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We need to secure unmitigated public trust and cooperation

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COVID-19:

Dr B. J. C. Perera

Specialist Consultant Paediatrician

Many outbreaks and epidemics such as HIV/AIDS, Ebola, as well as our past experience with vaccines and various types of treatment modalities for infectious diseases, have taught us many lessons. It is critical for us to use some of these most valuable lessons to build an effective and acceptable response to the Covid-19 pandemic caused by the SARS-CoV-2 microbe.

First and foremost, those epidemics have taught us that interventions must be based on sound and proven science. Just as in many instances of experience with an entirely new infectious disease, we face many uncertainties about the epidemiology, clinical presentation, and natural history of a new virus. SARS-CoV-2 science is therefore evolving quickly, but in a state of continuing flux, which adds to the complexity of decision making, communication, and development and sustainability of public trust. Yet for all that, Covid-19 presents an important opportunity for smart deployment of our hard-won knowledge.

HIV/AIDS has taught us the value and importance of involving affected communities in planning and implementation of research and care. Both HIV and Ebola have shown that accurate and timely local information are required to enable and guide tailored interventions; public health and medical experts should heed the slogan “Know your epidemic” and target interventions accordingly. The much-bandied notion of ‘one size fits all’ is perhaps of little use in this situation.

Of course, Covid-19 presents new challenges. The epidemiology of a pandemic respiratory virus changes rapidly, and responses must be nimble. Given that everyone is susceptible to this novel coronavirus for which we lack effective biologic interventions, the response has required large-scale behaviour change, including social distancing, scrupulous hand washing and wearing of face masks in public, which were proposed rapidly under emergency circumstances. These measures could have had greater impact, however, if they had been adopted earlier and more widely; rapid actions that require community trust and buying-in. There are examples of public health successes against Covid-19. Hong Kong, which has a much higher population density than New York City, had fewer than 100 Covid-related deaths, thanks in part to swift and widespread uptake of masking, augmented by easily accessible testing. Germany introduced large-scale Covid-19 testing combined with locally led responses and strong national leadership. Globally, individual and community-level responses required substantial sacrifices that had major economic effects. In stark contrast, the USA response however, has been hampered by denial, missteps, delays in scaling up testing, inconsistent messaging, and politicization of public health responses. A vile combination of some of these led to uncontrollable community transmission in many parts of the United States of America.

But this pandemic presents an opportunity to build bridges between scientists and the public. Trust must be earned. Experience with HIV/AIDS demonstrated that scientist–community collaboration was feasible and improved the scientific process. AIDS advocates pressured scientists to act more quickly, to be more transparent, and to communicate clearly about scientific rationale and methods. The result was shorter timelines for scientific investigation, regulatory review, and even implementation of effective interventions. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, provided an outstanding model for building bridges with the public. His willingness to listen to advocates’ concerns about AIDS research was instrumental in making clinical research on HIV/AIDS consultative and collaborative.

In facing Ebola, the Partnership for Research on Ebola Vaccines in Liberia (PREVAIL) trial demonstrated that substantial investment and adaptive approaches to community education and social mobilization could address myths about Ebola, motivate participation, and achieve high retention in vaccine trials, all secured in spite of widespread mistrust of government, low literacy, stigma associated with Ebola, and poor clinical infrastructure in the affected communities.

With Covid-19, community engagement must be on an even larger scale and must be adaptive and led by trusted scientists and public health experts. In the United States, Fauci has again led the way, confidently and authoritatively providing clear, fact-based communication about Covid-19. His voice must continue to be heard, especially since the U.S. pandemic response has become so politicized.

Scientists and public health professionals must convey the critical need for well-designed research, surveillance, and rigorously implemented clinical trials to identify safe, effective interventions, including pre-exposure and post-exposure preventive treatments, and vaccines. Objective markers of response are needed to assess efficacy, including SARS-CoV-2 shedding as a measure of infectivity, in addition to clinical end points. Given the plethora of treatment and vaccine trials, many tens of thousands of study participants are needed. Community engagement is needed to address mistrust of research and reluctance to participate in clinical trials. Health care providers, scientists, community leaders, and policymakers can, and in fact must, work in tandem to encourage participation.

