Did the delay in starting vaccination hurt Sri Lanka?

  • Making up for lost time, learning from past shortcomings, and sticking to policy plan

BY Sumudu Chamara

The gravity and complexities of the Covid-19 pandemic are becoming more and more evident as health experts keep discovering new information about the nature of the virus and the pandemic. What they highlight most is that regardless of the nature of the infection, managing the pandemic is a gradual process that requires both prevention measures and treatment, and prompt action could make a considerable difference.

On the home front, there were times when authorities took swift action, which, as mentioned, helped the country manage the spread of the pandemic. One such example is the very first lockdown, which was imposed before the situation got out of hand.

However, whether we did the same with regard to the most effective solution the world has found so far, i.e. vaccination, is debatable. Some parties have questioned whether Sri Lanka took the necessary steps to procure the vaccines at the right time, and some have even tried to attribute the present situation of the pandemic to the alleged delay in commencing the vaccination drive.

Causes for delay

While the Government and the health authorities have admitted that there have been some delays in providing and administering vaccines in certain areas at present, certain parties, especially Opposition political parties, claim that there were serious delays since the commencement of the vaccination drive.

The Morning spoke to former Health Minister and incumbent Samagi Jana Balawegaya (SJB) Opposition MP Dr. Rajitha Senaratne in this regard.

He added that at the initial stages of the pandemic, he had attempted to point out the importance of ordering vaccines as early as possible; however, the matter he pointed out did not receive adequate attention at the time.

“Speaking in Parliament, I appealed to the then-Health Minister to place orders for vaccines as early as possible, because developed countries had begun to place orders to get billions of vaccines. I said that vaccine-manufacturing companies cannot produce vaccines in billions, and that therefore, there will be a shortage. In October, during the health budget debate, I made a request again. I said that the vaccines will be in the market by January 2021.

“However, it was only once vaccines appeared in the market that the Government placed the first order. By that time, there were no vaccines available, because the vaccine-manufacturing countries had been supplying vaccines to the countries that had placed orders early. In this context, we had no choice, and we were receiving only a very little amount of vaccine doses from western countries. Also, we had to depend on Chinese-made vaccines.”

Because of these delays, Dr. Senaratne claimed, the commencement of Sri Lanka’s vaccination drive was set back. He also alleged that the Government had sought to depend on unproven, irrational methods, such as the infamous “Dhammika Peniya” (a local concoction) to deal with the pandemic, and that such behaviours were another reason behind the delay in commencing the vaccination drive.

“By the time the vaccination drive started, the country was in a mess,” he opined. He claimed that it also resulted in Sri Lanka not being able to secure vaccines with a higher efficacy rate.

“Due to this delay, we could not obtain the best vaccines such as the Pfizer-BioNTech and Moderna, which have an over 90% efficacy rate. Also, we could not get those vaccines in large numbers because they were not available in the market, as the manufacturers were supplying the vaccines to those who had placed orders early. Therefore, we had to depend on China, and we had to pay more. Bangladesh paid $ 10 per dose of the Chinese vaccine; however, we paid $ 15 per dose. We don’t know what happened to the $ 5.

“Later, the Oxford-AstraZeneca vaccine became available for $ 2, while the Pfizer-BioNTech vaccine became available for $ 5. In this context, there was no efficiency in the process of ordering vaccines; it was a very inefficient process. Also, only the Sinopharm vaccine is available everywhere, other than the small amounts of Pfizer-BioNTech and Moderna vaccines received from the World Health Organisation (WHO), and the US and other western countries.”

Janatha Vimukthi Peramuna (JVP) Politburo Member Dr. Nalinda Jayatissa also told The Morning that the delay in submitting the relevant documents to place orders for the vaccines caused a delay.

“The WHO advised every country to submit the necessary documents regarding the vaccines requirement for the Covid-19 Vaccines Global Access (COVAX) programme, but the Health Ministry failed to do that. That is why we could not get the necessary amount of vaccine doses on time. The readiness of the Government to obtain the vaccine was very slow. During parliamentary sessions, some of the Opposition members raised that question; however, we did not see any readiness on the part of the Government to procure the vaccines early,” he added.

