We are still mainly held up in Colombo city and its suburbs and do not have to carry over the mess we see around us to other districts and provinces.
by Kusal Perera
On Saturday (20 February) before the previous, the “DM Online” carried a news item headlined “Ad hoc vaccinations to stop; health officials to get tough” that confirmed for nearly a month, health authorities were not aware how COVID-19 vaccination was done. Two days later on Monday 22 February, Deputy Director General of Health Services (DDGHS) Dr. Hemantha Herath told DM that the “affluent class” is influencing them to get vaccinated out of turn and making it difficult for health officials to attend to their duties.
Yet another two days later on 24 February, minister in-charge of COVID-19 disease control Dr. Ms. Sudharshani Fernandopulle told media, “….guidelines and instructions have been taken for granted when the vaccination drive is being manipulated in the country”. She was referring to Health Ministry officials and had told media “Some decisions were changed and communicated over the phone at midnight. Certain crucial decisions were not properly conveyed. Vaccination drive can’t be done in that manner.”
Health officials who complain over undue “interferences” disturbing their duties were slammed by their own Minister as responsible for the chaos around us. All because the People were never educated on COVISHIELD vaccine and how the vaccination programme would be carried out. It was health ministry officials who opened up the vaccination programme to the Western Province. President of the College of Community Physicians Dr. Nihal Abeysinghe on a popular TV discussion, blamed health ministry officials on 24 February “for doing away with the priority list from Feb 16, without consultations”.
Meanwhile no trilingual public announcements were made to inform the public of changes. In Colombo the vaccination programme began as mere “word of mouth” news making rounds. No Ratepayer was officially informed by the municipal authorities. That no doubt invites “affluent” and “influential” intruders into the scene.
COVID-19 vaccine campaign demands important information in public domain before it is actually launched. People need to know the efficacy of AstraZeneca COVISHIELD vaccine, side effects and allergies if any, when the second dose should be administered, who the priority recipients are and how long it would take to serve the rest as planned. These are all information that must be disseminated to all households through community health workers like the PHIs, the Family Health Officers (FHOs) and the area GS officers, but were totally ignored.
Health Ministry official website too does not have information on COVISHIELD vaccination programme nor is there any link to a webpage that has one. But there is a 24 page “Guidelines for COVISHIELD COVID-19 Vaccination Campaign – January to February 2021” in the Epidemiology Unit website. It bears reference number EPID/400/2019/nCoV and had been sent to all relevant authorities under the signature of Director General Health Services (DGHS) Dr. Asela Gunawardne.
These Guidelines on COVISHIELD immunisation say the first round of the vaccination campaign “will be conducted from the last week of January to 1st week of February 2021”. This campaign period of just 02 weeks according to guidelines is for the first dose of the vaccine to the “Target group” decided as “All healthcare staff in the country (government and private), Non-health support staff considered as frontline workers directly in contact with Covid-19 patients in Covid-19 control and prevention activities (Defence Services, Police/STF, Civil defence etc.) and Selected staff at Ports of entry who directly in contact with possible Covid-19 import cases.” This “target group” seems the “Priority” list of the health ministry.
Meanwhile despite what health officials told media about “getting tough”, their decision to “open up vaccination in Western Province” had no planned system and no “priority list” with different “vulnerable groups” being spoken of. Details of chaos in and around Colombo flooding social media platforms with angry posts by Tuesday (23 Feb) afternoon proved nothing was planned. There was no uniformity in selection criteria though the Chief Medical Officer of Health (CMOH), Colombo praised himself saying “everything was well planned”. His planning apart, furious social media posts accused Colombo Mayoress of having her own special lists for vaccination. Some posts said there were no proper “Consent Forms”, no set form for personal details, no proper criteria in who gets “priority” with the “60 years and above” elderly group also dropped out in some areas. Even in healthcare service there is no one who knows the finally finalised final COVID-19 vaccination programme at present.
