By Harini Amarasuriya
Indian author Arundhathi Roy, writing to the Guardian newspaper described the Indian government’s failures in the face of COVID-19 as a “crime against humanity”. Certainly, the news and images from India are heartbreaking. When a society has reached a point where whether you are able to access lifesaving treatment or not, whether you live or die, whether you are able to grieve properly when you lose a loved one, depends on your position in society, your connections and your wealth – that society has hit rock bottom. These are consequences, – make no mistake, these are not accidents – of deliberate actions and policy choices, of callous and in Roy’s words, coldly indifferent leaders. Sri Lanka today is also at tipping point.
For several successive days, the number of COVID positive people has been a little under 2,000 a day. Since, this is based only on the numbers tested, we can only assume that the numbers are in reality higher. Reports from health personnel on the frontlines are not good – hospitals are reaching full capacity and people, even after testing positive, are forced to stay at home since intermediate treatment centres and hospitals are both at full capacity.
For those who are asymptomatic or showing mild symptoms this may not be a problem, but worryingly, this particularly strain of the virus seems to be more vicious. Therefore, the demands on the health sector are increasing. This is not just in terms of infrastructure but also human capacity. For example, providing a patient ICU care is not simply about provisioning an ICU bed – but requires a team of specialised doctors, nurses, equipment and medication. These, especially the human resources are much harder to deploy suddenly.
Increase in maternal morbidity
One of the greatest threats of COVID is the pressures it places on the health sector and its consequences not only in terms of managing the epidemic, but for managing other health issues as well. As all attention, resources and capacity get diverted to COVID, other equally pressing and urgent health issues are neglected and overlooked. Already, health personnel have warned that there may be an increase in maternal morbidity due to the pressures wrought by COVID on the system. This is why health and medical experts have been stressing the importance of not letting the COVID situation overwhelm the health sector. This is of course an incredibly difficult thing to do. It means managing the spread of the virus while simultaneously increasing the capacity of the health sector.
Strict implementation of health regulations is paramount
More than a year on, what we know is that as of now, we have not been able to strengthen the capacity of the health sector to deal with this ongoing crisis. ICU units have only increased marginally, quarantine centres, treatment centres, testing facilities and laboratories etc., and are still insufficient. It is evident that the government lost focus demonstrating either ignorance or disregard for the nature of this virus. What the world has learned over the past several months is that this virus mutates resulting in a cycle of infections. No country will be able to drop its guard until at least 70% of the world population is vaccinated.
This means, that creating awareness among the public of the need to continue following health regulations such as masking, hand washing/sanitation and maintaining social distance for the foreseeable future, is paramount. But most importantly it means steadily increasing the capacity of the health sector to cope with the epidemic. It requires prioritising health requirements and realigning all other policies at least for the next two years in anticipation of managing an ongoing global and health epidemic. Then what of vaccinations? Certainly, vaccination is important – but once again, a proper roll out plan for vaccination must be in place.
What we saw with the first round of vaccinations in this country was completely unacceptable. The priority list agreed to by health experts was quickly disregarded and the heavy political hand was evident as connections and position rather than need became the criteria for vaccination. Now, there also seems to be uncertainty about procuring vaccines even for the second dose for those already given the first. It is on this issue that the global inequalities in the health sector and the power of the pharmaceutical industry is most evident. While rich countries are hoarding vaccines, the industry is making billions in profit.
Poorer countries are falling way behind in vaccinating their populations. The head of WHO has said that the world is on the brink of a ‘catastrophic moral failure’ due to vaccine inequity. It is not only in the vaccine roll out that the inequity is evident: the ability to engage in health seeking behaviour – whether as a country or as an individual – is intimately tied up with socioeconomic conditions. The poor and the underprivileged are the hardest hit.
At the moment, there is a growing lobby demanding a Trade Related Intellectual Property Rights (TRIPS) waiver for COVID vaccines. In a major policy shift, the US (home to some of the biggest pharma companies including Modena and Pfizer that is manufacturing COVID vaccines) has agreed to a TRIPS waiver. Yet, working out the modalities of how this will work will require more lobbying, negotiation and hard work. The pharmaceutical industries have already started lobbying against the waiver and countries such as the UK, the EU, Canada and Australia have resisted this move. Also, it’s not only on the vaccine per se that a patent waiver is required, but on the technology that accompanies its production and roll out.
All this means that as important as the vaccine is, it will be some time before its impact will be felt. The time has also come to seriously take stock of the impact of decades of policies that encouraged privatisation of health care putting profitability over social justice. This ethos has also had huge consequences for research and development, where competitiveness and profit drive research agendas rather than collaboration and need. TRIPS waivers of medication and vaccines should not be simply about responding to ‘exceptional’ circumstances. The morality of TRIPS in areas especially relating to health, education, innovation and research must be questioned.
Meanwhile, in Sri Lanka, our challenges are far more fundamental. Our problems are primarily at the level of leadership – whether in politics, business or education. We seem to be saddled with leaders of incredibly narrow vision, with petty and selfish agendas. Combine that with incompetence and insecurity and you have a recipe for disaster. This country does not lack in experts, efficient administrators or competent professionals. Yet, they are being side-lined today.
COVID must be managed by health professionals and those experienced in disease control. From briefing the public to taking the final decision on measures for quarantine – it is paramount that we allow those who know to be in charge. It is worrying when even the State Minister for COVID prevention, herself a health professional hints at being undermined.
It is shocking when a senior Minister brazenly admits that he influenced a decision on lockdown in his constituency when the health personnel in charge of the area go public saying a lockdown is essential. What is worrying is not that the Minister interfered with a decision made by those in charge – but that he was allowed to do so.
This reflects the breakdown of the system of decision-making in the health sector which is the worst possible scenario we could have at this moment. People currently in power in Sri Lanka are still battling charges of war crimes. For the sake of the people of this country, let us hope that crimes against humanity in the face of COVID will not be added to their list of charges.