Features
COVID vaccine: Some vital information
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.
I have written several articles in The Island about the COVID vaccine in the very recent past, where I discussed some important bits of information. This present effort is undertaken to provide some additional details regarding the current state-of-play in this vitally important endeavour, geared towards winning the war against this tiny, but unbelievably powerful blight of a coronavirus.
The vaccine is here now, in our land, albeit in rather limited quantities and, up to the present time, it has arrived in about three tranches or batches. What we have got down, is the Oxford-AstraZeneca viral vector type of vaccine. It uses an inactivated chimpanzee adenovirus as just a vehicle to get a component of the SARS-CoV-2 virus that causes the COVID-19 disease, into the human body. This component then induces an immunological reaction in the recipient that induces the immune system of the body to recognise the spike protein of the virus, and mount an immunological reaction against it by producing antibodies. The spikes of the coronavirus are the all-important components that enable the virus to attach itself to human cells, particularly of the respiratory tract. The vaccine also induces the immunological system to develop antigenic memory where in any subsequent infection by the virus, the cells of the immune system react and produce antibodies to neutralise the coronavirus that causes COVID-19 disease. A second dose of the vaccine enhances the immunological capabilities of the body so that an immediate and sustained attack could be initiated quite rapidly, if and when the body is exposed to the pandemic virus.
The currently available vaccine in Sri Lanka was rolled out in the country from about mid-January, or so, this year. It was initially given to all frontline healthcare workers, the tri-forces and the police personnel who were involved in patient care, tracing of contacts and running the quarantine facilities. All these people belonged to a high-risk group who needed to be protected at all cost. Following the first dose, the recipients were requested to come back in four weeks for the second dose to complete the initial vaccination process. This procedure of administering the second dose was scheduled for the four-week period because the original clinical trials of all vaccines, except the single dose Johnson and Johnson vaccine, however were carried out with this time schedule. The studies showed a reasonable degree of protection from about 12 to 14 days after the initial dose. Following the initial vaccination efforts, some other age groups were also vaccinated, the efforts at this being dictated to by the resources available and the logistics that could be mustered. There was a huge demand for the vaccine but, unfortunately, the supplies were limited and certainly not quite sufficient to meet all the needs. To complicate matters further, ad hoc decisions were also made and some of the science-dictated priority lists were disregarded to a certain extent, perhaps for just a few days.
Then it was vaguely intimated that the second dose was going to be delayed to around three months after the first dose. Unfortunately, no proper communication as to the scientific reasons for this abrupt change in the timing schedule was conveyed to the general public and they were left wondering as to why this was done. Some thought that there was something wrong with the vaccine while others thought that the authorities were not able to get sufficient stocks of the vaccine to administer the second dose after four weeks. Many others smelled a rat in that entire endeavour.
In point of fact, there are some valid scientific reasons for changing the schedule. Once the vaccine was rolled out in other countries, especially in Europe and particularly so in the United Kingdom, continuing scientific assessments made it clear that the initial protection to a degree of around 60% was quite robust and was even extended to a period of more than three months. There was also some suggestion that by delaying the second dose, one might even get a stronger immune response and a more prolonged period of protection. Although opinions were divided, the United Kingdom went ahead and changed the schedule to have the second dose administered after three months. A secondary reason for extending the time interval was that as the supplies were sparse even in the UK. The positive benefit was that it was possible to give the first dose to a larger number of people, thereby increasing the total number of people who would have some immunity. There were protests even from some doctors in the UK that the authorities were going against science as the clinical trials of the vaccines had used the four-week time interval originally. Yet for all that it must be remembered that science could and does change with the unravelling of new data and that the decision that was taken by the authorities in the UK was based on sound public health principles. The advantages of protecting a larger group of people of a populace with the first dose of the vaccine is also scientifically tenable in a potentially lethal disease.
All these principles are also quite tenable and should be acceptable in the Sri Lankan scenario. But the down side of it all is that nobody came over the mass media to explain the reasons for the decision that was made to change the time schedule. It is absolutely imperative that we keep the public properly informed, mainly to prevent all kinds of unsubstantiated “devil’s playground” type of canards spreading around like wildfire and initiating as well as propagating public panic.
