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Saturday Dec 28, 2024
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Dr. Palitha Abeykoon
By Darshana Abayasingha
“On a relative scale, Sri Lanka has managed the COVID-19 pandemic quite well. At the start there were a few issues, but most of these got sorted out in good time,” opines Dr. Palitha Abeykoon, Senior Advisor to the World Health Organization and the Ministry of Health in Sri Lanka. He remarked that the world has the means, knowledge and technology to combat outbreaks, but the question remains whether these are available to all countries in an equitable manner.
Eminent Sri Lankan physician, Dr. Palitha Abeykoon, continues to serve as a leading light in the arena of managing global health, with his recent appointment to the Global Preparedness Monitoring Board. Co-convened by the World Health Organization (WHO) and World Bank Group, the Global Preparedness Monitoring Board (GPMB) provides comprehensive appraisal of global readiness to meet health emergencies, and Dr. Abeykoon is its only member based in the South Asian region. He was also a former WHO Special Envoy for COVID-19 Preparedness and Response.
As an independent monitoring and advocacy body, the GPMB urges political action to prepare for and mitigate effects of global health emergencies. The Board builds on work of the Global Health Crises Task Force and works independently of all parties, including its co-convenors. Each year the Board prepares a report that captures all lessons – positive as well as negative – from events and available science – and describes the current state of global preparedness and lays out a roadmap for a saferworld. The GPMB comprises globally recognised leaders and experts from a wide range of sectors.
Creating a prepared world
Dr. Abeykoon states his role within the GPMB is to bring into focus the public health aspects of preparedness and response based on his expertise and experience in Southeast Asia, and more importantly the lessons and learning as the WHO Director General’s Special Envoy for COVID-19. Devising necessary support to drive universal adoption of findings and recommendations was described as another key aspect.
Formed in 2018, the GPMB in its first report just before the initial cases of COVID-19, outlined a ‘cycle of panic’ that characterises global response to epidemics and pandemics. Despite the lessons of SARS, Ebola and H1N1, the world remained unprepared for a pandemic of a respiratory nature that could kill millions. The WHO together with the World Bank and other member states have now put in place a more comprehensive architecture for health emergency preparedness through the GPMB.
When asked how he would rate the global response to COVID-19, Dr. Abeykoon pointed out the pandemic taught us all many important lessons.
“The mistrust caused by an inequitable and incomplete COVID-19 response has demonstrated the importance of transparency and inclusivity. The still unsettled controversy about the origin of the virus is an example of this lack of transparency. The lack of a legal mechanism that binds countries to report any incidents that seem likely to be of international concern was a major deficiency in the COVID-19 response. The general belief is that somehow for whatever reasons China was slow to notify the outbreak. Therefore, a strong independent monitoring mechanism with authority is needed to provide a clear perspective.”
Everyone must do better
On how prepared the world is now to take on a new global pandemic such as COVID-19, Dr. Abeykoon said, “The answer must be a qualified yes, but it is ambiguous.” He noted COVID-19 underscored that preparedness must go far beyond the health sector. In many countries this was not the case, and is still not the case. The world has the means, knowledge, technology like vaccines and medicines, but the question is whether these are available to all countries in an equitable manner, Dr. Abeykoon said.
The main reason why COVID-19 is still lingering on (with the possibility of further outbreaks) is the fact that most developing countries did not get vaccines, and test kits and medicines were inadequately supplied and in time, he said. Some African countries have still not vaccinated at least 50% of its population with even one dose, whilst most developed countries have administered at least three doses and some four.
“This vaccine nationalism that Dr. Tedros describes will affect incidence and spread of future pandemics if they do arise. One function of the GPMB is to prevent these types of inequities, and preparedness essentially includes attention to minimise such disparities. Throughout the pandemic, GPMB highlighted gaps and key actions for preparedness to break that cycle. The Board has called on world leaders to take urgent action,” Dr. Abeykoon stated.
COVID in Sri Lanka
“How has Sri Lanka fared in comparison to peers in managing COVID-19?” the Daily FT posed to the members of the GPMB.
“On a relative scale Sri Lanka has managed COVID-19 quite well. At the start there were a few issues mainly with information and coordination, but most of these got sorted out in good time. These included the irrational disinformation, the myths and mysticism that were expounded regarding its management. Other areas we could have done better included better sharing of timely credible information, stronger community involvement and closer adherence to public health and social measures. Crucially, the pandemic highlighted the cardinal importance of good public health. It touched the core of the public health mission; and public health was the most vital intervention in reducing transmission and minimising burden on the healthcare system.”
