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Is herd immunity our best hope against variants?

18 Aug 2021

By Sumudu Chamara The staggering number of Covid-19 infected persons being admitted to hospitals and those succumbing to Covid-19 related health complications is increasing at an unforeseen speed, and Sri Lanka’s health sector shows signs of being on the brink of a burnout. The Government and medical experts are of the opinion that the fastest and currently the best way to rid the country of this pandemic is by making sure that the vaccination drive continues despite social and economic hardships. The primary responsibility of continuing and expediting the vaccination drive is in the hands of the Government and the health authorities; however, according to those in the medical field, the status quo calls for the vaccination drive to be a multi stakeholder endeavour, strengthened by the private sector and non-Governmental organisations. The Morning spoke to several persons in the field who are in a position to shed some light on several vaccination drive related matters that are being discussed at present. Proof of vaccination According to Health Ministry data, as of yesterday (18), a total of 11,963,739 persons had received at least one dose of a Covid-19 vaccine, while 4,956,288 persons had received both doses. According to the Cabinet Spokesman and newly appointed Health Minister Keheliya Rambukwella, although the overall vaccination drive is a success, the Government will keep looking for ways to improve the drive. However, in a context where the majority of people remain unvaccinated, and as the Government continues the vaccination drive with a plan to vaccinate all persons above the age of 18 by the end of September 2021, a question arises as to how to reduce the risk of the vaccinated transmitting the virus to the unvaccinated, until everyone is vaccinated. To address this concern, the health authorities recently said that they were planning to impose new regulations, requiring those above the age of 30 years to present proof of vaccination in order to enter public places.  Adding that this sort of regulations and practices are in place in around 41 countries, Rambukwella said that this move is aimed at encouraging unwilling people to get vaccinated. He added that there are certain religious and other forms of beliefs and individuals who advocate against getting vaccinated, and that the Government has therefore focused on encouraging the people to get vaccinated. He further added: “In this context, we have to find a way to entice the people to get vaccinated, and health authorities around the world who are concerned about the virus have also advised to do so. What they are saying is that the only way out of this pandemic is vaccination. There are certain other precautionary measures such as hygiene-related measures that the people have to take. But, at the end of the day, vaccination is the priority. So, if the people are trying to abstain from getting vaccinated for various reasons, we need to give them some kind of incentive or to entice them. As a way of doing that, we will introduce something like a credit card (an electronic card), which will have information about the vaccination status embedded in it or a barcode which helps to check that information. This will be applicable when a person has taken both doses of the vaccine, and information about a booster 3rd dose as well, if we decide to administer such a vaccine in the near future. It is not harassment, even though some might try to interpret it as such and use such a notion.”  Rambukwella emphasised that the fact of the matter is that Sri Lanka needs to encourage the people to get vaccinated as it is currently the only way out of the pandemic. In response to The Morning’s questions concerning the practicality and resources required to implement such a measure, he noted that no one should underestimate the country’s abilities. He also opined that this plan is not something that involves great cost-related concerns that the Government cannot bear. What is more important is not the cost, but concern towards managing the virus, and it is extremely important that Sri Lanka looks at the pros and cons of it and then take decisions, according to him.  A leading medical professional, Sri Lanka College of Pediatricians (SLCP) Council Member Dr. Surantha Perera also said that as the number of the vaccinated among the population grows, the vaccine card can be used as a vaccine passport when people enter public areas. He added that while this method remains in place, adults, especially those above the age of 65 and those living with health conditions that make them more vulnerable, should stay at home as much as possible until the entire population is vaccinated. Military involvement in the vaccination drive As the pandemic spread at an unpredicted speed, the Government had to utilise the manpower required to manage the increasing number of Covid-19 cases and deaths, and the result was the military’s involvement. While allegations of militarisation of the country grew due to this move, the military’s involvement in fact helped expedite the vaccination drive, especially when the health workers protested due to various reasons. It was after the medical professionals attached to the military recorded the highest