COVID-19 Vaccinations: Mixed Signals and Mixed Priorities

By Kshama Ranawana

 

 

Confusion and miscommunication seems to be becoming the hallmark of this government.

Just like the many other instances where gazettes are issued, then cancelled, prices of goods are lowered officially, but consumers are told by vendors that there is no price change, taxes removed or lowered and then re-introduced or raised, the much awaited roll-out of the National Vaccine Deployment plan too seems to be suffering the same fate.

Following World Health Organisation (WHO) guidelines, Health officials first said the vaccinations would be given to frontline and other at-risk professional groups and then to the public, starting with most age-wise seniors and those with comorbidities.  The plan had been approved by the National Advisory Committee on Communicable Diseases (NACCD).

And while the health sector prepared to receive the first batch of vaccinations from India, a web portal for the public to register was circulated, with a large number of individuals registering to receive the vaccine.  The form asked a host of questions, from age to area of residence, closest hospital and Medical Officer of Health (MOH) office and underlying health conditions. Those who registered received a reference number via SMS.

But after all that ‘excitement’, the website crashed, with the Minister for COVID-19 Prevention, Dr. Sudharshani Fernandopulle stating that the website was simply a trial!   Why then, for goodness sake was it rolled out to the public in the first place?  Aren’t trials contained to few hundred or thousand selected individuals first, to determine its effectiveness, and fix any issues?

 

 

Media reports stated that the first batch of vaccinations were due in the country by mid-February or early March, with plans to begin vaccinating the general public soon after frontline workers and other vulnerable populations had been inoculated.

Fernandopulle announced during the early days of February, that three hundred individuals would be vaccinated daily across 2000 centres, targeting a population of 600,000. The Colombo district in the Western Province which continues to record the highest number of victims falling prey to the virus was to get the first shots, followed by the Gampaha District.

But, it seems that the National Vaccine Deployment Plan has been discarded, and vaccinations are being administered willy-nilly.

Given the limited availability of this first round of vaccinations, a priority list of those who should be vaccinated had been prepared, says NADD in a media release dated February 22.  “These priority groups included frontline health staff, those front line staff in the security forces and the Police, elderly over 60 years of age, those with co-morbidities and high risk groups in economically important and essential service/institutions.”

Despite that list, the roll-out of the vaccinations this past week included those over 30 years of age.  And there is confusion!

Is the first round of vaccinations for the over 60’s or the 30 to 60 age group?  Or are all those over the age of 30 eligible?

Deviation from the approved plan, warns the NADD is dangerous, which says the decision of the Ministry of Health to vaccinate the 30 to 60 age group   “is a clear deviation from the scientifically agreed prioritization stated in the National Vaccine Deployment Plan. This strategy is neither an evidence based practice, nor a public health decision considering the wider public health and economic outcomes, and it totally derails the COVID-19 preventive activities in the country, dangerously undermining the public health response to COVID-19 especially with regard to the objective of reduction of complications and deaths due to COVID-19.”

But addressing the media, Fernandopulle said on February 24, that it was President Gotabaya Rajapaksa’s instructions that all those above the age of 30 be given the vaccination.

All but directly accusing the Secretary Health and the Director General of Health Services for the confusion, she stated that despite decisions taken in consultation with the Presidential Task Force, arbitrary decisions are made later.  Speaking in Sinhala she pointed out that decisions pertaining to the health sector are taken by them. ‘Calls are made at midnight, after decisions are made, to change instructions,’ she alleged.

If her claims are true, then it seems that her interventions as the minister in charge are ignored.  She reiterated to the media, that she is the representative of the President.

Naturally then there is confusion regarding to age criteria; is it those above 60 years of age, or the 30 to 60 age group or all those over 30?

On February 25th, a WhatsApp message originating from the MOH office in Pita Kotte advised residents of two areas that the vaccinations will be given on February 27, to those over the age of 60. Similarly another news report doing the rounds the same afternoon stated that as of the 26th, those over 60residing in the Dehiwela area would receive the vaccination.

So could the government please tell the public which age group it has decided to vaccinate first; the above 60 group or the 30 to 60?  Or, are all those over 30 years of age to be vaccinated?  Clearly, there is a difference of opinion between NADD on the one side and the President and the Minister on the other.  Or has Fernandopulle’s message changed since her media conference on the 24th?

On Friday the 19th, a mobile announcement was heard in the area this writer lives in. The message was muffled, with various residents sharing the bits and pieces of information as heard by them.  A phone call to the office of the Medical Officer of Health revealed that all those living in two of the grama niladaridivisions were to be given the vaccination the next day.  It was available for all those above thirty years.

While residents queued up from the early hours of the morning that Saturday to be registered and vaccinated at the Kotte MOH office, as per the practice adopted at all other centres, video footage of a vaccination centre in Narahenpita told a different story.  Here, residents were asked to register themselves on one day, and get the vaccination on another day.  

Of course true to Sri Lanka culture, the well-heeled and those with connections and a sense of entitlement pay little heed to the procedures in place.  A fairly large number of this privileged group has got the vaccination either by pulling strings or name dropping; several people residing outside Colombo for instance it is alleged, including a world-renown cricketing personality had been spotted at Colombo vaccination centres. There is also a purported list of names being mentioned as those who had been given priority. Naturally, lesser mortals are asking questions.

At the Kotte centre, an ex- staff member of the Municipal system was seen hovering around the registration desk, hopeful obviously, of being spotted and quickly registered by one of her former colleagues.  Thankfully, when confronted by others waiting for the vaccine, she had the grace to return to her spot in the queue.

But that does not happen everywhere.  Those with clout are obviously abusing the system, leaving the less affluent residents, the ‘nobodies’ whose lot has always been to make do with crumbs, stand for hours in the hot sun to be inoculated.

Meanwhile a host of others are opting out from getting the vaccine.   Many believe the jabs result in complications, while others assume their comorbidities would be aggravated if vaccinated. Some are simply fearful of the needle.  Many of those who are opting out of being vaccinated are also those who believe any old wives tale spread through social media about the virus.  They seem to be quite content in believing all the disinformation instead of the scientific findings on the vaccine.  Guess one could hardly fault them, when the government itself refused to accept scientific assurances on the highly sensitive burial issue of those who died of the virus!

The government made a great show of how well it managed the first wave of the coronavirus.  But that was in the run-up to the parliamentary election. Since then, the numbers infected have ballooned, and those dying of the virus have increased. We’ve also witnessed the circus of pots of blessed water being thrown in rivers, and supposedly healing concoctions, though none of those have had the desired effect ofcontaining the spread of infection or reducing deaths.

But now, there are even photos circulating of the Shaman who peddled a concoction he guaranteed would give lifetime immunity against the Coronavirus getting the vaccine himself!  

And now we are witnessing more of this tragi-comedy; A minister who goes public stating that officials at the health ministry are making arbitrary decisions and stating the vaccination is for those over thirty years, while the health officials seems to be complying with NADD approved guidelines.  

That chaos reigns over the administration of the vaccine, and that many amongst the public are fearful of taking the shot, is an indication that the governmenthas failed in its job- be it in ensuring all individuals have equal access to the vaccination without queue jumping or that the agreed and approved guidelines are adhered to and in addressing the fears of the people.

Health Service professionals still have the time to fix the mess; Enforce the priority list of the eligibility criteria as recommended and agree on the age group,  eliminate queue jumping, and launch a well thought out and comprehensive educational programme that would put myths and fears to rest.

 

 

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