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Midweek Review

Vaccines, pandemic politics, and Global South

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By Kalinga Tudor Silva

(A slightly amended version of a paper published as the editorial of Sri Lanka Journal of Social Sciences 44 (1) in June 2021.)

In describing the pandemic, the UN Secretary General Antonio Guterres stated in April 2020 “we are all in it together”. This laudable statement tried to drive home the point that the pandemic is a common challenge for the entire humankind and that a well-coordinated unified effort is needed from the world community – whether from the global north or south, majority or minority, infected or uninfected, to counter this unfolding human crisis. The twists and turns in the pandemic over the past one and a half years clearly demonstrated that everyone was vulnerable from heads of state at the top to mobile vendors on the streets. It also showed that while the virus does not discriminate, its impact does with elderly in institutional care, ethnic and racial minorities and socially underprivileged in general among the worst victims of the early phase of the pandemic globally. How the world will emerge from this terrible crisis is yet to be seen, but whether we like it or not it has taught us many lessons about what we should do and not do in responding to a global pandemic of this magnitude and the accompanying humanitarian crisis.

This powerful unifying statement by the head of the UN was made at a time when the pandemic was polarizing the world community in some fundamental ways. One was the disproportionate number of people of colour and minorities in general who fell victim to the pandemic in the United States and certain countries in Europe particularly during the onset of the pandemic. Thus, the pandemic was exposing serious disparities and the absence of universal coverage in the healthcare system even in the most economically advanced countries. Another was the pandemic of hate triggered by the COVID-19 outbreak, reflected in some mainstream and social media, whereby ethnic and religious other was often identified and labelled as the vector or carrier of the virus, reportedly spreading it to others at times purportedly deliberately. Thus, the social and political polarizing impact of the pandemic was as bad as its health (i.e., morbidity and mortality) impacts. We have seen some manifestations of this polarizing social impact of the pandemic in Sri Lanka as well. It is against this background that this valiant call for global unity and solidarity at the time of the pandemic must be understood. It is not framed as a plea for an unanticipated surge in ‘love in the time of corona’ along the lines of the award-winning novel of Marquez. Rather it was a pragmatic call for forgetting and perhaps overcoming the escalating internal differences within the world community when confronted by an unprecedented public health emergency unfolding right before our eyes.

Like many other UN calls and declarations, this enlightened UN statement too has fallen by the wayside. ‘Vaccine nationalism’ of developed countries directly relevant in the present context of the pandemic is a case in point. For vaccines to be effective as a widespread public health strategy for the control of COVID-19, the entire world, inclusive of developing countries, must have reasonable access to the vaccines so that the virus is contained satisfactorily throughout the world. However, the developed countries that manufacture the vaccines and have the technology and resources needed for production of vaccines have decided to order, stockpile and hoard much more than they actually require, purely taking their own self-interest into account to the neglect of third world countries in particular. According to an article published in The Guardian in March 2021, world’s rich countries with a total share of 14% of the global population, have secured 53% of the best vaccines for COVID- 19 produced or planned to be produced at the time (Bhutto 2021).

On the other hand, many countries in the global south will encounter a formidable challenge in the import of life-saving vaccines at current market prices due to their budgetary constraints and foreign exchange problems. This is likely to be even more challenging for smaller countries in the global south like Sri Lanka already heavily entangled in a debt trap along with intractable debt servicing problems as elaborated by Vinayagathasan and Sri Ranjith in their article in this issue. This situation is likely to create space for the virus to freely replicate and mutate in part of the world population in ways that will make it harder to contain the pandemic globally and prevent its upsurge in future. The reactions of corporate giants in the pharmaceutical world against cheaper manufacture of vaccines in the developing world reiterate the point that profits rather than human health across the board is the key driver of the global pharmaceutical industry. The fact that virus strains that emerged in India have spread to over 40 countries within a short period of their origin clearly points to the massive danger involved (Shrivastava 2021). China may be guided by their own vested interests and geopolitical agendas in rapidly developing and freely distributing their own vaccines, but the truth is that without access to lubricated and fast track Chinese supply line much of the developing world will be at the mercy of the multinational pharmaceutical corporations who will only use the pandemic as another profitable venture for accumulating wealth.

