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Sri Lanka faced significant health threats due to the pandemic and is attempting to regain a sense of normalcy, along with the rest of the world. The country’s challenges have been made worse due to the unprecedented economic and political crises. Despite the fact that a new variant has not emerged as a cause for concern following Omicron BA.5, it is important to recognize that the threat of the pandemic still looms large. Additionally new outbreaks such as monkeypox, recently declared a Public Health Emergency of International Concern (PHEIC), remains threats globally. Sri Lanka also faces challenges to its public health due to local outbreaks such as dengue and rise in non-communicable diseases. Thus, as the country navigates its economic crisis, there is significant value in strengthening our health system addressing preparedness for global threats as well as local threats. This article will explore existing key health threats and the importance of prioritizing the health system especially at a time when resources remain low.
Continued impact of COVID-19
While many countries are looking at living with COVID-19 as their long term plan, the impact of the pandemic continues to be felt across the globe. For example, in the United States that continues to record a daily average around 400 deaths, the government has taken off most of the public health mitigation efforts despite many public health experts advising against it. This development could be due to the highly polarized response to public health measures. Globally, we recorded 4.5 million new cases although COVID-19 infections dropped by 16% in the week of August 22 to 28 compared to the previous week. Just a couple of months ago, as Omicron BA.5 subvariant drove up the numbers infected due to its relatively high capacity to evade existing immune responses, vaccine companies have sought to develop more targeted vaccines for the public. These vaccines will continue to be administered as booster doses. Additionally, given the continued vaccine inequity, there is a strong chance of another variant emerging and becoming a variant of concern. Another perhaps an understated concern is the impact of long-COVID. Long COVID, which can impact anyone who has contracted COVID-19 with long term effects such as fatigue, fever and brain fog, does not have clear diagnostic tests and can affect the daily life of a person. Therefore, investing in minimizing potential infection spread, relevant booster coverage will be important. The benefits include having a healthy work force, not overtaxing a resource depleted health system and avoiding any unexpected surges of novel variants.
Rise of monkeypox as a PHEIC
A public health emergency of international concern is only declared when a disease has the potential to threaten global population. Globally, 41,664 cases and 12 deaths have been reported across 96 countries/territories. Monkeypox, which saw a rapid rise in cases especially in the European region, significantly affects men who have sex with men, with multiple partners, relatively more. However, it is important to avoid stigma especially from a standpoint of public health safety since monkeypox can spread among anyone through close, often personal skin to skin contact. Currently, monkeypox is considered to pose a moderate threat globally and the case numbers in the South Asia region remains low. While Sri Lanka is currently relatively unaffected from this threat, being prepared is important.
Additional emerging global health threats
As the climate crisis continue to impact us globally with many natural disasters, the increased number of diseases jumping from animals to humans will grow. Furthermore, the world is also facing serious global health threats such as Anti-Microbial Resistance (AMR) where antibiotic resistant pathogens (bacteria, fungi) impact the health of the global population. Strengthening Sri Lanka’s health system both at the level of resource availability (e.g. meeting targets of increasing ICU bed capacity by 10 percent every year) and improving stewardship on AMR to reduce over or misuse of antibiotics are key factors to protect the health of the population.
Local health threats
Local outbreaks such as dengue also continue to impact Sri Lanka. This year has seen over 50,000 cases of dengue, reminding us even as we face global emerging and existing health threats, more specific threats that existed continue to affect us. In addition to continued impact of infectious diseases Sri Lanka will also need to be aware and mindful about non-communicable diseases affecting our population especially with a growing ageing population. The demographic models indicate an increased older population. If we are to successfully support them, we will need to strengthen our health system improving aspects ranging from accessibility to care. Other crucial needs such as mental health needs will need continued support to grow especially in a time where we witness self-harm and suicides due to prevailing socio-economic conditions.
Given all these challenges, Sri Lanka needs to take timely and thoughtful action in strengthening the health system and supporting health care workers. While being aware of the resource constraints, prioritizing strengthening the health system will pay dividends economically as it will directly contribute to maintaining the health of the workforce and reducing further health related costs by preventing disease spread. Neglecting or de-prioritizing preparedness and other health system needs in relation to the pandemic and emerging global and national level threats puts an already vulnerable community at risk with a health system that is under resourced.
The author is a doctoral candidate in global health policy at McGill University. He is formerly a Policy Associate at the Center for Policy Impact in Global Health at the Duke Global Health Institute.
