The Virus, Vaccine and the Task Force

by Rajan Philips

The doctors have been saying it daily. Vaccine alone is not enough to stem the spread of Covid-19, especially the Delta variant. Doctors have been calling for greater isolation, lockdown, and even a curfew. “An immediate curfew will prevent at least 1,200 additional deaths within the next 20 days,” Prof. Suneth Agampodi, Rajarata University, is reported to have predicted. This is based on a forecasting model he has developed with two Sri Lankan colleagues at Harvard and MIT. At the present death rate there could be 3,000 deaths in 20 days. The government seems to think otherwise, and apparently believes that rapid vaccination alone is enough to achieve national immunity and end the pandemic.

Lockdowns and curfew can be measures of last resort – that is the official government position. When is that going to be? Doctors seem to think it is already time for last resort. But – trust the vaccine, spurn the doctors – seems to be the governing motto. Quite apart from the fact that you need to trust your doctor before you trust the medication, the evidence of mounting infections, deaths and hospital admissions clearly gives credence to the worries and warnings of our doctors. Why distrust them now? Why not trust the doctors, even err on the side of caution, and stop pretending to be firm in spite of evidence?

The government’s strategy to rely solely on the vaccine would have worked any time last year, when Sri Lanka was a rather fortuitous beneficiary of low infections and even lower death rates. But there was no vaccine last year. There is no question, Sri Lanka’s current vaccine rollout is truly impressive in spite of initial hiccups and political cockups. Achieving 250,000 to 500,000 doses a day is indeed remarkable. But the fact of the matter is that even if Sri Lanka were to deliver one million shots a day, that will not be enough to overtake the virus spread, let alone stop it.

Vaccine and the Virus

At about 350,000 shots a day, it will take about two weeks to fully vaccinate 10% of the population. So, optimistically it will be end of the year or early next year before Sri Lanka can achieve maximum and effective vaccination. That is a long interval to expect to keep the virus down and keep the unvaccinated out of harm’s way.

While vaccines are for the weeks and months ahead, the spread of the virus has been gathering speed over days, weeks and months gone by. While it will be some time before all adults receive their first dose, there will be time lags between the first and second doses, and additional time periods before vaccine efficacy clicks in even after full vaccination. But the virus is not going to take a break during any or all of these time intervals.

The current surges in infections and deaths are believed to have started in May/June, nearly two months ago. Mid last week, the official death total was rising to 5,500, and the infections were rising to 345,000. Some Epidemiologists are fearing that the death total may climb to 20,000 by the end of the year with daily totals reaching as high as 300. The current trends are pointing in that direction.

For almost a week now daily death total has been exceeding 100, while daily infections have remained high between 2,500 to 3,000. These are the official figures. The actual figures are considered to be three to four or five times higher. On Thursday, doctors were complaining that hospital admissions were higher than the infection numbers put out by the Ministry of Health. There you go. So, regardless of the rate of vaccination, deaths and infections are going to keep increasing. And hospitals are going to be overwhelmed, leaving both Covid-19 patients and other patients who need hospital care to stay home and fend for themselves.

There is also the question of vaccine efficacy even for those who are vaccinated. There are six authorized vaccines (AstraZeneca, Sinopharm, Sputnik V, Pfizer, Sinovac and Moderna) in Sri Lanka, but mostly four of them have been used so far. Sinopharm from China is the most widely used vaccine followed by Oxford-AstraZeneca from India, Japan and the WHO. Sputnik V (Russia) has been used in limited quantities and the use of Pfizer (US and EU) started recently. A supply of Moderna is also expected from the US.

The different vaccines have different levels of efficacy – after the initial dose and the second dose. There are also differences when the same vaccine is used for both doses, and when two different vaccines are used. With the rise of the Delta variant (and the newest Columbian variant) – the concern is about the longevity of vaccine efficacy even after the two doses have been completed. All of the vaccines are known to have shown varying levels of success in minimizing the severity of illness, avoiding hospitalization, and virtually eliminating deaths due to Covid-19. But none of them are as successful in protecting the vaccinated from getting infected or from becoming sources of virus transmission.

As well, in the US, over 90% of current hospitalizations and deaths are among the unvaccinated, whereas in the UK as much as 30% of hospitalizations have been found to be among the fully vaccinated owing to the Delta variant. This is the background to the push for a third dose of vaccine in countries that have money to buy, and by vaccine manufacturers who want to keep selling to rich governments. Israel, Germany, France and lately the US have announced that a third dose of vaccine will be given to targeted groups among their citizens.