With Covid-19, we have the public attention, due entirely to the actual nature of the pandemic. That alone is not quite enough. Now we need to earn their trust by doing things according to the best science available, as efficiently as we can, and by clearly communicating our rationale, methods, and results. The buzz word is ‘TRANSPARENCY’. We have very limited preclinical data on SARS-CoV-2 to guide drug development and immunologic strategies. It is our duty as scientists to avoid supporting unproven interventions, blend opinion with evidence, or make strong proclamations based only on valid science, which are then picked up by the media.

More specifically, the fight against HIV demonstrated the need for a combination of interventions to reduce new infections and revealed the false dichotomy between treatment and prevention. HIV treatment has the powerful secondary benefit of preventing transmission by means of viral suppression, and some HIV medications have high efficacy for primary prevention. Initial efforts to prevent HIV infection focused on behavioural interventions, even as the biomedical pipeline was being developed. Eventually, we saw treatment breakthroughs, and now we have more than 30 antiretroviral drugs. Neither this portfolio nor HIV prophylaxis would exist if we had stopped after the initial studies. Investment in HIV drugs has led to major reductions in new infections, better quality of life for people with HIV, and lower mortality. Mind you, all these important gains being secured even without an effective vaccine.

 

HIV has also taught us that the timing of an intervention during the disease course may be critical to its therapeutic impact. Delaying treatment because of the magnitude of immunocompromise led to unnecessary illness and deaths. This principle is key in addressing Covid-19, given the potential contribution of a hyperimmune response to the severity and duration of illness. Early intervention is needed to prevent acquisition of Covid-19 or disease progression before multi-organ involvement occurs.

We need multiple strategies for preventing and treating Covid-19, including some forms of preventive treatments, and vaccines. It is highly unlikely that such therapeutic and preventive strategies would be successful at the very first attempt. Scrupulous scientific analysis of proposed therapeutic interventions and vaccines would be the key. It is absolutely crucial to realise that, like HIV, Covid-19 will continue to require non-pharmacologic public health strategies, even after a partially effective drug or vaccine is identified. The rationale for testing repurposed drugs needs to be clearly articulated and based on their potential activity against SARS-CoV-2 and on available safety data. For example, the drug remdesivir was originally evaluated for Ebola and has now shown partial efficacy for moderate-to-severe Covid-19 infection. Data from in vitro studies led hydroxychloroquine and chloroquine to be selected as candidates for preventive treatments and for treatment of established Covid-2 cases. This secured political support, media attention, and heightened expectations and even misconceptions. The first trials, however, were small and poorly controlled, and the results received disproportionate media attention. The problem was compounded by the publication and subsequent retraction of a study showing potential harm or lack of benefit from hydroxychloroquine, which led to further confusion and undermining of public trust in science.

Thus, the scientific community’s priority, as past experience suggests, should be to pursue hypothesis-based and data-driven strategies with sufficient imagination and resources to test new approaches for Covid-19 prevention and treatment. Clinical trials should be coordinated and implemented well, and the results should be scrutinized and interpreted clearly as well as objectively. We need to prepare the general public for a discovery process that is iterative and seldom linear. Interventions should not be strictly compartmentalized into biomedical and behavioural categories since decisions about testing, masking, quarantine, and use of preventive or therapeutic interventions, all have social and behavioural components. Scientific and public health efforts therefore require multi-disciplinary teams and intense collaboration.

Yet for all this, Covid-19 presents opportunities commensurate with its challenges, including the chance to build on our collective experience with high-priority, high-impact, high-quality science conducted in an efficient and coordinated manner. Throughout the process, we must build and sustain public trust by communicating clearly about our evolving understanding of this life-threatening disease. Medical professionals and health scientists should work tirelessly and hand-in-hand, to be transparent and secure unmitigated public trust. Policy decisions of the government should invariably take into account the health perspectives presented by professionals and medical scientists. The implementing authorities entrusted with all forms of prevention, quarantine and isolation of areas, should work within humane standpoints and with sustained empathy. It is paramount to realise that the only way out of this conundrum is to secure absolute and unadulterated public faith and belief in the authorities by being transparent, committed and intensely public-spirited, on the part of everyone involved with this pandemic, including the legislators, healthcare professionals, the implementers and the law enforcement authorities. It would most definitely be counter-productive to ‘wield the stick’. It is also not the time or the place for political bickering, finger pointing and assumption of ‘holier-than-thou’ attitudes. Willing and unstinting public cooperation can only be secured if the general populace has implicit trust in the authorities concerned. For their part, everybody involved in this battle against this little blight, should feel honoured and privileged to declare that it is the least they could do for our populace in this blessed land.



