Sri Lanka: Perils of Vaccine Diplomacy

When the vaccine shortfall erupted, it was thanks to Sri Lanka’s non-aligned diplomacy that it could turn to China which immediately provided a gift of 600,000 doses of its Sinopharm in March followed up by 500,000 doses in May. 

by Dr Sarala Fernando

Prime Minister Modi led the global response to Covid 19 with his vaccine maithri diplomacy. By end of March 2021 India had supplied 60 million doses of its locally produced Astra Zeneca or Covishield to over 70 countries through grants in aid, gifts and commercial transactions. Sri Lanka was fortunate and grateful to be one of the earliest beneficiaries under the Indian gift, receiving 500,000 doses at the end of January. This, together with a similar amount purchased from the Serum Institute combined with the WHO first Covax donation of 264,000 doses enabled the vaccination roll-out in Sri Lanka to begin early.

However, in a twist of fate, the Modi government is now being criticized in India for generosity to the world without providing sufficiently for India’s own needs while at the other end of the spectrum, governments like the UK are being criticized for hoarding vaccines in an abundance of caution over new variants!

As a recipient country Sri Lanka’s dilemma was different, having made the initial mistake of deciding to control the import and distribution of the vaccines without private sector participation. These controls have led to unending charges of lack of equity and transparency, generating a public uproar which has become like a ticking time bomb for the government. Take for instance the first WHO Covax donation to Sri Lanka which was intended for the most vulnerable, the elderly, numbering some 2.65 million over 60’s . However the elderly are way down on Sri Lanka’s priority list. Now that Covax has confirmed it will provide a second round of Astra Zeneca, will the authorities target the elderly, at least those within the 600,000 waiting for the second jab?

When the vaccine shortfall erupted, it was thanks to Sri Lanka’s non-aligned diplomacy that it could turn to China which immediately provided a gift of 600,000 doses of its Sinopharm in March followed up by 500,000 doses in May. This gift was initially administered in both doses to the Chinese community in Sri Lanka and enabled a trial run to see its efficacy on new infections and morbidity rates. It is a pity the Sri Lanka government has not released this data which would help build confidence in the Chinese vaccine even as the Western manufacturers are ramping up their publicity for their own vaccines. France has recently announced free entry for visitors having one of the western vaccines, Pfizer, Moderna or Astra Zeneca, casting those with the Chinese and Russian vaccines into quarantine requirements.

However now that the US coming out of the Covid crisis, Sri Lanka’s best hope for meeting its urgent needs of the Astra Zeneca, resides with the US which is holding large stocks of this vaccine (which has not been authorized there). The question is whether Sri Lanka, applying its friendship-with- all foreign policy, will be able to lobby at the highest levels in the US and obtain the required second doses for those waiting here patiently for almost four months now. President Biden’s plan is to make available immediately some 19 million doses through Covax and he has refuted any political bias: “We are sharing these doses not to secure favors or extract concessions… we are sharing these vaccines to save lives and to lead the world in bringing an end to the pandemic, with the power of our example and with our values.” South Asia, including Sri Lanka, was supposed to receive some seven million of these doses through Covax. So why has there been no public announcement here on this second donation from Covax?

Mr Biden has spoken of an “arsenal of vaccines” and has pushed the G7 to match his pledge with another 1 billion doses in this new global campaign. However some worry that this American campaign may become part of a new Cold War to push back on the Chinese and Soviet vaccines that have come to the forefront thus far, supplying many developing countries in their time of need. Domestic politics is clearly playing into vaccine manufacture around the globe. President Biden’s new campaign to donate billions of vaccine doses will focus on the Pfizer vaccine developed by BionTech in Germany and produced in the US. Nevertheless, good intentions and public relations apart, the US campaign may run into trouble given that the Pfizer requires stringent cold chain conditions, not generally found in tropical developing countries.

