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UPDATE ON COVID 19 VACCINES

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Dr. H. T, Wickremasinghe

It is commendable that the government of Sri Lanka has planned to get down nine million doses of Covishield Vaccine from Serum Institute of India, the world’s largest vaccine manufacturing company. This vaccine is actually none other than AstraZeneca –Oxford Vaccine manufactured by The Serum Institute of India, by the name of Covishield. To date, Sri Lanka has already administered about 200,000 doses to healthcare workers. The next consignment would be given to persons over 65 years and persons with co-morbid conditions such as diabetes, hypertension, heart disease and kidney disease.

With the rolling out of the vaccine globally, new observations have surfaced. The original schedule of the vaccine was to give two doses 28 days apart. This provided almost 70% immunity. However, new evidence has come out last month, suggesting that it would be better to increase the gap between two doses to 12 weeks (3 months) instead of four weeks. This would offer a more robust 84% immunity. The United Kingdom is already using the three months interval between two doses. This will provide greater flexibility for vaccine roll-out, and help the health authorities to deal with any possible supply disruptions, while consistently sustaining the maximum immunity to the public.

A study done by the independent COVID 19 Vaccine Research Group in UK had shown that until the time of conclusion of the study at three months, a single standard dose would provide 76% protection with no declining of immunity. How long this protection would last is not known yet. But time would tell us. As with any other vaccine, an introduction of a second dose at three months would certainly boost the immunity.

 

The second observation made during the roll out of this vaccine is that it appears to provide some form of protection to community spread of the disease. This study revealed that there was 67% reduction in community spread of the disease. This is in fact very good news, as when we go on vaccinating more and more people, there would be less and less community spread of the disease, reducing the burden on hospital medical services.

Another issue which surfaced while rolling out of the vaccine is the safety and efficacy of the vaccine in persons over 65-years of age. Unfortunately, all phase three trials done by AstraZeneca have not included many persons over 65 years of age. They primarily targeted the 18-55 year age group. According to the data from AstraZeneca’s phase three trials, only two out of 660 persons in the trial aged over 65 were infected with COVID 19. Such a small number of participants is grossly insufficient to make a global decision. It is obvious that AstraZeneca has failed to provide reasonable data of safety and efficacy of their vaccine in the elderly population. They are already paying the penalty as countries such as Germany, France, Austria, and South Africa have declined to use the vaccine for persons over 65 years, despite the recommendation made by the European Medicines Agency (The governing body of drug evaluation in EU countries) to use the vaccine for all ages. However, the United Kingdom decided to continue vaccination for all ages including persons of over 80. Their interim analysis during the early part of the vaccination programme shows that the vaccine is not only effective and provide the same immunity as for others but also has slightly less side effects.

Considering the seriousness of COVID 19 in the elderly and it’s very high mortality, it is my considered opinion that even if the vaccine is less effective or has more side effects, it is still worth giving it to old persons as it would save their lives.

With more and more new genetic variations of SARS CoV 2 virus emerging, a reasonable concern has transpired among scientists whether the vaccines would be able to provide immunity to the new emerging strains. Up to now globally there are more than 8,000 variants. Out of those, three variants, the South African variant, the Kent (UK) variant and the Brazilian variant are few rapidly gaining global spread. The UK variant has been identified in Colombo, Avissawella, Biyagama and Vavuniya.

Studies done in UK has shown that AstraZeneca vaccine would provide immunity to the UK variant. However, a similar study done on over 2,000 participants in South Africa has unfortunately revealed that this vaccine is not effective against the new South African strain.

There are more than 150 vaccines against COVID 19 in the production pipeline. Out of those a dozen are nearing completion and awaiting submission of their dossiers to World Health Organization for approval. With such a vast array of vaccines, it would be easy for WHO to distribute vaccines early to provide vaccination to all needy people in the world. But it would not be easy to have the same vaccine supply without disruptions with the expanding global demand. At the same time, some vaccines would show immunity to some new emerging variants, while another vaccine would show immunity to other variants. This brings us to another new strategy. What if we combine vaccines? Combined vaccines theoretically will provide greater flexibility for vaccine rollout and help to deal with any possible intermittent supply shortages of a particular brand.

