1
Introduction
The Global Response to Infectious Diseases [GRID] index was introduced based on a
research study commissioned by the Institute of Certified Management Accountants,
Australia. The index was created to rank countries across the globe taking into account
the effectiveness and efficiency of leadership and preparedness of health systems
in each country in managing the COVID-19 pandemic [9]. In April 2020 Sri Lanka ranked
10th in the GRID index thus, achieving global recognition for its response to the
pandemic [9]. This paper provides an analysis of Sri Lanka's response to the 1st wave
of COVID-19, particularly focusing on three aspects: 1) trends and impacts; 2) risk
governance and 3) science policy interaction. In exploring the trends and impacts
of the COVID-19 outbreak in the country, the present paper discusses the health and
socio-economic impacts and how these impacts were reported. With regard to the aspect
of risk governance, attention has been paid to the manner in which risk knowledge,
risk assessment, communication and advocacy and monitoring with early warning were
utilised in managing the pandemic situation in the country. Further, the aspect of
science policy interaction has been examined with reference to the way science and
expertise were mobilized for decision-making and the data and evidences-related challenges
faced in countering the virus outbreak in the country. The main objective of the present
paper is to provide insights to national policy-makers on the way COVID-19 affected
Sri Lanka, and how the crisis was managed and governed.
2
Methodology
Information presented and reviewed in this paper has been obtained from various up-to-date
secondary sources including scholarly articles, government publications [both online
and print], local and international news websites, publications and websites of relevant
Non-Governmental Organizations [NGOs]; International Non-Governmental Organizations
[INGOs] and International Organizations and webinars. Apart from this, the paper has
drawn from qualitative in-depth key informant interviews conducted with sub-national
level state authorities in order to probe into how the virus outbreak was managed
at the local level and grass-root level issues and challenges. The interviews were
carried out with the District Secretary of the Polonnaruwa District; the Divisional
Secretary of the Thamakaduwa Divisional Secretariat Division [DSD] of the Polonnaruwa
district and Assistant Directors of the District Disaster Management Coordinating
Units in the Ratnapura and Badulla districts of Sri Lanka. The districts from which
the interviewees were sourced were purposively selected based on the following reasons.
The Polonnaruwa district is the focal point of rice production in the country. Rice
being the staple food of Sri Lanka, uninterrupted continuity of agricultural activities
had to be ensured in the district regardless of the constraints posed by COVID-19.
Simultaneously, said district was also host to the Kandakadu Quarantine Centre: one
of the main quarantine centres that were functioning in the island. Further, the districts
of Ratnapura and Badulla were at risk from floods and landslides respectively during
the COVID-19 outbreak which meant that these districts were faced with the risk of
compound events or parallel hazards. The mentioned districts therefore qualified as
interesting cases capable of providing insights into various dimensions of managing
the pandemic situation at the local level. Both primary and secondary data gathered
were qualitative in nature and were therefore subject to thematic analysis.
This paper primarily examines in detail the aspects of 1) trends and impacts; 2) risk
governance and 3) science policy interaction pertaining to the country's attempts
at combatting the 1st wave of the COVID-19 pandemic. The key facts pertaining to said
aspects have been summarised in fig. 01. This is followed by a discussion that provides
a gist of the key strengths and limitations of Sri Lanka's response to the outbreak
[also see Fig. 2]. Finally, the paper provides key considerations for national policing
and planning related to pandemic preparedness and response simultaneously identifying
future directions for research. (See Fig. 1.)
Fig. 1
COVID-19 in Sri Lanka: Key Facts.
Fig. 1
Fig. 2
Sri Lanka's Response to COVID-19: Key Strengths and Limitations.
Fig. 2
3
Trends and impact
3.1
Origin, evolution and impacts of COVID-19 in Sri Lanka
Throughout its history, the world has been plagued by a number of pandemic outbreaks
like the Spanish flu of 1918 and the Asian flu of 1957 [30]. The most recent and perhaps,
one of the most widespread outbreaks, is the COVID-19 pandemic, which has continued
to debilitate the entire global system. Tracing the roots of the COVID-19 pandemic,
on 31st December 2019, an outbreak of a pneumonia of unknown reason was identified
and reported from the Wuhan City in Hubei Province of China to the World Health Organization
[WHO] Country Office for China [44]. On 7th January 2020, this was diagnosed as the
‘Novel Corona Virus’. While on 30th January, the outbreak of the virus was declared
a Public Health Emergency of International Concern [PHIEC] by the WHO, on 11th March
2020 it was recognised as a pandemic [14].
