Sunday Times 2
Reflections on the COVID-19 pandemic and the rational path to modernisation
While the numbers given daily of those infected are relatively unimportant since they are only a reflection of the numbers tested which are comparatively a small sample of the total population or ‘universe’ — to use statistical phraseology. The more people are tested the more likely that the numbers would increase till the effects of isolation and vaccinations kick in. The number of deaths is relatively small when compared to the death toll in developed countries. Research has shown that Asians living in tropical zones are less likely to succumb to the virus. On the other hand with the onset of winter there was a steady increase of reported cases in countries with a cold climate.
Vaccination: A commendable job by Lanka's health services
The initial ‘roll out’ of the vaccine has been quite successful with nearly seven hundred and thirty thousand people, especially in the ‘At Risk’ categories receiving the injection. Unlike in many other countries, the numbers resisting getting the vaccine injection in Sri Lanka seem to be small — and this is a good sign. In many other countries in our region that is a major problem.
If we can rapidly vaccinate a large segment of the population the pace of testing need not be a priority. It would be more reasonable to deploy our limited medical services to administer the vaccine. The rumour that there will be insufficient vaccines to go round seems to be disproved by the regular shipments that are arriving.
Public health service
Sri Lanka is fortunate to have a good public medical service as the World Health Organisation has noted on several occasions. Since the introduction of the adult universal franchise, our political leaders of different persuasions have agreed on the need for an efficient public health service. The trauma of the Malaria epidemic of the 1930s led to the State Council supporting an extensive rural health programme which is associated with the name of George E De Silva, the State Council member for Kandy and Health Minister. He was supported by Dr S.A. Wickremasinghe then of the LSSP and later of the Communist Party. He became the ‘Father of the Rural Health Scheme’ which transformed the health standards of the disadvantaged village people. It also laid the foundations of the Demographic surge of the forties and fifties, the results of which are seen in the overwhelming population configurations and economic planning dilemmas of our present times.
Under this initiative, rural hospitals were built all over the country. Midwives were appointed countrywide and pre-natal and post-natal care was undertaken by the state. As a consequence, there was a sharp drop in infant and maternal mortality and a rise in life expectancy. A world renowned economist summarised this situation when he said “Sri Lanka is a third world country with a first world health service.”
Social scientists are aware of a debate that took place many years ago in the ‘Demography’ journal regarding the reasons for the population surge in Sri Lanka. Some argued that this was due to the discovery of DDT and the elimination of Malaria, particularly in the Dry Zone with the introduction of colonisation schemes. Others led by Ananda Meegama replied convincingly that this development was not mono-causal but depended on several innovations and policy packages associated with the rural health schemes which were put in place by the State Council and continued by Parliament after Independence.
This debate drew scholars’ attention to the welfare measures undertaken in our country. The Nobel prize winning Economist Amartya Sen wrote that Sri Lanka and Kerala had adopted a style of growth which could provide a model for the Third World. I must say, however, that whenever I met Dr Amartya Sen at meetings and discussed our situation, he would say that his sanguine prognostications about Sri Lanka had been derailed by the failure to address the ethnic issue. His bets on Sri Lanka were off because we could not solve our ethnic problem. I have always felt that George E de Silva had a raw deal in our history writing. If C.W.W. Kannangara has been lauded as the father of free education, De Silva should receive a similar accolade as the father of free health.
As shown above we have a health service we can be proud of. Even from the aspect of inoculations, our health services have administered the polio vaccine and the triple vaccine countrywide and have been lauded by the WHO. Today no Sri Lankan child dies of these infections. The best example of our able medical service is Dr Sudarshini Fernandopulle, State Minister of COVID prevention. She was my State Minister when I was Minister of Science and Technology. As a specialist physician, she boldly and courageously held her ground when other Ministerial bigwigs were throwing holy water into rivers and swallowing magical portions in front of television cameras. Never in the history of the Government Health sector has there been an exhibition of such stupid behavior by political authorities. Another Minister is reported to have generously provided government funds for a nutmeg crushing machine to make more of the anti-covid brew. A few intelligent journalists blew this snake oil salesman’s credentials sky high when they reported that the gullible swallowers, including famously the lady Minister of Health, had contracted Corona and were hospitalised under intensive care. In a noteworthy coincidence two of the ‘peni’ drinkers were struck by the virus within a few days.
The Speaker who hosted the swallowing session in Parliament in the glare of publicity was shown a few days later meekly getting the anti-corona jab. But what took the cake was his statement published in the newspapers that he agreed to be vaccinated because he wanted to set an example. As a former MP who was continuously in the House for twenty six years, I was dismayed to find the Speakers Office used to promote dubious products merely because an MP wished to accommodate one of his constituents. Of late, Speakers have tended to act as political leaders in waiting who have no hesitation in using their high office for personal benefit. That is another recent development contributing to public disenchantment with Parliament. [As a social scientist, I was intrigued by the discovery via a Baas Unnehe that the snake oil salesman, that Kali -- a fond abbreviation for Badrakali the demoness -- was a Tamil language speaker. When this ‘Peniya’ salesman lost his cool with the throng of supplicants surrounding him at home, he, on behalf of Kali, shouted ‘Poda Poda Poda’ at a woman who also responded in gibberish. A Tamil friend told me that ‘poda’ is ungrammatical Tamil when addressing a female.]
While there may have been a few mishaps which have been reported in the media, the vaccination programme has been carried out smoothly, thanks to the public officials and the army. Many of my friends, admittedly over sixty, were anxious that they would not be able to access the vaccine but in a couple of days were able to get it without much difficulty. Whatever may have been the instructions in most centres there was a queue for over sixties and the Grama Sevakas could recognise the people from their divisions.