However, the official guidance given by vaccine authorities in the world state that anyone who has already taken a vaccine should get the same brand of vaccine for both doses. The US Food and Drug Administration and the UK’s Joint Committee on Vaccination and Immunization (JCVI) recommend as much. It’s only in ‘very rare circumstances’ that vaccines of different brands may be used and only if one vaccine is available at a certain time, or it is not known which one was administered for the first dose. Nevertheless, the usefulness of a combined vaccine, in case of a short supply or with combating a new emergent variant, cannot be underestimated. New research is underway to find out the efficacy and safety of such combinations. The initial report with AstraZeneca-Pfizer vaccine combination will be available by mid-2021. Similar trials will be undertaken soon, so that the health authorities of countries would have a better and competitive option of choosing vaccines for their public.

Despite all this good news, we still have question for which we have to wait for an answer. How long the immunity will last is the question for with no answers are available yet. Many countries have already commenced their vaccination programme, even before the introduction of free vaccine programme by WHO sponsored COVAX. In the race of COVID 19 mass vaccination, Israel is well ahead of all the countries in the world already covering 43% of the total population. The number of new cases and deaths due to COVID 19 has come down. Even in the US, the initial wave of vaccination is slowly showing results of reduction of mortality from COVID 19 related complications.

The majority of the vaccines used so far may not provide the expected picture-perfect immunity and the world may continue to have COVID 19 infections, but based on evidence, speculations have already been made to claim that vaccination could provide almost 100% protection from death, This is what we all want.

With that positive note, let me conclude while emphasizing the need to continue our general public health measures such as wearing masks, social distancing and avoiding crowded gatherings to reduce the risk of contact with an infected person. There is no science to beat common sense.

 

(The writer, a Senior Consultant Paediatrician, is President of the Vaccine and Infectious Diseases Forum of Sri Lanka)

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Olga Sirimanne (1923 – 2021)

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In memoriam

My darling beautiful angelic wife Olga (First batch of Air Ceylon stewardesses) and I commenced a partnership of love in Holy Matrimony on 17th June 1954. We loved each other deeply, enjoyed a blissful relationship for over 66 happy years with each other. We devoted our lives to give love and happiness not only to each other but also to all those who came to know us during our delightful almost 100 years. Beautiful incidents and memories are portrayed in several photo albums. Our friends and family loved listening to Olga’s exciting experiences and stories laced with humour and laughter as she was an excellent story teller.

Olga was blessed with three loveable children, Sunil, Laksen and a beautiful daughter Minoli; adorable grandchildren, Shelana and Sanjev, Rahel and Sariah, Kaitlyn and Taylor; great grandson, Sevan and darling niece, Ashie whose mother (Olga’s only sister) passed away some years ago. Ashie considered Olga, her ’Loku Ammie’ as her surrogate mother. Her son-in-law and daughters-in-law too loved her deeply with great respect and love. She held them fondly close to her heart with pride.

Her lifelong heart-throb was me. She always called me ‘darling’ but never addressed me as ‘Siri’ though all her friends did. Since I was ‘Thathie’ to our loving children, she too affectionately called me ‘Thathie’ even when she was on the verge of passing away. I too enduringly called her ‘Ammie’ as I loved her as much as our children.

Her gentle protective care and devotion helped me to maintain youthful looks and excellent health to celebrate my 100th birthday on 31st January 2020. She and our daughter had arranged a Holy Mass at home followed with a surprise birthday party attended by a few close friends and relations. She too received Holy Communion with blessings for the peaceful and happy years of coexistence with me. I too responded to her caring ways and helped her maintain her health and beautiful charming looks to the end.

Her 98th birthday was on 12 January 2021. She was greeted by me first thing in the morning, with loving kisses, hugs and prayers to God for giving us another year of peace and happiness. She received with warm wishes lots of beautiful bouquets and baskets of flowers, birthday cards and a countless number of telephone calls from children, grandchildren, relations, friends and loved ones here and scattered around the globe. It thrilled her to know that so many remembered and loved her.

Deep within our hearts, there was this chilling fear of the unbearable sorrow if one of us was left without the other. As age was creeping into our lives, every night we started reciting together a prayer to God before going to sleep, kissing each other and whispering, “I love you darling, God Bless you.”

The inevitable happened on 3rd February 2021 when my darling (Olga) passed away in my arms to the Kingdom of Heaven to be with Jesus. Thus, ended our happy and peaceful partnership, me afflicted with sorrow and yearning for her presence. I love you darling, my love. Rest in Peace.

