- Presidential Advisor Lalith Weeratunga says ensuring consistent vaccine flow key challenge to immunisation campaign
- Says focus on vaccinating economically important population segments
- Even though 26 m doses needed, Govt. has received only 1.2 m
- Wants 13 m people above 30 years vaccinated quickly
- Observes no issues with vaccine drive, public support
- Govt. willing to accept private sector support, proposes funds funnelled through Treasury
- Assures no funding issues as State supported by WB and ADB
By Shailendree Wickrama Adittiya
Principal Advisor to the President Lalith Weeratunga
Regular and consistent supplies are the greatest constraint faced by the country in terms of COVID-19 immunisation, Principal Advisor to the President and Presidential Task Force for National Deployment and Vaccination Plan for COVID-19 Vaccine Chairman Lalith Weeratunga said recently.
He was speaking on Thursday at a conference organised by the World Bank, which saw the participation of representatives from the World Health Organization (WHO), COVAX, Government of India, and the Serum Institute of India. During the discussion, Weeratunga said the current focus was on vaccinating as much of the economic sectors as possible.
“We have gone through two major groups. That is the frontline health workers as well as those working with the frontline workers who come from the armed forces, the Police, and the State intelligence services,” he said, explaining that the country has received 500,000 doses of vaccines as a donation from the Government of India, 500,000 doses purchased from the Serum Institute of India, and is expecting 260,000 doses through the COVAX facility.
“With a population of 21 million, we need to vaccinate at least 13 million people who are above 30 years old, which means we need 26 million doses. Right now, what we have got is 1.2 million doses,” Weeratunga said.
With 4,000 vaccination centres across the country, the COVID-19 immunisation program is being carried out through the 14,000 Grama Niladhari Divisions in Sri Lanka.
“We are now concentrating on the epicentre of the epidemic, that is the districts of Colombo and Gampaha which are fairly populated districts. We want to ensure that everybody above 30 will be vaccinated as early as possible,” he added.
Weeratunga went on to explain that the constraints would be a regular and consistent supply of vaccines and that the country was awaiting support from COVAX as well as contractual support from the Serum Institute of India.
He explained that if supplies are regular, rollout would be easy due to the country’s excellent health infrastructure. Flexibility in measures is assured, with the ability to scale up or down to suit the needs of the population and ensure there are no dry periods, where no one is vaccinated.
“We depend very much on vaccine supply and we do not foresee many issues at the moment. We do not see any adverse reactions from our population. And we also do not see any hesitance, which is very important,” he said.
With regard to financing, Weeratunga’s remarks pointed to the State’s willingness to accept private sector involvement and support, a shift from their stance at the initial stages of the immunisation program.
“The large [private sector] employers have pledged that they would also contribute to the Government’s effort to vaccinate the people, but Sri Lanka’s policy of vaccination is that every citizen will be vaccinated absolutely free of charge,” he said, adding, “But if there is any support from the private sector, that can go into a Government fund to the Treasury.”
He, however, stressed that the country does not face any issues in terms of financing, as the Government has allocated considerable funds and the World Bank and the Asia Development Bank having pledged a fair amount of assistance.
Weeratunga’s remarks were in response to questions that highlighted key challenges in vaccinating South Asia. World Bank Vice President for the South Asia Region Hartwig Schafer discussed these challenges during the opening remarks.
A key point highlighted by Schafer was how effective protection against the pandemic requires greater regional cooperation. “This is absolutely important because significant amounts of vaccines have to be allocated across borders and the countries in South Asia need to take initiatives and have started to take initiatives to share information about this and to make this transport and logistics chain easier,” he said.
It was also important to learn from the pandemic and prepare as countries and a sub-region for the future.
He also shared information on the vaccination project carried out by World Bank, saying: “Over the next couple of weeks, we will take the first project for vaccination forward. This is, of course, in close collaboration with COVAX.”
The first three countries to receive vaccines through the project will be Afghanistan, Bangladesh and Nepal. They will be followed by Pakistan and Sri Lanka. The program will complement COVAX.
