• Registration of vaccine suppliers has commenced
• Discussions on vaccine with Russia on hold
• Discussions now ongoing with India
• First round of vaccination in mid-February

By Sarah Hannan

With news of vaccinations for Covid-19 being made available for most countries in the world, Sri Lanka has decided to consider all options to bring down the vaccinations including applying for the COVAX Facility that is recommended by the World Health Organisation (WHO).

[caption id="attachment_112846" align="alignleft" width="274"] State Minister for Primary Healthcare, Epidemics, and Covid-19 Disease Control Dr. Sudarshini Fernandopulle[/caption]

Amid the hype of early vaccination becoming accessible across the globe, people are also eager to commence their air travel. Sri Lanka therefore piloted the project since end-December 2020, two months after the initial plan of reopening the country in October that was hindered by the second wave of Covid-19 being activated that month.

This week on The Sunday Morning Hot Seat is State Minister for Primary Healthcare, Epidemics, and Covid-19 Disease Control Dr. Sudarshini Fernandopulle, who answered some of the questions we all have regarding the vaccination programme and whether reopening the country for tourism was the best choice given the new strains of Covid-19 present.

Excerpts of the interview below:

Has Sri Lanka taken a decision as to whether we would source the vaccinations from one country, or will we be looking at several options?

We have registered with the COVAX Facility to receive a segment of the vaccinations that would be released and the balance consignments are to be supplied through the Serum Institute of India and several other vaccination suppliers as well as with whom we have initiated discussions.

Right now, the WHO has given emergency approval for Covid-19 vaccinations prepared by Pfizer-BioNTech and AstraZeneca to be issued for all countries.

Through the COVAX Facility, we are still not aware as to which vaccination would be allocated to Sri Lanka. For the moment, we are preparing for both options that are made available through the COVAX Facility and from other countries that have agreed to supply stocks.

What is the progress on the discussions that Sri Lanka initiated with Russia over the Sputnik V vaccination?

Russia initially offered to supply part of the requirement of vaccinations to Sri Lanka. However, those discussions have been halted, as we are having negotiations with India for their vaccination. In addition to that, China too has offered to supply vaccinations to us. In any case, all these vaccination suppliers will have to register with the NMRA (National Medicines Regulatory Authority) and we will allow multiple suppliers to register following the due process.

When can Sri Lanka expect the first batch of vaccination that will be released to 20% of the population as informed last year?

We may not receive the entire bulk of the two million vaccinations in one go, and the estimated timeline to commence immunisation programmes has been set for mid-February with a tentative timeframe going up to March, first week.

Has the priority list for receiving the vaccination been drafted yet? Who are the target groups that would first receive the vaccination?

Three committees were appointed by the Ministry of Health, and the list that has been put together as priority would be the frontline health workers, the military, and the police personnel that are directly involved in Covid-19 management; those above the age of 50; persons considered to be vulnerable to the virus due to non-communicable diseases; and factory workers with the main focus being on the apparel industry, since they are one of the highest generators of foreign currency revenue for the country.

Moreover, the apparel industry owners have also offered to raise funds to contribute towards the vaccination purchasing fund of the Government to support the task. People are to visit the state hospital to receive their inoculation shots for Covid-19.

Is the first consignment afforded to Sri Lanka free of charge? If not, have we allocated sufficient money to purchase these vaccinations?

It depends on the COVAX Facility. We will get 20% of the vaccinations, which would be free, and we will have to purchase the rest of the vaccination supplies. The Government is committed to obtaining the consignments on behalf of its people.

Have we considered registering suppliers of these vaccinations with the NMRA? When will the Expression of Interest (EOI) be opened?

The State Ministry was informed on Wednesday (6) that the registering process for suppliers of Covid-19 vaccinations has been initiated. The WHO has already given emergency approval for Pfizer-BioNTech, with AstraZeneca now completing its clinical trials. So, the registration procedures with the NMRA have commenced. Anybody that is planning to supply the vaccination to the country will have to be registered with the NMRA.

Will there be a special tender procedure that would be followed since these are essentials and considered emergency medical supplies?

The tenders will be called through the Government and will have to proceed through the guidelines issued. Also, the 20% that we will get through the COVAX Facility and the negotiations that we are currently pursuing with India, would give us the necessary consignments for the first round of vaccinations. The procurements of all these vaccinations will take place through the State Pharmaceutical Corporation (SPC), so the regular tender procedures will follow.

Do we have the required infrastructure for large-scale importing of vaccines?

For the vaccination from AstraZeneca, we do not have a storage issue at all, and even if we decide to bring in the vaccination from Pfizer-BioNTech, we should be able to manage with the present infrastructure we have in place. When the need arises, we will hire the cold storage trucks and the logistics will be managed according to the requirement.

The Government has also accounted for budgets to support infrastructure development in the health sector. Therefore, I don’t see that it would be an issue. We can manage with the available resources, but there would be instances we would need additional amenities, for which the necessary suppliers have been consulted through donor agencies.

How long would it take for the vaccinations to be freely accessible through the state healthcare system to the general public?

The initiative will be taken from the Government’s end, and if you consider the vaccination programmes that have been in place, most of it was made available to the public through the state healthcare system for free. Therefore, the frontrunner for Covid-19 vaccinations too will be the Government and the Ministry of Health.

Would the vaccination programme be included in the private sector health facilities as well?