This is, however, not to argue that we should counter vaccine nationalism of the developed world with our own brand of home-grown parochial nationalism where we limit ourselves to herbal remedies inherited from the past or so-called miracle sweeteners (paniya) of one kind or another. Instead, what is needed is a critical approach where we subject both scientific inventions and herbal therapies and inherited legacies to an equally robust validation procedures without accepting them uncritically just because they are sanctioned and legitimised by western science or “power of ancient knowledge” (Perera 2021) combined with eastern mysticism at times driven by populist identity politics and deep-seated political instincts. At this critical juncture of pandemic politics, we need to work towards evolving social policies and decision-making processes that are well informed, evidence based and able to withstand political pressures and partisan demands for favouritism in matters such as vaccination coverage. While pandemic does call for urgent action, monitoring and evaluation should be part and parcel of all interventions for pandemic control and mitigation just as much as they are routinely deployed in all development practice. What is important at this stage is a carefully crafted state policy that transcends narrow fault lines in society and polity and seeks to stand for collective interests and the common good of all humanity confronted by an unprecedented common challenge with all of us entangled in it collectively. This is where countries in the global north as well as global south must transcend short-term self-interests and popular appeal to identity politics in order to face an unprecedented global challenge where we are all entangled in one way or another.

Papers in this issue of SLJSS are diverse as they deal with a variety of economic, social and cultural issues. None of the papers in this issue speak to the devastating pandemic immediately confronting us as a society. They do, however, highlight the need for well-informed social policies in selected domains in life. For instance, Perera’s article on social safeguard policies of the World Bank, Asian Development Bank and other such agencies reveal that while such policies have been carefully developed and imposed by these multilateral banks on their borrowers, they are not well integrated with related policies and principals of other international players such as the United Nations. The article has a specific focus on their lack of integration with Universal Declaration of Human Rights. The article also comments on the lack of fit between the social safeguard principles advocated by these lending institutions and ground level realities of developing countries, with the lenders having to “nudge the borrowers to adopt safeguard best practices” (this issue p. 63) without necessarily pushing them to incorporate the guidelines in their development practices in general. The author reiterates the point that social safeguard policies of these key development actors are guided by the immediate concerns of the lending institutions and their global agendas rather than changing ground realities and economic and social drivers in the developing world itself.

Another interesting story about social policy is presented by Wanninayake in his paper in the current issue of the journal. In contrast to much of the literature dealing with the larger body of Tamil and Muslim IDPs in northern and Eastern Sri Lanka, this article focuses on Sinhala IDPs displaced from Vavuniya South to northern part of Anuradhapura District during the war. The prevailing state policies encouraged war induced IDPs to go back to where they were displaced from at the end of the war. Most of the IDPs in Anuradhapura, however, opted to stay back in Anuradhapura using existing and newly established kinship ties to establish a self-settlement pattern and a wide range of social networks with host communities (p. 140). The prevailing state policies about return and resettlement of IDPs which tried to reestablish a status quo prior to their displacement perhaps due to ideological and political reasons were obviously uninformed by this sociological reality that the author identifies as a successful adaptation mutually beneficial to both IDPs and their hosts due to economic and social considerations applicable to the post war situation. IDPs did contribute to economic development in host areas by sharing their agricultural knowledge and skills, disseminating cultivation methods and supplying farm labour at a time many local youth were mobilized in military employment. The paper calls for a IDP resettlement policy that is more in line with ongoing social reality and choices made by the IDPs themselves in place of armchair policy making by bureaucrats and politicians purely guided by political exigencies and ideological considerations of the ruling regime at the time.