In Sri Lanka, the first confirmed case of COVID-19 was reported on 27th January 2020.
The infected person was a Chinese national who had arrived in Sri Lanka as a tourist
two weeks prior to the reported date. By 27th January 2020, the Corona Virus had been
reported from 11 countries with 2798 confirmed cases and 80 deaths. The Chinese national
who was diagnosed with COVID-19 was admitted to the National Institute of Infectious
Diseases [NIID] and subject to treatment [14]. By 28th January 2020, five other individuals
were suspected of the Corona Virus, out of which two were Sri Lankan nationals. These
individuals were kept under surveillance at the NIID [14].
On 19th February 2020, the first confirmed patient was fully recovered and discharged
from the NIID. There were no other confirmed cases reported in the country until a
tour guide working with Italian tourists was diagnosed with the virus and thus, identified
as the second confirmed case [also the first local case] on 11th March 2020 [14].
By 31st March 2020, the total number of confirmed cases in the country had increased
to 122 reporting 2 deaths. By 31st July 2020, the number of COVID-19 cases in Sri
Lanka had escalated to a total of 2814, including 951 imported cases constituting
returnees from other countries, and 1833 local cases. The majority of local cases
constituted individuals from the Sri Lanka Navy and their close contacts [14]. The
latest statistics indicate that close to 2500 confirmed cases and a total of 12 deaths
have been reported in the country.
Illustrating the systemic nature of risk, the COVID-19 pandemic soon transformed from
a health crisis to a social and economic crisis causing a number of adverse economic
and social effects in the country. For example, Sri Lanka's Gross Domestic Product
[GDP], which was expected to rise by 4.5%–5% following the 2019 Easter Sunday attack,
was predicted to rise at a rate of only 2.2% when the country was hit by the pandemic
[22]. The lockdown also posed a detrimental impact on the country's key economic sectors,
namely manufacturing and services. Elaborating on this, the tourism sector, which
is one of the key service sectors in the country, contributes to around 5% of the
country's GDP [43]. However, owing to the worldwide travel bans imposed during the
pandemic period, the arrival of tourists in the country decreased by 71% in March
2020 and tourists arrivals were nil in the following months of April, May and June
[41]. Similarly, the Purchasing Manager's Index [PMI] of the manufacturing sector,
which was recorded at 54 in January 2020 dropped to 24.2 in April 2020 specifically
owing to a decline in new orders, production and employment [6,41]. Further, industrial
exports in the country dropped by 74% while agricultural exports declined by 32% on
a year over year basis, thereby posing an unfavourable effect on export earnings in
the country [41].
In addition to this, it is important to note that private remittances sent by migrant
workers to Sri Lanka contribute significantly to the country's foreign exchange earnings
[42,20]. For instance, private remittances sent by migrant workers contributed to
63% of total export earnings in the country [20]. However, workers' remittances decreased
by 32% in April 2020 thereby posing a negative impact on the country's foreign exchange
earnings [41].
Similarly, a recent labour market survey conducted among 2764 private sector establishments
revealed that while 1465 establishments were fully closed, 1025 enterprises were functioning
under their maximum capacity and only 94 establishments were functioning in their
full capacity during the pandemic period [46]. Out of the total number of enterprises
involved in the survey, 1084 employers were unable to pay salaries to their workers
during the pandemic period in the country. High levels of unemployment, loss of job
security and pay cuts resulted in anxiety and economic stress among the population
in the country [46].
The impact of the pandemic on Small and Medium Scale Enterprises [SMEs] and the informal
sector including daily wage earners was severe [46]. Illustrating this, most SMEs
in Sri Lanka were challenged by a shortage of materials to continue production or
service provision, decline in local and global demand for their products and difficulties
in repaying loans [29].
