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Act on credible evidence and marshal all resources

2 years ago

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  • Authorities must prioritise pandemic response to avert India’s fate

By Sakuntala Kadirgamar   Recently, there have been decisive actions taken by the medical profession and civil society demanding informed, concerted responses from the Government that are grounded in science and prioritise public health. They have expressed grave concern with the Government’s way of handling the unfolding third wave of the Covid-19 pandemic in the island. As the detection of Covid-19-positive persons increases, it is ever more important that the Government considers responding to the pandemic as its highest priority. This is especially clear in light of the alarming crisis faced by India, our closest neighbour. The world over, countries that considered their pandemic response as the top priority are now benefiting from their swift and decisive actions. Failing to follow their example will ensure not only long-term ramifications on Sri Lanka’s economy, but also the destruction of innocent lives and their families. Only the Government can signal to the general public the gravity of the situation, and it must lead by example and through fostering a sense of solidarity and confidence in the policy measures being taken against the pandemic. Citizens are confused by the unfocused and inconsistent policies of the Government, and this in turn has led to their apathy and wanton behaviour in respect of wearing masks, social distancing, testing, and isolating even when exposed to infected persons. It is also easier for them to deny and dismiss the possibility of Covid-19 “in our locality”. Elections, religious and cultural festivals, and personal celebrations have taken the priority and the political leadership has been at the forefront of this irresponsible behaviour. Worst of all, the health professionals have fallen victim to the general sidelining of the bureaucracy and independent professionals, and this could not have happened in the worst of times. The Government of Sri Lanka must ensure the following steps are taken as a matter of the highest priority and greatest urgency. The Government, especially the Cabinet of Ministers, must ensure its decisions and discussions reflect the urgency and priority of the pandemic situation. Despite what is clearly an unfolding crisis, many recent Cabinet decisions were seen to be irrelevant to responding to that crisis. The recent Cabinet decisions of 3 May prioritised establishing a Buddhist vihara in Beijing, China and 500 mobile gyms while item 13 of the 13 Cabinet decisions focused on the decision to purchase more testing kits. Ironically, as the world is being told to cover their faces with face masks, Sri Lanka focused on banning face veils as a national security measure. Tackling the pandemic requires many crucial policy decisions to be made and scarce resources to be reallocated towards an urgent response, especially in terms of ramping up testing, tracing, and treating against Covid-19. The Government must dedicate its time to discussing and making these lifesaving decisions as the highest priority as this will signal to the public the urgency of the situation.   Prioritising finances for Covid-19 response in a transparent manner Even as reports of depleting healthcare resources emerge, stories of the Government allocating resources to re-trial the “Dhammika paniya” (a dubious concoction by one Dhammika Bandara) emerged, despite findings that were previously released that said the concoction was ineffective in fighting Covid-19. Most troubling is the recent report that only 6% of the money in the Itukama Fund established by the Government – funds from private and corporate donors – were spent. The publication of these inadequacies has led the Government to hastily provide a plan for using the balance funds, but this should be done on the basis of careful planning. At the same time, the Sri Lanka Podujana Peramuna (SLPP) party has announced the construction of 10,000 hospital beds through funds raised privately by the party. This is gravely concerning. If the ruling party recognises the desperate lack of healthcare resources, so, too, must the government acting in office. We urge the Government to prioritise the pandemic in allocating its scarce resources.   Risk communication and community engagement Clear and consistent communication from the Government and health officials on the status and decisions around Covid-19 management is a key element in winning the trust and confidence of the public. Clear information on social distancing, masking, getting tested for Covid-19, self-isolating, quarantining, etc. as well as transparency on testing rates, positivity rates, transmission rates, and related information should be presented at regular press conferences by a specific public health administrator with adequate expertise. The public is also anxious that there is no assurance that those who received the first dose of the Oxford-AstraZeneca Covishield vaccine manufactured by the Serum Institute of India will receive the second dose from the same manufacturer. The blithe assurances from ministers that unnamed “experts” have determined there is no problem with mixing brands is no assurance at all. Will the ministers mix brands for themselves and their families? We think not. The Government must also curb the wave of disinformation involving cures for the virus, fear mongering around the vaccine, and the seriousness of the pandemic, by being clear, transparent, and consistent in its own messaging. State officials must lead by example by following the messaging.   Governance Three ministries being assigned to handle the pandemic is a recipe for disaster. The prevention and treatment of Covid-19 and the supplies required for social protection should be efficiently and effectively co-ordinated at the highest policy-making levels. Therefore, a clearly formulated structure and procedures, personnel and finances, and a chain of command to co-ordinate and support the response to the pandemic should be established. In this crisis, we are told that the Chair of the presidential task force to manage the economic fallout of the pandemic has left the country. Will he be subjected to the same quarantine procedures on his return?   