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UPDATE ON COVID 19 VACCINES

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Dr. H. T, Wickremasinghe

It is commendable that the government of Sri Lanka has planned to get down nine million doses of Covishield Vaccine from Serum Institute of India, the world’s largest vaccine manufacturing company. This vaccine is actually none other than AstraZeneca –Oxford Vaccine manufactured by The Serum Institute of India, by the name of Covishield. To date, Sri Lanka has already administered about 200,000 doses to healthcare workers. The next consignment would be given to persons over 65 years and persons with co-morbid conditions such as diabetes, hypertension, heart disease and kidney disease.

With the rolling out of the vaccine globally, new observations have surfaced. The original schedule of the vaccine was to give two doses 28 days apart. This provided almost 70% immunity. However, new evidence has come out last month, suggesting that it would be better to increase the gap between two doses to 12 weeks (3 months) instead of four weeks. This would offer a more robust 84% immunity. The United Kingdom is already using the three months interval between two doses. This will provide greater flexibility for vaccine roll-out, and help the health authorities to deal with any possible supply disruptions, while consistently sustaining the maximum immunity to the public.

A study done by the independent COVID 19 Vaccine Research Group in UK had shown that until the time of conclusion of the study at three months, a single standard dose would provide 76% protection with no declining of immunity. How long this protection would last is not known yet. But time would tell us. As with any other vaccine, an introduction of a second dose at three months would certainly boost the immunity.

 

The second observation made during the roll out of this vaccine is that it appears to provide some form of protection to community spread of the disease. This study revealed that there was 67% reduction in community spread of the disease. This is in fact very good news, as when we go on vaccinating more and more people, there would be less and less community spread of the disease, reducing the burden on hospital medical services.

Another issue which surfaced while rolling out of the vaccine is the safety and efficacy of the vaccine in persons over 65-years of age. Unfortunately, all phase three trials done by AstraZeneca have not included many persons over 65 years of age. They primarily targeted the 18-55 year age group. According to the data from AstraZeneca’s phase three trials, only two out of 660 persons in the trial aged over 65 were infected with COVID 19. Such a small number of participants is grossly insufficient to make a global decision. It is obvious that AstraZeneca has failed to provide reasonable data of safety and efficacy of their vaccine in the elderly population. They are already paying the penalty as countries such as Germany, France, Austria, and South Africa have declined to use the vaccine for persons over 65 years, despite the recommendation made by the European Medicines Agency (The governing body of drug evaluation in EU countries) to use the vaccine for all ages. However, the United Kingdom decided to continue vaccination for all ages including persons of over 80. Their interim analysis during the early part of the vaccination programme shows that the vaccine is not only effective and provide the same immunity as for others but also has slightly less side effects.

Considering the seriousness of COVID 19 in the elderly and it’s very high mortality, it is my considered opinion that even if the vaccine is less effective or has more side effects, it is still worth giving it to old persons as it would save their lives.

With more and more new genetic variations of SARS CoV 2 virus emerging, a reasonable concern has transpired among scientists whether the vaccines would be able to provide immunity to the new emerging strains. Up to now globally there are more than 8,000 variants. Out of those, three variants, the South African variant, the Kent (UK) variant and the Brazilian variant are few rapidly gaining global spread. The UK variant has been identified in Colombo, Avissawella, Biyagama and Vavuniya.

Studies done in UK has shown that AstraZeneca vaccine would provide immunity to the UK variant. However, a similar study done on over 2,000 participants in South Africa has unfortunately revealed that this vaccine is not effective against the new South African strain.

There are more than 150 vaccines against COVID 19 in the production pipeline. Out of those a dozen are nearing completion and awaiting submission of their dossiers to World Health Organization for approval. With such a vast array of vaccines, it would be easy for WHO to distribute vaccines early to provide vaccination to all needy people in the world. But it would not be easy to have the same vaccine supply without disruptions with the expanding global demand. At the same time, some vaccines would show immunity to some new emerging variants, while another vaccine would show immunity to other variants. This brings us to another new strategy. What if we combine vaccines? Combined vaccines theoretically will provide greater flexibility for vaccine rollout and help to deal with any possible intermittent supply shortages of a particular brand.