One of the most pressing issues to be noted in terms of the social impacts of the
pandemic is the disruption of educational activities. Lockdown restrictions that accompanied
the demands for social distancing resulted in the closure of primary, secondary and
tertiary educational establishments [Eg: schools, universities and support classes].
In response, the GoSL promoted continued provision of educational services online
[23]. While online education would have been the readily available solution, it has
widened inequalities in access to education and fuelled social unrest as some population
groups, specifically those residing in rural areas, did not have access to the facilities
and infrastructure necessary for online learning [23].
Another social implication that cannot be overlooked is the stigmatization of population
groups who were exposed to the public. Certain population groups, like health sector
workers and people who served at supermarket counters, were stigmatised in their own
communities. This is because they were represented in essential services that continued
to be provided despite the pandemic situation in the country, were unable to self-isolate
and were thus perceived as potential carriers of the disease (Key informant interviews,
2020).
3.2
Measures taken in response to the evolution and impacts of the pandemic
Sri Lanka's mission of combatting the COVID-19 pandemic was led under the vision of
His Excellency the President: ‘proactive intervention to prevent any outbreak of COVID-19
within Sri Lanka’ [34]. In alignment with this vision, the Government of Sri Lanka
[GoSL] acted well in advance of the advent of the pandemic into the South Asian region.
For example, a day before the first confirmed case of COVID-19 was identified in the
country, i.e. on 26th January 2020, the National Action Committee for COVID-19 was
formed [34]. Consequent to the identification of the first confirmed case, who happened
to be a Chinese traveller, the Government of Sri Lanka suspended the issue of visa
upon arrival to Chinese travellers from 28th January 2020 onwards [17,18]. Since the
reporting of the first local case, the Government of Sri Lanka enforced a quarantine
period of 14 days for all travellers who had arrived from or transited through China,
Italy, Iran or South Korea. As of 17th March 2020, all entry visas for citizens of
Austria, Bahrain, Canada, Denmark, France, Germany, Iran, Italy, Netherlands, Qatar,
South Korea, Spain, and Sweden, along with all incoming flights, were suspended as
initial measures to curb the spread of the Corona virus [17,18].
Apart from being proactive, the GoSL was also stringent in terms of its measures taken
to curb the spread of the virus in the country. Some of these measures include a ban
on all public gatherings, closure of all education centres including schools and universities,
discontinuation of non-essential services and the enforcement of an island wide curfew
with a work from home option for the population across the country [1,36]. While stringent
controls like the imposition of curfews, most often followed by the declaration of
a ‘State of Emergency’ are much called for to curtail the spread of the virus, the
justifiability of such measures has been contested on the basis of fundamental human
rights violations that are closely linked to such measures [11,39]. A ‘State of Emergency’
represents a situation of exceptional threat, danger or disaster during which the
government is vested with extraordinary powers to take rapid measures [not permitted
during normal times] to curtail the threat, even if such measures may restrict certain
fundamental human rights [3,7,8]. In Sri Lanka, a state of emergency was not declared
by the Government in the face of the COVID-19 pandemic [11]. Regardless, the GoSL
announced an island-wide curfew on 20th March 2020, approximately one week following
the reporting of the first local case of COVID-19. The curfew was implemented as a
preventive measure to curb the spread of the virus [17,18,28]. Later the curfew was
eased for most districts of the country and was limited to night hours other than
in high risk areas like Colombo, Kalutara and Gampaha. Given that no new cases of
community infection were reported for almost two consecutive months, the GoSL completely
lifted the curfew imposed on 28th June 2020 [28].