Our children, Sunil, Laksen, Minoli and I wish to thank all those who attended the private funeral, sent floral tributes and messages of condolences and regret our inability to thank you individually . Please accept our heartfelt gratitude.

 

D.L.Sirimanne

leosirimanne@gmail.com

 

 

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Divided people in a distorted democracy

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The Geneva Calamity comes more from the thinking of the Ministry of Foreign Affairs, than that of the former Chilean politician who is now the UN High Commissioner for Human Rights.

It is such thinking of disaster advancement that made our Foreign Minister tell the Geneva meeting in his virtual address that Sri Lanka acted in ‘self-defence” in the fight against the LTTE’s terrorism. Was it self-defence that led to the actions of the armed forces or the fundamental right to safeguard the unitary state, sovereignty and territorial integrity of the Republic of Sri Lanka – whether Democratic Socialist or not?

The debate will go on in Geneva about our actions for self-defence, that defeated the LTTE, and what has taken place after that assurance of self-defence, that relates to wider reaching issues of Human Rights, with emphasis on responsibility and accountability.  Now that Yahapalana is no more, it is the task of the Powers of Fortune, or Saubhagya, to make its own case on how Sri Lanka relates to the international community.  This is certainly no easy task as we see the unfolding of the politics and crooked governance in Sri Lanka.

As the echoes of Geneva goes on, we are much more involved in the Easter Sunday carnage and the Presidential Commission report on it. The people are certainly puzzled as to why the planners and directors of this hugely bloody act of Islamic terrorism have not been revealed. We have the unique situation where the person who appointed this Commission of Inquiry, none other than former President Maithripala Sirisena, is to be legally punished for this carnage. 

Are we to have special satisfaction on the possibility that future Heads of State, who appoint such commissions of inquiry, will be the first accused, even in the much-delayed reports of such commissions?  There is not much hope for such satisfaction. The Head of State is the emblem of supremacy, with all the powers of the 20th Amendment to the Constitution. 

The families of the victims of that terrorist attack at the Katuwapitiya -Negombo, Kochchikade – Colombo, and Batticaloa churches, will certainly remain in search for the exposure and punishment of those who planned and carried out these situations of carnage. What we are shown is the true purpose and meaning of a Presidential Commision of Inquiry – PCoI.

We have certainly gone back to the origins of such inquiries, and the powers of Saubhagya at Rajavasala, have shown their honour to J. R Jayewardene, who brought the Presidential Commission as the show of the five-sixth majority Jayewardene Power.  Mr. Sirisena may remember how the first PCoI of the Jayewardene era, ensured the removal of civic rights to Mrs. Sirimavo Bandaranaike, the defeated Prime Minister and Mr. Felix Dias Bandaranaike, former Minister of Justice.  

Punishment of one’s political opponents is the stuff and substance of Presidential Commissions of Inquiry, and Sri Lanka is now showing the whole world how much this is a part of a Distorted Democracy. A show of power that was enabled by 69 lakhs of voters in the presidential election, followed  by the parliamentary two-thirds gained through those who bowed their so-called critical heads on ‘Dual Citizens” coming to Parliament, and the huge Muslim MP cross-over – for the benefits they must have gained – as all such cross-over politicians always obtain.

The Archbishop of Colombo, Malcolm Cardinal Ranjith, who certainly prevented the Easter Sunday carnage leading to even more bloodshed, by a few timely words of caution and Christian thinking that tragic day, must be now wanting to know why he was so keen to get the report of this Commission.  Who were the planners, the funders, the trainers and leaders of this carnage? What will the people know in the weeks and months to follow, and how much can the feelings of the families that were the bloody victims of this massacre of the innocents, be brought to some relief?

This PCoI is the answer to the political prayers of those manipulating power today. It is the answer to the continually rising Cost of  Living, the protection to those who keep destroying our forests and jungles, the safeguard for all those who keep reducing the Alimankada pathways of our elephants, it is the whistle blow of  go ahead to the forces of urban destruction, and the show-piece managers of Presidential visits to the rural people. 

The rising voices of sections of the Maha Sangha against this PCoI, the call from Christian voices to expose and deal with the planners and movers of this carnage, and the louder voices for the protection of nature and the environment, will be the cause of joy to the powers of a Deadly Dominant Democracy. It is the message of power to those who take pride in killings of the past – be it the Tigers of the LTTE, or the cases of killed, injured and missing journalists, and the abduction of children.

