Covid-19 vaccination programme: Priority a must for jab rollout 

• 70-80% of population should be vaccinated to curb spread: Prof. Vitharana 

• Vaccination programme hindered by political agendas, lacks transparency 

• Calls to include children and young adults in immunisation programme 

By Yumiko Perera    Sri Lanka at present is grappling with the worst outbreak of Covid-19 since the onset of the pandemic, as the third wave has brought the healthcare system of the country to its tipping point. As a result, pressure continues to mount on the Covid-19 vaccination programme.  Averaging at nearly 2,500 cases daily, the fatalities have passed the 2,000 mark. As new infections and fatalities continue to soar, the focus remains on expediting vaccination campaigns.  It is estimated that only 3% of Sri Lanka’s population has been fully vaccinated with both doses so far and only 10% of the population have been administered with a single dose, while securing vaccines itself has proven to be a herculean task.  Speaking with The Sunday Morning, renowned virologist and World Health Organisation (WHO) Advisor Prof. Tissa Vitharana stated: “If you look at the recent number of infections being reported, it has become quite evident that the virus is now in community spread.  “If our strategy is to curb the further spread through immunisation of the masses, then we would have to fully vaccinate at least 70-80% of the population, or else we would not be able to see effective results.”  He stated that while the elderly, as well as the frontline workers, remain the main priority groups, ideally, everybody should be vaccinated. Especially those who are the most vulnerable, and susceptible to infection.  According to Prof. Vitharana, while the country requires at least 80% coverage to prevent further transmission, not only would it be expensive, but it would also require more time.  Reiterating that the lack of transparency in the process and the underlying political agendas had hindered the implementation of vaccination programmes across the island, he further emphasised that time is of the essence and that this isn’t the time to play the blame game.  “The virus has undoubtedly spread amongst the community, and the whole community is exposed to the disease. The chances of infection are higher, and nearly 80% of people are asymptomatic.  “The important takeaway is that these asymptomatic people may go about their usual day, but they could be spreaders, and this is precisely why the vaccination process should be expedited, and young adults and children should also be considered for immunisation,” Prof. Vitharana elaborated.  While children and young adults are at the back of the priority lists at present, priority groups are selected considering several factors such as mortality rates and morbidity rates under the guidelines of the WHO.  The main priority groups are vaccinated first, and then the rest are vaccinated according to the availability of resources.  Prof. Vitharana further emphasised that there are still certain discrepancies in the process that needs to be taken into account.   “Many people who succumb to the virus are often mistaken to have died from severe illness, and sometimes, PCR tests are not being conducted, which gives an underestimation on the number of deaths. The actual number of deaths owing to infection could be much higher, and there is a need for these things to be recorded methodically,” he elaborated.  Stating that the health guidelines must be ingrained into the minds of the general public by raising more awareness, educating the masses, and not by instilling fear, Prof. Vitharana went on to say that the authorities need to adopt a different approach if the country is to make any progress on this front.  Against this backdrop, a stock of close to 200 used vials of the Covishield vaccine still containing a considerable amount of doses that could have been used for inoculation, had recently been discovered stashed away in a bathroom in the Wathupitiwala Hospital.  Moreover, the spokesperson for the Wathupitiwala hospital had later stated that the vials were to be disposed of, and the Ministry of Health had been informed in this regard through a letter. The question however remains, had there indeed been a wastage of vaccines?  Meanwhile, discrepancies in the system may appear to be insignificant at first glance, it is evident that mistakes like this are costly, and is simply not something the country can afford at present.    Procuring the vaccines   Sri Lanka is still seeking to secure vaccines from several countries; as per Epidemiology Unit statistics, 356,610 doses of the Covishield second jab have been rolled out, with over 600,000 people still awaiting the second jab. A total of 1,401,455 doses of the Sinopharm vaccine have been rolled out as the first jab, along with 382,972 vaccines as the second jab, while 64,986 doses of Sputnik V vaccinations have also been administered as the first jab, along with 8,991 as the second jab as of 17 June. Sri Lanka is still seeking to secure vaccines from several countries; as per Epidemiology Unit statistics, 357,868 doses of the Covishield second jab have been rolled out, with over 600,000 people still awaiting the second jab. A total of 1,423,874 doses of the Sinopharm vaccine have been rolled out as the first jab, along with 417,448 vaccines as the second jab, while 81,695 doses of Sputnik V vaccinations have also been administered as the first jab, along with 11,691 as the second jab as of 18 June. Speaking with The Sunday Morning, Covid-19 Vaccine Committee Chairman and the Senior Advisor to President Lalith Weeratunga stated: “We are expecting more consignments of vaccines. However, the exact number and when the