Sri Lanka needs proactive, decisive Investment in health, not dependence, denial, and wishful-thinking

A resident wearing a facemask rides past the entrance of Sri Lanka’s Infectious Diseases Hospital near Colombo, where most confirmed cases are treated.

ECONOMYNEXT – In the parliament last week, Vasudeva Nanayakkara said Sri Lanka doesn’t need a vaccine and that we’ve other ways to control the pandemic. While at it, he insulted a war veteran, an army commander who put to an end a three-decade-long war.

Vasu further says America needs it, and we don’t. Why? Because come the worst case, our people-loving health minister will sacrifice herself to the ocean? Sure, America has a larger caseload, a higher mortality rate, and thank god, Trumpian Vasu isn’t our president.

Meanwhile, neighbouring India is already producing and testing a vaccine, and they’ve gotten Bill Gates’s support to make locally Astra-Zeneca’s. Thailand, another Asian nation with historical ties to Sri Lanka, is also testing their own, has licensed production with Astra-Zeneca, and has an intelligence-sharing deal with Pfizer. Thailand’s response – praised by the WHO – stands as one of the best, and Thailand is developing Asia’s best health care system.

And no, it’s not just about Licensing deals. Implementing a new vaccine requires safe ways to transport, store, monitor, and distribute. The highly successful Moderna and Pfizer vaccines using mRNA needs to be stored at minus 20OC and 70OC. There’s a lot can that can go wrong. According to WHO data, half of all the vaccines globally go to waste.

Field Marshal Fonseka is right; the newly presented budget says zilch about investing in vaccines and tangible preventative care. While some additional resources have been put into the health sector, it’s not clear how and where they will go. Nor are the resources adequate given the abysmal state of the Sri Lankan health sector.

From the budget resource allocations or the millions of dollars received from China, World Bank, EU, US, and elsewhere as loans and grants, there’s little information made available to the general public about how these funds are being dispensed. Wanting our government to succeed, I want to believe that the government is using them wisely, but they’ve failed to let us – the citizens – know what will happen to the monies that ultimately belong to Sri Lankan citizens. Kudos to Omalpe Sobhitha Thera, Anura Kumara Dissanayake, and others who are raising these questions, and as citizens, we too should seek answers.

“Arogya Parama Laba,” said Lord Buddha; he saw health as the foremost wealth. He put the utmost value on human life – caring for the sick and elderly in example too. However, the successive governments of the “Sinhala-Buddhist” nation have faltered in living their professed values. According to the 2019 human development Index, Sri Lanka ranks at 71 above Thailand (77) and Vietnam (118). However, when it comes to health, it’s a different story. As a percentage of Gross Domestic Product, Sri Lanka only spends 1.67% on health – compared to 2.85% in Thailand and 2.65% in Vietnam (WHO, 2017).

Between 2000 and 2017, our government’s health spending (% of GDP) has dropped by 27%, while Thailand and Vietnam have increased theirs’ by 66% and 60%, respectively. As a percentage of total government expenditure – Thailand’s health investment is currently at over 15%, while Sri Lanka’s at a mere 8.5% and falling. Vietnam has increased by 2% in this period.

Perhaps what’s even more telling is the out-of-pocket expenditure – Sri Lanka’s citizens, rich and poor – cough up nearly 50% of the medical bills. In contrast, in Thailand, widely recognized as developing Asia’s best healthcare system, citizens only spend 11%. In a global pandemic like what’s happening now, well-funded public healthcare systems have not fared better, but they are a necessity. And Vietnam, one of the best Covid responders in the world, has a much lower per capita income than Sri Lanka.

Sure, compared to South Asia, Sri Lanka’s health spending as a percentage of GDP and Covid-19 overall performance looks good. However, given Sri Lanka’s level of human development, we should be far better, and the point is we can and should improve by learning from the best.

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Herein, we have explored examples from the East rather than the West for a reason. East-Asia, including our best friend China, has handled the pandemic far better than the West. In the past few decades, China has lifted more people out of poverty than any other nation on the planet by investing in public goods, including health, education, and social protection. In response to the pandemic, they built make-shift hospitals, performed widespread testing, and adapted technology and practical and disciplined ways to contain the spread.

Unfortunately, we’ve failed to learn from our Asian brethren, especially when it matters the most. We’ve also forgotten our religious and cultural heritage of putting health first. Not by voodoo magic of throwing pots into rivers, but that of building hospitals and health facilities like our ancestors from the Anuradhapura kingdom.

