speaking, it involves acknowledging the country’s geopolitical placement, the strengths of its proud history and civilisation, and the limitations of its repeated struggles and political dismay. While material realism, when faced honestly, disciplines excess and teaches gratitude for what we already have, the immersion in poverty should remind us about how greed can lead to corruption and about the illusion that fulfillment lies in accumulation. A nation that does not discern its desires with its own resources and real capacity—human, historical, cultural, and environmental—will always mortgage its future to satisfy temporary cravings. We must ask ourselves honestly: how different are we today from the colonial era, when our decisions were shaped by external powers, if we remain bound by foreign debts, external models, and a forgetting of our own identity?

The immersion of plurality should not be understood as a slogan, but as a lived ethic. Sri Lanka’s diversity of language, religion, culture, geography, and memory is not the problem; it is the unfinished promise. Sinhala and Tamil, Muslim and Burgher, Buddhist, Hindu, Christian, and Muslim, village and city, coast and hill—all belong to the child in the chalk circle. While Natella-like politics weaponise difference and division, pulling the child apart to claim possession, Grusha-like care holds plurality together, recognising that it is the unity in diversity that sustains, protects, and frees the child, carrying it safely home. Freedom figures like Siddi Lebbe, Veera Puran Appu, Sir Ponnambalam Ramanathan, Sir Ponnambalam Arunachalam, C. W. W. Kannangara, T. B. Jayah, Anagarika Dharmapala, and D. S. Senanayake emerged from different faiths, languages, and regions, yet shared a common ethic: the country mattered more than self, party, or community. They were not perfect, but they were Grusha-like—unwilling to pull the child apart to prove ownership, willing instead to carry her patiently across danger.

Grusha-like care, therefore, holds plurality together, recognizing that no single group can carry the country alone. Rather, it is plurality which is the ground of freedom from coercion, selective justice, and hostage-taking—whether by professions, ideologies, or institutions that prioritize self-interest over the common good. It also demands freedom from resistance to positive change, especially when that resistance is motivated by private gain rather than the common welfare. A plural society asks: Does this serve the nation, or merely my group, my party, my advantage?

The immersion in prudence is perhaps the rarest and most neglected virtue. Prudence calls us to move from myth to science, from avidyā to vidyā, from superstition to evidence. Recent floods and landslides were not merely natural disasters; they were moral warnings. Thy painfully revealed what happens when desire overrides restraint, when planning ignores science, when land is abused, when short-term gain overrides long-term responsibility, and when development forgets sustainability. Freedom from disaster is inseparable from freedom from ignorance. Prudence teaches us to listen actively, speak intentionally, plan with evidence, build with environmental awareness, and govern with foresight. Prudence is not only about grand reforms; it is also very much about our everyday civic behaviour, such as how we treat Mother Earth and shared spaces.

For example, freedom from spitting on the ground, freedom from littering public places, and freedom from leaving behind what we refuse to clean or return. These are not small matters; they are indicators of whether people see the nation as a common home or as a place to be used and discarded. These are only a handful of many instances where we need to hear what JFK (John F. Kennedy) asked the Americans in 1961: “Ask not what your country can do for you – ask what you can do for your country”. The WWII-devastated Japan’s development is not built merely on technology, but on discipline, as systems like 5S cultivate order, responsibility, and respect for shared space. Clean Sri Lanka and the proposed Education Reforms 2026 can become transformative moments—but only if truth replaces pretense, cooperation replaces cynicism, and ownership replaces vengeful rhetoric. Prudence allows a nation to appreciate its ownness—its history, institutions, cultural resources, and the agendas for the common good—without rejecting learning from the world. Without prudence, novelty becomes addiction, and reform becomes fashion.

Before the history repeats itself for another 77 years, either as a series of tragedy or comedy, it is important, therefore, to recognise that freedom from debt, disaster, and dependency (national or personal) is impossible without all three types of immersions working together—poverty of desire, plurality of belonging, and prudence of action. Initiatives such as education reform and Clean Sri Lanka offer genuine opportunities, but only if we cooperate, think long-term, and resist turning reform into another slogan. This raises an uncomfortable question: Do we truly want to be free? Or are we content to remain in the same rut, so long as ignorance is preserved, education is left unreformed, and distractions are supplied by a handful of greedy politicians—their vengeful rhetoric, their allies, lopsided media, and mushrooming content creators—while the powerful continue to benefit from it all? Freedom is demanding. It asks for memory, restraint, cooperation, and courage. Dependency, by contrast, is easy.

Therefore, the question before us is not who shouts the loudest, who claims patriotism most aggressively, or who promises instant miracles. It is who remembers, who renounces, who embraces plurality, and who acts with prudence as her stewards and not owners. When are we going to immerse ourselves in these three immersions and be free? After Rabindranath Tagore’s poem, W. D. Amaradeva once sang, “Patu adahasnam paurinen lokaya kabaliwalata nobedi, jnanaya iwahal we… Ehew nidahase swarga rajyataṭ, mage dæśaya avadi karanu mena, Piyanani…“— Where knowledge keeps the world from being divided by the walls of narrow thoughts… Into that heaven of freedom, Father, let my country awake. How many poems, how many Amaradevas, how many freedom speeches, how many religious sermons, how many inundations, and how many struggles must come and go before we awaken to that truth and let Mother Lanka be out of that vicious pattern or circle of collapse and recovery—whole, healed, and free?

By Dr. Rashmi M. Fernando, S.J.
Loyola Marymount University, Los Angeles, CA, USA
Rashmi.Fernando@lmu.edu | https://orcid.org/0009-0006-3310-721X

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