COVID-19 vaccination: Chaos could have been averted

by Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

After much speculation and frantic waiting, the vaccine against the SARS-CoV-2 virus that causes COVID-19 is here. From the time it was decided by the government to get the vaccine for our population, it took a couple of months for the arrival of this precious vaccine. What we have in Sri Lanka now is the Oxford AstraZenica vaccine which is a World Health Organisation approved viral vector borne type of vaccine. So far, we have had it being administered over the last month or so but the doses were provided in two tranches. All in all, one million doses, hardly enough to cover even those who really needed it.

In the global scenario, there were significant problems regarding the vaccine, including the inappropriate paying for and hoarding of vaccines by rich Western countries, inadequate production, loads of misconceptions, vaccine hesitancy, anti-vax groups, inequality and inequity of provision of vaccines to developing countries, emergence of mutant variants of the virus, so on and so forth. Incidentally, hoarding vaccines is a crime against humanity, one that even the United Nations Human Rights Arm should take serious note of.

Here, in our resplendent isle, there were some discussions on the vaccine and a priority list was formulated well before the arrival of the vaccine. The frontline healthcare and frontline armed forces and police personnel came first, followed by those over 60 years with coexistent diseases that increase the risk of a fatal outcome, then those aged between 30 – 60 years, etc. Those under 18 years were to be excluded as there was no scientific evidence regarding that age group up to that time.

The healthcare workers and the frontline forces people got the vaccine first. However, it is interesting that some of the retired senior doctors, including retired Consultants, who were in active clinical practice, were refused the vaccine by the authorities of the Ministry of Health and they were asked to wait for the next batch of vaccine. Yet, for all that, when these doctors made inquiries from the hospitals, they were received with open arms, treated like royalty and given the vaccine pronto. For this, all credit should go to the administration of these hospitals who recognised the need to provide the vaccine for these retired personnel, who qualified for it anyway as they were all over 60 years of age. After much agitation, the larger Private Hospitals, too, were provided with the vaccine for their frontline staff but the smaller institutions were refused, although they too were in the frontline against the coronavirus.

Then all hell broke out. In their wisdom, the authorities suddenly, and without proper discussion, started an ad hoc campaign to vaccinate the 30 – 60 year age group in preference to those over 60 years. Very many of this latter group being refused the vaccine, even when they had significant comorbid diseases, like diabetes, high blood pressure, respiratory disorders, etc., which are well-recognised as those which would increase the mortality of the disease. Many of the elderly went from pillar to post and waited in queues for hours and several finally managed to get the vaccine from one place or another. This is information from the horse’s mouth itself, as related to this author by very many affected elderly themselves.

This short-sighted campaign to vaccinate the 30 – 60 year group lasted only a couple of days, mainly because of agitation by several medical academic organisations. Then the over 60-year-olds, too, were brought into the vaccine eligible circle but without any preferential administration of the vaccine to them. They had to jostle with the crowds, in very long queues, with no physical distancing or washing of hands. Mayhem reigned supreme. THERE WAS NO SEPARATE QUEUE FOR THE OVER 60 YEAR GROUP AT THE PLACES WHERE THE VACCINES WERE GIVEN. The general public rallied round and really made a special effort to get the vaccine and as a result there were mile-long queues with loads of elderly people, too, in the same queue. Some of these elderlies are diabetics with blood sugar lowering drugs who need to have regular meals, some others were high blood pressure sufferers who cannot wait in queues for hours on end. There were loads of the infirm and the frail who were not, given any consideration whatsoever.

All these problems, and the chaos that reigned, could have been avoided. All that was needed was a bit of common sense and a wholehearted dedication to the cause. There were a couple of months where things could have been planned even to the last of the finest details. The logistics could have been sorted out well in advance. The finalised priority list should have been implemented scrupulously and to the letter. There should have been separate queues for the over 60-year-old people. Henchmen, hangers-on, the rich, the influential and the powerful, as well as the politicians, should have been firmly told to keep away and not try to subvert the queues and the priority list. Discipline should have been maintained with the assistance of the tri forces and the police. In fact, many people told this author that there was not even a single policeman at the vaccination centres. If there was a shortage of forces personnel, they could have reined in the retired officers and the reservists. Very many of them would have obliged even on a volunteer status. The ages of the people could have been very rapidly checked with the National Identity Cards or Passports. The NICs give the year of birth in the first two digits in the old cards and the first four digits in the new cards. What was needed was custom-made planning and an iron hand of implementation. The desperate need of the hour was certainly not a weak-kneed and half-hearted whimper of a response nor an unabridged compliance with the dastardly whims and fancies of the rich, the powerful, the hangers-on and the politicians.

There was no proper communication between the stakeholders as well as a desperate lack of clear instructions being issued to the public as to who are eligible for the vaccine and where they should go to get the vaccine. It was mostly a free-for-all. The powers-that-be in the upper echelons of the government and the Ministry of Health reigned supreme in their air-conditioned offices while the poor general public, including the frail and the infirm, suffered on the ground. All in all, to say the very least, it was a disgrace. We have managed to vaccinate less than a million people so far. We need to vaccinate many more millions, right up to about 14 to 15 million, to get the maximum benefit from the entire immunisation process against COVID-19. When more tranches of the vaccine arrive and the jabs are to be given on a wider scale, God help us if these very same scenarios are going to be re-enacted. Proper planning and streamlining of the infrastructure and making good use of all available human resources, including the tri-forces and the police, would be essential to bring in some order and humaneness into the proceedings. Sanity must prevail and things should be so organised so that the only pain inflicted on our populace is just only the pain of the injection of the vaccine.

Yet for all this, even when a major proportion of our population has been vaccinated, there is no freedom of the ass for dumping the proven and by now time-honoured health guidelines, for prevention of COVID-19. WE MUST CONTINUE TO ABIDE BY THE CRUCIALLY IMPORTANT 3Ws… Wear a mask, Wash the hands and Watch the physical distance. There is no way in which the observance of these measures could be compromised.