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COVID-19 vaccination: Priority list discarded; controversy as over-60s are turned away
The current COVID-19 public vaccination programme is mired in controversy and confusion after the health authorities arbitrarily discarded the ‘priority list’.
With a major deviation from the planned list which is based on international practices taking into account the high-risk groups, the Health Services Director-General, in a damage control move, on Friday evening instructed that the over-60s who had been excluded be “included”.
The programme which was rolled out among the public on Wednesday, with limited vaccine doses, after the frontline health and security forces personnel had got their jabs, immediately ran into trouble with strong protests from many quarters.
The Sunday Times also understands that there has been a high-level change with regard to the epidemiological coordination of the programme but it was unclear whether it was linked to the priority-list fiasco.
By Friday afternoon, the DG issued instructions to vaccination centres in the high-risk Western Province where the programme was underway to extend vaccination to those beyond 60 years of age, but questions arose whether there would be enough stocks to do so.
Earlier, those on the priority list, were the frontline health workers, the frontline security forces personnel – both groups who have been vaccinated with around 250,000 doses of the 500,000 doses of COVISHIELD donated by India – followed by the high-risk elderly category of people over 60 years of age and the high-risk younger people (from 19 years to 60 years) who had co-morbidities.
A lightning decision, reportedly by the Epidemiology Unit, had dumped this priority list even though earlier repeated assurances had been given by those heading the vaccination initiative that it would be adhered to and no one would be allowed to crash the queue.
The Sunday Times understands that vociferous protests had ensued at a meeting of the National Advisory Committee on Communicable Diseases (CDs) on Wednesday. A majority of members of this highest technical committee chaired by the Health Services DG, had finalised the priority list and insisted that the ad hoc decision be rescinded immediately.
Repeatedly in the past, both Presidential COVID-19 Vaccine Task Force chief Lalith Weeratunga, and National Vaccines Committee head Dr. Lakshmi Somatunga, had assured that the jabs would be given according to the priority list of the National Vaccine Deployment Plan. These assurances have been published in the Sunday Times.
“Who decided to throw out the priority list and on what basis,” asked former Chief Epidemiologist Dr. Nihal Abeysinghe, saying that this sudden change of plans, with only limited quantities of doses being available, was to create utter confusion and get politicians and their henchmen to jump the queue.
He said that COVID-19 vaccines should be given to prevent deaths firstly and when looking at data anyone could see that most of deaths were among the elderly and younger people with co-morbidities. This change in the priority was unacceptable.
Other health sources said there were two schools of thought. One is that the elderly and those with co-morbidities should be vaccinated to prevent deaths, while others argued that it is better to vaccinate the young to prevent the transmission of COVID-19.
The source said that many were opposed to the second school of thought because “sochcham doses” (small amounts of doses) would not break the chain of transmission.
Sri Lanka Medical Association (SLMA) President Dr. Padma Gunaratne, when contacted, reiterated that the first priority, through vaccination, should be to prevent deaths, complications, developing symptoms, hospital admissions and ICU occupancy.
“Those who are likely to get severe COVID-19 and succumb to illness are older individuals and those with co-morbidities including kidney disease, diabetes, hypertension etc.,” Prof. Neelika Malavige, Head of the Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, told the Sunday Times.
She said that in all countries, after immunising the frontline workers such as healthcare workers, they immunise these vulnerable groups of individuals. In Sri Lanka, the incidence of COVID-19 is so much more in Colombo than other places. Therefore, older individuals in the Colombo district are more likely to develop severe disease and fatal COVID-19. In fact, over 50% of those who have died are from the Colombo district.
“Therefore, it would be important to immunise older individuals giving preference to those living in COVID-19 hotspots. The reasons for deviating from this commonsense approach is beyond me,” added Prof. Malavige.
What is the basis on which the priority list was changed, queried Consultant Paediatrician Dr. LakKumar Fernando, pointing out several instances where home-bound young people have been vaccinated this week, while people over-60 who are going to work have been refused the jab point blank.
Many dissenting voices also came from the outstations, with Dr. Sunil Seneviratne, a past SLMA President, stating that when he sent his “frontline” health staff from his clinic with a letter, to get vaccinated at the Matara Hospital on Thursday, they were turned away.
“The medical officer refused to vaccinate my staff and they were turned away, with the excuse that he has no authorization to give vaccines to our staff. In fact, over the week I gave several calls and sent an email too to the Epidemiology Unit in Colombo, but they too refused to accommodate our health staff saying they have to save the vaccine for garbage collectors and other high-risk people,” he said, adding that there is obviously a mix-up of priorities.
Some calls to areas in the Western Province where the vaccine was being administered brought to light some heartrending tales of how the healthcare staff had to turn away those over 60 years and how sons and daughters were agonized over the decision to vaccinate them without including their parents in the programme.
Calls and messages to Presidential Task Force Head Lalith Weeratunga, National Committee Head Dr. Lakshmi Somatunga and the Epidemiology Unit elicited no response.