However, the official guidance given by vaccine authorities in the world state that anyone who has already taken a vaccine should get the same brand of vaccine for both doses. The US Food and Drug Administration and the UK’s Joint Committee on Vaccination and Immunization (JCVI) recommend as much. It’s only in ‘very rare circumstances’ that vaccines of different brands may be used and only if one vaccine is available at a certain time, or it is not known which one was administered for the first dose. Nevertheless, the usefulness of a combined vaccine, in case of a short supply or with combating a new emergent variant, cannot be underestimated. New research is underway to find out the efficacy and safety of such combinations. The initial report with AstraZeneca-Pfizer vaccine combination will be available by mid-2021. Similar trials will be undertaken soon, so that the health authorities of countries would have a better and competitive option of choosing vaccines for their public.

Despite all this good news, we still have question for which we have to wait for an answer. How long the immunity will last is the question for with no answers are available yet. Many countries have already commenced their vaccination programme, even before the introduction of free vaccine programme by WHO sponsored COVAX. In the race of COVID 19 mass vaccination, Israel is well ahead of all the countries in the world already covering 43% of the total population. The number of new cases and deaths due to COVID 19 has come down. Even in the US, the initial wave of vaccination is slowly showing results of reduction of mortality from COVID 19 related complications.

The majority of the vaccines used so far may not provide the expected picture-perfect immunity and the world may continue to have COVID 19 infections, but based on evidence, speculations have already been made to claim that vaccination could provide almost 100% protection from death, This is what we all want.

With that positive note, let me conclude while emphasizing the need to continue our general public health measures such as wearing masks, social distancing and avoiding crowded gatherings to reduce the risk of contact with an infected person. There is no science to beat common sense.

 

(The writer, a Senior Consultant Paediatrician, is President of the Vaccine and Infectious Diseases Forum of Sri Lanka)

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Islamophobia and the threat to democratic development

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There’s an ill more dangerous and pervasive than the Coronavirus that’s currently sweeping Sri Lanka. That is the fear to express one’s convictions. Across the public sector of the country in particular many persons holding high office are stringently regulating and controlling the voices of their consciences and this bodes ill for all and the country.

The corrupting impact of fear was discussed in this column a couple of weeks ago when dealing with the military coup in Myanmar. It stands to the enduring credit of ousted Myanmarese Head of Government Aung San Suu Kyi that she, perhaps for the first time in the history of modern political thought, singled out fear, and not power, as the principal cause of corruption within the individual; powerful or otherwise.

To be sure, power corrupts but the corrupting impact of fear is graver and more devastating. For instance, the fear in a person holding ministerial office or in a senior public sector official, that he would lose position and power as a result of speaking out his convictions and sincere beliefs on matters of the first importance, would lead to a country’s ills going unaddressed and uncorrected.

Besides, the individual concerned would be devaluing himself in the eyes of all irrevocably and revealing himself to be a person who would be willing to compromise his moral integrity for petty worldly gain or a ‘mess of pottage’. This happens all the while in Lankan public life. Some of those who have wielded and are wielding immense power in Sri Lanka leave very much to be desired from these standards.

It could be said that fear has prevented Sri Lanka from growing in every vital respect over the decades and has earned for itself the notoriety of being a directionless country.

All these ills and more are contained in the current controversy in Sri Lanka over the disposal of the bodies of Covid victims, for example. The Sri Lankan polity has no choice but to abide by scientific advice on this question. Since authorities of the standing of even the WHO have declared that the burial of the bodies of those dying of Covid could not prove to be injurious to the wider public, the Sri Lankan health authorities could go ahead and sanction the burying of the bodies concerned. What’s preventing the local authorities from taking this course since they claim to be on the side of science? Who or what are they fearing? This is the issue that’s crying out to be probed and answered.