Here’s a sad truth: Despite openly rejecting the West in the political rhetoric, our ideology and response in tackling healthcare and the pandemic have been grossly Western capitalist. American right-wing conservatism has been the model for decades – starting from J.R. Jayawardena to the present day. Little investment for collective wellbeing and public goods, but cutting taxes for the wealthy and corporations, deregulating environment and industry standards, and blaming the power-less – all in the name of “development.”

That something’s Western or American isn’t a bad thing; what’s disastrous here is that we’ve failed to learn what delivers results for us irrespective of where they come from. Trickledown economics only benefit the wealthy elite, leave the masses – middle class and poor – worse off, and over the long-term, tank entire economies. To see this model failing, you don’t need to look any further than our nationalists’ professed worst enemy – America. It’s the world’s worst at Covid-19, worse in healthcare than many developing nations, and their education systems have been faltering for decades.

Sri Lanka needs to get a move on – in the right direction, taking collective responsibility and delivering. The government and leaders need to do more and take decisive action to ramp up health investment, think beyond the moment, plan for vaccinations, and adapt technology proactively. We can’t hold back – we must listen to our experts. GMOA, PHIs, and media have complained about the lack of resources for testing, care, tracing, and elsewhere. And, we can’t merely rely on international hand-me-downs.

Months ago, I wrote Leading for a New Safe and Prosperous Normal and Changing Behavior Through Awareness, Key to Recovery from Covid-19. I both highlighted the opportunities we had and the perils of letting our guard down. Those who responded with the right action, discipline, and commitment, like China, Thailand, and Vietnam, have done better. They are now looking at turning their economies around with better outlooks than the rest of the world. Sri Lanka, who may have had the same chance had we done what was necessary, is now in a worse crisis than ever before.

If we pull all-in invest as much as we can on healthcare and social wellbeing now, we may still be able to turn this around. Yes, the economy is important, but if we don’t prioritize the health intervention, the economy will be hit harder, and we will suffer for longer.

Right now, we need decisive, transparent, and urgent action. The leaders and citizens will all do well to keep “Arogya Prama Labha” in mind. Health, indeed, is the greatest wealth.

Nipuna Kumbalathara is a communications expert who has worked with local and international organizations. The views herein are his own and not of any organization he is or has been affiliated to. He can be contacted at [email protected]

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  1. Very interesting points in this article. I too see that if a nation does not give sufficient weight to health, then progress and development will suffer and the country will eternally be subject to foreign influences. That said, vaccines are not the solution, but only a “next best available” option. The reason is the new vaccines cannot stop the virus or the so-called pandemic. Even the vaccine manufacturers have stated the vaccine will only prevent the severity of symptoms. They cannot and will not prevent the virus from running through the population or prevent deaths. The reason being that the vaccine only creates antibodies against the proliferation of the virus but cannot stop the proliferation, merely reduce it only (and hopefully so). Most people think the vaccines would buy them immunity. No, they won’t. For immunity, you need T-cell immunity. T-cells are in the first line of immune defense (“antibodies” being a kind of “second line” defense that decrease the likelihood of the disease being fatal). No vaccine can produce T-cell immunity.

    Also, vaccines can only be effective against a single or at best, only a mere handful of strains of the virus. It cannot be comprehensively effective against a virus that is rapidly mutating). What can produce the necessary T-cell immunity that can stop the development of the pandemic in its tracks is a robust immune system response. What is preventing this and causing “the pandemic” is poor lifestyles and poor nutrition. Accumulating damage to the immune system over years of poor lifestyles including nutrition leaves the human being immunocompromised and therefore, susceptible to any passing virus. Those who are so susceptible, succumb. Those who are not, survive (the older you are are, the more accumulated damage and greater the risk; the younger population not already compromised are less likely to succumb). A vaccine may save a few lives but will not stop fatalities or the pandemic.

    Then what would stop the pandemic? Not just this pandemic, but any future pandemic (and there will be more to come in the near future as well if for nothing else than the rampant proliferation of the genetic modification of natural organisms in “biosecurity labs” the world over)?

    What will prevent a population being badly affected is a robust home-based healthcare plan incorporating a comprehensive national nutrition policy at the individual level – a plan that is carefully formulated to embrace agriculture (both commercial and non-commercial i.e. home-garden-based), distribution and education. This is what is important, going forward. This would be the pinnacle of wisdom that can and will give effect to the Buddha’s message of “Arogya Parama Labha”. There can be no “Arogya Parama Labha” without this. Vaccines in themselves cannot be linked to “Arogya Parama Labha”.

    How to approach implementation of a national nutrition plan is another subject which I have written about recently in brief, but cannot elaborate here for lack of time and space. It would also require research into resource availability and should link to a resourcing plan. Not to approach healthcare with such a plan is to assure a population (nation) will remain perpetually subject to foreign agendas and therefore lacking in true independence.

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