SLMA urges govt. to implement efficient vaccination strategy

Sri Lanka Medical Association (SLMA), in a letter directed to President Gotabaya Rajapaksa, stressed that Sri Lanka’s vaccination strategy implemented at present is flawed.

Calling for a composite review of the inoculation drive, the SLMA urged the government to implement an efficient strategy targeting the high-risk groups to achieve maximum control that would avoid the necessity for repeated lockdowns.

The death analysis of patients from the MoH, Sri Lanka, indicates that 73% of deaths occur in people over 60 years of age and 83% of deaths were in people with co-morbidities, the SLMA pointed out.

Research findings have clearly demonstrated that vaccination reduces deaths and complications in patients infected with COVID-19, however, they do not support benefits of vaccination to reduce transmission of infection unless a large majority of the population is vaccinated, the letter read further.

“There is clear and compelling evidence to support prioritisation of vaccination of older adults more than 60 years, followed by people with comorbidities in the age group of 30-60 years.”

The SLMA pointed out that there is no appreciable benefit in vaccinating people with the highest mobility in so-called hotspots, as is currently carried out in the Sri Lankan setting.

The letter emphasized the need of a definitive roadmap providing priority of vaccination in certain geographical locations. “Presence of a roadmap would help in gaining the confidence of our people on the vaccination programme.”

According to the SLMA, selecting Grama Niladhari divisions of high-risk locations for vaccination cannot be recommended as the infection would have already spread and the majority would have developed immunity by the time the vaccination programme is carried out.

The opinion of experts with regard to selecting the geographical location is to select high-risk provinces or districts and to vaccinate high risk people in crowded areas such as main cities in those selected provinces or districts, the letter continued.

“An equal amount of vaccines could also be given to hospitals to immunize high risk people with comorbidities. Along with vaccinating high-risk persons, people working in higher numbers in enclosed areas with longer shifts in economic hubs and other essential congregate settings also could be prioritized.”

Further, the SLMA urged the government to provide a solution to the 600,000 people awaiting the second dose of the AstraZeneca’s COVISHIELD vaccine as early as possible. “We see that offering them the first dose of Sputnik V following a quick clinical trial of the efficacy of such a manoeuvre as a reasonable option to solve the issue. Monitoring antibody levels 2 weeks following vaccination with Sputnik V in about 100 people who have had the 1st dose of COVIDSHIELD vaccine may provide a reasonable answer to this question. The importance of documenting the adverse effects during such a clinical trial also needs to be emphasized.”

The SLMA went on to highlight the need in future to reserve the second dose in instances where a second dose is in the schedule.

Commending the government’s move to restrict movement across the country ‘at the most crucial hour,’ the SLMA said this has salvaged Sri Lanka from getting into the abyss of a major catastrophe and a breakdown of the country’s healthcare system which in turn would have led to a breakdown of all systems.

Pointing to the surge in COVID infections that has overwhelmed the hospitals, the SLMA said it is still too early to see a visible impact of the lockdown on the healthcare system. “Opening the country at this juncture would invariably facilitate the spread of the infection leading to increasing number of cases that in turn would cause a complete paralysis of the healthcare system.”

In addition, the SLMA urged the Epidemiology Unit of the Ministry of Health to pay more attention to the surveillance indicators and present the data of relevant indicators to arrive at meaningful decisions.

The SLMA questioned as to whether the Epidemiology Unit has data regarding PCR positivity rates in factories that are kept open, in case a necessity arises to advise the Government in this regard.

Noting that there had been a significant reduction of the number of PCR tests carried out over the last two weeks, the SLMA said: “We understand that the majority of reported PCRs are exit PCRs that do not measure the extent of transmission in the community. Unless PCRs are carried out proactively, it is likely that the usefulness of the results of analysis of samples with a majority of exit-PCRs will remain low despite the disease spreading rapidly. Similarly, unless the disaggregated test results based on context categories and geographical locations are analysed, the inference made by all PCRs together is likely to be most erroneous.”

SLMA’s chair Dr. Padma Gunaratna said the association’s council members the members of the Intercollegiate Committee, Prof. Neelika Malavige, Prof. Malik Peiris and Prof. Kamini Mendis have contributed to this discussion on measures mitigation of COVID-19 infection in Sri Lanka.

Further, Dr. Gunaratna appealed to the President to schedule a meeting for the SLMA council members and the Intercollegiate Committee to discuss the issues pointed out in the letter.

Sri Lanka Medical Association- Letter to President by Adaderana Online on Scribd