- Int’l study reports lessons that SL can learn from its Covid-19 vaccine programme
Although considerable disparities could be observed in Covid-19 vaccinations in
Sri Lanka, especially between geographic areas (districts) and different age groups,
the country has been able to reach a satisfactory level of national vaccination
coverage. However, despite the fact that the threat of Covid-19 has subsided, and
Covid-19 vaccinations are no longer considered a pressing need, the country could
look back and learn from its vaccination programme.
This was highlighted in a study report titled the “Covid-19 Pandemic and Vaccine
Equity in Sri Lanka” which was authored by Dr. Vinya Ariyaratne and was released
this week in Sri Lanka. Issued by several groups, namely, the South Asia Alliance
for Poverty Eradication, the People’s Vaccine, and the Least Developed Countries
Watch, the study analysed the state of vaccine equity (ensuring that every person
who is need of a vaccine has access to vaccines) in the country, based on the
Covid-19 vaccination data updated up to 14 August 2022.
The political economy of vaccines, its impacts
From the beginning of the vaccine rollout in Sri Lanka, the report said, there have
been serious concerns about several related matters, including the lack of
transparency in the process of vaccine selection, procurement, and deployment
plans, some of which were raised by the civil society. “Notwithstanding a clear
policy framework in Sri Lanka in the form of the National Deployment and
Vaccination Plan (NDVP), there have been serious concerns regarding the
transparency and accountability of the entire process of the identification, approval, procurement, and equitable distribution, and the administration of
vaccines in the country,” the report added, noting that as early as 7 December
2020, Transparency International Sri Lanka had raised concerns about possible
corruption in the vaccine procurement process.
The report claimed that it is now evident from the various statements issued by
professional bodies and the extensive newspaper coverage on the subject, that
the vaccine rollout in Sri Lanka faced serious problems, and that it was clear that
there was no proper accountability or oversight mechanism in place to safeguard
public interest in the vaccination process. It added: “The Minister of Health sacked
a few key expert members of the National Medicines Regulatory Authority
(NMRA) in the wake of a controversy over approving the Sinopharm vaccine.
When Sri Lanka received a donation of 600,000 doses of the Sinopharm vaccine,
the expert panel of the NMRA refused to provide approval in the absence of the
required data from the manufacturer. Wide publicity was given to this
controversial decision, casting serious doubts in the public mind on the efficacy
and safety of the Sinopharm vaccine, in turn eroding to a great extent, the public
trust that was there in the stringent approval process. Delays, mismanagement
and other irregularities related to vaccine procurement have been a cause for
concern as the country continued its vaccination campaign. Procurement
guidelines provided extraordinary powers to the Government to make emergency
procurement through any means necessary.”
Myths and misconceptions
With regard to vaccine hesitancy and misinformation, the report said that from
the initial phase of the vaccination process, there were concerns, especially
doubts and misconceptions, about the efficacy, side effects, and other long-term
complications that could be caused by Covid-19 vaccines, as they were developed
within a short period of time. “Even though hesitancy towards the vaccine was
relatively low amongst people in Sri Lanka in comparison to other countries,
numerous myths associated with the vaccine, and other misconceptions have
been identified within different communities, which have in turn driven some individuals to reject the vaccine. This was evident in the reluctance that was
observed amongst the youth in taking the second dose,” the report read.
It further explains that although vaccine hesitancy has not been a serious concern
for Sri Lankans for the first dose, and to some extent in taking the second dose, it
has clearly been an issue for the third and fourth doses (i.e. first and second
booster doses) as evident from the low vaccination figures for the booster doses.
However, it was underscored that despite the aforementioned situation, Sri
Lankans have not shown much hesitancy towards the vaccine in comparison to
other countries.
Among the beliefs and information-related challenges faced by Sri Lanka’s
Covid-19 vaccination programme, were certain myths and beliefs about the
adverse effects following immunisation and vaccine safety, placing more trust in
indigenous medicines, doubts about the effectiveness of the vaccine, and certain
conspiracy theories such as people being used as lab rats and that the
Pfizer-BioNTech vaccine is rapidly given as there is a stock which is supposed to
expire soon.
