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Covid-19 vaccine: Getting the ball rolling 

03 Jan 2021

  • Available in SL end-February or early March

  • Presidential task force to be appointed

  By Ravini Perera   [caption id="attachment_111818" align="alignright" width="538"] Photo © United Nations[/caption] As Covid-19 began spreading around the globe, various nations pioneered the development of vaccines to help curb the transmission and build immunity. With several vaccinations indicating high levels of success among recipients, many countries have come forward to purchase these vaccines and roll out vaccination campaigns.   While countries such as the US, the UK, and many other European nations, have already started administering the vaccination to its people, Sri Lankan authorities are still at the preliminary stages of obtaining a vaccination for its citizens.   Extensive work is yet to be carried out in the process. Putting together a national vaccination plan and providing indemnification are among many other tasks undertaken by the Ministry of Health following consultations with experts.  Chief Advisor to the President Lalith Weeratunga was appointed with the task of overlooking the importation of the Covid vaccination to Sri Lanka in late December. Weeratunga spoke to The Sunday Morning on the developments surrounding the importation.    Bilateral relations    Weeratunga explained that he was tasked with discussing and co-ordinating the way forward in obtaining the vaccination with all interested parties, including local officials and foreign governments, that have expressed a willingness to assist in the process.   “This will mainly be a government-to-government transaction, highly dependent on our relations with foreign nations,” he said.   Weeratunga went on to explain that while countries such as India, Russia, and China have shown interest in supporting the Government’s efforts in the importation process, the Government will prioritise its efforts to obtain at least a percentage of the vaccinations free of charge.   For instance, the authorities of Sri Lanka have held discussions with the World Health Organisation (WHO) that has expressed its willingness to provide the vaccine to 20% of the population free of charge as soon as the vaccine is made available.     A well-orchestrated plan    Prior to administering the vaccination to the public, many measures need to be put in place. Registering the vaccination under the National Medicines Regulatory Authority (NMRA) is one such step. As such, companies have already begun registering under the NMRA in case such commercial registrations would be necessary for a potential purchase. Thus, approvals for these companies by the NMRA would also be needed.  The Ministry of Health would be expected to utilise its expertise in putting forward an islandwide vaccination programme which requires the approval of the Cabinet of Ministers. Such a programme may focus on the first group of individuals qualifying to be vaccinated. The most vulnerable at the hands of the virus including the frontline health workers, armed forces, the elderly, individuals with non-communicable diseases, or a combination of all the above mentioned, may be prioritised.  Furthermore, factors such as the quantity to be allocated to each group of individuals can also be pre-planned in the days to come.   Moreover, as this injection is an intramuscular one and can be administered easily, training or retraining health workers to administer the injection has also been suggested.  A task force will be appointed by the President in the coming weeks comprising experts including the Commander of the Sri Lanka Army and the health officials to make recommendations on the importation of the vaccine.  “The armed forces and the Police will play a crucial role in the process of implementing a national vaccination programme. Thus, they will contribute in terms of logistics,” he added. Expert advice on proper distribution, transportation, maintaining orderliness, and storing is to be sought, especially from branches of the Sri Lanka Army such as its Medical Corps.     Factors to be considered    Many vaccines have been developed and are being tested across the world as of now. Thus, when considering the most suitable vaccine to be imported to Sri Lanka, factors such as the availability, cost of purchasing, its availability on a free-of-charge basis, easy administration, storage, and transportation facilities required, will all be considered very thoroughly. Elaborating further, Weeratunga said: “The American vaccine, Pfizer, requires a minus 70 degree centigrade (-70°C) storage which is very unlikely to be obtained by the Sri Lankan Government, given its difficulty of storing.”   He further expressed his beliefs on even a combination of vaccines being made available to the public, given the demand and supply in the market.  “A country cannot rely on a single vaccine, as it would cause trouble if the supply was to be interrupted. Therefore, being mindful of all cures being developed in the world is important,” he said.    Indemnification is another vital part of the importation process. Covax will mandate signing of an indemnification clause by a competent authority to avoid holding the supplier accountable in case an adverse reaction is observed among the individuals vaccinated.     International guidelines and observations   Given the lack of time and the deadly situation at hand, Sri Lanka will rely on the studies, tests and observations recorded by foreign countries with regard to the vaccine.   The successful completion of various steps is necessary for the introduction of a novel vaccine. The vaccines that are currently available against Covid-19 are at the final phases of its introduction process, where a post-market evaluation is now being carried out among a sample population.  “The vaccine would hopefully be available to Sri Lankans by late February or early March.”   No assurance can be given to the public regarding the vaccine carrying zero complications following administration. Hence, data received from foreign countries on the reactions faced by people and the guidelines and recommendations of the WHO will be given prominence in selecting a vaccine.   “India, one of the most affected nations, has begun developing and testing the AstraZeneca vaccine introduced by the Oxford University in four Indian states. This experiment carried out in India will be beneficial for our country, as the Indian and Sri Lankan populations share similar living conditions, climate, and food,” explained Weeratunga.   Furthermore, he stated: “The vaccine benefits will have to be weighed against its adverse reactions. For this, a carefully balanced equation needs to be introduced by the scientists, doctors, and administrators involved in reaching a conclusion.”  The WHO will further instruct the country on the suitability or unsuitability of the vaccination, which is another criterion followed in considering a vaccine made available in the market.    Stakeholders and funding when importing    The ability of the authorities to administer the vaccine among the selected members of the public, with gradual increases in the number of vaccines given, will depend mainly on its cost, production, and availability. The quantity of vaccinations the country will receive cannot be confirmed as of now. “Even at the end of 2021, we will not be able to say for certain the number of vaccines our country will receive,” Weeratunga said.   “The citizens of a country producing a vaccine will be given first priority in receiving the vaccination. The second and third priority will be given to other countries thereafter,” he elaborated.  Though no confirmed decisions have been taken by the Sri Lankan health officials as of yet, the upcoming weeks are considered to be crucial for the decision makers to reach a conclusion, The Sunday Morning learnt.   The Government is to initiate the importation of the vaccine and the private sector stakeholders are expected to later join forces. A “no cost” plan is to be prioritised but given that purchasing is required, the Government of Sri Lanka has displayed no reluctance in doing so.   Referring to the stakeholders assisting Sri Lanka, the Asian Development Bank has granted a loan to the Government and the World Bank has come forward to assist Sri Lanka with funding a cure for its people. Furthermore, the WHO is also expected to invest money in Sri Lanka to assist the country to obtain the necessary resources.   Discussions are continuously being carried out among appointed committees and experts on the most suitable vaccines for Sri Lankans. However, it is to be noted that no final decision has been arrived at yet, and more plans are yet to be put in place according to the recommendations of the resource personnel. 

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