At the onset, the Government will offer the vaccination free of charge to the people that are considered to be the high-risk and vulnerable groups. But once the Government starts the vaccination programme, we would later permit the private sector health facilities to administer the vaccination.

Firstly, the Government will take the responsibility in administering the Covid-19 vaccinations to the public. We will also offer a smaller share of the vaccination programme to the private sector healthcare organisations. So, the people who do not fall into these categories that are currently listed as priority, could get their vaccination from private practices, if they are willing to pay for the vaccine. But that would be done in due course, not right at the beginning of the vaccination programme rollout.

Would price controls be implemented on the Covid vaccinations available at private hospitals?

We will issue a price control over the vaccinations that would be administered through private hospitals. The Government will be giving it free of charge anyway. But the private hospitals will be calculating the controlled price for the vaccination and will add the cost of logistics to it.

For instance, if you take the PCR testing that is currently taking place, the majority of it is done through state hospitals, and a smaller percentage of the population is willing to pay for the diagnostic test.

For that, there is a controlled price at the moment, but when there is competition among the sector, automatically the prices will also come down.

Would we also provide volunteers for the clinical trials taking place for vaccinations that are produced globally, given that several Covid-19 strains are present in Sri Lanka?

So far, we have not had any discussion on that.

Are we prepared to treat any persons that would have adverse reactions to the vaccination?

Of course. We have had vaccination programmes in the country for over 50 years. Sri Lanka’s healthcare sector has a very good system in place to monitor the adverse effects following immunisation. We are prepared to treat them; the only difference this time is that we are vaccinating adults. We have the emergency preparedness triage and there will be doctors in charge to handle such situations.

Will Sri Lanka have the facilities to formulate its own vaccinations in the future? Is that something the healthcare system has requested from the Government?

We are very keen on setting up our own production facilities to produce our own supply of medicines. There has been discussion with the WHO, which was initiated by the Sri Lanka WHO Representative on the request of Basil Rajapaksa, concerning the domestic production of the necessary medicines and pharmaceuticals. So, we will consider these facility implementations as well.

The issue is that Sri Lanka does not have a large market and we do not have a ready market like other countries, because our population is limited. If we produce pharmaceuticals, we should have an international market for it as well. Therefore, we need to consider the external factors as well. But of course, we are ready to initiate such projects and the Government too is very keen on improving and expanding domestic production.

On the Ukrainian tour groups pilot project, there have been concerns over protocol breach, such as violation of certain quarantine rules and the Sri Lanka Tourism Development Authority (SLTDA) not being briefed about the tour itineraries. What are your thoughts on this?

What we must remember is that this was the pilot project to reopen the country for tourism amid the pandemic. This was done to identify the strengths and gaps. The Ministry of Health prepared the guidelines in collaboration with the Ministry of Tourism. These guidelines are to be reviewed constantly, and we at the Health Ministry will advise the Tourism Ministry on how to take control of such situations in the future.

We identified certain weaknesses and as the Health Ministry have advised the relevant sectors to follow the guidelines that were given. It is also the responsibility of the rest of the stakeholders such as the Tourism Ministry and the relevant agencies to ensure that guidelines are complied with.

This pilot project was done to restart tourism and once again provide the opportunity to the near three million people that are directly or indirectly involved in the tourism sector to benefit once the country’s borders are fully reopened for leisure tourism. I should reiterate that it is the responsibility of the relevant agencies and the people to comply with the guidelines that have been issued, so that the rest of the tourism sector could also reap the benefits from the tour groups that will be coming into Sri Lanka in the weeks to follow.

The Government has announced that airports will fully reopen for commercial flight arrivals by 23 January. Have the necessary health measures for it been discussed?

The Ministry of Health is closely working with the Airport and Aviation Services (Sri Lanka) Ltd. (AASL), the Civil Aviation Authority (CAA), and the Ministry of Tourism and Aviation to ensure that the Covid-19 preventive measures and the health screening procedures are followed.

All along, there have been flights in operation, although commercial flights were not allowed into the country, and those who arrived through the repatriation process were managed accordingly at the airports.

We will however continue to monitor these procedures and should there be a weakness in the procedures followed, we will take necessary measures to strengthen them promptly. The Health Ministry will intervene and ensure that there is no breach in protocol.

Covid-19 prevention should not only be the responsibility of the Ministry of Health. We need the support of the rest of the stakeholders and the public alike to open the country up, as Covid-19 cannot be eliminated in a specified time period.

The country’s economy needs to rebound while taking preventive measures to prevent the virus from spreading and safeguarding the health and wellbeing of the citizens of Sri Lanka.

What steps do we have in place to ensure that the recently mutated variants don't enter the country?

Everyone that would be arriving from overseas will be sent for mandatory quarantine for two weeks and the laboratories will conduct the necessary investigation and run diagnostics for PCR testing and then study the different strains that are entering the country. The new strain of the virus, although highly infectious, is not fatal. Disease surveillance is in place; we have a team studying the sequence of the strains and observing the behaviour of the virus strains that are in the country at present.

Do we have the necessary health infrastructure to ensure constant monitoring of the virus and its possible variants?

Our Epidemiology Unit is constantly monitoring the incidents and the fatalities that are caused by various strains. We are also being supported by the university laboratories to conduct further studies into the Covid-19 strains that are present in Sri Lanka.