Photo courtesy of dsrmedias.com
Although Sri Lanka managed to control the initial COVID-19 outbreak, the country is now at a critical juncture where political and public health priorities are at odds. There is an election scheduled for August 5, and the country recorded 300 cases – the highest number of cases within a day – on July 10. The pandemic is still raging across the globe with over 13 million number of cases and over 573, 000 deaths globally. As experts point out a vaccine is at least 12-18 months away and will face challenges related to access that will disproportionately affect less wealthy nations.
In this global backdrop and rising number of cases locally, it important to both re-evaluate Sri Lanka’s political and policy priorities in the interest of public health. It is also important to distance ourselves from political priorities and to focus on how best we can successfully sustain our efforts in saving lives.
Two questions can help Sri Lanka guide its way in addressing these changes: first, how can we maximize the early success against COVID-19? Second, what lessons can we learn from our mistakes?
How can Sri Lanka maximize its early success against COVID-19?
The success in Sri Lanka can be broken down to four main factors: i) political will ii) using science to guide policies iii) the public health system iv) dedicated collective effort.
First, in a public health emergency political will is vital to act in a timely manner and to provide relevant financial and logistical backing. Sri Lanka, since reporting the first case in late January, reacted with deliberate containment policy efforts from the highest office of the country. The political will needs to continue to support COVID-19 combating measures, and prioritize public health in a fair, equitable manner. Political will is also a combined effort, requiring politicians of all parties to commit to supporting the COVID-19 response. This effort includes not exaggerating the success of containing COVID-19, not downplaying the threat of COVID-19 and not disregarding the importance of public health measures. This effort also includes financial commitment from the government and ensuring transparency related to all COVID-19 financing efforts of both external aid and local funds.
Second, policies need to remain grounded in science. Many countries that are failing, are failing due to their political leadership not using scientific evidence to guide its policies. Both the United States and the United Kingdom which were considered better prepared to face a pandemic have failed miserably due to their political leadership disregarding scientific guidance. Thus, it is alarming to hear the disagreement between the Jayewardenepura University testing lab and the government authorities on test results of COVID-19, which led to the university exiting the testing. Swift resolutions are needed in ensuring that the integrity of the science is respected. Additionally, task forces related to COVID-19 can be improved by including public health officials instead of just members of the military.
Third, the public health system is key and so are healthcare workers. The dedication of healthcare workers brought us thus far. Therefore, ensuring their protection by continuing to supply necessary personal protective equipment and providing on time payment is very necessary for the continuation of containment of COVID-19. Additionally, the health system needs strengthening to sustain an elongated response including more capacity for testing and tracing. In addition to external aid, such as US $128 million from the World Bank to strengthen the COVID-19 response in Sri Lanka, further long-term government commitment will play a huge role in the response and recovery from COVID-19.
Fourth, Sri Lanka’s success was due to a country-wide collective effort and that needs to be recognized by both the people and the government. This means following health guidelines and continuing to provide support to essential workers such as grocery store workers and bus drivers to stay safe. This also means not placing the blame on the public or select group of people such as ethnic groups or those returning via repatriations. Finally, it also means managing the burden on healthcare workers by prioritizing their needs and being respectful towards their efforts.
What lessons can we learn from our mistakes?
The three main areas Sri Lanka can improve on are i) communicating policy decisions clearly ii) minimizing stigma and iii) following health guidelines.
Although the Health Promotion Bureau is doing a commendable job in getting the facts to the public, Sri Lanka’s policy decision communication has been confusing and at times contradictory. Most recent example being the conflicting statements by the top public health official and the top military official related to community spread in Sri Lanka. Many instances of the curfew related news and explanations in the past few months led to confusion among the public. As the COVID-19 cases increase lack of clear policy communication leads to panic buying and sharing misinformation via social media – some of which are happening right now. Therefore, policy decisions require clear explanations that are logically backed by science, to “bring the people along with the government” as policy decisions are made. Thus, the responsibility of clear, easy to understand, tri-lingual communication lies with all arms of the government, not just the Health Promotion Bureau. However, if the decisions are politically motivated, then we are not only risking confusion due to unexplainable policies but also are risking the lives of the people. Media and social influencers should also prioritize responsible communication based on verifiable facts. The media and influencers are also obligated to educate themselves to avoid spreading of misinformation and harmful half-truths. Resources such as epidemiology crash courses for journalists are available by top experts online.
Sri Lanka, did poorly in managing stigma related to COVID-19 both at a societal level and at a policy level, especially the specific targeting of the Muslim community and those in armed forces calls for better measures on tackling stigma. The change in the burial guidelines from the WHO interim guidance and lack of a clear explanation has disproportionately affected the Muslim community. In cases of both communities (Muslims and armed forces), many issues arose from unethical journalism practices, lack of awareness of the impact of stigma, and delayed policy response from the government in relation to handling stigma. Thus, equitable policies based on science and active advocacy against stigmatizing communities are required from the government. Additionally, the Sri Lankan public, media and influencers can play an active role in taking action against stigma. Politicians have an added responsibility to not spread rumors related to minorities for political gain during the pandemic. The absence of clear policies and protections against stigma can lead to less people testing, as stigma can be a significant threat to public health.
It is sad to note that the most significant violations of health policy guidelines were by politicians – belonging to all major parties – in Sri Lanka. Many public political gatherings during the lockdown blatantly violated the health guidelines and politicians continue to violate health guidelines with impunity. The law has also been selectively enforced, at times brutally, on those who lack political power. Perhaps the selective, preferential treatment for politicians remains the single, biggest challenge to tackling COVID-19 as it encourages the public to violate guidelines when the opportunity arises. Moving forward with an election on the horizon political gatherings, regardless of parties, should consider public health to be their number one priority and postpone if needed. Clear guidelines are needed for political rallies to protect the health of the candidates and the general public. A call has gone out for issuing health guidelines on the election processes. Such guidance is required urgently and will provide election monitoring bodies avenues to contribute towards protecting public health. If public health officials declare postponement of rallies or elections, pushing against these guidelines will invariably risk the health of the public and eventually the stability of the country.
In conclusion, there is a clear theme that has emerged in both what Sri Lanka has done successfully and where it has fallen short when responding to the COVID-19 pandemic: Sri Lanka has succeeded when we have prioritized science over politics and lives of people over political gain. Sri Lanka has fallen short when political priorities have interfered with public health priorities. Thus, if Sri Lanka is to follow in the footsteps of countries such as New Zealand to reach zero cases, our success is dependent on actions of our leadership, which includes not only the President but leaders of all political parties, health officials, ministry officials and leaders of businesses and organizations.
The pandemic is far from over. Sri Lanka needs to prioritize saving lives of the people over politics – right now and at every juncture.
The writer is a Policy Associate at the Center for Policy Impact in Global Health of the Duke Global Health Institute. He tweets at @ShashikaLB