Considering the need for absolute truthfulness and honesty on the part of all relevant persons and quarters in matters such as these, the latter have no choice but to resign from their positions if they are prevented from following the dictates of their consciences. If they are firmly convinced that burials could bring no harm, they are obliged to take up the position that burials should be allowed.

If any ‘higher authority’ is preventing them from allowing burials, our ministers and officials are conscience-bound to renounce their positions in protest, rather than behave compromisingly and engage in ‘double think’ and ‘double talk’. By adopting the latter course they are helping none but keeping the country in a state of chronic uncertainty, which is a handy recipe for social instabiliy and division.

In the Sri Lankan context, the failure on the part of the quarters that matter to follow scientific advice on the burials question could result in the aggravation of Islamophobia, or hatred of the practitioners of Islam, in the country. Sri Lanka could do without this latter phobia and hatred on account of its implications for national stability and development. The 30 year war against separatist forces was all about the prevention by military means of ‘nation-breaking’. The disastrous results for Sri Lanka from this war are continuing to weigh it down and are part of the international offensive against Sri Lanka in the UNHCR.

However, Islamophobia is an almost world wide phenomenon. It was greatly strengthened during Donald Trump’s presidential tenure in the US. While in office Trump resorted to the divisive ruling strategy of quite a few populist authoritarian rulers of the South. Essentially, the manoeuvre is to divide and rule by pandering to the racial prejudices of majority communities.

It has happened continually in Sri Lanka. In the initial post-independence years and for several decades after, it was a case of some populist politicians of the South whipping-up anti-Tamil sentiments. Some Tamil politicians did likewise in respect of the majority community. No doubt, both such quarters have done Sri Lanka immeasurable harm. By failing to follow scientific advice on the burial question and by not doing what is right, Sri Lanka’s current authorities are opening themselves to the charge that they are pandering to religious extremists among the majority community.

The murderous, destructive course of action adopted by some extremist sections among Muslim communities world wide, including of course Sri Lanka, has not earned the condemnation it deserves from moderate Muslims who make-up the preponderant majority in the Muslim community. It is up to moderate opinion in the latter collectivity to come out more strongly and persuasively against religious extremists in their midst. It will prove to have a cementing and unifying impact among communities.

It is not sufficiently appreciated by governments in the global South in particular that by voicing for religious and racial unity and by working consistently towards it, they would be strengthening democratic development, which is an essential condition for a country’s growth in all senses.

A ‘divided house’ is doomed to fall; this is the lesson of history. ‘National security’ cannot be had without human security and peaceful living among communities is central to the latter. There cannot be any ‘double talk’ or ‘politically correct’ opinions on this question. Truth and falsehood are the only valid categories of thought and speech.

Those in authority everywhere claiming to be democratic need to adopt a scientific outlook on this issue as well. Studies conducted on plural societies in South Asia, for example, reveal that the promotion of friendly, cordial ties among communities invariably brings about healing among estranged groups and produces social peace. This is the truth that is waiting to be acted upon.

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Pakistan’s love of Sri Lanka

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By Sanjeewa Jayaweera

It was on 3rd January 1972 that our family arrived in Karachi from Moscow. Our departure from Moscow had been delayed for a few weeks due to the military confrontation between Pakistan and India. It ended on 16th December 1971. After that, international flights were not permitted for some time.

The contrast between Moscow and Karachi was unbelievable. First and foremost, Moscow’s temperature was near minus 40 degrees centigrade, while in Karachi, it was sunny and a warm 28 degrees centigrade. However, what struck us most was the extreme warmth with which the airport authorities greeted our family. As my father was a diplomat, we were quickly ushered to the airport’s VIP Lounge. We were in transit on our way to Rawalpindi, the airport serving the capital of Islamabad.

We quickly realized that the word “we are from Sri Lanka” opened all doors just as saying “open sesame” gained entry to Aladdin’s cave! The broad smile, extreme courtesy, and genuine warmth we received from the Pakistani people were unbelievable.

