Vaccination drive goes ahead amidst challenges | Daily News

Vaccination drive goes ahead amidst challenges

A vial being prepared for vaccination at a vaccination centre in Colombo
A vial being prepared for vaccination at a vaccination centre in Colombo

Sri Lanka continues to be in a state of standstill as the Government last week enacted a series of measures to curb the ‘third wave’ of the Coronavirus pandemic, imposing strict travel restrictions throughout the country that will be effective until at least next week before they are reviewed.

The restrictions were required after other measures such as local lockdowns and inter-district and inter-provincial travel restrictions, imposed initially in a bid to contain the third wave but sustain economic activity at the same time, failed to achieve the desired results with the pandemic escalating.

They also came after the three major medical organisations in the country, the Association of Medical Specialists (AMS), the Sri Lanka Medical Association (SLMA) and the Government Medical Officers’ Association (GMOA) in a statement called for stringent measures to deal with the pandemic.

These organisations raised concerns after reports from hospitals throughout the country and the results of testing suggested that the number of infections was on the rise. At present, about 3,000 new infections are recorded daily. The daily death toll has averaged between 30 to 40 in recent days.

As of Tuesday, the total number of infections recorded in Sri Lanka stood at over 186,000. The country has recorded 1,527 deaths due to the Coronavirus. Health experts predict that the peak of the pandemic in Sri Lanka is yet to be reached. Hence the need for continued restrictions.

Coronavirus infections

With the current focus being the short-term aim of controlling the spread of Coronavirus infections, the authorities are also busy planning a longer-term strategy. This is based on an efficient roll out of a vaccination programme against the Coronavirus. This has already commenced.

The start of the vaccination roll out was however not without its fair share of controversy. Initially, the major hurdle encountered by the Government was the lack of vaccines on the world market and thereby having to rely on donations of vaccines from friendly nations such as India, Russia and China.

Ironically, this is because Sri Lanka contained the first wave of the virus very effectively by employing lockdown restrictions early last year. At the same time, most of the Western world such as Europe, the United Kingdom and the United States suffered significant casualties from the pandemic.

As a result, these nations rushed to place orders with major vaccine manufacturers for millions of vaccines. Some countries have even stockpiled excessive doses of vaccines, sufficient to vaccinate their population several times, anticipating failures from one or more vaccines.

These issues were compounded by the administration of the AstraZeneca vaccines in large numbers that meant that the administration of a second dose was not possible. The Government later clarified this issue, stating manufacturers failed to provide adequate stocks in a timely manner.

At the time of writing, available statistics suggest Sri Lankans were administered about 1.87 million vaccines and about 346,000 persons, most of them healthcare workers, had been fully vaccinated. The latter amounts to about 1.6 per cent of the population. About 7 per cent had at least one dose.

Vaccination programme

The initial roll out of the vaccines featured the AstraZeneca vaccine sourced through the World Health Organisation (WHO) as part of the Covax initiative launched by the world body. It was bolstered by half a million injections of the Covishield vaccines donated by neighbouring India under its “Vaccine Maitri” programme.

The Government’s problems were further compounded by the scale of the unprecedented outbreak in India. Following the initial half a million doses of the vaccine received from India, Sri Lanka placed orders for a further 1.5 million Covishield vaccines but these were not delivered.

Following the massive outbreak of the pandemic in India, it had to suspend the export of both commercial and grant-based vaccine doses to other countries, including those in the neighbourhood who had already paid for the shipments, with the last batch going out at the beginning of April.

“Today, our needs are far greater, and all our partners understand that in this context, what we require is to speed up our own vaccination programme, to 2-3 billion, so we have to ramp up significantly,” Indian Foreign Secretary Harsh Shringla said, explaining his country’s decision to suspend exports.

This meant that Sri Lanka had to source the vaccine from alternate sources. The so-called ‘popular’ vaccines such as the Pfizer vaccine and the Oxford AstraZeneca vaccine were not feasible options as their respective manufacturers were struggling to cope with the excessive demand for these vaccines.

