ECONOMYNEXT – With 165 deaths and 8,812 active cases reported at the time of writing, Sri Lanka has yet to announce a concrete plan to acquire a COVID-19 vaccine. Public health experts, lawmakers on both sides of the aisle, and other commentators have made various pronouncements on the pressing need to secure a vaccine best suited for Sri Lanka’s people and her ailing economy. Others, however, including experts, advise against rushing into importing a vaccine, suggesting instead that the government concentrate its efforts on containing the spread of the virus for the time being. The calls for a decision either way have become louder in the wake of the establishment’s ill-advised, alarmingly anti-science endorsement of an untested indigenous miracle cure.

State Minister of Primary Health Care, Epidemics and COVID Disease Control Sudarshini Fernandopulle told EconomyNext on Friday (18) that it is still early days. Sri Lanka’s health authorities, she said, have focused their attention on the different vaccines developed by international pharmaceutical and biotechnology companies but, in the absence of sufficient data, a decision has yet to be made.

“It is too soon to tell which vaccines would be the best for our country and would be compatible with our citizens,” she said.

The state minister said the government has been in talks with the World Health Organisation (WHO) to ensure that 20 percent of the population will receive a COVID-19 vaccine for free through the COVAX initiative once the WHO has approved a vaccine.

COVAX, a global initiative spearheaded by Gavi, an international vaccine alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI), aims to equitably cover 20 percent of a signatory nation’s vaccine needs, irrespective of income level. Some 190 countries have signed up for the programme, including wealthy nations such as the UK and Canada.

The WHO said in a statement on Friday (18) that COVAX had arrangements in place to access nearly two billion doses of COVID-19 vaccine candidates.

“For the vast majority of these deals, COVAX has guaranteed access to a portion of the first wave of production, followed by volume scales as further supply becomes available. The arrangements announced today will enable all participating economies to have access to doses in the first half of 2021, with first deliveries anticipated to begin in the first quarter of 2021 – contingent upon regulatory approvals and countries’ readiness for delivery,” the statement said.

Sri Lanka’s readiness for delivery is unclear, at best.  State Minister Fernandopulle said the country’s infrastructure shortcomings such as cold chain issues also present practical difficulties with regard to storing a vaccine, particularly the Pfizer-BionTech which must be stored at -70 degrees Celsius.

“Transporting that vaccine at that temperature is not very practical in Sri Lanka,” she said

Pointing to a lack of clarity in the effectiveness of the vaccines currently being rolled out in the UK and elsewhere, Fernandopulle said more information was needed. For instance, both the Pfizer-BionTech and Moderna vaccines are said to be 95% effective. However, as pointed out by the Vaccine and Infectious Diseases Forum of Sri Lanka (VIDFSL), these are preliminary phase three results that have yet to be peer-reviewed.

The state minister noted that the duration of  immunity to the novel coronavirus following vaccination is also unclear.

“We’re not told how many times we have to get it. For example, we know the polio vaccine is for a lifetime. With this, we don’t know,” she said.

According to Fernandopulle, in the event a vaccine eventually arrives in the island, high risk groups and frontline workers as well as members of the armed forces and police will be given priority.

The minister gave an assurance that Sri Lanka will import a vaccine that is deemed best suited for the country, though she did not commit to a timeline. The Sunday Times reported quoting a government official today that Sri Lanka is in talks with the World Bank to secure a Rs 10 billion loan to purchase a vaccine.

“We are still studying this. We will bring in the best and the safest vaccine for patients and citizens in the country as soon as possible. Financially we are under no stress. Funds will be given by the World Bank. The president, too, provides his fullest support,” she added.

Meanwhile, Executive Director and fellow of the Institute for Health Policy (IHP) Dr Ravindra Rannan-Eliya said Sri Lanka ought to take its time in working out a strategy for vaccinating the country against COVID-19.

“I don’t think we should rush. We don’t have thousands dying right now. Only two vaccines are approved by some countries, and we don’t have critical data even for those, in particular their ability to stop transmission,” he said.

Speaking to EconomyNext on Friday (18), Dr Rannan-Eliya said the countries who urgently need vaccines today are those with rampant COVID-19 spread and thousands dying.

“We are not in that category, unless the government has decided it has changed the national strategy of aiming at elimination, without telling us. It may have since ministers are now saying we should live with the virus. if you have eliminated the virus, you don’t need vaccines urgently, unless people need to travel abroad,” he said.

According to Dr Rannan-Eliya, to prevent transmission, Sri Lanka needs to vaccinate 90% of the population, an endeavour that is not economically viable at present, to say the least.

“This could easily cost 1% of GDP, and the protection might only last one to two years. We can’t blame the government alone, since our limited fiscal capacity stems from decades of cutting taxes. We’ve chosen to reduce tax collection (10% of GDP) below the average in Sub-Saharan Africa (18% of GDP). Business people will understand that choices have consequences. One of those is that we can’t afford to buy vaccines for everyone with our own money,” he said.

Though COVAX will give Sri Lanka 20% for free, the WHO has yet to approve a vaccine, a process that will take several months. Dr Rannan-Eliya is looking at a timeline between 2021 to 2022.

While it is unclear at present when exactly the WHO will approve a vaccine, The National Geographic reported earlier this month that COVAX’s bargaining power was at risk. The programme’s funding depends on donations from its signatories, the magazine said, which have been slow to arrive.

“Meanwhile, some 9.8 billion doses of COVID-19 vaccines are already reserved as of November 30, and more than half are dedicated to well-off countries through pre-purchase agreements. Assuming the vaccines prove effective, the United States has already secured enough doses to vaccinate its population twice over. For the UK, it’s thrice. And if it fulfills its orders, Canada could offer five doses to all of its 38 million citizens with some left over,” the NatGeo report said.

Dr Rannan-Eliya believes it is possible to eliminate the virus in Sri Lanka through tight border control and through rigorous testing, among other measures.

“This is a fraction of the cost of vaccinating everyone in the next 12 to 18 months. Plus, vaccinating everyone will not eliminate the virus anyway, since the initial vaccines are probably not good enough to do that.

“Our best option is to eliminate the virus using proven methods, maintain secure borders through 2021 and then pick the best and most affordable vaccine options in about six months time when more vaccines will be available and prices have started to drop. It would probably be prudent to raise taxes/reduce debt to pay for coverage for all in say 2022 or 2023,” he said.

In the meantime, Dr Rannan-Eliya said, vaccines will be needed for people leaving the country. If it is for personal reasons, he said, the cost should be borne by the traveller, but for other travels, the state will have to find the funds.

“Maybe a charge on incoming tourists might be an option since they will increase the cost for us of keeping the virus at low levels as we “live with the virus”, which [seems to be] the new policy?” he said.

Dr Rannan-Eliya reiterated that Sri Lanka ought not to rush.

“Pfizer would cost us USD 20 x 2 doses x 20 million people = USD 800 million. This does not include other deployment costs, indemnifying Pfizer for side effects and paying compensation ourselves since Pfizer will not. Even that will not remove the need for other measures, since transmission and deaths will still occur if we open borders,” he said.  (Colombo/Dec19/2020)