This was all to do with Mrs Sirima Bandaranaike’s decision to allow Pakistani aircraft to land in Colombo to refuel on the way to Dhaka in East Pakistan during the military confrontation between Pakistan and India. It was a brave decision by Mrs Bandaranaike (Mrs B), and the successive governments and Sri Lanka people are still enjoying the fruits of it. Pakistan has been a steadfast and loyal supporter of our country. They have come to our assistance time and again in times of great need when many have turned their back on us. They have indeed been an “all-weather” friend of our country.

Getting back to 1972, I was an early beneficiary of Pakistani people’s love for Sri Lankans. I failed the entrance exam to gain entry to the only English medium school in Islamabad! However, when I met the Principal, along with my father, he said, “Sanjeewa, although you failed the entrance exam, I will this time make an exception as Sri Lankans are our dear friends.” After that, the joke around the family dinner table was that I owed my education in Pakistan to Mrs B!

At school, my brother and I were extended a warm welcome and always greeted “our good friends from Sri Lanka.” I felt when playing cricket for our college; our runs were cheered more loudly than of others.

One particular incident that I remember well was when the Embassy received a telex from the Foreign inistry. It requested that our High Commissioner seek an immediate meeting with the Prime Minister of Pakistan, Mr Zulifikar Ali Bhutto (ZB), and convey a message from Mrs B. The message requested that an urgent shipment of rice be dispatched to Sri Lanka as there would be an imminent rice shortage. As the Ambassador was not in the station, the responsibility devolved on my father.

It usually takes about a week or more to get an audience with the Prime Minister (PM) of a foreign country due to their busy schedule. However, given the urgency, my father spoke to the Foreign Ministry’s Permanent Sectary, who fortunately was our neighbour and sought an urgent appointment. My father received a call from the PM’s secretary around 10 P.M asking him to come over to the PM’s residence. My father met ZB around midnight. ZB was about to retire to bed and, as such, was in his pyjamas and gown enjoying a cigar! He had greeted my father and had asked, “Mr Jayaweera, what can we do for great friend Madam Bandaranaike?. My father conveyed the message from Colombo and quietly mentioned that there would be riots in the country if there is no rice!

ZB had immediately got the Food Commissioner of Pakistan on the line and said, “I want a shipload of rice to be in Colombo within the next 72 hours!” The Food Commissioner reverted within a few minutes, saying that nothing was available and the last export shipment had left the port only a few hours ago to another country. ZB had instructed to turn the ship around and send it to Colombo. This despite protests from the Food Commissioner about terms and conditions of the Letter of Credit prohibiting non-delivery. Sri Lanka got its delivery of rice!

The next was the visit of Mrs B to Pakistan. On arrival in Rawalpindi airport, she was given a hero’s welcome, which Pakistan had previously only offered to President Gaddafi of Libya, who financially backed Pakistan with his oil money. That day, I missed school and accompanied my parents to the airport. On our way, we witnessed thousands of people had gathered by the roadside to welcome Mrs B.

When we walked to the airport’s tarmac, thousands of people were standing in temporary stands waving Sri Lanka and Pakistan flags and chanting “Sri Lanka Pakistan Zindabad.” The noise emanating from the crowd was as loud and passionate as the cheering that the Pakistani cricket team received during a test match. It was electric!

I believe she was only the second head of state given the privilege of addressing both assemblies of Parliament. The other being Gaddafi. There was genuine affection from Mrs B amongst the people of Pakistan.

I always remember the indefatigable efforts of Mr Abdul Haffez Kardar, a cabinet minister and the President of the Pakistan Cricket Board. From around 1973 onwards, he passionately championed Sri Lanka’s cause to be admitted as a full member of the International Cricket Council (ICC) and granted test status. Every year, he would propose at the ICC’s annual meeting, but England and Australia’s veto kept us out until 1981.

I always felt that our Cricket Board made a mistake by not inviting Pakistan to play our inaugural test match. We should have appreciated Mr Kardar and Pakistan’s efforts. In 1974 the Pakistan board invited our team for a tour involving three test matches and a few first-class games. Most of those who played in our first test match was part of that tour, and no doubt gained significant exposure playing against a highly talented Pakistani team.

