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Newly formed Govt. Medical Professionals’ Association concerned over ad hoc vaccination programme
Dr. Lakshman Edirisinghe
The ad hoc vaccination programme against COVID-19 has caused much concern among the newly formed Government Medical Professionals’ Association (GMPA), with state doctors banding together to address critical issues faced by the public with constructive suggestions.
Before focusing on the specific concept of vaccination, GMPA President Dr. Lakshman Edirisinghe says that vaccinating a person and administering an injection are two different medical modalities.
He said that for a non-medical person it may seem the same – some liquid or powder from a glass vial sometimes mixed with a liquid, drawn into a syringe and jabbed into the skin. But this injection is given to a person who is ill (a patient) and symptomatic, having a disease agent in the bloodstream or body tissue. It will then kill that disease agent and the patient will get cured.
However, vaccines are given to healthy people to prevent them from falling ill. There is no infectious agent in the person being vaccinated. Vaccines prevent illness on a mass scale, he said, reiterating that vaccination is a public health intervention, may be in a certain geographic area, to keep people healthy from getting a specific disease.
In a limited resource setting, the government health agency carrying out a vaccination programme should clearly identify its objectives, according to Dr. Edirisinghe. These objectives include:
- What is the vaccine stock that will be secured?
- How will this vaccine stock be secured?
- What is the cost of this vaccine stock?
- How safe is the vaccine?
- What is the target population who would receive the vaccine?
“It is vital that once these objectives are identified, the authorities work towards them without deviating,” said Dr. Edirisinghe.
Lauding Sri Lanka which has achieved remarkable health successes in a low-resource setting by using the preventive medicine model rather than the curative medicine model, he stressed that the current vaccination programme against deadly COVID-19 should be studied in this light. Are we on the correct track, have we gone wrong somewhere and, if so, where?
What is the “magic” that we had in our earlier programme, he asked, answering that when the colonial government introduced western medicine here spurred by the onset of malaria, the Sri Lankan model was different to other countries. The colonials were at their wits’ end – they had a huge economic problem as the labour force including the plantation workers were getting infected with malaria.
“The way forward was to eradicate malaria and so was born at the grassroots the public health system earlier dubbed the sanitation programme which evolved into a programme comprising Medical Officers of Health (MOHs) and Public Health Inspectors (PHIs). This was the preventive programme. The curative services with its strong hospital network came later,” said Dr. Edirisinghe.
Pointing out that this is the key to our success, he said that it is how Sri Lanka eradicated polio, malaria and filariasis and also leprosy though it is raising its head again.
Long queue at a vacination centre in Piliyandala. Pic by Indika Handuwala
These programmes were run with precision and efficiency, he says, recalling how in one day polio drops would be administered to a large target population. It was a multi-pronged public health approach for malaria to control the agent, the host and the environment.
He delves into how the “excellent” Infectious Disease Surveillance Programme works. There is a Register of Notifiable Diseases maintained by the relevant PHI who has to keep the MOH updated on the situation daily. On the last page of this register, there is space for any unusual activity by a disease not being followed up usually, with a record of the specific area where it is happening.
Every Friday, these reports are forwarded to the relevant MOH who compiles information from all PHI areas coming under him/her into one report and sends it by Saturday morning to the Epidemiology Unit in Colombo. Every Monday, the Weekly Epidemiology Report (WER), a summary of the consolidated WER data, is circulated among all MOHs, so that they know exactly what is happening even elsewhere. This system is effective.
What has happened during the COVID-19 pandemic is that there is a move to re-invent the wheel…….“as if we have suddenly got up and thought we need a system when there is a good system already in place. There may be a few shortcomings but the need is to correct or repair them rather than replace the system”, he says.
Referring to the vaccination programme against COVID-19, Dr. Edirisinghe says that no calculation of the number of people seeking vaccination has been made. People from different areas are going hither and thither from their places of residence in search of the vaccine.
“If we take Colombo, with large crowds gathering at different locations, vaccine clusters could form very easily. People who have no immunity against the virus (those unvaccinated) gather to get the jab. For the two doses of a vaccine to take effect, it takes a while, at least six weeks, during which time the virus has ample time to incubate, cause disease and spread,” he says.
Pointing the way, he says that it is ideal for Public Health Midwives who have around 6,000 people under each of them to coordinate the vaccination programme in their specific areas along with the PHIs and the MOHs. These midwives have a band of volunteers who can be mobilized to support the programme.
“No person would need a chit, influence or recognition and it could be carried out at ground level in designated areas without any glitches, unlike now where people from wide-ranging areas flock to one place, get the vaccine and go back, most probably taking the virus back as well and causing its spread,” he said.
Another major concern raised by Dr. Edirisinghe is how Sri Lanka will achieve ‘herd immunity’ against COVID-19. Vaccination is intended for a target population who should be immunized within a certain period of time. For maximum effect, that total population needs to be vaccinated within a specific period to prevent the disease agent from getting transferred. This is herd immunity.
“How can we achieve herd immunity if one person from one area and another person from another area are being given the jab in an ad hoc manner,” is his worrying conclusion.