Addressing the derogation of human rights associated with the imposition of curfew
measures, the Human Rights Commission of Sri Lanka (2020) has questioned the legal
basis for the enforcement of an island wide curfew. While the relevant authorities
declared that the island wide curfew was imposed in accordance with the provisions
of the Quarantine and Diseases Prevention Ordinance of Sri Lanka, the Human Rights
Commission of Sri Lanka (2020) asserts that quarantine regulations under said ordinance
only allow for the prevention of entry into and exit from ‘diseased localities’ which
refer to areas with infected persons or those suspected of infection as declared by
the ‘proper authority’ who in this case is Director General of Health Services [DGHS]
in the country. The Commission questions the legality of extending these powers to
declare an island wide curfew. According to the Human Rights Commission of Sri Lanka
(2020), a curfew can only be regulated and formalized under the provisions of the
Public Security Ordinance No.25 of 1947. While Section 16 in Part III of said ordinance
vests the President with the authority to impose curfew and restrict the mobility
of citizens ‘where the president considers it necessary to do so for the maintenance
of public order, the provisions of the same ordinance require the President to seek
parliamentary approval of the decision by gazetting the imposition of curfew and disclosing
the details of the gazette to the parliament [35]. However, the Parliament of Sri
Lanka was dissolved on 2nd March 2020 and the parliamentary elections, which were
to be held in April, were postponed to contain the spread of the pandemic. The old
parliament was not reconvened until it was safe to hold parliamentary elections [11].
Hence, the provisions of the Public Security Ordinance No.25 of 1947 fail to provide
the legal basis for the imposition of an island wide curfew in the absence of a sitting
parliament in the country [35].
Another salient feature of the GoSL's response to COVID-19 is the involvement of multiple
stakeholders resembling a multi-sectoral approach. Elaborating on this, the GoSL's
approach to minimizing the spread of the pandemic broadly focused on four Lines of
Operations [LOOs] namely: 1) Military/Police/Intelligence LOO; 2) Medical and Health
care LOO; 3) Psychological LOO and 4) Economic and Community Well Being LOO which
called for the involvement of diverse stakeholders [34]. The Military/Police/Intelligence
LOO was coordinated by the Ministry of Defence and the main stakeholders involved
were the State Intelligence Service, Sri Lanka Army and the Police. This LOO was concerned
with identifying individuals who have either arrived in the country from contaminated
areas or have been exposed to the virus, isolation of these individuals by enforcing
measures like self-quarantine or central quarantine in quarantine centres, isolation
or complete lock-down of clusters that have been exposed to the virus, and tracing
of origins of cases [34].
On the other hand, the medical and healthcare line of operations was predominantly
carried out by public health sector authorities in the country. This LOO involved
activities like rapid contact tracing of infected persons and detecting positive cases
through laboratory confirmation of suspected persons, sampling of associates of positive
cases, random sampling of high risk areas or vulnerable communities, and sampling
at border control points [34].
Along the same lines, the Ministry of Health and Indigenous Medical Services published
the ‘Sri Lanka Preparedness and Response Plan COVID-19’ on 9th April 2020. The plan
was prepared in alignment with the guidelines provided in the Strategic Preparedness
and Response plan developed by the WHO. This constituted an action plan to handle
clusters of cases [resembling stage 03 of the four transmission scenarios for COVID-19
outlined by the WHO] and to tackle the future possibility of community transmission
in the country [36]. The plan consisted of four strategic objectives, namely: 1) Limit
human-to-human transmission, including secondary infections among close contacts and
health workers, preventing transmission amplification events and preventing further
international spread; 2) Identify, isolate and care for patients early, including
optimizing care for all patients, especially the seriously ill; 3) Communicate critical
risks and event information to all communities and counter misinformation; and 4)
Minimize impacts through multi-sectoral partnerships and whole-of-society approach
[36]. The country has also been commended for its robust health system and high testing
rate in the context of the COVID-19 pandemic [40]. Elaborating on this, Sri Lanka
was able to maintain a high testing rate relative to other countries in the South
Asian region. For instance, during the months of March and April, the country had
conducted 930 tests per 1 million people compared to 393 in Bangladesh, 703 in Pakistan
and 602 in India [40].
Under the psychological LOO, the GoSL communicated key messages on behavioural guidelines
to be followed by the general public like hand washing, the use of sanitizers and
social distancing.