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Features

Port City Bill Requires Referendum

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by Dr Jayampathy Wickramaratne,PC

The Colombo Port Economic Commission Bill was presented in Parliament on 08 April 2021, while the country was getting ready to celebrate the traditional New Year. With the intervening weekend and public holidays, citizens had just two working days to retain lawyers, many of whom were on vacation, and file applications challenging the constitutionality of the Bill in the Supreme Court within the one-week period stipulated in the Constitution. One wonders whether the timing was deliberate.

Special economic zones are common. They are created mainly to attract foreign investments. In return, investors are offered various concessions so that their products are competitive in the global market. Several negative effects of such zones have also been highlighted. The sole purpose of this article, however, is a discussion on the constitutionality of the Bill.

The Bill seeks to establish a high-powered Commission entrusted with the administration, regulation and control of all matters connected with businesses and other operations in and from the Colombo Port City. It may lease land situated in the Colombo Port City area and even transfer freehold ownership of condominium parcels. It operates as a Single Window Investment Facilitator for proposed investments into the Port City. It would exercise the powers and functions of any applicable regulatory authority under any written law and obtain the concurrence of the relevant regulatory authority, which shall, as a matter of priority, provide such concurrence to the Commission. The discretion and powers of such other authorities under the various laws shall thus stand removed.

The Commission consists of five members who need not be Sri Lankan citizens, quite unlike the Urban Development Authority, the Board of Management of which must comprise Sri Lankan citizens only. One issue that arises is that the vesting of such powers upon persons with loyalties to other countries, especially superpowers, would undermine the free, sovereign, and independent status of Sri Lanka guaranteed by Article 1 of our Constitution. It would also impinge on the sovereignty of the People of Sri Lanka guaranteed by Article 3 read with Article 4.

The removal of the discretionary powers of the various regulatory authorities is arbitrary and violative of the right to equal protection of the law guaranteed by Article 12 (1).

Under Clause 25, only persons authorized by the Commission can engage in business in the Port City. Clause 27 requires that all investments be in foreign currency only. What is worse is that even foreign currency deposited in an account in a Sri Lankan bank cannot be used for investment. Thus, Sri Lankans cannot invest in the Port City using Sri Lankan rupees; neither can they use foreign currency that they legally have in Sri Lanka. The above provisions are clearly arbitrary and discriminatory of Sri Lankans and violate equality and non-discrimination guaranteed by Article 12. They also violate the fundamental right to engage in business guaranteed by Article 14 (1) (g).

Under clause 35, any person, whether a resident or a non-resident, may be employed within the Port City and such employee shall be remunerated in a designated foreign currency, other than in Sri Lanka rupees. Such employment income shall be exempt from income tax. Clause 36 provides that Sri Lankan rupees accepted within the Port City can be converted to foreign currency. Under clause 40, Sri Lankans may pay for goods, services, and facilities in Sri Lankan rupees but would be required to pay a levy for goods taken out of the Port City, as if s/he were returning from another country! The mere repetition of phrases such as ‘in the interests of the national economy’ throughout the Bill like a ‘mantra’ does not bring such restrictions within permissible restrictions set out in Article 15.

Clause 62 requires that all disputes involving the Commission be resolved through arbitration. The jurisdiction of Sri Lankan courts is thus ousted.

In any legal proceedings instituted on civil and commercial matters, where the cause of action has arisen within the Port City or in relation to any business carried on in or from the Port City, Clause 63 requires Sri Lankan courts to give such cases priority and hear them speedily on a day-to-day basis to ensure their expeditious disposal.

The inability of an Attorney-at-Law to appear before the court even for personal reasons, such as sickness, shall not be a ground for postponement. These provisions are arbitrary and violate Article 12.

Clause 73 provides that several Sri Lankan laws listed in Schedule III would have no application within the Port City. Such laws include the Urban Development Authority Act, Municipal Councils Ordinance, and the Town and Country Planning Ordinance. Under Clauses 52 and 53, exemptions may be granted by the Commission from several laws of Sri Lanka, including the Inland Revenue Act, Betting and Gaming Levy Act, Foreign Exchange Act, and the Customs Ordinance.

The Commission being empowered to grant exemptions from Sri Lankan laws undermines the legislative power of the People and of Parliament and violates Articles 3 and Article 4 (c) of the Constitution.

