The credit of elimination of many deadly diseases in the known history – smallpox, malaria and polio – goes to western science.
When the malaria epidemic raged in Sri Lanka, mainly in the Sabaragamuwa and northwestern provinces in the 1830s, nearly 80,000 people died out of a population of some six million. Sufferings of people were immense, and more than hunger, in some places there was no one to bury the dead. The leaders of the leftist movements at the time, took the lead in providing relief to the poor.
This is one of the first hand experiences of them, vividly explained in the book “Revolt in the Temple”, written in commemoration of the 2500 Buddha Jayanthi. The relief workers entered a village in Sabaragamuwa. No people could be seen, as most of them have either died and some had left the area. When they traced the village deeper, a cry of a child could be heard. It was a child sucking the breast of the dead mother. By the side of the mother was a dead elder child. In front of the house was a mound of soil, the grave of the father, who had died earlier.
Finally it was western science, quinine, not indigenous medicine, which rescued people.
I must hasten to add the following. When I returned after foreign training about 20 years ago, I was posted temporarily to a major hospital at Sabaragamuwa. After seeing quality healthcare abroad, it was shocking to see more than 25 newborn deaths per month. I, along with my senior female colleague (currently at Lady Ridgeway Colombo) got the JAICA Japanese project expedited and changed to the best standards. Finally, when we left, one year later, only one or two newborn deaths occurred per month. Very small babies were surviving and the quality of care was excellent. Now such care is available islandwide, thanks to western medicine (and free health service).
In both the above-mentioned examples, quality healthcare is due to the advancement of western science. The famous evolutionary biologist Professor Richard Dawkins, referring to the journal New Scientist, says, (available in YouTube,”try to understand science or you ….).
Even a bodhisathwa would suffer thirst or hunger depending on the place of birth, as per Buddhist teachings. The availability of western science and medicine for survival, is part of niyama dharma of Buddhism? (Anyone interested in niyama dhamma can browse the same).
Dr LAL RATNASIRI
Fork in the road: Will we protect medicines that protect us or deal with incurable diseases?
By SHOBHA SHUKLA – CNS
The spotlight is once again on preventing antimicrobial resistance that is not only devastating human health but also threatening the sustainability of our planet earth. Will we protect the medicines that protect us or lose them, resulting in diseases that become difficult or impossible to treat? “The answer my friend is blowing in the wind” as the legendary lyrics go.
What is antimicrobial resistance?
Antimicrobial resistance occurs when bacteria, viruses, fungi or parasites become resistant to, and hence no longer respond to the antimicrobials or drugs (antibiotics, antivirals, fungicides and parasiticides) used to treat the diseases caused by them. While antimicrobials are the backbone of modern medicine, their misuse and overuse in humans, animals and plants is driving the emergence and spread of antimicrobial resistance, making it difficult or even impossible to treat infections, increasing the risk of disease spread, severe illness and death.
Progress on all SDGs threatened by antimicrobial resistance
Antimicrobial resistance is not only causing a huge loss of human life (contributing to over 6 million deaths every year directly and indirectly) but also posing a crippling mountainous economic burden, said Dr Haileyesus Getahun, who is the Director, Global Coordination and Partnership on antimicrobial resistance, and also the Director, Quadripartite Joint Secretariat on antimicrobial resistance at the World Health Organization (WHO). Dr Getahun was the inaugural speaker at a recently concluded 2nd Annual Global Media Forum in lead up to 2022 World Antimicrobial Awareness Week.
According to a 2017 World Bank report, if no action is taken now, antimicrobial resistance is likely to cause an USD 1.2 trillion additional health expenditure per year by 2050, and push up to 24 million additional people (particularly in low-income countries) into extreme poverty by 2030. Dr Getahun warned that antimicrobial resistance can directly affect progress on at least 6 of the 17 UN Sustainable Development Goals and can be linked indirectly to the remaining 11 as well.
Inequity also ails antimicrobial resistance
As the burden of antimicrobial resistance is greatest in low-resource settings, particularly in sub-Saharan Africa, and South Asia, it is not only a global public health problem, but also an issue of health equity and socioeconomic development, says Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit at the World Health Organization (WHO). Along with ensuring a rational use of antibiotics “having access to clean water, sanitation, and hygiene, as well as good infection prevention and control measures, such as hand washing and vaccination, are vital in the fight against antimicrobial resistance,” he emphasises.
One Health approach is vital to address antimicrobial resistance
Humans, animals, plants and environment are continuously interacting and sharing with each other the microbials that have become resistant to drugs. So curbing antimicrobial resistance to protect human lives is not possible without protecting the health of our plants, animals and environment.