 The powers that be will continue to sing loud about how we acted in self-defence against the LTTE terror. The echoes of Geneva will keep ringing in the ears of manipulative politics and power. But this and other PCoI reports that are seen as the substance of crooked power, will soon lead our people and country to an Age of Disaster – an age of new confrontations and calamities. How much worse can we become than the JRJ manipulation of anti-democratic power?

 How much can we allow our people to be divided, and thus supportive of a Distorted Democracy?

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HOW REBIRTH  TAKES PLACE

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The passing away of the consciousness of the past birth is the occasion for the arising of the new consciousness in the subsequent birth. However, nothing unchangeable or permanent is transmitted from the past to the present.

(From THE BUDDHA AND HIS TEACHINGS by Venerable Narada Mahathera)

“The pile of bones of (all the bodies of) one man
Who has alone one aeon lived
Would make a mountain’s height —
So said the mighty seer.”

— ITIVUT’TAKA

To the dying man at this critical stage, according to Abhidhamma philosophy, is presented a Kamma, Kamma Nimitta, or Gati Nimitta.

By Kamma is here meant some good or bad act done during his lifetime or immediately before his dying moment. It is a good or bad thought. If the dying person had committed one of the five heinous crimes (Garuka Kamma) such as parricide etc. or developed the Jhānas (Ecstasies), he would experience such a Kamma before his death. These are so powerful that they totally eclipse all other actions and appear very vividly before the mind’s eye. If he had done no such weighty action, he may take for his object of the dying thought-process a Kamma done immediately before death (Āsanna Kamma); which may be called a “Death Proximate Kamma.”

In the absence of a “Death-Proximate Kamma” a habitual good or bad act (Ācinna Kamma) is presented, such as the healing of the sick in the case of a good physician, or the teaching of the Dhamma in the case of a pious Bhikkhu, or stealing in the case of a thief. Failing all these, some casual trivial good or bad act (Katattā Kamma) becomes the object of the dying thought-process.

Kamma Nimitta

or “symbol,” means a mental reproduction of any sight, sound, smell, taste, touch or idea which was predominant at the time of some important activity, good or bad, such as a vision of knives or dying animals in the case of a butcher, of patients in the case of a physician, and of the object of worship in the case of a devotee, etc…

By Gati Nimitta, or “symbol of destiny” is meant some symbol of the place of future birth. This frequently presents itself to dying persons and stamps its gladness or gloom upon their features. When these indications of the future birth occur, if they are bad, they can at times be remedied. This is done by influencing the thoughts of the dying man. Such premonitory visions of destiny may be fire, forests, mountainous regions, a mother’s womb, celestial mansions, and the like.

Taking for the object a Kamma, or a Kamma symbol, or a symbol of destiny, a thought-process runs its course even if the death be an instantaneous one.

For the sake of convenience let us imagine that the dying person is to be reborn in the human kingdom and that the object is some good Kamma.

His Bhavanga consciousness is interrupted, vibrates for a thought-moment and passes away; after which the mind-door consciousness (manodvāravajjana) arises and passes away. Then comes the psychologically important stage –Javana process — which here runs only for five thought moments by reason of its weakness, instead of the normal seven. It lacks all reproductive power, its main function being the mere regulation of the new existence (abhinavakarana).

The object here being desirable, the consciousness he experiences is a moral one. The Tadālambana-consciousness which has for its function a registering or identifying for two moments of the object so perceived, may or may not follow. After this occurs the death-consciousness (cuticitta), the last thought moment to be experienced in this present life.

There is a misconception amongst some that the subsequent birth is conditioned by this last death-consciousness (cuticitta) which in itself has no special function to perform. What actually conditions rebirth is that which is experienced during the Javana process.

With the cessation of the decease-consciousness death actually occurs. Then no material qualities born of mind and food (cittaja and āhāraja) are produced. Only a series of material qualities born of heat (utuja) goes on till the corpse is reduced to dust.

Simultaneous with the arising of the rebirth consciousness there spring up the ‘body-decad,’ ‘sex-decad,’ and ‘base-decad’ (Kāya-bhāva-vatthu-dasaka).

According to Buddhism, therefore, sex is determined at the moment of conception and is conditioned by Kamma not by any fortuitous combination of sperm and ovum-cells.

The passing away of the consciousness of the past birth is the occasion for the arising of the new consciousness in the subsequent birth. However, nothing unchangeable or permanent is transmitted from the past to the present.