The WHO is opposed to this medical prodigality of the rich when only 1.2% of the people in low-income countries have received even a single dose. There is, however, a medical justification for a third dose for immuno-compromised people (e.g., those with transplants). Doctors in Canada have indicated that a third dose is not needed in Canada and that the Canadian government should give away its surplus vaccine supply to needier countries. There is also criticism that some of the vaccine-rich countries are holding on to their vaccines for too long and are then using the vaccine-poor countries as dumping ground for vaccines that are nearing their use-before dates.

Crucial Task Force Meeting

For Sri Lanka, it would be irresponsible to talk about a third dose. But political headline grabbers are already on to it, musing about third doses. The medical profession, on the other hand, is pleading in unison for stronger measures to ensure isolation and social distancing. That alone will deny the virus the human conduit it needs to spread and multiply. The Daily Mirror reported at the crack of dawn on Friday that “another crucial meeting” was to be held later that morning between “President Gotabaya Rajapaksa and the Presidential Task Force on Prevention of COVID-19 to decide if travel restrictions will be imposed over the weekend to combat the spread of the COVID-19 virus.” The breaking news came as I was writing this column, so I could not have the benefit of knowing what transpired at the meeting.

But the Army Commander and Head of the COVID-19 Task Force General Shavendra Silva gave a glimpse of what could be expected from the meeting. According to Gen. Silva, the meeting will have “the participation of ministers, Director General of Health Services and several other experts to discuss the current developments and further decisions to be taken related to the coronavirus pandemic in the country.”. He went on to opine, “though experts had made statements to media over a lockdown, not a single formal request had been made to the COVID-19 Task Force.” And he added, “however, the matter is likely to be noted at the meeting today.”

Perhaps the good General, reasonable man and logistics expert he is supposed to be, should ask himself – why is NOT every shade of medical expertise appropriate to Covid-19 included in the Task Force? Then these experts and their professional organizations will have no reason to run to the media and make statements. The General should also concurrently ask those who are supposed to be medical experts on his Task Force – what they have to say about the statements to the media calling for lockdowns and curfews, by medical experts who are not on the General’s Task Force? And the General will be doing everyone in the country a transparent favour by releasing the names of all the members of the COVID-19 Task Force and the specific expertise and skill, other than patriotism and presidential loyalty, that each one of them brings to the task force forum.

It is not my purpose to pick on the army, inadvertently or otherwise, unlike Ranil Wickremesinghe. After falsely ridiculing the SJB that it had set a world record in moving a No Confidence Motion against an individual Minister instead of the whole government, Mr. Wickremesinghe landed both his feet in his mouth by appearing to be critical of the Army while meaning to criticize the government for its handling of Covid-19. He had a point in highlighting the diminished roles of parliament and cabinet government, but Mr. Wickremesinghe was inarticulate in expressing it and unnecessarily implicated the army.

(By the way, there is nothing unprecedented about moving No Confidence Motions against Prime Ministers or individual ministers in Sri Lanka or elsewhere. Ranil Wickremasinghe himself was the target of an NCM in 2018 when he was Prime Minister. His own President supported the NCM because MS could not fire RW! More prominently before RW, and always unsuccessfully, NCMs were brought against Sirima Bandaranaike as Prime Minister, and against Felix Dias and GG Ponnambalam as Ministers, but decades apart).

There is nothing to blame the army about for what it has been doing on the Covid-19 front. The army would have done what it did without a Task Force. Not surprisingly the task forces have hurt the GR presidency more than they have helped it. Even as the task forces and advisory cabals have sidelined cabinet ministers and their administrative machineries, they have also isolated the President from the structure of government of which the President is the civilian head even as he is the commander in chief of the armed forces. This has led to an artificial situation where there is nothing meaningfully mediating between the President and the 6.9 million voters who voted for him in November 2019. Other than his frequent reminders that he polled 6.9 million votes and his (not anymore) monthly village visits, there is nothing that is keeping the President connected to his larger constituency.

The Task Forces were an unnecessary invention to sideline the cabinet of ministers and render irrelevant the parliament of Sri Lanka. If the Task Forces had worked even partially, the task force system would have been acclaimed as a presidential stroke of genius. But they were doomed to fail as indeed they have. Political societies did not labour over centuries to create institutions like parliament, cabinet, taxation, banks and systems of law and order, for the dubious genius of one individual or a family of individuals to simply jettison and replace with whatever contraptions that are found to be most convenient for wielding power. What may have come as a shock to some, however, is the level of incompetence associated with the otherwise predictable failures of the government’s unorthodox enterprises in the arenas of the state.