With regard to the economy and well-being of community LOO, the government of Sri
Lanka introduced a stimulus package for SMEs for which the government released a fund
of LKR 50 billion [approximately USD 270 million]. The stimulus package constituted
a working capital loan of up to LKR 25 million [approximately USD 135,000] The loan
was targeted at enterprises with an annual turnover of less than LKR 1 billion [approximately
USD 5.4 million]. However, when approximately 45,000 private sector businesses applied
for this loan, the government realised that the allocation of LKR 50 billion was inadequate
to meet the demands, As a result, the government decided to increase the funds allocated
up to LKR 150 billion [approximately USD 810 million] [41]. However, based on an analysis
of stimulus packages provided in 18 other countries, it has been revealed that the
stimulus package provided by the GoSL was inadequate compared to an average of 3.5%
of GDP allocated for the provision of stimulus packages in other countries [41].
Apart from this, income tax arrears of SMEs were partially waived off, payment terms
were relaxed and legal actions against non-payers were frozen [21]. Similarly, the
government introduced a debt repayment moratorium which included a six-month debt
moratorium for affected industries in tourism, garment, plantation and IT sectors
and SMEs [21]. As mentioned prior, the GoSL also provided an allowance of LKR 5000
for low income families and economically vulnerable population groups like daily wage
earners. The government also introduced a maximum retail price for selected essential
items and established a fuel price stabilization fund [41].
Another significant aspect of Sri Lanka's response to the COVID-19 pandemic is the
emulation of a decentralised approach to addressing the effects of the pandemic. The
Sri Lanka Disaster Management Act No. 5 of 2013 vests powers with District Secretaries
and Divisional Secretaries to make independent decisions during a disaster situation,
particularly with regard to the provision of emergency relief and related post disaster
scenarios. Accordingly, District Secretaries and Divisional Secretaries, together
with Grama Niladhari [GN] officers, played a pivotal role in key activities such as
distributing an allowance of LKR 5000 [approximately USD 27] among economically vulnerable
population groups, providing recommendations for the issue of curfew passes to individuals
when required, facilitating the supply of food to the village level, providing pension
to pension holders, and ensuring that social order was maintained (Key informant interviews,
2020). While in some districts existing district, divisional and GN level disaster
management committees, headed by District Secretaries, Divisional Secretaries and
GN officers respectively, were activated, in certain other districts new committees
at said levels were formed and functioning. The decisions taken at the district committee
meetings were implemented via divisional and GN level committees. Further, the District
and Divisional Secretaries, in collaboration with the Assistant Directors of District
Disaster Management Coordinating Units [DDMCUs], were able to draw in donations and
aid from the private sector, including large scale corporations and NGOs to carry
out said activities at the local level (Key informant interviews, 2020). This approach
has enabled the effects of the pandemic to be addressed in a contextualised manner
by resolving problems and leveraging resources that are local to a particular area.
However, several challenges were posed at the sub-national level. For example, a lack
of updated information on village population at the local level made it challenging
to accurately identify beneficiaries for the provision of relief services [Eg: LKR
5000 allowance] at the sub-national level. Additionally, there was lack of consistency
in circulars issued at the national level with regard to the provision of relief services,
which in turn made the accurate listing of beneficiaries arduous (Key informant interviews,
2020).
4
Risk governance
4.1
An outline of COVID-19 risk governance in Sri Lanka
The Quarantine & Prevention of Diseases Ordinance chapter 222, No.3 of 1897 makes
provisions for the prevention of the introduction of the plague and all other contagious
and infectious diseases into Sri Lanka and the prevention of the spread of said diseases
within and outside of Sri Lanka [26]. In most regulations framed under this Ordinance,
the Director General of Health Services [DGHS] has been assigned as the proper authority
for facilitating the prevention of the spread of said diseases [26]. The Ministry
of Health and Indigenous Medical Services is headed by the DGHS [16]. Against the
provided legal framework, the DGHS chaired regular meetings with Deputy Director Generals,
Directors and the Chief Epidemiologist to assess the COVID-19 situation in the country.
Instructions to implement the decisions taken at these meetings were given by the
DGHS under ordinances, acts and laws of parliament vested under the purview of the
DGHS [36].
