By Rajan Philips –

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 economic argument against a total lockdown is a necessary consideration but not a sufficient reason to reject the Doctors’ pleas out of hand. The economy has been deteriorating and living conditions have been worsening owing to a whole host of reasons in Sri Lanka, and another period of restrictions is not going to make a huge difference especially if that is the only way to SAVE LIVES as the ‘WHO expert group’ in Colombo has reportedly suggested to the government. Whatever restrictive measures are imposed they could be selective by time and place based on area-specific data and advice my medical professionals. In any event, vaccination has to continue even under a lockdown. Not that the Doctors are not aware of it.   

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.

The daily death total has been exceeding 100 for more than a week and reached 150 by the weekend. 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. Doctors have been complaining that hospital admissions are higher than the infection numbers put out by the Ministry of Health. Discrepancies have been reported in the Gampaha District and in the Eastern Province. 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 immunocompromised 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.

Task Force Politics

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. The World Health Organization (WHO) expert group has warned that trends in Sri Lanka indicate a potential “health crisis of unprecedented proportions,” and called on the government to implement stringent measures similar to those imposed in April-May to “SAVE LIVES.”   

The government remains unmoved. As reported by the Daily Mirror, at “another crucial meeting” held on Friday between “President Gotabaya Rajapaksa and the Presidential Task Force on Prevention of COVID-19,” the President reportedly “was not ready to impose an island wide lockdown but opted for tougher travel restrictions.” Speaking before the meeting, the Head of the COVID-19 Task Force General Shavendra Silva had indicated that the purpose of the meeting was to enable “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.”  He added, “however, the matter is likely to be noted at the meeting today.” But the President is not ready to listen to the Doctors.

It is fair to ask why the Task Force did not invite the medical experts making statements to the media to attend the “crucial meeting” on Friday. Put another way, 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 to make statements. Equally, what do the supposedly medical experts currently on the Task Force have to say about the statements by other experts calling for lockdowns and curfews? Come to think of it, the government 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. 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 have 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 them 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. On the other hand, it would be a tragedy for everyone if the efforts to stop Covid-19 were to fail owing to political incompetence in spite of professional advice.