All in all the initial ‘Roll Out’ seems to be successful without the usual absentees that have been reported in other countries. Presumably, it will be extended to other parts of the country so that the ‘herd immunity’ would make it possible for us to open the economy and the social life of the country.
Medical Scientists have said that to reach such immunity, about seventy percent of the population has to be vaccinated. I read with interest that Basil Rajapaksa had said that we should aim at such an immunisation. As a small country we should find this possible and would help in positioning us as a lead country for investment and tourism. In this Israel provides us with a good model. Being a small country with good links to their compatriots in the scientific and business fields in the West, Israel has set a blistering pace in vaccinating its population. Sadly its racial policies have left out the Palestinians from the vaccination programme. This discrimination is so reminiscent of what Hitler did to their forefathers in the Thirties and early forties. What we can learn from their vaccination programme, however, is the clear prioritisation of access to the vaccine. They identified the over 60s as their target group based on demographic data and covered this category promptly. According to the Economist, hospitalisation of the over 60 cohort dropped substantially after seventy percent of the number in that cohort was vaccinated by the Israeli government.
One of the grumbles about our vaccination programme, as seen in the letters to Editors, is shifting attention away from the over sixty cohort which is abnormally large in our particular demographic profile. By uncritically following the WHO guideline in this matter, we seem to have ignored the ground realities of our demography. This was shown in the unanticipated demand from this category which had to be accommodated by hastily adding a separate queue for the over sixties in the vaccination centres. Let me now turn to some basic issues which came to the fore due to the Covid pandemic.
The first is the need to recognise the role of modern science. All too frequently our media have highlighted anti-scientific ‘mumbo Jumbo’ to direct the conversation away from the need to establish a science-based society in our country. Many people supported President Gotabaya Rajapaksa because he was a tech savvy moderniser. Unlike our other leaders, he was not seen weighed against gold, half naked in a ‘Thulbaram’. [It is an irony that many of these godmen or poosaris died recently after contracting Corona.] Indeed unlike our politicians, GR knew that wars cannot be won by making Poojas. You need manpower planning and training, use of proper modern weapons, the latest communications technology, research and logistical superiority to overwhelm an opponent who had access to top weapons experts worldwide.
I was a minister when the LTTE with superior weapons such as MBRLs was on the verge of driving our armed forces out of Jaffna peninsula. One of the reforms introduced by the GR-Fonseka team was to immediately get the latest weaponry. Unfortunately the leaders of the UNP-led by Ranil, could not understand any of this and were setting up the media to question the financing of those planes and weapons.
The discovery of the Covid vaccine is nothing short of a modern scientific miracle. Says the Economist of February 2021: “To call vaccination a miracle is no exaggeration. A little more than a year after the virus was first recognized, medics have already administered 148 million doses. Although the vaccines fail to prevent all mild and asymptomatic cases of Covid 19, they mostly seem to spare patients from death and the severest infections that require hospitalisation, which is what really matters.”
Inefficient provincial system
Another problem which is facing the country is the inefficient provincial health system. Many of our chief ministers were small time politicians who had very little idea of management. I am now revealing a secret that President J.R. Jayewardene never wanted to appoint politicians as chief ministers. His idea was to appoint senior public servants with a proven track record of management to run the newly established provincial councils. I remember that politicians like Dissanayake of Gampola lobbied against this saying that officials had no political savvy. Instead he proposed himself for the post of chief minister of the Central Province and JRJ was made to change his mind by confidants like Gamini Dissanayake and Ronnie de Mel. Any investigation will show that the rural hicks who became chief ministers plundered the revenue of the provincial councils for salaries and perks for their colleagues. Money set apart for education and health were squandered to give jobs for the boys in order to get political mileage for their attempt to enter Parliament. This irresponsibility has led to a crisis in provincial education and health. Except perhaps in the North, the public in all other provinces want this subject reverted to the Central Government as the local education and health systems have broken down. The health services in the provinces can effectively function at present because fortunately the councils are dissolved.
It is upto the Government to make a realistic assessment of the Provincial council system which has been an utter failure in the Sinhala provinces. I would suggest the setting up of an international group of experts to evaluate the provincial council system which has been in operation for over thirty years. As I shall show later a streamlined health system will become a necessity in the ‘Post-Covid World, a better framework for health and education, especially in rural areas must be evolved. An inquiry must be launched as to how the funds allocated to PCs have been misappropriated and wasted in political ‘Gift giving’.
Scientists and economists are now talking of the ‘New Coronormal’. The epidemic has created a new normal with which we have to live. Says the Economist, “To the extent that medicine alone cannot prevent lethal outbreaks of Covid 19, the burden will also fall on behavior, just as it has in most of the pandemic. Habits like mask wearing may become part of everyday life. Vaccine passports and restrictions in crowded spaces could become mandatory. Vulnerable people will have to maintain great vigilance. Those who refuse vaccination can expect health education but limited protection. But even if Covid19 has not been completely put to rest, the situation is immeasurably better than what might have been. The credit for that goes to medical science.”
Finally we cannot avoid the mega question of our attitude to the process of modernity. Though cranks and eccentric academics may muddy the waters, we cannot avoid the thrust of modernisation. All countries in this interrelated world follow a path to modernity which is time tested and, above all, practical. The covid virus has clearly shown the pathetic inability of non-science to address practical issues. While individuals may be delusional and call on gods like Natha to answer their prayers, real life is different and cannot succeed by rhetoric and speechification. We need to get our priorities right and seek rational solutions.
It is clear that countries that have successfully negotiated the modernisation process can give a better life for the people. Covid is a wakeup call. I invite all concerned politicians, administrators, business people and academics to begin a discussion on the rational path to modernisation which alone can lift us out of the morass in which we find ourselves now.