The UN policy stand regarding the pandemic has an immediate relevance to us as there is a distinct need to reach out to all sections of society and make them realize that we are all in it together and that we must work together diligently and intelligently in dealing with the pandemic. While enforcement of quarantine regulations and health guidelines is certainly needed, people must realize that their health is partly in their own hands, but partly in the hands of the community at large and at the hands of a heartless virus adept at multiplying that can be contained only collectively. In tracing the global history of epidemics, McNeill (1976) observed “Humans often have complicated and contradictory motivations. Microbes do not: they ‘want’ to reproduce.” Trust building in systems and among each other is as much needed as delivering vaccines and establishing effective health services and effective hand washing practices in workplaces at this hour of national and global emergency. It must be stated here that Sri Lanka’s outstanding achievements in public health developed from 1930s onwards ultimately rest in the skills, dedicated commitment, and application of health workers at all levels and the confidence with which the public voluntarily utilized the services available as a routine practice. As an unfolding global event, a pandemic may be a completely different challenge, but we have dealt with similar epidemics in the past and we have a well-developed health care system with wide outreach to all communities in the country (Jones 2015, Silva 2014). All efforts must be made to reinforce and revitalize this system in dealing with the crisis at hand.

References

Bhutto, F. (2021). The World’s Richest Countries are Hoarding Vaccines. The Guardian, March 17, 2021.

Jones, M. (2015). Sri Lankan Path to Health for All from the Colonial Period to Alma Ata. In A. Medcalf et al. eds. Health for All: The Journey of Universal Health Coverage. Hyderabad: Blackswan.

McNeill, William (1976). Plagues and Peoples. Garden City: Doubleday.

Perera, S. (2021). Science, Belief and State Policy: Towards a Necessary Exercise in Discursive Disentanglement. Presentation to National Academy of Sciences in Sri Lanka on January 22, 2021.

Silva, K.T. (2014). Decolonisation, Development and Disease: A Social History of Malaria in Sri Lanka. Delhi: Orient Blackswan.

Shrivastava, B. (2021). Virsu Strain behind India’s Surge in Covid Cases Detected in 44 Countries. Fortune, May 12, 2021.

 

 



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Midweek Review

Crossmatch: A moral mirror

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by Santhushya Fernando

Blossoming somewhere between a Chinaman and a Jam Fruit Tree is a Lotus. An unusual place to bloom, but there it is, anyway, Crossmatch. Crossmatch is Carmel Miranda’s debut novel that won the Gratiaen Prize 2020. Here’s what isn’t there in Crossmatch: steamy sex, profanity, harsh political commentary, preaching, flowery similes, structured ‘tools of literary writing’, boring descriptions. Probably uninfected by formal literary training, Miranda writes a provocative story with the acumen of a skillful doctor documenting on a patient’s bedhead ticket with some hardcore suspense thrown in. Crossmatch, for its entire 261 pages is captivating in its heart race potential.

Is she for real?

About 20 pages into Crossmatch, I phoned a senior friend who has spent the better part of his life at the Faculty of Medicine and the National Hospital of Sri Lanka (NHSL). “Seriously, you had a colleague called Dr Carmel Miranda? She writes like a hawk observing it all- is this a real name?” He’s was entertained, and replied “Carmel Miranda is for real. She spoke very little, did very much. Never spoke an unnecessary word: serious, committed, all about the patient, precise, not attention seeking, you know, the kind of person you miss when they are not there”. Oh, so I figure. Like Lotus. In Crossmatch.

The plot

Lotus, the protagonist is a third year medical student at the Faculty of Medicine, University of Colombo. She’s requested to pay a social visit to a hospitalised patient by her aunt, as all aunts of all medical students do. Like all medical students up to their eyes in real or imaginary stress, Lotus, grudgingly obliges visiting Anil Kumara only to find him dead. Events take Lotus to Lionel, the NHSL mortuary attendant with one glass eye, who convinces her to safe keep the dead boy’s mobile phone wrapped in a newspaper. Something about the numbers in the phone that includes the namesake Lotus Hospital, the NHSL ENT unit number and the contents of the newspaper drives Lotus to dig in deep. She uncovers, quite accidentally, the dangerous underbelly of organ trafficking mafia, poverty, inequality and the heart wrenching plight of the poor in our so called free healthcare system. Was it an accident that killed Anil? If not, who then is the killer? Finally Lotus finds answers and also confronts a devastating personal truth about her umbilical linkage to the Lotus Hospital. Even at the helm of her shatter, Lotus retains her characteristic objectivity and dignity. Throughout Crossmatch Miranda displays a true gift at maintaining the fidelity to her characterisation in personality, lingo, and mannerism.