Gaps in Govt. policy and implementation to contain Covid-19
The report noted that there was no genuine “whole of society” (Government
engaging all stakeholders including the civil society, communities, the academia,
the media, the private sector, non-governmental organisations [NGOs], other
voluntary associations, families, and individuals to strengthen the resilience of
communities and the society as a whole) or even for that matter, a “whole of
Government” (an approach in which public service agencies work across portfolio
boundaries in order to develop integrated policies and programmes towards the
achievement of shared or complementary, interdependent goals) approach.
“As stated elsewhere, the approach to prevent and control Covid-19 was very
centralised and extensively involved the security forces. Formal or planned
community service organisations’ (CSOs) involvement in Government programmes
was minimal. Had there been a formal recognition and involvement of the CSOs,
the social and economic impact on the poor could have been mitigated more,” it
added, claiming that the Government did not follow its own strategic documents
such as the Strategic Preparedness, Readiness and Response Plan, or the NDVP.
Role of civil society
CSOs, including NGOs, faith-based organisations, community-based organisations
who were amongst the “first responders” to any previous man-made or natural
disasters, found it nearly impossible to find their role or niche in the national
response to Covid-19, according to the report. It further said that the complexity
of reasons, which included the animosity and distrust (both perceived and real)
that existed between CSOs and the newly elected Government, prevented any
formal engagement of the CSOs, and this remains largely unchanged to date when
the country is facing a devastating socio-economic and political crisis, and that
none of the national-level bodies created to manage Covid-19 in Sri Lanka
included any representation from the civil society.
The CSO interventions in Sri Lanka’s Covid-19 vaccination programme included
emergency relief for vulnerable groups, livelihood support, risk communication,
community engagement, psychosocial support, and policy advocacy.
Recommendations, CSOs’ requests to the Govt. and int’l community
The report pointed out several concerns pertaining to the Covid-19 vaccination
programme, regarding which, it recommended future steps. “Overall, the Covid-19
vaccination programme in Sri Lanka has been a success with satisfactory coverage
for the first and second doses, and to a great extent, for the first booster dose.
However, district-level disparities have been observed and cannot be fully
explained without further systematic study and analysis,” the report explained,
recommending in-depth, quantitative and qualitative studies to verify whether
these differences are statistically significant, and to identify underlying reasons for such differences.
“The uptake by the public of the second booster dose has been poor, despite wide
publicity by the health authorities indicating a degree of vaccine hesitancy. Even
though the risk of Covid-19 is now waning, addressing misinformation and
disinformation related to vaccines is of paramount importance towards managing
future pandemics,” the report said, recommending the setting up of an
independent mechanism to monitor public perceptions, and to make appropriate
recommendations to the Government and the other stakeholders to initiate
timely action. In addition, explaining that the socioeconomic impact of Covid-19
has been devastating, particularly on the poor and the marginalised, and that this
has been further aggravated by the socioeconomic and political crisis which
followed in early 2022, it was recommended to review the existing social
protection systems in Sri Lanka with the objective of revamping and/or
establishing a new and modern social protection mechanism which is more
targeted and inclusive of vulnerable groups in the country. In this regard, the
report said that CSOs can play a significant role in such a mechanism by helping to
identify such communities and empowering them to graduate from such benefit
schemes within a specified period of time.
“Covid-19 is not the last pandemic that humanity will face, and therefore,
pandemic preparedness is an important area of public health intervention. The Sri
Lankan experience has clearly proven the important role played by communities
and CSOs in both the prevention and control of Covid-19.” In this regard, it was
recommended to set up an integrated co-ordination mechanism (building on the
United Nations’ Humanitarian Country Teams Cluster Mechanism) where the
Government, CSOs, the private sector, and development partners can work
together towards pandemic preparedness and response, adding that such efforts
should centre around resilience building at the community level. What is more,
the report described that significant deficiencies and even malpractices were
reported in Sri Lanka’s vaccine procurement, thus highlighting the importance of
health related governance. And in order to address this, it was recommended that
the public and the donors demand full transparency in the procurement and
distribution process of medicines, vaccines and devices.