number of doses administered in a single day, which was 500,000, that the World Health Organisation’s (WHO) attention too was attracted to Sri Lanka. Former Health Minister Dr. Rajitha Senaratne, however, expressed mixed opinions about the military’s involvement in the vaccination drive and in the Covid-19 management efforts. He acknowledged that the utilisation of the human resources under the defence forces is neither new nor unacceptable. “The Army's involvement in the prevailing environment is very good, especially in carrying out the vaccination drive and other campaigns against Covid-19. After Independence, every Government has used the Tri-Forces and the Police for this type of welfare work, and we should allow the Government to continue working with the Army. However, the Army cannot take decisions related to Covid-19 and the decisions must be taken by the health authorities, because this is a medical subject. Even though other countries and leaders gave the opportunity for medical experts to manage the pandemic, in Sri Lanka, the Government does not listen to medical experts and that was the problem. Therefore, the Government should allow the Health Ministry to do the work, and dissolve the Presidential Task Force set up to manage the Covid-19 situation. It is the health experts, not the President nor the Army Commander who should handle this. In fact, with the support of the health authorities, during my tenure of five years, we were able to control six epidemics.” When inquired about these allegations, Rambukwella was of the opinion that the value of the military’s involvement should be evaluated based on the contribution they make, and that collective effort of several parties are crucial in order to make the vaccination drive a success.  “Primarily, it is the health sector, and there is no doubt about that. However, we need supporting services from other parties. In this sort of a situation, we cannot act in isolation. It is the combination of various institutions that helps bring about the final result.” When inquired about the allegation that the Government does not obtain the expert opinions of independent medical bodies and experts, Rambukwella denied it, adding: “We do take advice from medical professionals and authorities. At the same time, we have other sectors as well, because it is not only the medical sector that is involved. The medical sector is highly technical and their advice is very much sought after. However, at the same time, we have logistical issues, and sometimes, the defence forces as well as various other institutions can help us. We will be taking assistance from them whenever necessary and available. However, we do not forget that the primary priority is the health sector.” While the military’s involvement in the vaccination drive remains a much discussed topic, the importance of the vaccination drive being a multi stakeholder endeavour, which Rambukwella too highlighted, was also emphasised by Dr. Perera. He added that as the vaccination drive continues, Sri Lanka can perhaps re-orient the current strategy depending on the need to vaccinate different communities and various other needs. Various parties such as the defence forces, the public, and the health authorities including the public health workers working together, according to Dr. Perera, is a good development, because at the end of the day, the management of Covid-19 is a multi stakeholder effort.  He added: “All parties should come together to achieve this. This is a very difficult task, and their support goes beyond the current vaccination drive because sometimes we may need booster doses and at the same time we have to manage the economy. Also, while we manage the Covid-19 situation, we have to think about the deaths due to other causes as well. So, balancing all these aspects also exists in the fight against Covid-19. We have to move forward as a team, and the next three months would be very challenging.” Vaccination of children As the country is moving towards vaccinating people below the age of 30 years as the next step of the vaccination drive, the medical community also raised concerns about vaccinating vulnerable groups irrespective of their age. Among these groups that they said should receive priority in the vaccination drive are pregnant women and children. After rounds of discussions, the health authorities said that pregnant women should get vaccinated as soon as possible, in a context where medical experts have noted that all pregnant women who died due to Covid-19 were unvaccinated. Covid-19 cases among children, on the other hand, are also on the rise, and Prime Minister Mahinda Rajapaksa recently stated that the vaccination of children over the age of 12 years, especially those living with various medical complications, would begin soon. However, pediatricians are of the opinion that this should be expedited. To look into the vaccination of children, The Morning discussed with Dr. Perera, who noted that even though the vaccination of children does not receive adequate attention in South Asian countries, a lot of countries have either planned to do so or have started it. “The cut off age limit is currently about 12 years, and most of the time, the vaccine they (countries that vaccinate children against Covid-19) have used is Pfizer-BioNTech and Moderna. They have