The moral mirror

If you have read the captivating Gratiaen winner Chinaman by Shehan Karunatilaka, you would know that one need not be a cricket fan to fall in love with that book. Miranda shows similar skill and humility in telling a “medical story” without medical jargon interfering with storytelling. She has labored well to tell a story about the holes of a medical system in effortless lay language. Never does she matronizingly “explain” medical terms down to the reader, weaving it all in, silkily.

Miranda holds a moral mirror on to our conscience with Crossmatch. It’s a grand mirror with one in center in front of which the reader is stands. That mirror is hinged with two mirrors on the side: the moral mirror of medical education and the moral mirror of medical practice. Both the hinged mirrors reflect unto the main mirror creating an ‘n’ number of reflections.

The moral mirror of medical education in Crossmatch touch on teaching via humiliation, linguism, unjust hierarchies, lack of cohesion in medical education, doctors past their medical fitness ‘expiry date’ continuing to practice medicine. But the beauty of Miranda’s moral mirror is that it does not discuss this in a malicious spirit. All is written with astounding tenderness and sensitivity towards human fallibility. It’s a mirror that every teacher must consider standing before.

The more serious moral mirror in Crossmatch is the territory that few would dare to tread: the kidney mafia, organ trafficking, bending the law, exploitation of the poor in kidney transplantation, lack of a transparent registry for organ donation, the legal and moral dilemma of compensation for organ donation. Importantly, this moral mirror in Crossmatch shines blindingly in our eye asking us questions: do you know what it means to be poor? The desolation beneath the label of poor? How many times do the rich donate kidneys to the poor? Is there ever a free lunch at a private hospital?

Our collective crime: poverty

Miranda reflects the moral mirrors on us for the sole purpose of telling her story. Her tender observations about how people live, talk, move, rationalize, love and sacrifice are all for the purpose of storytelling. Her power of observation is consistent across the slums of Wanathamulla to the bungalows down Rosmead place. After reading Crossmatch you cannot afford to be Sri Lankan and be divorced from the collective social crime called poverty that we all contribute to, by commission or omission. For poverty is the one crime that has the direct or indirect consent of society. The crisp humorful language, sharp precise observation, humane narration without judgment- all these make it a good read. Noteworthy is Miranda’s security as a writer who doesn’t feel the need to climb on top of her story.

Perhaps the only anti-climax of Crossmatch is its epilogue. In an uncharacteristic bout of a need to tie up too many ends, Miranda writes an epilogue reminiscent of last minute commentary over movie credits in a Hollywood or Bollywood movie stating how each character ended up happily. The last line of the main novel (prior to epilogue) “But that doesn’t stop me from dreaming “is disappointing and reminiscent more of a line out of a Hallmark card. Miranda could have written a killer last line. The epilogue takes her matter of fact story telling a bit too far and negotiates a mediocre “happily ever after” to a thought provoking , disturbing story meant to induce a bit of reader- insomnia.

Yes, Crossmatch makes us stand in front of a difficult moral mirror.

To Carmel Miranda I say: “You. Go. Girl!!!!”

(Dr Santhushya Fernando is a senior lecturer in Medical Humanities at the Faculty of Medicine, University of Colombo)

 

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Midweek Review

Proposed Plantation University and its economic benefits

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by Dr L M K Tillekeratne
Former Director of the RRI and UNIDO consultant in Rubber Processing

President Gotabaya Rajapaksa’s recent address to the nation made an emphatic reference to the establishment of a Plantation University by amalgamating all major crop research institutes, such as Tea Research Institute (TRI), the Rubber Research Institute (RRI), Coconut Research Institute (CRI), Sugarcane Research Institute (SRI). Of these four research institutes, two were established by British rulers over a century ago. The core mandate of the research institutes was to develop the respective agricultural crops, as the plantation crops generated the highest amount of foreign exchange for almost four decades.

With the advent of the free market economy in late 1970s, though the remittances from migrant workers and revenue from the garment industry surpassed the foreign exchange earnings of the plantation sector, the plantation industry continues to play a dominant role in terms of foreign exchange and employment.