The Government here has been unable to obtain vaccines in any predictable fashion although from time to time we hear that supplies for the missing 600,000 doses have been secured from one country or the other. Some say Sri Lanka is misreading diplomatic courtesy eg. “to give sympathetic consideration” to our request does not mean that the vaccine donation has been agreed. Even the Japanese embassy in Sri Lanka has not confirmed the press reports in Colombo that they have promised to provide the vaccines needed in Sri Lanka. How can Japan make such an announcement amidst their domestic crisis where infections are rising and there are huge protests over whether the July Olympic Games will become a health threat to the country. Nor is it clear whether any future Japanese donation, will be Covishield or Pfizer manufactured in Japan.

The Government has recently announced that 300,000 doses of Pfizer has been paid for and will arrive in July and that it will be like a “trial run.” Pfizer has to be stored and distributed at below zero conditions and in Sri Lanka for example, the only such cold storage is said to be at the Blood Bank. Significantly Japan has extended a grant of US$ 3 million through UNICEF to enhance cold storage capacity (cold chain equipment, walk in cold rooms, ice lined refrigerators, vaccine carriers) in Sri Lanka. This is only part of the problem, as everyone agrees the Pfizer is best given in hospitals and clinics and is not suitable for mass vaccinations such as at Campbell Park. Judging by the chaos of the vaccine roll-out so far, if indeed the purchased Pfizer vaccines are arriving in July in Sri Lanka, should they not be administered as a public-private partnership to better manage the huge crowds defying social distancing requirements? How will the government address the competing demands for different vaccines at a time when the Sinopharm and Sputnik are being rolled out around the island?

Another problem amidst the confusion on statistics is whether the government knows how many in fact have already obtained the second Covishield jab, by hook or by crook? At hospitals like Lady Ridgeway and Army hospital where the immunization campaigns were conducted professionally, they had retained sufficient to give the second jab to those vaccinated on their priority list. However several scandals have broken out recently alleging some have obtained the second jab through political pressure and “secret” vaccination campaigns such as in Galle are being investigated. It is well known that the GMOA had demanded and obtained the second jab at the National hospital for thousands of their members, families and households provoking much public anger. These scandals bring into focus the plight of those who are waiting patiently to receive the second jab of Covishield. Do they have reason to fear that any new stocks will not go to the intended beneficiaries, the elderly, despite the promises made recently by the Director General of Health Asela Gunawardene, who is at last speaking out and is probably the only credible voice on government vaccine policy.

Sri Lanka’s public health service has a fantastic reputation and is known for its stellar performance and ability to handle crises such as the Tsunami. Even during the armed conflict, children were vaccinated under a truce with the LTTE. Today it is apparent that this system has broken down and many are questioning the lack of vaccines, the modalities of the roll-out, even the accuracy of the statistics. No explanation yet about the validity dates of the Government held Covishield stocks still being given in driblets through various centres, while some African countries are reported to be destroying vaccines that had expired.

A larger problem is looming on the horizon with many manufacturing countries ramping up production. By the end of the year, some believe there may even be a glut of vaccines in the market leading to a price war. For all these reasons, the government should be cautious in trying to enter into any speedy local manufacturing of the Chinese or Russian vaccines in this country. There are several manufacturers now with long experience and reliability accelerating production in India including on the new Novavax and it is a matter of time by the end of the year when the Serum Institute resumes its exports of Covishield and fulfils its contractual obligations.

Instead of going into local manufacturing of vaccines, shouldn’t the government focus instead on a big problem that has already arisen in Sri Lanka on disposal of Covid waste, vials, needles, PPE and masks? Not so sexy as local manufacture of vaccines but perhaps a more enduring problem for the nation’s environment and wildlife.

(Ms. Sarala Fernando, retired from the Foreign Ministry as Additional Secretary and her last Ambassadorial appointment was as Permanent Representative to the UN and International Organizations (including WHO) in Geneva . Her Ph.D was on India-Sri Lanka relations and she writes now on foreign policy, diplomacy and protection of heritage).