Transparent and decentralised decision-making The highly centralised nature of the current response distances citizens from the effort to tackle the pandemic, leading to a deficit in trust and the lack of co-operation in managing the pandemic. Decision-making around the public health response must be carried out in a participatory and consultative manner, not only drawing on the expertise of public health officials, medical professionals, and civil society groups, but also recognising the specific concerns of the communities that pandemic measures apply to. This can only be achieved by ensuring that the pandemic response is deployed through participatory and consultative mechanisms that already exist within communities. The military may play an implementation role, but policy-making should centre on civilian communities.   Testing Identifying positive cases and isolating and treating them should be the foundation of the Government’s pandemic response. Only by rigorously testing the population, especially by making testing more accessible to people presenting Covid-19-like symptoms, can the Government truly arrest the spread of the virus. Therefore, the Government should focus on the uninterrupted supply of logistics.   Treating Considering the high literacy rate of the citizens and the well-established public health system in the country, all asymptomatic people with the Covid-19 infection can be allowed to be in home quarantine. Traditionally, Sri Lankans are familiar with home quarantine due to chicken pox and smallpox. To treat people with symptoms, better equip and resource government treatment facilities and this should be done to meet the increase in demand for in-ward treatment.     Lockdowns Lockdowns are imposed when the patients exceed the health system’s capacity to treat them, to suppress transmission and, by extension, the number of hospital admissions. The fear of a total lockdown, considering its adverse economic impact in the short term, is well understood. However, the long-term impact of a worsening health crisis should also be considered, especially if it reaches the extent seen in India. Though a difficult and unwelcome decision, the Government must not completely rule out the possibility of a strict lockdown. Testing, tracing, treating, vaccinating – all these would be efforts in vain if the transmission of the virus continues unabated, and will eventually exhaust the healthcare system to the breaking point. If total lockdown is only to be the last resort, intermittent lockdowns (lockdowns during weekends and holidays), area-wise lockdowns with restrictions on inter-district or inter-province travel, etc. must be effectively implemented. Announcing but not enforcing these measures leads people to believe not only that they can do as they please, but also that the Government is not taking the pandemic seriously. An element of care is also crucial when implementing a lockdown. Government relief packages must be adequately and equitably distributed to everyone affected and in need, prioritising the most vulnerable. Effective mechanisms to identify those requiring assistance are essential. It is hoped that the Government learned lessons from the first lockdown and has developed contingency plans to avoid the same pitfalls.   Borders The decision of the Civil Aviation Authority to halt the arrival of all passengers from India is welcomed, but the damage may already be done, with a possible arrival of the Indian Covid-19 variant among the passengers who have already come into the country. Continued vigilance on Sri Lanka’s porous marine borders to ensure the variant is not transmitted into the island by those looking to enter it by illegal means is urged. The relevant authorities must understand the gravity of the situation, and that the entry of even one infected individual could pose extreme threats to the public health in the country.   Vaccination The Government has stated that it sees vaccination as the only solution to Covid-19. However, medical professionals are increasingly reporting that the vaccines being administered now are less effective against emerging variants, and some might be wholly ineffective in the face of the Indian variant. In addition, relying on vaccinations is not prudent to recognise that there will always be people who are “not eligible” to receive the doses, which means they still remain at risk. In addition to ensuring vaccination as far as possible, this should not overshadow the importance of continuing contact tracing of those that test positive, testing more people, and isolating those who are positive. If vaccination is indeed to be Sri Lanka’s main response to the pandemic, people should be made aware of the vaccination process. Many citizens who received the first dose have not been informed if and when they will receive their second dose. Eligibility and defining “priority” groups were also flawed and resulted in those in high-risk groups with pre-existing medical conditions not receiving the dose due to the shifting parametres. The missteps of the first vaccination process must be avoided and people must be informed when and where the vaccination is available in their localities, and the vaccination must be administered in safe locations and in ways that enable social distancing.   Strict enforcement of health guidelines It is essential that the health guidelines are enforced to ensure that wider community spread does not occur. The correct wearing of masks and the practice of social distancing must be stressed and implemented in all possible sectors. Unless a lockdown is put in place, there are many who might not be able to practise some of these guidelines, such as those who rely on public transport for their travel. In such instances, crowding must be managed strictly by the relevant official, such as by ensuring that no one in excess of a stipulated number is allowed to embark a bus or train. If the Government is determined in refusing to put a lockdown in place, it should be taking such steps necessary to ensure that transmission does to occur. The unfolding situation in India is the “worst-case” outcome of repeatedly ignoring warnings and scientific findings by public health officials and medical professionals with regard to managing the pandemic. It should act as a warning sign to the Government of Sri Lanka that has been carrying out similar actions, such as placing the economy and populist engagements with the people above public health. This recklessness with the lives of its citizens could have irreversible consequences. In this light, it is essential that the Government make the pandemic response its highest priority and demonstrate to its citizens that it values their lives. In the current context, the Government’s “failure to act on credible evidences” leading to a large number of deaths will have significant consequences.   (The writer is the Executive Director of the Law and Society Trust)

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