Several Pakistani greats were part of the Pakistan and India team that played a match soon after the Central Bank bomb in Colombo to prove that it was safe to play cricket in Colombo. It was a magnificent gesture by both Pakistan and India. Our greatest cricket triumph was in Pakistan when we won the World Cup in 1996. I am sure the players and those who watched the match on TV will remember the passionate support our team received that night from the Pakistani crowd. It was like playing at home!

I also recall reading about how the Pakistani government air freighted several Multi Barrell artillery guns and ammunition to Sri Lanka when the A rmy camp in Jaffna was under severe threat from the LTTE. This was even more important than the shipload of rice that ZB sent. This was crucial as most other countries refused to sell arms to our country during the war.

Time and again, Pakistan has steadfastly supported our country’s cause at the UNHCR. No doubt this year, too, their diplomats will work tirelessly to assist our country.

We extend a warm welcome to Mr Imran Khan, the Prime Minister of Pakistan. He is a truly inspirational individual who was undoubtedly an excellent cricketer. Since retirement from cricket, he has decided to get involved in politics, and after several years of patiently building up his support base, he won the last parliamentary elections. I hope that just as much as he galvanized Sri Lankan cricketers, his political journey would act as a catalyst for people like Kumar Sangakkara and Mahela Jayawardene to get involved in politics. Cricket has been called a “gentleman’s game.” Whilst politics is far from it!.

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Covid-19 health rules disregarded at entertainment venues?

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Believe me, seeing certain videos, on social media, depicting action, on the dance floor, at some of these entertainment venues, got me wondering whether this Coronavirus pandemic is REAL!

To those having a good time, at these particular venues, and, I guess, the management, as well, what the world is experiencing now doesn’t seem to be their concerned.

Obviously, such irresponsible behaviour could create more problems for those who are battling to halt the spread of Covid-19, and the new viriant of Covid, in our part of the world.

The videos, on display, on social media, show certain venues, packed to capacity – with hardly anyone wearing a mask, and social distancing…only a dream..

How can one think of social distancing while gyrating, on a dance floor, that is over crowded!

If this trend continues, it wouldn’t be a surprise if Coronavirus makes its presence felt…at such venues.

And, then, what happens to the entertainment scene, and those involved in this field, especially the musicians? No work, whatsoever!

Lots of countries have closed nightclubs, and venues, where people gather, in order to curtail the spread of this deadly virus that has already claimed the lives of thousands.

Thailand did it and the country is still having lots of restrictions, where entertainment is concerned, and that is probably the reason why Thailand has been able to control the spread of the Coronavirus.

With a population of over 69 million, they have had (so far), a little over 25,000 cases, and 83 deaths, while we, with a population of around 21 million, have over 80,000 cases, and more than 450 deaths.

I’m not saying we should do away with entertainment – totally – but we need to follow a format, connected with the ‘new normal,’ where masks and social distancing are mandatory requirements at these venues. And, dancing, I believe, should be banned, at least temporarily, as one can’t maintain the required social distance, while on the dance floor, especially after drinks.

Police spokesman DIG Ajith Rohana keeps emphasising, on TV, radio, and in the newspapers, the need to adhere to the health regulations, now in force, and that those who fail to do so would be penalised.

He has also stated that plainclothes officers would move around to apprehend such offenders.

Perhaps, he should instruct his officers to pay surprise visits to some of these entertainment venues.

He would certainly have more than a bus load of offenders to be whisked off for PCR/Rapid Antigen tests!

I need to quote what Dr. H.T. Wickremasinghe said in his article, published in The Island of Tuesday, February 16th, 2021:

“…let me conclude, while emphasising the need to continue our general public health measures, such as wearing masks, social distancing, and avoiding crowded gatherings, to reduce the risk of contact with an infected person.

“There is no science to beat common sense.”

But…do some of our folks have this thing called COMMON SENSE!

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