Jacqueline Álvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP), rightly points out that “Antimicrobial resistance is both, a cause and a consequence of the triple planetary crisis of climate change, biodiversity loss and pollution and chemicals.”
Dr Getahun calls for increased financing, political advocacy and coordinated global action to better respond to the converging threats of antimicrobial resistance and the climate crisis before it is too late.Scott Newman, Senior Animal Health and Production Officer for Asia and the Pacific at the Food and Agriculture Organization of the United Nations (FAO), stresses upon preserving antimicrobial efficacy while we sustain food and agriculture production.
“Loss of biodiversity and ecosystems, as well as of natural habitats for agriculture, has also led to an increase in antimicrobial use, and pathogen spread. We have to ensure that emergence and spread of antimicrobial resistance is slowed down across all food sectors (animal husbandry and agriculture). We need to switch to sustainable food production, by promoting climate-smart agriculture, agro-ecological approaches, nature-based solutions, and efficient and safe production methods biosecurity and disease prevention and control,” added Scott Newman.
Antimicrobials cannot compensate animal husbandry practices
“Antimicrobials are also used to prevent infections in animals apart from their use in treating animal diseases. But we must note that antimicrobials used in animals to prevent infections, must not be done to compensate poor animal husbandry practices. Rather antimicrobials should only be used for infection prevention in animals, who are at risk of acquiring a specific infection or in a specific situation where infectious disease is likely to occur, if the drug is not administered,” cautioned Delfy Gochez, Data Management Officer, antimicrobial resistance, and Veterinary Products Department, World Organisation for Animal Health (WOAH).
Jane Lwoyero, Technical Officer on antimicrobial resistance at the WOAH shared that in Africa, and globally, WOAH (World Organisation for Animal Health)’s strategy is followed by them to promote prudent use of antimicrobials. “We have also disseminated farm biosecurity guidelines in Kenya and Ethiopia to curb antimicrobial resistance. We also helped pilot the information and alert system for substandard and falsified veterinary products (during October – December 2021)” said Jane. “WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans.”
Improve the basics to strengthen antimicrobial stewardship
“To contain antimicrobial resistance, we need better evidence, and evidence-backed actions; we need to improve diagnostic stewardship; we need to have good infection control practices in the hospitals and the community; and without these pillars – we cannot truly practice antimicrobial stewardship,” said Dr Kamini Walia, Senior scientist, Indian Council of Medical Research.
“Diagnostic stewardship and infection control – both are significant challenges in our country because we have sub-optimal investment in the healthcare system, and we do not have good diagnostic laboratories in secondary and primary healthcare services (and good laboratories are essentially limited to tertiary care health services). Being a tropical country, we have a significant burden of infectious diseases. This further leads to sanitation and hygiene problems, and most of the antimicrobials which are prescribed are to compensate for poor sanitation and hygiene – both in communities and in hospitals. So, if we really want to make progress on antimicrobial stewardship we have to improve the basics, such as improving diagnostics, infection control, and other necessary actions,” rightly added Dr Walia.
“Studies done in India show that almost half of all prescriptions audited in the study, were of antibiotics, and over 55% of antibiotic use was prescribed for uncomplicated respiratory symptoms. More alarmingly, less than 1% of these patients had any microbiological diagnosis done. Many of these prescriptions show the levels of inappropriate use or higher use of antibiotics. Also, over two-third of these drugs are available over the counter. We need to prevent over-the-counter dispensing of antimicrobials,” said Dr Prapti Gilada-Toshniwal, senior microbiologist and founder head of UniLabs.
“We need stronger and practical antimicrobial stewardship programme for our context and ground realities so that we can effectively promote the appropriate use of antimicrobials (including antibiotics), improve treatment outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms,” added Dr Prapti Gilada-Toshniwal. “We need to boost diagnostic capacities at all levels. Access to accurate, rapid, and point-of-care diagnostic facilities for different diseases and conditions, should be scaled up.”
Clock is ticking
All this points towards the urgency of tackling antimicrobial resistance through an integrated and comprehensive response involving all the sectors, what is now referred to as the One Health approach. In the words of Dr Getahun, “One Health approach is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.”Collaborative efforts are needed that involve public health, agriculture, animal husbandry and environment sectors, as well as whole of society approach, to effectively address the challenge of AMR and make economies resilient to its impacts.