When queried about his opinion about the overall efficiency in the process of ordering and procuring vaccines, Dr. Jayatissa said: “We had a good vaccination programme since 1940 or 1950, and our health system is capable of carrying out the Covid-19 vaccination drive. We can see that with the support of the tri-forces, the Health Ministry is able to implement the vaccination programme very quickly. But the failure was in the initiation and supervision part of this process.”

Meanwhile, Public Health Inspectors’ (PHI) Union Secretary Mahendra Balasooriya also said that there were delays in the vaccination drive. However, what he pointed out had more to do with the implementation of the vaccination drive, than the commencement of it. He said that these delays had changed the original vaccination plan, and that it had affected the pandemic’s severity too.

“Compared to other countries, initially, we saw a certain delay in the implementation of the vaccination drive. When other countries like India implemented their vaccination drive promptly, Sri Lanka took a significant amount of time for experts’ discussion on how the vaccination process should be carried out, including the vaccination plan for various identified groups. Therefore, there was a delay. First, Sri Lanka imported the Oxford-AstraZeneca Covishield vaccine from India, and due to the pandemic situation that arose in India, there was a delay in administering the second dose of the vaccine.

“I think that is one of the reasons behind the drastic increase in the number of deaths that are being reported at present. We are of the opinion that had the vaccination drive been carried out more swiftly during that same period, we could have saved a considerable number of people above the age of 60. However, what is more important is devising proper plans for future activities.”

He also expressed concerns about the manner in which the vaccination plan was changed.

“The vaccination drive is being carried out on the basis of identified age groups. During the initial period of the vaccination drive, the Health Ministry planned this process properly – they planned to vaccinate those above 60 years first, and to gradually vaccinate those below 60 years later. However, due to certain circumstances and rational and irrational reasons during the initial period, the original plan was changed.”

According to Balasooriya, while some of these reasons were political, the nature of some of these reasons is not clear.
Although The Morning attempted to contact Production, Supply and Regulation of Pharmaceuticals State Minister Prof. Channa Jayasumana in this regard, he was not reachable. However, speaking in Parliament on 7 September, he shed some light on delays that exist at present.

In response to a question, he stated that certain grama niladhari areas did not receive vaccines adequately due to two reasons.

According to him, China’s prioritisation of vaccinating its own people due to the increasing number of Covid-19 cases is one of the reasons for the delay in receiving the Sinopharm vaccine. He added that by 12 September, however, all districts in need of Sinopharm will receive the necessary doses.

The other reason he pointed out was flaws in calculating the number of people requiring the vaccine in certain districts. He explained: “In some districts, the health officials provided data as to how many vaccines those districts need. However, the number had been calculated based on the 2012 Census. Due to this, in some areas, there was a difference of around 3,000-4,000.”

Challenges and future

Acknowledging the flaws in the vaccination drive, those who spoke with The Morning expressed their opinions about the future of the drive.

Balasooriya explained: “It should be noted that there are certain flaws in the ongoing vaccination drive and we see a situation where the vaccination is carried out in different ways in different districts. In some districts, those older than 60 years are prioritised, while in certain other districts, those between 30 and 60 years are vaccinated. Still in other districts, those above 30 years are being vaccinated without an age limit, while vaccinating those below 30 years is also in progress.

“We see this kind of an unorganised vaccination process in Sri Lanka, and we also see the people clashing with the health authorities and defence personnel due to the unnecessary congestion at vaccination centres. This situation can further develop as there is a certain fear among the people and at the same time an enthusiasm to get vaccinated. In this context, we request the authorities to create an environment in which the people can get vaccinated from vaccination centres nearer to their respective areas, preferably within their grama niladhari areas. This is a need of the hour.”