Several matters dealt with by the Bill come under the Provincial Councils List. They include local government, physical planning, and betting and gaming. Article 154G (3) requires that such a Bill be referred to Provincial Councils for their views. As Provincial Councils are not currently constituted, passage by a two-thirds majority will be necessary in the absence of the consent of the Provincial Councils.

The exclusion of the Municipal Councils Ordinance from the Port City area is not possible under the Constitution. When the Greater Colombo Economic Commission was sought to be established in 1978 under the 1972 Constitution, a similar exclusion was held by the Constitutional Court not to be arbitrary. Since then, under the Thirteenth Amendment under the 1978 Constitution, local government has been given constitutional recognition and included under the Provincial Council List. Under the present constitutional provisions, therefore, the Port City cannot be excluded from laws on local government.

The writer submits that in the above circumstances, the Colombo Port Economic Commission Bill requires to be passed by a two-thirds majority in Parliament and approved by the People at a Referendum. Quite apart from the constitutional issues that arise, such an important piece of proposed legislation needs to be widely discussed. It is best that the Bill is referred to a Parliamentary Committee before which the public, as well as citizens’ organizations and experts in the related fields, could make their submissions.

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Investigative Journalism?

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I usually end up totally exhausted when I finish reading the local newspapers from the Pearl. There are so many burning questions and so much is written about them but there are no conclusions and definitely no answers. For example, we seem to have three burning issues right now and this is not in order of importance.

We have a lengthy report that has been published on the Easter Sunday carnage. Everybody knows what I am talking about. However, no one, be it an editor, a paid journalist or a single one of the many amateurs who write to the papers, has reached a conclusion or even expressed an opinion as to who was responsible. At least not a believable one! Surely there are energetic and committed young people in the field of journalism today who, if asked, or directed properly will go out and find a source that would give them at least a credible hypothesis? Or do conclusions exist and has no one the courage to publish them?

At least interview the authors or should I use the word perpetrators of that report. If they refuse to be interviewed ask them why and publish an item every day asking them why! Once you get a hold of them, cross-examine them, trap them into admissions and have no mercy. It is usually geriatrics who write these reports in the Pearl and surely a bright young journalist can catch them out with a smart question or two, or at least show us that they tried? The future of the country depends on it!

We have allegations of contaminated coconut oil been imported. These are very serious allegations and could lead to much harm to the general populace. Do you really believe that no one can find out who the importers are and what brands they sell their products under? In this the Pearl, where everyone has a price, you mean to say that if a keen young journalist was given the correct ammunition (and I don’t mean 45 calibres) and sent out on a specific message, he or she couldn’t get the information required?

We are told that a massive amount of money has been printed over the last few months. There is only speculation as to the sums involved and even more speculation as to what this means to the people of the Pearl. Surely, there are records, probably guarded by extremely lowly paid government servants. I am not condoning bribery but there is nothing left to condone, is there? There are peons in government ministries who will gladly slip you the details if you are committed enough and if you are sent there to get it by a boss who will stand by you and refuse to disclose his sources.

I put it to you, dear readers, that we do not have enough professional, committed and adequately funded news organisations in the country. We can straightaway discount the government-owned joints. We can also largely discount those being run by magnates for personal gain and on personal agendas. As far as the Internet goes, we can forget about those that specialise in speculative and sensationalist untruths, what are we left with O denizens of the Pearl? Are there enough sources of news that you would consider willing to investigate a matter and risk of life and limb and expose the culprits for the greater good of society? Can they be counted even on the fingers of one hand?

In this era when we have useless political leaders, when law and order are non-existent when the police force is a joke, it is time the fourth estate stepped up to the mark! I am sure we have the personnel; it is the commitment from the top and by this, I mean funding and the willingness to risk life and limb, that we lack. Governments over the last few decades have done their best to intimidate the press and systematically destroy any news outlet that tried to buck the usual sycophantic behaviour that is expected from them by those holding absolute power.

Do you think Richard Nixon would ever have been impeached if not for the Watergate reporting? Donald Trump partially owes his defeat to the unrelenting campaign carried out against him by the “fake news” outlets that he tried to denigrate. Trump took on too much. The fourth estate of America is too strong and too powerful to destroy in a head-to-head battle and even the most powerful man in the world, lost. Let’s not go into the merits and demerits of the victor as this is open to debate.