All clinical trials have shown up the vaccine to be quite effective and safe apart from mild side effects during the first 48 hours or so after the administration of the vaccine. These were very well documented as chills (feeling cold), fever and body aches. All these respond quite well to simple pain-killers such as paracetamol. Generally, both here and abroad, these side-effects have not led to any cause for alarm.
However, over the last week or so, there are disturbing reports of more serious problems that have occurred in certain countries in Europe. These have been reported and generally even sensationalised by all types of media. The general public of our country must be getting really worried about these latest developments as regards the vaccine. These worrying effects seem to have occurred predominantly, although not exclusively, after the second dose of the vaccine and have been reported with the Oxford-AstraZenica vaccine. These undesirable effects consist primarily of documented cases of unexplained clotting of blood in deep veins with, in some cases, the clots being detached and getting deposited in the blood vessels of the lungs. There has been a couple of deaths as a result of the clots getting deposited in the lung arteries, a condition known as pulmonary embolism. As a result of these initial reports, many European countries have temporarily suspended the administration of the Oxford-AstraZenica vaccine till more intensive investigations are carried out to ascertain a definitive cause-and-effect relationship.
At the present time, there is no direct evidence as to whether the problem was definitely caused by the vaccine. We do not know whether the affected individuals had a coexistent abnormality in clotting of blood. These clotting problems in deep veins are more common in the European countries anyway. Though seen from time to time, these deep vein thrombosis problems are quite rare in tropical countries, especially in Sri Lanka. It is generally seen here after major surgery where mobility of the patient had been severely curtailed and clotting occurs in the deep veins of the legs. The increased tendency for clotting of blood in deep veins may also be related to the use of certain other medications such as oral contraceptive drugs, which are used a lot more in the European countries and in the Western hemisphere of the world. The message that we should convey to the public is that THERE IS NO CAUSE FOR UNDUE ALARM AND PANIC in our country regarding this problem at the present time. The position would be clearer within the next few weeks when these cases are thoroughly investigated. For the time being at least, there are no grounds for suspending the administration of the Oxford-AstraZenica vaccine in our country.
Initially, all the clinical trials indicated that the vaccine was capable of reducing the severity of the disease and would thereby reduce deaths. That was the primary reason for the use of the vaccine. However, there seems to be some accumulating evidence now that it would reduce the ability of the virus to infect humans as well, at least to a certain extent. There is some evidence that even if the vaccinated subject gets infected, the number of virus particles in the body may be reduced by a considerable extent. Although all these findings imply that this is not a complete or one hundred percent protection against being infected, the implication of this is that it could perhaps reduce transmission of the virus from infected people to those uninfected. In a new scientific paper published in a pre-print journal on the 01st of
February 2021, the researchers found that the vaccine cut the number of cases with detectable virus by 67% after a single standard dose, and wrote that this shows the potential for a substantial reduction in transmission.
From a public health perspective that is an added bonus. If sufficient herd immunity could be instituted by widespread use of this vaccine, then the rate of spread could also be reduced and then the pandemic could be controlled. It would also serve the main purpose of reducing the severity of symptoms and thereby reduce the all-important deaths while reducing the need for high-powered intensive care for those who become symptomatic.
As so graphically pointed out by Dr Tedros Ghebreyesus, the Director General of the World Health Organisation (WHO) and reproduced verbatim here, “This is a time for facts, not fear. This is a time for rationality, not rumours. This is a time for solidarity, not stigma“. These are indeed a set of golden words for our populace as well as for the powers-that-be in our paradise isle. We are learning a lot about this coronavirus and the pandemic virtually daily. We need to explore windows of opportunities and change our strategies according to the scientific details that would be unravelled.
Yet for all that, all of us…, every single one of us, need to still comply very strictly with the all-important health recommendations of the 3Ws…, Wearing a mask; Washing of hands and Watching out for the maintenance of the physical distance of at least one to one and a half metres. The vaccines do not give us unabridged permission to abandon these public health measures towards controlling the pandemic. There is no way in which the observance of these measures could be put aside at the present time. By all means, get the vaccine when it is made available to you but even after that, do abide by the health guidelines. That will be your humble but priceless contribution towards saving lives.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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