observed less side-effects; other than a little bit of shedding of skin or redness in the vaccinated area, and sometimes mild fever too. Therefore, there is nothing much to be concerned about with regard to vaccinating children. However, if we take into consideration the figures, we can see that out of millions, only around 1,400-1,500 children experience such side-effects. Also, most of the children recover from it, and it does not last for more than one or two weeks,” he added. He noted that even though there are no significant side-effects or other complications among vaccinated children, raising awareness about it, especially among parents, is of great importance. He further said that when vaccinating children, those living with health issues such as asthma, joint problems, and heart diseases should receive more attention, and then expand the vaccination of children with special needs. According to Dr. Perera, even though side-effects are a concern every parent has, when comparing the benefits to the side-effects of vaccinating children, potential advantages outweigh potential disadvantages.  He noted that although the vaccination programme as a whole is continuing very well, the only problem Sri Lanka is facing is the amount of vaccine doses the country receives. Opining that this situation can be detrimental, owing to the present situation of the pandemic in the country, he added that the speed at which Covid-19 is spreading, especially the virulent B.1.617.2 delta variant of Indian origin, has become a battle to subdue with vaccination. He, however, expressed concerns about how any Covid-19 spread among children would evolve once the adult population is vaccinated fully and are protected against the virus, while children are vaccinated only later. He expressed fears that it may pose a significant threat towards more children. He also said that when deciding on the priority level of vaccinating children, health complications children are likely to experience as a result of or after contracting Covid-19 should be taken into account. Vaccination vs. Prevention Even though vaccination is seen by many as the best short term solution to manage the pandemic, the Government Medical Officers Forum (GMOF) is of the opinion that while the vaccination is of utmost importance, the ultimate priority of the health authorities should be ridding the country of the presence of the virus and preventing infections. When contacted, GMOF President Dr. Rukshan Bellana said that instead of doing so, the Government is immersed in the vaccination programme and providing facilities to treat the patients. He added: “If Covid-19 is a virus that remains without mutating, vaccination can actually turn out to be very effective. But, unfortunately, we already know that this virus mutates. The authorities have put a lot of faith in the mass vaccination of the population; however, even though mass vaccination can provide immunity to a particular subtype of the virus, we don’t know whether the virus would respond to the vaccine in the event of a mutation. Without knowing this, we are blindly going ahead with mass vaccination. I must say that we cannot depend on the vaccine alone in the long run. The main focus of the vaccination is to achieve herd immunity or immunity for the entire population; however, that is not going to become a reality, if there are constant mutations of the virus, as we have noticed. Therefore, the focus needs to be on getting rid of the presence of the virus from society, and we need to understand that it can only happen through a lockdown. A minimum two weeks lockdown can resolve a lot of problems that we are faced with. However, I acknowledge that vaccination is one of the most important aspects of controlling this disease. But it is not the key mechanism or the technique of controlling the virus. We are very much focused on the vaccination, and it may result in a disaster, because vaccines have several problems such as the time it takes to strengthen immunity. The vaccinations are delayed, and the vaccination programmes are not organised in such a way that it adheres to the basic fundamentals of quarantine laws. A person will require two doses and another two weeks after the second dose to reach the optimal immunisation level. The time it takes can be risky. In fact, it is strategically wrong to focus mainly on the vaccination programme. We can already see that even the people who have received the two doses are contracting the disease.” He also highlighted the importance of the private sector and non-Governmental organisations extending their support to manage the pandemic. The Government does its duty by providing the vaccine, and it is the people’s duty for themselves and their fellow citizens to get vaccinated and not be a victim of the misconceptions about getting vaccinated.  Although there are pros and cons about the overall vaccination drive, for the time being, it is the best solution to reduce the spread of Covid-19. However, as those who spoke with The Morning noted, vaccination is a short term measure aimed predominantly at reducing deaths due to Covid-19 related complications, and the people should not take it for granted. At the end of the day, prevention is still the best way to see the end of this pandemic.


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