The national public health emergency mechanisms were activated under the purview of
the DGHS to respond to the COVID-19 pandemic in the country. Elaborating on this,
the Disaster Preparedness and Response Division [DPRD] of the Ministry of Health and
Indigenous Medical Services functioned as the overall country level coordinator for
the health sector, coordinating all activities in the Ministry of Health including
surveillance and cases investigation; infection prevention and control, Points of
Entries [POEs]; case management; risk communication and community engagement and operations
support and logistics during the COVID-19 pandemic in the country [36]. Further, various
stakeholders under the Ministry of Health and Indigenous Medical Services acted as
focal points of the activities mentioned above. For example, POEs were managed by
the Quarantine Unit, while the Medical Research Institute [MRI] played a key role
in surveillance and cases investigation through PCR testing and the responsibility
of hospital based case management was vested with hospitals where the central role
was played by the National Institute of Infectious Diseases [NIID] [36]. Additionally,
the DPRD was responsible for the intra-sectorial coordination with Ministry of External
Affairs, Consulates of Countries, Civil Aviation Authority, Airports, Airport Aviation
Services Limited, Ministry of Defence (Tri-forces, Police and STF), Department of
Customs, Department of Immigration and Emigration, Ministry of Finance, Ministry of
Defence, Disaster Management Centre, Ministry of Ports and Shipping during the COVID-19
pandemic situation in the country [36].
Apart from this, the GoSL established the ‘National Operation Centre for Prevention
of COVID-19 Outbreak [NOCPCO]’ as the national body for spearheading the management
of the COVID-19 outbreak, the necessary health care provisions and relevant public
services in the country. The Centre was headed by the Chief of Defence Staff and Commander
of Army [32,33]. Media briefings regarding the updated situation on the virus in the
country were held regularly at the NOCPCO. These briefings were represented by the
Head of the NOCPCO and the DGHS. Apart from these regular media briefings, status
updates on the pandemic situation [Eg: the number of positive COVID-19 cases] were
made available to the general public by the NOCPCO via the President's Office and
the Government Department of Information [32,33]. This demonstrates a considerable
degree of transparency and accountability in GoSL's response to the COVID’19 pandemic.
In addition to the NOCPCO, three task forces were appointed by the President to address
the deleterious cascading effects of the pandemic. One of the task forces was appointed
on 26th March 2020 by way of Gazette Extraordinary No. 2168/8 and was vested with
extensive powers direct, monitor and coordinate the supply of essential services and
to ensure the sustenance of overall community life in the context of the COVID-19
pandemic in the country [7,8,34,37,38]. This task force consisted of a total of 40
members and included Provincial Governors, Secretaries to Ministries, security chiefs,
heads of various departments, corporations and authorities, commanders of tri-forces
and district and divisional secretaries. The activities that this task force was responsible
for included but were not limited to providing facilities for farmers to continue
agricultural production, ensuring an unhindered supply of food, facilitating the distribution
of medicines and coordinating with relevant authorities [Eg: Ports, Customs and corporate
banks] to import dry rations and medicine into the country and the distribution of
the LKR 5000 grant to low income families [37,38]. Apart from this, two other task
forces were appointed, one of which was concerned with reviving the economy and eradicating
poverty and the other to ensure the uninterrupted provision of educational services
during the pandemic situation. The Task Force for Economic Revival and Poverty Alleviation
was established by way of Gazette Extraordinary No. 2172/9 on 22nd April 2020 while
the Task Force for Sri Lanka's Education Affairs was formed by way of Gazette Extraordinary
No. 2173/7 on 28th April 2020 [7,8].
4.2
Risk communication during the pandemic: processes, tools and related failures
The Health Promotion Bureau of the Ministry of Health and Indigenous Medical Services
served as the focal point for island wide risk communication during the COVID-19 pandemic.
The risk communication network was led by the Ministry of Health and Indigenous Medical
Services with the support of the WHO and UNICEF. The Epidemiology Unit, Health Promotion
Bureau and the National Operations Centre for Prevention of COVID-19 Outbreak [NOCPCO]
played a key role in this regard [36]. Medical Officers of Health and the WHO Sri
Lanka engaged in active rumour monitoring to ensure the accuracy and reliability of
information provided.