Addressing loss and damage finance: It’s more than money
BY Ashish Barua
The main objective of the United Nations Framework Convention on Climate Change (UNFCCC) is to stabilise greenhouse gas (GHG) concentration in Earth’s atmosphere. Over the last three decades, it has achieved the opposite because of our indifference and disregard for the millions of climate-vulnerable people in Global South, now extended to the North as well, who are suffering the adverse impacts of climate change. The UNFCCC started with a focus on mitigation and gradually moved on to adaptation. It is evident that those are not enough, and tackling “loss and damage” is a must-do now.
The 19th climate conference, held in Warsaw, Poland in 2013, established the Warsaw International Mechanism (WIM), which works as a policy framework on the issue of loss and damage. Then the Santiago Network on Loss and Damage (SNLD) at COP25 started as a technical assistance provider in addition to knowledge and resources. However, the financial mechanism has remained a big question for a long time.
The good news came ahead of COP27 when issues related to funding arrangements to respond to loss and damage caused by human-induced climate change were incorporated as a sub-agenda under finance-related matters. After having different opinions, debates, and negotiations throughout the two-week-long climate conference in Egypt this year, the parties found a common ground and agreed on the finance mechanism for loss and damage during the extended period.
So COP27 decided to establish a new funding arrangement to assist developing countries regarding loss and damage, which is “new and additional.” It also decided to establish a fund and a Transitional Committee to operationalise the new funding arrangement. The committee has been suggested to make recommendations to operationalise the funding arrangement at COP28 due to be held in Dubai next year, which will be a critical outline for how the funds are mobilised and utilised.
To make the fund operational, the parties also agreed to establish institutional arrangements, modalities, structure, governance, and terms of reference; define the elements of the new funding arrangements; identify and expand funding sources; and ensure coordination and complementarity with the existing arrangements.
There will be critical challenges for the Transitional Committee, such as who will provide the fund or how the new fund will be generated, and how it will be utilised. etc.
Beyond the UNFCCC process, there has been good news. The Scottish government, the pioneer in loss and damage funding, has come forward with its enhanced pledges. The Wallonia province of Belgium and Denmark were also there with their commitment; Austria and New Zealand also came forward, creating peer pressure on Global North to come out of their backsliding mindset.
They came forward with their actions on two fundamental principles. The first one is climate justice, challenging the unjust impact on climate-vulnerable nations who are not responsible for the crisis. The second one is moral obligations, and the responsibility of the developed countries.
The solidarity of the global community must be at the centre of the loss and damage finance facility. The Intergovernmental Panel on Climate Change (IPCC) has presented enormous scientific evidence, enough data and information on the table. The gravity, scope, and frequency of loss and damage are growing all over the world. Hence, the parties to the climate change convention must take an informed political position and enhanced pledges. The developed and developing countries’ accountability now is to keep the positive spirit up so that the empty promise of USD 100 billion every year for adaptation is not repeated.
Most importantly, climate-vulnerable nations and communities live amid the effects of climate change; they act, respond, and know how to address loss and damage on the ground. They do it with their best efforts and the least resources – they need support to do it right. And here comes the question of solidarity and empathy, which is more valuable than money.
As the loss and damage funding arrangement is already agreed upon, the fund mechanisms are critical as community needs are urgent and need to be grounded. For developing countries, this will work only if the fund is accessible, flexible, and fast to deliver to the affected communities, unlike other funding facilities such as the Green Climate Fund and Global Environment Facility. It is essential to determine how much funding is reaching the affected communities and, with this, how fast they can address the loss and damage issues in their lives and livelihoods.
Climate-vulnerable countries can take a proactive role in feeding the Transitional Committee with their actions on the ground so that the committee can go ahead with the right information and inputs. For example, Bangladesh has earmarked its fund from the Climate Change Trust Fund, which can put real-life learning to use. Helvetas Bangladesh, Young Power in Social Action, and the International Centre for Climate Change and Development (ICCCAD) are partnering with the Scottish government and Climate Justice Resilience Fund, which can help put actions forward in both economic and non-economic sectors of loss and damage.
(The Daily Star/ANN)
Ashish Barua is programme manager for the Climate Change and Sustainable Development programme of Helvetas Swiss Intercooperation in Bangladesh.
Savings bombshell – 93% of Sri Lankans are beyond means
By Saliya Weerakoon
The recent research by PepperCube, led by Atheek Marikar, reported that only 7% of the respondents are within means. A whopping 93% spend more than their earnings. The all-island sample indicates where the country is heading. This is understandable, given the difficult economic conditions we are in. However, 93% is a fascinating figure. 90% of the top-tier banks had negative profitability growth compared to the nine months of 2021. The cost of living and high inflation is taking a toll on the public.