vaccines would arrive in the country would be notified soon.” Furthermore, according to Ministry of Health Deputy Director General of Public Health Services and Disaster Preparedness and Response Division Head Dr. Hemantha Herath, the country is expecting consignments of the AstraZeneca vaccine through the Covid-19 Vaccines Global Access (COVAX) facility. “We have been informed that AstraZeneca doses will be sent through the COVAX facility. However, we were also informed that there are some requirements we need to fulfil in this regard. As per that list of activities, if those requirements are met, then we would receive the doses. Although, I am not aware of a specific date as to when the consignments would arrive or how many doses would arrive. However, as I said before, the country needs to fulfil the requirements and report back to get the doses, and I have not yet been informed of anything in this regard as of yet,” he noted. According to State Minister of Production, Supply, and Regulation of Pharmaceuticals Prof. Channa Jayasumana, it is not yet confirmed whether Sri Lanka would receive AstraZeneca vaccines under the COVAX programme. Speaking with The Sunday Morning yesterday (19) he stated: "It is not confirmed yet; however, certain countries have been selected to receive the second dosage under the COVAX programme. “They would announce as to which countries the vaccines would be sent to and the number of vaccines that would be sent out, by Wednesday (23) or sometime next week. “We have requested them to send us 600,000 vaccines, and out of that, we are expecting a minimum of 264,000 doses to match the number of vaccines that had been administered to the people the first time around. “We are expecting more than that; as you know, nearly 550,000 people are still awaiting the second jab.” Moreover, according to Dr. Jayasumana, a consignment of Pfizer vaccines may arrive in the island by mid-July, while the Ministry of Health had made requests for Sputnik V vaccines as well. "There is a delay in the supply of Sputnik V, as they had given priority to India, given the peak in the third wave India is experiencing at present. Although we expected at least 1.5 million Sputnik V vaccines by June, they only sent us around 130,000 so far," he noted. According to Dr. Jayasumana, Sri Lanka received 115,000 doses of Sputnik V vaccines so far as the first jab, and 15,000 more as the second jab, amounting to a total of 130,000 vaccines. "We are also expecting 500,000 doses of the Pfizer vaccines for this year, and out of that, they will send us 300,000 soon," Dr. Jayasumana noted.   ---------------  BOX 1:  Wastage of vaccine doses?  Speaking with The Sunday Morning, Ministry of Health Deputy Director General of Public Health Services and Disaster Preparedness and Response Division Head Dr. Hemantha Herath stated: “Additional doses are included in a vial to compensate for the content that would be lost when drawing out the vaccine using a syringe. The use of AD syringes (Auto-Disable Syringes) had been put in place to make sure there is minimum wastage of doses. “However, regardless of what anybody may say, health officials have always made sure even that the wastage would remain minimal.”  Furthermore, he stated that health authorities opted for this method, as they realised it is the most effective way to ensure more people are vaccinated, emphasising that if there is any vial containing a sufficient amount that can be administered to a single person, then it could be administered.  “This step had been taken in order to reduce possible wastage, and regardless of what many people have to say, it needs to be highlighted that this was not something done deliberately and we would further make sure that the vaccines would be used to its maximum capacity.”  The Epidemiology Unit initially issued guidelines stating if a small volume of vaccine remains after the final dose, it should not be used to inoculate another person. This resulted in the wastage of thousands of doses of AstraZeneca Covishield vaccine.  However, the directive had later been changed and the Epidemiology Unit revised the guidelines so that the most could be made out of a single vial, being able to inoculate up to 11-12 people instead of only administering 10 doses and discarding the rest. While Sri Lanka had initially received 1,264,000 doses of the Covishield vaccine, nearly 923,954 people had been inoculated with the first jab through these doses. Furthermore, nearly 18,000 vials out of the lot had already been used before the initial directive had been amended, resulting in a wastage of nearly 35,000 doses that could have been used to inoculate people. As such, it’s evident that the vaccination process has various shortcomings as it has been both inefficient and ill-prepared for. Although the initial directive issued by the Epidemiology Unit saw a significant amount of doses go to waste, it is important to highlight that Sri Lanka continues to grapple with the shortage of 600,000 doses of the Covishield vaccine to be administered as the second dose.  Multiple attempts made by The Sunday Morning to get in touch with Chief Epidemiologist Dr. Sudath Samaraweera for further clarifications, proved futile.   BOX 2: Stolen vaccines? An investigation was launched by the Police after the Habaraduwa Medical Officer of Health (MOH) had lodged a complaint with the Habaraduwa Police, accusing a driver and staff member of stealing 30 vials of Sinopharm vaccines worth Rs. 90,000. According to Police Media Spokesperson Deputy Inspector General of Police (DIG) Ajith Rohana, the Habaraduwa Police has launched an investigation into the matter, and a special police team had been deployed as per the advice of the Senior DIG of Galle.