Information on aspects like the nature of the virus, the status of the pandemic in
the country and advice on aspects such as preventive measures were communicated to
the public using a variety of measures [36]. Risk communication messages were delivered
to the public using mass media like TV stations and other media like mobile communication
networks [19,36]. Apart from this, risk communication was performed through daily
press briefings, situation reports and FAQs. Additionally, social media constituted
a significant mode of formal risk communication. For instance, an official Facebook
page with over 40,000 followers and a Twitter account with over 10,000 followers were
maintained to communicate vital information regarding the pandemic risk to the public.
In addition to this, a Viber group and a YouTube channel were utilised for communication
of risk to the public.
Further, an official website for the GoSL's response to the COVID-19 pandemic was
launched by the Ministry of Defence [25]. The website provided various information
such as the latest news on the pandemic situation in the country, up-to date statistics
[Eg: the number of confirmed cases, active cases, recovered cases and deaths], Corona
related guidelines and circulars, contact details of quick response health lines etc.
Website content was sourced from various organizations including the President's Media,
the Health Promotion Bureau and the Department of Government Information. The site
can be accessed through the following link: https://covid19.gov.lk/. The website was
designed and launched with the objective of providing the general public with convenient
access to accurate and updated information on the global and local status of the pandemic
[25].
A 24/7 trilingual hotline named ‘Suwasariya’ [number – 1999] was also made available
to the public for any enquiries [19,36]. Simultaneously, updates on the Corona Virus
situation in the country and information on preventive measures were displayed on
a tri-lingual website maintained by the Health Promotion Bureau [19]. In addition
to this, Information, Education and Communication [IEC] material including pictograms,
leaflets, stickers and posters were designed and printed in all three languages –
Sinhala, Tamil and English – and displayed at appropriate locations. The efforts made
to carry out risk communication in all three languages demonstrates sensitivity to
language differences among various ethnic groups in the country and the inclusivity
of the GoSL's approach to risk communication.
The Health Promotion Bureau also liaised with provincial and district level health
authorities like the Provincial and Regional Directors of Health; Health Education
Officers and Community Physicians at sub-national levels to ensure that risk communication
reached the grass root level [36].
However, there was a tendency for false and misleading information to be transmitted
through certain unofficial online platforms [Eg: news websites and social media platforms
like private Whatsapp groups and private Facebook pages]. For example, a list of COVID-19
preventive measures purported to have been issued by the country's Infectious Diseases
Hospital [NIID] was published in an article on an online news website. This went viral
via private Whatsapp and Facebook accounts. However, the public was subsequently made
aware that the NIID had not issued the mentioned set of guidelines and that the public
should rather adhere to the set of approved guidelines [2]. Although, there was a
tendency for false and misleading information to be transmitted via unofficial online
platforms, such information did not cause a significant change in public behavioural
trends. This is because transmission of fake information was effectively controlled
and managed as rumour identification and management was identified as an essential
component of overall risk communication by the Health Promotion Bureau. In this regard,
the Health Promotion Bureau carried out rumour monitoring, identification and verification
activities through a 24/7 call centre, social media analysis and mass media analysis
[36].
4.3
Accounting for compound events and specific vulnerabilities
There is an urgent need to rethink the current approaches to preparedness planning
and response to other hazards which may occur concurrently in the context of the COVID-19:
‘new normal’. The occurrence of other hazards [whether sudden or slow onset events]
amidst the pandemic gives rise to new complexities and compound vulnerabilities. This
may require the tailoring of preparedness and response activities for such hazards
to address the novel challenges posed by the pandemic. Demonstrating this, some districts
in the country had to execute disaster preparedness activities for the Southwest Monsoon
during the COVID-19 pandemic and these activities had to be configured accordingly
(Key Informant Interviews, 2020). For instance, the district of Ratnapura was faced
with a high risk of floods and landslides with the onset of the Southwest monsoon.