Atheek and I have worked on public opinion research for many years, and he was spot on and had near-perfect accuracy in insights and findings. I have no reason to doubt the above figure, given my first-hand experience with him.I have been talking to various business stakeholders in the country, and all are unanimous that we are probably in the worst economic crisis post-independence. The PepperCube research shows that most of the public does not think economic conditions will improve in the next 12 months. The citizenry is rapidly losing hope, and specially educated youth have high hopes of leaving the country for greener pastures.
The officially reported food inflation is a killer. When you add inflation in transportation, educational expenses, medicines, rent, and other miscellaneous expenses puts the citizen of Sri Lanka on difficult ground. The credit card lending rates at 36% per annum and home loans, personal loans and vehicle loans also have a steep increase in interest rates. On top of it, the country’s highest-income earners will have an increased tax payment.
The cost is unbearable for the absolute majority of the country. The 93% of Sri Lankans living beyond their means no longer surprises me. We are a ticking bomb that can be exploded anytime, and the country’s leaders must understand the gravity of the situation.
The current peril will have an impact on all businesses in the country. Despite higher interest rates for bank deposits, financial institutions will struggle for deposit mobilisation. The FMCGs will find it hard to sell their products in the market. Also, the research data, I witnessed, shows people are less patronising modern trade/supermarkets vis a vis last year same period.
The Central Bank of Sri Lanka reported that in the first eight months of 2022, the nominal wages of the informal private sector increased substantially (Roughly about 25%), primarily due to the demand-based for daily wagers due to high inflation. Some private sector employees received pay hikes, but anyone can argue that the wage increase is in no way relatable to the rising cost of living.
In Q2 2022, credit cards had a transaction value of LKR 100.5 billion. This is a 63% increase in to the corresponding period of 2021. We must remember that credit cards have a rolling over 36% per annum interest rate; I am aware from personal business experience that most credit cardholders are paying the minimum payment and rolling the balance, sometimes through the years. The increase in credit card usage indicates that all is not good in the top bracket of the country. As per CBSL reports, they are over 2 million credit cards in circulation, and many possess multiple cards. I estimate that we have approx. 1.2 million unique cardholders in the country.
Where are we heading as a country? No one seems to have a clue. The government looks at a one-person show where everyone is looking to President Wickremesinghe to give solutions. It’s hardly visible that cabinet and state ministers are doing anything productive. The Opposition is in disarray and I doubt they can do much other than making statements. The President’s budget was politically safe and brutally honest about the situation of the country. The SOE’s must be restructured, and the government should not be in business of making money, which they are bad at it. The public-private partnerships are the way but there should be credibility in restructuring SOEs and optimising their potential. We have a bad history of restructuring and privatisation of state assets, which should not be the case this time. I am of the view that we should recruit experts to do the job, and they should be paid handsomely to avoid any malpractices.
The public is helpless. According to research, 93% of people will have anger, disappointment and frustration. The easiest thing is to leave the country but there should be an opportunity in another country to get an employment. Given that fact most of the countries are now giving preference to their own citizens when it comes to employment it will be hard task to get a slot. However, there are many Sri Lankan youth in Dubai on visit visa to find employment. My 23-year-old nephew found a job after trying for eight months in Dubai and he left the country to support his family. He was working for LKR 20,000 salary in Sri Lanka, and I did not have the heart to stop him leaving the country because I knew the salary he was getting here was not enough for transportation and miscellaneous expenses.
As of 30th June 2022, 190,000 credit cardholders have defaulted card issuing institutions. In the coming months, we will see an increase of this as, unless someone change their lives completely, one will not be able to withstand the external pressure. My friends in the banking system are worried that the non-performing assets may increase sharply and that will erode the profitability. Even during the 30-year-old war, banks kept on increasing profits every year, and what we have now is an unprecedented situation.
The leaders are still busy playing politics and ineffective governance is nothing new. Let it sink 93% of Sri Lankans are beyond their means and human mind only can take limited pressure. The financial freedom is not everything but its healthy to have the means. For 74 years we have been seeing the decline of our coffers and almost all countries in the region have passed us for prosperity. The problem we are facing is grave in nature and we should not look for politician to give us solutions. Simply, because they can’t and they won’t. One person will not be able to get us out of this trouble unless we all get together. I hope that sanity prevails.
The writer, an entrepreneur, alumnus of Harvard Kennedy School in Public Leadership with 27 years’ experience in the business world with international experience. Saliya can be reached on
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