According to Office of the COVAX Facility Country Engagement Director Santiago Cornejo, Sri Lanka is among the countries set to receive COVAX supplies this weekend, along with Nepal, Maldives and Afghanistan. The South Asian region is looking at an allocation of 82 million doses by May this year, with the target of COVAX being to deliver at least 2 billion doses globally by the end of 2021.
The facility is also lending financial support to manufacturing in order to ensure early access.
“We are very optimistic about where we are. Based on our deals, we have approximately secured deals for over 2 million doses already, of course subject to scale production and approvals, but we believe that we are on track,” he said.
Cornejo added that Gavi is also mobilising financial resources to pay for vaccines for the 92 most vulnerable economies, which include the eight South Asian economies. The target is to supply at least 1.3 billion doses to these 92 economies in 2021, but the mechanism will be long-term.
According to him, $ 16 million has been provided to South Asian countries for storage equipment and $ 26 million has been provided in technical assistance.
World Health Organization
The World Health Organization plays a key role in the pandemic and the COVAX facility. “The first milestone was last week when the COVAX shipment from the Serum Institute of India started going out. Over 10 million doses have gone to 15 countries and this is just the beginning,” World Health Organization Chief Scientist Soumya Swaminathan said.
She added that 5% of COVAX supplies will be for humanitarian needs, for instance for refugees or migrants who are not being vaccinated by the countries they are currently in. This program will commence from April.
“While some high income countries are now completing their high risk groups and going onto vaccinate the lower risk adults in their populations, many countries, over a hundred countries, are still waiting their first doses of vaccines,” Swaminathan said, emphasising the importance of facilities like COVAX.
In addition to ensuring equitable access to vaccines, WHO and other agencies are also currently preparing to issue guidance on criteria that manufacturers and developers of vaccines will be required to adhere to when they modifying vaccines in the face of mutations and variants.
The criteria will simplify the process of phase three clinical trials, she explained.
“One of the goals that CEPI and the partners of COVAX are putting out for the next pandemic is a 100-day goal. You need to have a vaccine out within a hundred days and scientifically and technically it is possible to do but you need a lot of advanced preparedness and investment,” Swaminathan said in response to a question on preparing for the next pandemic.
Serum Institute of India
The one million doses currently being put to use in Sri Lanka as well as the vaccines expected through the COVAX facility are AstraZeneca COVID-19 vaccines manufactured by the Serum Institute of India. The CEO of the Serum Institute of India, Adar Poonawalla, also took part in the discussion, sharing his views on the pandemic, vaccination and constraints.
“When the pandemic came about and was announced around about this time last year, we had to commit and take huge risks in partnering with the right scientists and institutions. We had to buy equipment at short notice,” he said, explaining that facilities had to be refitted to be able to handle the technologies needed to produce large quantities of vaccine doses at a rapid pace.
This allowed the Serum Institute of India to ship out 90 million doses of vaccines to 51 countries, including India, when they received emergency use licensure in India in January. At present, the distribution of vaccines in India and out of India is almost at a 50:50 ratio.
Poonawalla explained that Serum Institute supplies are being focused to COVAX as this would ensure equitable distribution and not put the burden of decision-making on who gets how many vaccines on the manufacturer.
With regard to constraints, he shed light on the need for regulatory harmonisation between organisations like WHO and countries like India, US, and UK. This would allow for a common platform enabling parallel approvals.
“If regulatory harmonisation can happen, not maybe to 100% but to some extent, we can shave off time,” he stressed.
Another constraint Poonawalla highlighted was regulatory restrictions imposed on the export of raw material and critical items like bags and filters required for vaccine manufacturing.
“The Novavax vaccine that we are a major manufacturer of needs these items from the US. Now the United States has chosen to evoke the Defence Act, in which there is a sub-clause which prevents the export of critical raw materials required for local vaccine manufacturers,” he explained.
This puts severe limitations on the manufacturing capacity all over the world.
“We are talking about having free global access to vaccines but if we cannot get the raw materials out of the US, which a lot of manufacturers and not just Novavax needs, that is going to be a serious limiting factor for other manufactures to scale up,” Poonawalla stressed.