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The College of Community Physicians of Sri Lanka has expressed grave concerns about the current process and the direction of Sri Lanka's COVID-19 vaccination campaign.

Issuing a statement on Saturday (22), they observed that ad hoc decision-making without a clear strategic plan in the vaccination campaign to fulfill individual requirements or respond to critics has created chaos.

They noted six issues with regard to the country's vaccination campaign and urged the authorities to allow technical experts to handle the vaccination campaign without undue interference.

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"The COVID-19 vaccination has become the most discussed, advanced, and accelerated vaccination campaign in human history.

Experts envisioned nightmare scenarios that included vaccine mafia, inequitable distribution and thus set up an international initiative called COVAX to ensure equitable access by all countries to vaccines, irrespective of their income level.

However, global vaccine inequity was inevitable and showed a gross disparity in vaccine distribution. Vaccination in high-income countries was 80 times more compared to low-income countries.

Since Last week of January 2021, Sri Lanka received three different vaccines (AztraZeneca, Sputnik, Sinopharm) primarily as donations and purchased only 500,000 AstraZeneca vaccines.

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Following the initiation of vaccination campaign, Sri Lanka has experienced and is still facing a surge of cases. Only ~8% of the target population has so far received at least a single dose of vaccine against COVID-19.

The COVID-19 decision-making process in Sri Lanka is a fully centralized procedure with all decisions related to resource allocation, control strategies, vaccination deployment, etc.. are taken at the top level.

We observed that too many decision-makers and lack of coordination have led to many issues during the COVID-19 control in Sri Lanka.

The Sri Lankan Immunization programme is globally considered as one of the most successful, with high coverage and early achievements in many global initiatives, including polio and measles elimination.

The Epidemiology Unit of Sri Lanka is the center of excellence for vaccine procurement and surveillance for adverse events following immunization.

The history of vaccination in Sri Lanka dates back to the 19th century.

The program functioned in a decentralized manner fully integrated into the public health system. All public health staff at the divisional level, including MOH, SPHI, PHI, PHNS, SPHM, and PHM, are well trained in the vaccination procedure.

The COVID-19 vaccination campaign ideally should have had timely procurement of vaccines, financial resource allocation, staff training, well coordinated deployment, and, most importantly, a clear roll-out strategy to quickly reach the high-risk groups.

This should have gone hand in hand with adequate pre-planning, risk communication, and preparation of field staff to deliver routine work uninterruptedly.

Ad hoc decision-making without a clear strategic plan in the vaccination campaign to fulfill individual requirements or respond to critics has created chaos. It will lead to short and long-term repercussions.

We have observed the following issues in the COVID-19 vaccination campaign so far.

1) Lack of a clear roll-out plan

2) Lack of prioritization of the available limited quantity of vaccines to minimize complications and deaths

3) Inadequate planning leading to demand and supply mismatch (financial as well as human resources.

4) Too many irrelevant stakeholders interfering with the vaccine campaign

5) Inadequate risk-communication

6) Uncertainty at all levels (individual, organization, and political)

With these issues in the COVID-19 vaccination campaign, irregularities in vaccine deployment (selling, unauthorized use, etc..), the uncertainty of completing the vaccination (for those who received the AstraZeneca vaccine), and many other issues have surfaced within the past few weeks.

Additionally, a deliberate attempt to tarnish the well-praised national public health vaccination program was also observed, which is carried out by certain groups.

We the College of Community Physicians of Sri Lanka, a key stakeholder with the necessary technical expertise to carry out a successful vaccination campaign along with the grassroots level public health staff, have a great concern about the current process and the direction of the COVID19 vaccination campaign.

We are afraid this would jeopardize the faith people had in our National Immunization program. Hence, we urge the authorities to allow technical experts to handle the vaccination campaign without undue interference."