Just as the wheel rests on the ground only at one point, so, strictly speaking, we live only for one thought-moment. We are always in the present, and that present is ever slipping into the irrevocable past. Each momentary consciousness of this ever-changing life-process, on passing away, transmits its whole energy, all the indelibly recorded impressions on it, to its successor. Every fresh consciousness, therefore, consists of the potentialities of its predecessors together with something more. At death, the consciousness perishes, as in truth it perishes every moment, only to give birth to another in a rebirth. This renewed consciousness inherits all past experiences. As all impressions are indelibly recorded in the ever-changing palimpsest-like mind, and all potentialities are transmitted from life to life, irrespective of temporary disintegration, thus there may be reminiscence of past births or past incidents. Whereas if memory depended solely on brain cells, such reminiscence would be impossible.

“This new being which is the present manifestation of the stream of Kamma-energy is not the same as, and has no identity with, the previous one in its line — the aggregates that make up its composition being different from, having no identity with, those that make up the being of its predecessor. And yet it is not an entirely different being since it has the same stream of Kamma-energy, though modified perchance just by having shown itself in that manifestation, which is now making its presence known in the sense-perceptible world as the new being.

Death, according to Buddhism, is the cessation of the psycho-physical life of any one individual existence. It is the passing away of vitality (āyu), i.e., psychic and physical life (jīvitindriya), heat (usma) and consciousness (vijnana).

Death is not the complete annihilation of a being, for though a particular life-span ends, the force which hitherto actuated it is not destroyed.

Just as an electric light is the outward visible manifestation of invisible electric energy, so we are the outward manifestations of invisible Kammic energy. The bulb may break, and the light may be extinguished, but the current remains and the light may be reproduced in another bulb. In the same way, the Kammic force remains undisturbed by the disintegration of the physical body, and the passing away of the present consciousness leads to the arising of a fresh one in another birth. But nothing unchangeable or permanent “passes” from the present to the future.

In the foregoing case, the thought experienced before death being a moral one, the resultant rebirth-consciousness takes for its material an appropriate sperm and ovum cell of human parents. The rebirth-consciousness (patisandhi vijnana) then lapses into the Bhavanga state.

The continuity of the flux, at death, is unbroken in point of time, and there is no breach in the stream of consciousness.

Rebirth takes place immediately, irrespective of the place of birth, just as an electromagnetic wave, projected into space, is immediately reproduced in a receiving radio set. Rebirth of the mental flux is also instantaneous and leaves no room whatever for any intermediate state (antarabhava). Pure Buddhism does not support the belief that a spirit of the deceased person takes lodgement in some temporary state until it finds a suitable place for its “reincarnation.”

This question of instantaneous rebirth is well expressed in the Milinda Panha

The King Milinda questions:

“Venerable Nagasena, if somebody dies here and is reborn in the world of Brahma, and another dies here and is reborn in Kashmir, which of them would arrive first?

“They would arrive at the same time. O King.

“In which town were you born, O King?

“In a village called Kalasi, Venerable Sir.

“How far is Kalasi from here, O King?

“About two hundred miles, Venerable Sir.

“And how far is Kashmir from here, O King?

“About twelve miles, Venerable Sir.

“Now think of the village of Kalasi, O King.

“I have done so, Venerable Sir.

“And now think of Kashmir, O King.

“It is done, Venerable Sir.

“Which of these two, O King, did you think the more slowly and which the more quickly?

“Both equally quickly, Venerable Sir.

“Just so, O King, he who dies here and is reborn in the world of Brahma, is not reborn later than he who dies here and is reborn in Kashmir.”

“Give me one more simile, Venerable Sir.”

“What do you think, O King? Suppose two birds were flying in the air and they should settle at the same time, one upon a high and the other upon a low tree, which bird’s shade would first fall upon the earth, and which bird’s later?”

“Both shadows would appear at the same time, not one of them earlier and the other later.

The question might arise: Are the sperm and ovum cells always ready, waiting to take up the rebirth-thought?

According to Buddhism, living beings are infinite in number, and so are world systems. Nor is the impregnated ovum the only route to rebirth. Earth, an almost insignificant speck in the universe, is not the only habitable plane, and humans are not the only living beings. As such it is not impossible to believe that there will always be an appropriate place to receive the last thought vibrations. A point is always ready to receive the falling stone.

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