Within this mess what is also missing is information on side effects COVISHIELD vaccine could have on “recipients” and how to respond in managing them. People’s right to know details about side effects listed in the Guidelines for COVISHIELD COVID-19 Vaccination Campaign completely ignored, led to the “Consent Form” being filled out only as a “permit” to get vaccinated. People therefore do not know whom to contact or where to go in case they develop side effects.
Worst is, in this country People are not aware of “allergies”. In fact, the larger majority including the middleclass is ignorant about their own allergies, if any. Often eating something that leads to an “allergy” is passed off as an “indigestion” and is given a quick fix that ends there. None of such allergies matter much. What matters is allergy to any “excipient” of the COVISHIELD vaccine. AstraZeneca has listed over 08 excipients and there may be individuals allergic to any one-off them but would not know. There are also other conditions like an “unidentified trigger” for multiple classes of drugs that would need consulting an allergy specialist, says AstraZeneca. Allergies therefore have to be given importance in educating the public in any vaccination campaign.
Looking at the total picture of COVISHIELD vaccine campaign there are many flaws, all due to negligence, incompetence, inefficiency and irresponsibility bundled together with political bankruptcy. All that covered up with the “elite psyche”, people can be herded for vaccination. This mentality prevailed in prevention work from day one. The necessity to win confidence and trust of People for prevention work was replaced by “orders and commands” accompanied by punishments. Society was often told by authorities “in-charge of COVID-19 disease control” they know how to “control” and they would do the “controlling, and “people should co-operate”. Thus, a social psyche was created that lapses in adhering to announcements on COVID-19 prevention meant a punishable “social crime”.
That being how of COVID-19 disease control was attempted, guidelines were not compatible with the vaccine campaign on the ground. A vaccine campaign is a People based campaign and it should begin with people made aware of all developments including priorities and logistics relevant to their resident area. This fundamental part that provides vaccination programme its credibility and its “green light” was completely absent.
A regimented “command oriented” programme does not see any necessity in briefing “healthcare staff in the country” either on COVID-19 vaccines. Healthcare staff was thus not updated regularly and provided necessary information about COVISHIELD COVID-19 Vaccination. Sadly, the larger majority of healthcare staff remained ignorant not only about AstraZeneca but also about other details like the “priority list”, side effects and allergies attributed to AstraZeneca, when vaccination would begin in their area and availability of the second dose. There is a frightening gap between top health officials and those in provinces regarding information about the vaccination programme.
All that leaves the actual workplan for immunisation covering the second dose as well, fundamentally unplanned. Therefore, there is no system established for proper immunisation with human and material resources necessary for both the first and the second dose. What is necessary goes beyond distributing the vaccine, having staff to provide the vaccine jab and people queued up to have it. It should have ‘waiting rooms’ for the elderly and for the immunised, a competent medical officer with staff in waiting for any emergency, an information desk to provide post vaccination details, a digitised data unit of all vaccine recipients among other necessities. It is about PHIs, FHOs and other support staff attached to local MOH offices given good briefing on AstraZeneca vaccine and then responsibilities in organising, monitoring and regulating the area vaccination programme with necessary facilities including networking with special units established in all hospitals for emergency care.
Where all decisions are taken by a few in Colombo, where programmes are run on “orders and directives” issued from Colombo, where local healthcare staff are not given a thorough brief about the vaccine, a clear responsibility with a mandate to carry through a “workplan” for immunisation with well calculated targets, what we are left with is “passing of the buck” from decision makers and health authorities to politicos and to the people. That, we do not have to. We have a very well trained and organised community healthcare service that should be immediately briefed on COVID-19 virus and used with strengthened and equipped MOH offices as the main focal point in local immunisation campaigns.
We are still mainly held up in Colombo city and its suburbs and do not have to carry over the mess we see around us to other districts and provinces. The only fundamental change that needs to be made right now is to shift from the present “command and order” approach accompanied by “threats and punishments” to a “community-based programme” with people’s participation. We have enough time for a “people’s change” with required vaccines coming in short supply too giving us added time. Sadly, even “community healthcare” experts don’t demand this positive change.
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