The Government has now been able to negotiate further stocks of vaccines. This came in the form of increased imports from Russia and China, providing the Sputnik V and Sinopharm vaccines respectively. Vaccination with these brands has already commenced in many centres in the country.

There were several developments as the Government concentrated its efforts on accelerating the vaccine rollout through the country. The expansion of the rollout continues on a district by district basis, focusing on the most populous and most ‘at risk’ districts in the country first.

The districts of Colombo, Gampaha, Kalutara, Matara, Galle, Kandy and Kurunegala were identified by health authorities as being at the highest risk currently and have been given priority in the vaccination drive. This is to be followed by the districts of Ratnapura and Jaffna, officials said.

In a bid to generate more doses of the AstraZeneca vaccine, Director General of Health Services Dr. Asela Gunawardena has directed officials to generate extra doses of the vaccine from the liquid remaining in each vial. This can be administered to those who had already received the first dose of the vaccine.

“It has been brought to my notice that at times, the remaining liquid is adequate for the administration of another dose,” Dr. Gunewardena said, noting that it is particularly important that the correct amount of 0.5 ml per dose should be carefully drawn for each dose without wasting the vaccine.

In another positive development regarding the AstraZeneca vaccine, the WHO said that there is no need for recipients of AstraZeneca vaccines to restart the full course of vaccination, in case the administration of their second dose is substantially delayed beyond the recommended 8-12 weeks.

The WHO has noted that the global supply of AstraZeneca vaccines is constrained due to multiple factors including company related production delays, shipping delays and specific unforeseen country needs. This is precisely what occurred in Sri Lanka, resulting in a shortfall of about 600,000 doses.

Sputnik V and Sinopharm vaccines

After further research, the WHO has concluded that updated data indicate a strong response even after an interval of six months between the two doses. It is now thought that, after the administration of the first dose, there has been a more than 80% reduction in hospitalisation and deaths due to the virus.

Sri Lanka is also counting heavily on the Sinopharm vaccine for the success of its vaccination programme. The second doses of the Sinopharm vaccines will begin to be administered from June 8, exactly a month after the first doses began to be administered, the Government announced.

Army Commander General Shavendra Silva who also heads the Presidential Task Force on Covid-19 said that the doses of the Sinopharm vaccines need to be administered four weeks apart. Those who received the first dose were expected to note their due dates and visit the same centres, he said.

A stock of one million doses of Sinopharm vaccines will be released for delivery to Sri Lanka on June 6 under a commercial arrangement, Channa Jayasumana, State Minister of Production, Supply and Regulation of Pharmaceuticals said. A further one million doses will be received next month, he said.

In what may amount to be another way forward for Sri Lanka’s vaccination drive, there was hope that the Russian Sputnik vaccine could also be a valuable source to control the pandemic, with indications that a single dose of the vaccine could confer significant levels of immunity to the public.

Russian authorities have informed Sri Lanka that its Sputnik vaccine could even be used as a single dose vaccine following new clinical data about the development of 70-80 per cent efficacy after the first dose, National Medicines Regulatory Authority (NMRA) Chairman said.

However, the NMRA had granted previous approval for the Sputnik vaccine to be administered in two doses. That decision would remain operative and any reversal of the policy decision would require the analysis of clinical data that emerged after the latest studies, the NMRA Chairman said.

The two dose Russian vaccine was also designed to be given 28 days apart. Emerging data suggest that the second dose could be delayed up to 90 days, Dr. Wijewantha noted. Over 65,000 doses of the Sputnik vaccine have already been delivered to Sri Lanka and more are due shortly.

Managing the Coronavirus is becoming a challenge of balancing travel restrictions with economic needs, ensuring the maintenance of essential service and trying to get ahead in the race to secure and administer vaccines on a mass scale - challenges the Government is now fighting on a daily basis.