“I have a minor regional role in the pandemic and I can say that relative to other countries in our region, and even though we could identify a few areas that we might have handled better, by any estimate I believe Sri Lanka has managed the pandemic reasonably well. We constantly gathered new information and evidence about the disease to inform and plan our response. If there is one lesson to us from the epidemic, it should be the central need for further strengthening our health system, built on our public healthcare infrastructure,” Dr. Abeykoon stated.
Vaccine Injustice
The GPMB Board member lamented developing countries’ struggle to obtain vaccines, as they had been bought and stockpiled by richer countries with political power, who even grabbed five or ten times their total need. Some countries are yet to administer a single dose to over 10% of the population, he said. “We have heard a lot about global solidarity, but unfortunately words alone will not end the pandemic and bring about solidarity.”
The WHO’s Director General Dr. Tedros Adhanom says it has sadly proven to be ‘vaccine injustice’, he pointed out.
Like other pandemics, this pandemic also has thrived on inequity, causing substantially higher mortality among those living in poverty and in disadvantaged groups as well as amongst elderly and those with chronic comorbidities. A second set of countries had issues with engaging the community and were adversely affected by disinformation. In some developed countries anti-vaccine groups that were fringe groups started becoming mainstream groups. These were mostly in developed countries and consequently many deaths that could otherwise have been prevented did take place, Dr. Abeykoon pointed out.
“We keep saying no one is protected or no country is protected until all are protected. If we believed in what should have happened, there should have been equitable sharing of global vaccine supply according to an order of priority on strict criteria. This did not happen,” he added.
Thirdly and crucially, the pandemic has highlighted the cardinal importance of good public health experts, which many developing countries do not possess. In this respect Sri Lanka was fortunate to have a pool of extremely qualified and experienced public health experts who lent their support to the COVID-19 effort, Dr. Abeykoon said.
Enhancing supply chains
Responding to a question on readiness and developing more equitable supply chains for vaccines and other essential medical goods, Dr. Abeykoon said this was a very important aspect of preparedness.
“Preparedness must include availability and access to diagnostics, vaccines and other technology. The lesson from COVID-19 is that countries will not voluntarily adhere to equity and fairness and nationalism prevails. The vaccines and other diagnostics were not shared fairly and this gave rise to problems. Particularly with vaccines. China was a major player in vaccines but not the main player. Some countries depend on China to a large extent but other vaccine manufacturers delivered much larger quantities of vaccines than China. The lesson has been to widen the number of vaccine manufacturers and the WHO and international community under the Covax mechanism has already set about doing so. It is setting up vaccine manufacturing in South Africa for the African region and manufacturers will be supported in the Asian Region also. China is a major player in diagnostics also, but this area too is now being coordinated by the same mechanism. I do not know if China is sharing vaccine technology with other countries. Perhaps it will,” he said.
Commenting on the privilege of being the only Sri Lankan and South Asian on the board, Dr. Abeykoon modestly confessed he was honoured to be a member of this board that consists of some of the global leaders in each of the represented fields. “I hope I will be able to offer my advocacy and technical inputs in all relevant areas of public health. I am somewhat informed on including health system strengthening to respond fast and to build resilience, community empowerment and engagement, and relevant aspects of epidemiology such as health risk assessment. I feel that my long experience in the WHO and in Sri Lanka will come useful in this work,” he enthused.
Towards a healthier future
The GPMB’s latest report titled ‘From Worlds Apart to a World Prepared’ outlines how the failures of the COVID-19 pandemic were rooted in inequality and inaction. Over the past five years, most governments, health departments and various non-governmental organisations in our region, often supported by the WHO, have proposed and implemented multiple measures of public health emergency preparedness. Despite these efforts still the picture of national and regional level preparedness is not clear enough. Sometimes due to ambiguous preparedness goals, and a weak system of accountability. International Health Regulations also require further streamlining. “I will work with the relevant parties to strengthen the levels of preparedness in the South East Asian Region.”
One task is to support the current negotiations led by WHO for an Emergency or Pandemic Accord that will be a statutory instrument to hold countries accountable and responsible. It will strengthen the global architecture beyond measure. “I will contribute as best as I can to make sure the preparedness for all emergencies, particularly for pandemics and to see these are undertaken at sufficient scale. That it results in a global architecture that is more effective, sustainable and more equitable and inclusive. The GPMB’s role as an independent watchdog will be essential to ensure that the new global architecture lives up to its promise. We need a world that is better prepared.”