Now, do we have anything like that in the Pearl? Surely, with 20 million-plus “literate” people, we should? We should have over 70 years of independence built up the Fourth Estate to be proud of. One that would, if it stood strong and didn’t waver and collapse under pressure from the rulers, have ensured a better situation for our land. Here is Aotearoa with just five million people, we have journalists who keep holding the government to account. They are well-funded by newspapers and TV networks with audiences that are only a fraction of what is available in the Pearl. Some of the matters they highlight often bring a smirk of derision to my face for such matters wouldn’t even warrant one single line of newsprint, should they happen in the Pearl.

Talking of intimidation from the rulers, most of us are familiar with the nationalisation of the press, the murder and torture of journalists, the burning of presses to insidious laws been passed to curtail the activities of Journalism. These things have happened in other countries, too, but the people and press have been stronger, and they have prevailed. We are at a watershed, an absolutely crucial time. It is now that our last few credible news sources should lift their game. Give us carefully researched and accurate reports with specific conclusions, not generalisations. Refuse to disclose your sources as is your right, especially now that the myopic eye of the UNHCR is turned in our direction.

All other ways and means of saving our beloved motherland, be it government, religion, sources of law and order and even civil society leadership seems to have lapsed into the realm of theory and rhetoric. Our last chance lies with the Fourth Esate and all it stands for. I call for, nay BEG for, a favourable reaction from those decision-makers in that field, who have enough credibility left in society, DON’T LET US DOWN NOW!

 

 

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Features

The world sees ugly side of our beauty pageants

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Yes, it’s still the talk-of-the-town…not only here, but the world over – the fracas that took place at a recently held beauty pageant, in Colombo.

It’s not surprising that the local beauty scene has hit a new low because, in the past, there have been many unpleasant happenings taking place at these so-called beauty pageants.

On several occasions I have, in my articles, mentioned that the state, or some responsible authority, should step in and monitor these events – lay down rules and guidelines, and make sure that everything is above board.

My suggestions, obviously, have fallen on deaf ears, and this is the end result – our beauty pageants have become the laughing stock the world over; talk show hosts are creating scenes, connected with the recent incidents, to amuse their audience.

Australians had the opportunity of enjoying this scenario, so did folks in Canada – via talk show hosts, discussing our issue, and bringing a lot of fun, and laughter, into their discussions!

Many believe that some of these pageants are put together, by individuals…solely to project their image, or to make money, or to have fun with the participants.

And, there are also pageants, I’m told, where the winner is picked in advance…for various reasons, and the finals are just a camouflage. Yes, and rigging, too, takes place.

I was witnessed to one such incident where I was invited to be a judge for the Talent section of a beauty contest.

There were three judges, including me, and while we were engrossed in what we were assigned to do, I suddenly realised that one of the contestants was known to me…as a good dancer.

But, here’s the catch! Her number didn’t tally with the name on the scoresheet, given to the judges.

When I brought this to the notice of the organiser, her sheepish reply was that these contestants would have switched numbers in the dressing room.

Come on, they are no babes!

On another occasion, an organiser collected money from the mother of a contestant, promising to send her daughter for the finals, in the Philippines.

It never happened and she had lots of excuses not to return the money, until a police entry was made.

Still another episode occurred, at one of these so-called pageants, where the organiser promised to make a certain contestant the winner…for obvious reasons.

The judges smelt something fishy and made certain that their scoresheets were not tampered with, and their choice was crowned the winner.

The contestant, who was promised the crown, went onto a frenzy, with the organiser being manhandled.

I’m also told there are organisers who promise contestants the crown if they could part with a very high fee (Rs.500,000 and above!), and also pay for their air ticket.

Some even ask would-be contestants to check out sponsors, on behalf of the organisers. One wonders what that would entail!

Right now, in spite of the pandemic, that is crippling the whole world, we are going ahead with beauty pageants…for whose benefit!

Are the organisers adhering to the Covid-19 health guidelines? No way. Every rule is disregarded.

The recently-held contest saw the contestants, on the move, for workshops, etc., with no face masks, and no social distancing.

They were even seen in an open double-decker bus, checking out the city of Colombo…with NO FACE MASKS.

Perhaps, the instructions given by Police Spokesman DIG Ajith Rohana, and Army Commander, General Shavendra Silva, mean nothing to the organisers of these beauty pageants…in this pandemic setting.

My sincere advice to those who are keen to participate in such events is to check, and double check. Or else, you will end up being deceived…wasting your money, time, and energy.

For the record, when it comes to international beauty pageants for women, Miss World, Miss Universe, Miss Earth and Miss International are the four titles which reign supreme.

In pageantry, these competitions are referred to as the ‘Big Four.’

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