Hence, the President’s thinking that the creation of a national university exclusive for the plantation sector is a far-reaching vision that could transform the plantation sector by increasing land productivity and by developing the value-added products manufacture particularly in the case of rubber that the country desperately needed at this juncture. In this context, that the article written by J. A. A. S. Ranasinghe, Productivity Specialist and Management Consultant in a leading English newspaper was a comprehensive analysis of the justification of the creation of a national university for the plantation sector. Such an incisive analysis should have come from a scientist initially.

Dearth of Scientists in the Research Institutes

I whole-heartedly agree with Mr. Ranasinghe on his assertion that research institutes are functioning today in isolation without trained staff to carry out research projects. As he has very correctly identified the dearth of scientists of all the research institutes has hampered the research programmes, and that in turn has led to the deterioration of the productivity of all the sectors during the last two decades. Thus, bringing all the scientists and resources under one umbrella is the need of the hour and that could be accomplished relatively at a short time by establishing an exclusive university for the plantation sector.

The President’s far-reaching vision will be a turning point in producing scientists to run the plantation industry. At a time when most of the other countries in Asia and Africa are increasing their productivity levels of the plantation crops, it is unfortunate that Sri Lanka is far behind in terms of research during last two decades, though its Tea and Rubber research institutes are internationally known.

Downfall of the Rubber Industry

It is sad that in Sri Lanka, the first country in the world to have a rubber plantation established outside Brazil and distributed planting material to other countries mainly in Asia to grow rubber, rubber production has plummeted significantly for the last 25 years. The countries that learnt rubber planting technology from the scientists of Rubber Research Institute of Sri Lanka, such as Myanmar, Cambodia and Vietnam, have already been able to overtake us both in terms of production and land productivity over the past two decades pushing Sri Lanka down to the 12th place as a NR producer at present. I strongly believe that the situation regarding tea is either the same or even worse.

As Ranasinghe has correctly pointed out in his article, our productivity has fallen to 50% of what we produced a decade ago while countries like Myanmar and Cambodia have been able to double their annual production during this period.

Dearth of Plantation Technologists

It is true that we have agricultural universities producing agriculture graduates. But they do not specifically focus on crops like Tea and Rubber, and cannot undertake the task of increasing productivity by means of applying new technology introduced regularly to overcome issues related to agronomy and tapping. Fresh Agriculture and Science graduates who joined the plantation sector lack the skills and knowledge the plantation industry demands and this mismatch has resulted in a shortage of plantation technologists with required competency levels.

Distinctive Advantages of Plantation University

The agricultural graduates of Sri Lankan universities, however, would be in a very authoritative position in that they can cover a wide variety of other crops better than the graduates getting their agricultural degrees overseas. Agriculture and science graduates should necessarily possess the required field exposure and experience to find gainful employment in plantation sector. Hence, fresh graduates who join the plantation sector will have to work for at least 10 years to be an expert who can identify problems and sort them out on them individually. The industry can ill-afford to wait for such a long period to produce talented plantation expert or qualified scientists, given the dearth of scientists in the country. As Ranasinghe has correctly mentioned, there is a severe shortage of scientists virtually in all departments of research institutes to tackle problems in the industry, which will badly affect the research institutes, if the present system is allowed to continue. More than 50% of the raw rubber and latex end products industry is imported at competitive prices. The coconut production is sufficient for the local consumption and there is no surplus for export in the form of oil or DC.

Exodus of Research Scientists to join Universities

Most of the scientists trained for special mandates in the research institutes have already joined the national universities purely due to better salaries and perks. However, according to the situation existed in early 1960s, those who joined research institutes for developing the agriculture sector were paid higher salaries than those who joined universities, considering their contribution to the development of the economy and the difficult conditions under which they work in remote areas.

Hence, the science graduates’ first choice was research institutions. Today, it is the other way around, and only those who cannot find employment in universities and with low merits join research institutes to get post graduate training utilising the limited number of foreign training scholarships offered to research institutes and get qualified to join universities. Empirical studies have shown that trained researchers with special skills to tackle problems in the plantations have become misfits as academics.