He also stressed the importance of keeping the supply of vaccines uninterrupted, adding that by doing so, the vaccination drive could be streamlined, which in turn will result in a decrease in Covid-19-related deaths. 
According to Dr. Senaratne, addressing the flaws in the vaccination process calls for what he called a “vaccination policy”.

He added: “The Government is not following any policy on vaccination or lockdowns. The future of the vaccination programme should be in order, and therefore, there must be a policy on vaccination. This country always had a vaccination policy, only this time there is no such policy. All the medical experts have one view about our vaccination policy, and I request that policy be followed at least from now onwards.”

He noted that a proper policy would help manage delays, deaths, and Covid-19 cases, and that under such a policy, the priority groups and at-risk groups would be able to get the vaccines on time.

“There is a classification of countries based on the level of risk of Covid-19. The first category is the green list, the second one is the yellow list, and the third one is the red list. We are among the high-risk countries with countries such as Bangladesh, India, Nepal, Pakistan, and the Philippines. Now, the authorities claim that Sri Lanka is leading in the vaccination campaign. The vaccination can be administered now at a high speed, but the problem is that we are already late. We have recorded over 10,000 deaths. The Government must take the responsibility of taking political decisions, not medical decisions,” Dr. Senaratne claimed.

Meanwhile, Dr. Jayatissa noted that due to the increasing production of vaccines, Sri Lanka would be able to obtain vaccines like Pfizer-BioNTech, Moderna, and Oxford-AstraZeneca more easily. However, he added that Sri Lanka first needs a proper programme with regard to the type of vaccines it requires.

He spoke of the issues in the ongoing vaccination drive, including changing plans devised by health experts.
“On 18 January, Health Ministry experts prepared a programme called the ‘National Deployment and Vaccination Plan’, and we have to stick to the population categories it prioritised. The main problem in Sri Lanka’s vaccination programme is that during the programme, Sri Lanka changed its priority list. That is why I think that we are seeing around 10,000 Covid-19-related deaths,” he opined.

“When we observe the deaths, we can see that more than 70% of the deaths were from the over-60 years age group, and that nearly 92% of them had not been vaccinated. In conclusion, of the 10,000 people that died, around 6,500-7,000 of them had not been vaccinated and they were in the age group of over 60 years. That is the main problem.”
In this context, he added that Sri Lanka must not delay vaccinating people over 60 years of age, and those living with critical illnesses.

“If we are planning to give a third dose, we have to focus on people with immune suppression (suppression of the body’s immune system and its ability to fight infections and other diseases) in any category. In any case, if we are able to use the opinion of the experts from the health sector as well as the epidemiology field, we can overcome these issues. But the way I see it, the Health Ministry, expert groups, and the Task Force on Covid-19 Prevention have different views.”

Speaking in Parliament, Prof. Jayasumana explained: “Our initial target was to vaccinate those over the age of 60. Now we are vaccinating those between the ages of 30 and 60, and we are in the final stage of that process as only a small number of people from that category are left to vaccinate. We are now vaccinating those between 20 and 30 years, and we hope to vaccinate all above 20 years in six weeks. There shall be no issue as to the brand name of the vaccines administered to youths, as studies have shown that there is no significant difference, and that any type of vaccine could help strengthen immunity.”

He also spoke of the Pfizer-BioNTech vaccine, adding: “Sri Lanka receives 100,000 doses every week, as per the agreement signed in January this year. However, from October, Sri Lanka will receive more. We are expecting four million doses in October.”

Even though attempts were made to contact Health Minister Keheliya Ramukwella and several top officials who have direct knowledge of the vaccination drive to discuss the allegations levelled by those who spoke with The Morning, at the time of writing this article, they were not reachable.

As most of the individuals who spoke with The Morning agreed, and the health authorities have claimed, Sri Lanka is currently in the process of securing vaccines for the next few stages of the vaccination drive, and the country is carrying out a speedy vaccination drive.

However, past delays do not belong entirely to the past. It is important to look back and understand as to whether there were delays, as by doing so, the authorities will be able to plan the future steps and prevent the recurrence of the same.