Ad hoc recruitment criteria

The situation that existed prior to the late 1980s was totally different even with regard to recruitment criteria. It is due to the shortage of graduates produced by local universities due to closure of the university education for almost three years, due to the insurrection. There was a severe shortage of special degree holders and hence a decision was taken by the government to allow general degree holders in places where previously only special degree graduates with a class were recruited as research assistants in research institutes. Since then the quality of research produced by the research institutes has suffered.

The distinctive benefit in the President’s proposal is that in the future we might be able to produce graduates capable of tackling problems in the plantation sector with their adequate field exposure and hands on experience during their undergraduate studies.

In addition, there will be a good opportunity for institutions like TRI and RRI with international reputation to attract foreign students for training in Sri lanka thereby earning additional revenue to the country as the UK, India and Malaysia do even without having such recognition. If the proposed national plantation university is properly run, it will be quite possible for them to sustain adequate revenue from foreign students without depending purely on annual Treasury grant. Even now trainees from countries like Myanmar, China, Cambodia, Ethiopia and even from Malaysia have got their research assistants trained at these two crop institutes under international grants.

Contribution to the national economy by way of enhanced production

On a hypothetical basis, if the production of rubber in the country is increased to 135,000 Mt, which was the amount produced years ago, purely by increasing the land productivity, without even increasing the planted area, the country can reap maximum benefits from the fast-increasing rubber prices in the world market. Rubber was selling at around Rs 100 to 150 per kg during the last half a decade. Surprisingly, it has gone up to almost Rs 450 per kg now and the situation is expected to increase further with time to come owing to the demand for NR on account of the Covid-19 pandemic.

If the production is increased to 135,000 Mt, additional revenue the country can enjoy would be (Rs 450 x 50000 x1000) Rs 22.5 billion annually.

We should not lose sight of the fact that due to the shortfall in the supply of rubber, a considerable amount of NR and latex is imported by our rubber products manufacturers for value added products manufacture at a cost of over Rs 30 billion.

If this extra production is used to produce goods such as surgical/examination gloves for which the demand is fast increasing due to Covid-19 spread, the additional revenue country can gain is over 200%. It will be possible to create more employment opportunities as well.

Arduous task for the new Minister

The task before Economic Development Minister is to consider how best to improve the economy in bad state. This objective can be achieved in less than a year by getting the neglected rubber farms into tapping and by using techniques like lightly stimulated low frequency tapping and by utilising proven new techniques like rain guards to minimise crop losses due to rain. The additional cost involvement for these developments is insignificant and the time taken is less than a year.

New planting and replanting are two other ways of increasing the crop; they are costly and take nearly a decade to give a reasonable crop increase. Further, there is no guarantee that the improved rubber prices will remain high until then. However, replanting, and new planting should be continued according to the RDD targets.

Another factor that caused a drop in the rubber production was the removal of the extension services from the research wing and its attachment to the subsidiary function of the Rubber Development Department owing to an illogical decision taken by the then government almost 25 years ago. Today, the RDD is functioning in isolation ignoring the recommendations of the RRI. This has been the main cause for the drop in productivity of rubber farms in Sri Lanka. For example, the population of low yielding clones like PB 86 are still distributed and the clone population in the country is an utter mess.

Undoubtedly, everyone looks forward to the establishment of the plantation university.

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Midweek Review

“Madam” and her Wards

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By Lynn Ockersz

Six anxious, awkward teenage girls,

Are following their “Madam” close at heel,

To the rundown Spa hardly seen in the busy street,

But sought by restless men when darkness sets in,

But in the Isle fabled for its charity,

No one looks askance at this sight,

No one dare asks questions that matter;

Nor is accountability exacted from office holders;

But posers like the following may be asked,

By those who choose to care for the ‘nation’,

Now that Ishalini too has brought things into focus:

Isn’t this an induction into prostitution?

What lured the girls away from school,

And made them walk footloose on the streets?

Would the “Madam” be ever taken to task?

Or would she be allowed to go, with no questions asked,

When a swoop by the uniformed gentry,

Thrusts the girls into a police lockup,

And makes them wilt there sadly,

Though into primal youth they are about to bloom.

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