Hence special attention had to be paid to how such preparedness activities for potential
floods and landslides could be carried out while containing the spread of the pandemic
within the district. Some important measures were taken in this regard (Key Informant
Interviews, 2020). For example, while in other years families residing in flood prone
areas were evacuated to safety houses, steps had to be taken this year to reduce the
number of safety houses as far as possible and evacuate vulnerable families to the
houses of their relatives/friends. While around 500 people who resided in flood prone
areas were directed to the homes of their relatives or friends, only 19 safety houses
were maintained in the district. Further, before people were registered at a safety
house, they were checked for fever by local level health authorities like Public Health
Inspectors and the Public Health Midwives. If a person was diagnosed with fever, they
were admitted to a hospital and were thus, not registered at the safety house. In
addition to this, movement of people into and out of the Safety Houses was strictly
restricted. Social distancing was maintained in the safety houses and facilities like
masks and sanitizers were provided to the occupants. Apart from this, those families
who had to be self-quarantined and were also residing in flood and landslide prone
areas were separately identified and evacuated to separate places. Community centres
and closed schools were used for this purpose (Key Informant Interviews, 2020).
On the other hand, it is important to note that while COVID-19 is a global disaster,
some of the vulnerabilities created can be largely specific to certain regions, countries
or localities. A case in point is the vulnerability experienced by migrant workers
of Sri Lanka. Elucidating this, the International Labour Migration from Sri Lanka
has surged over the past three decades, particularly consequent to the adoption of
open economic policies in 1977. There are over a million Sri Lankan residents who
work abroad and the annual reported migrants amount to approximately 200,000 persons
[20]. Many of these migrant workers, including students who had migrated overseas
for study purposes, were stranded without employment and thus, financial capacity
to meet their basic needs like food and shelter during the COVID-19 pandemic period.
Given that Sri Lanka closed its borders to prevent an influx of imported COVID-19
cases, the GoSL was responsible for repatriating its citizens who had been stranded
abroad [4]. Given this background, Sri Lanka faced an increased risk of the virus
from imported cases, particularly from migrant workers and Sri Lankan students who
were looking forward to returning to their home country [27]. Nevertheless one of
the conditions for repatriating these workers was the adequate availability of quarantine
facilities. Therefore, the chances of this risk being materialized were low [27].
5
Science-policy interaction
5.1
Mobilization of scientific expertise and evidence in responding to the pandemic: ways
and concerns
Since the 1990s, the practise of evidence based policy making has been advocated by
both governments and scholars with the intention of improving policy outcomes. Evidence
based policy making calls for basing policy decisions on scientific expertise and
rational analysis so that the extent to which sources of bias like ideology, value
judgements and political expediency are reflected in policy making is minimized [5,10].
This section of the paper evaluates the extent to which the policy decisions made
during the COVID-19 pandemic in Sri Lanka had been informed by scientific expertise
and evidence. Primarily, the GoSL consulted medical specialists for technical guidance
and advice in planning its response to the outbreak in the country. Meetings were
held with specialist medical professionals including the Director General of Health
Services [DGHS], the President of the Association of Medical Specialists [AMS] and
other medical consultants [37,38]. At these meetings recommendations and proposals
on the effective control of the spread of the COVID-19 pandemic were presented to
state representatives like the Minster of Health by said health authorities [37,38].
Further, at the sub-national level District Disaster Management Committee meetings
were held in most districts to plan district level responses to the pandemic. These
meetings were chaired by the respective District Secretaries and convened by the Assistant
Directors of District Disaster Management Coordinating Units. The meetings were represented
by the Regional Directors of Health Services who provided the necessary technical
guidance on the measures to be taken to curb the spread of the virus (Key informant
interviews, 2020).
Apart from this, data collection, compilation, analysis and reporting pertaining to
epidemics and pandemics in the country are carried out through a disease surveillance
system [26]. The disease surveillance system facilitates a hierarchical flow of information
from sub-national level public health authorities like hospitals, Medical Officers
of Health [MOH], Regional Directors of Health Services [RDHS] to national level public
health authorities cum institutions that include the Epidemiological Unit, the Deputy
Director General of Public Health Services and the Director General of Health Services.
The surveillance of communicable diseases in the country, including communicable epidemics
and pandemics, is supported by a Notification System designated to provide notifications
on diseases identified in the ‘List of Notifiable Diseases’ in the country [15,26].
During the COVID-19 pandemic period in the country, the Epidemiology Unit of the Ministry
of Health and Indigenous Medical Services functioned as the focal point of disease
surveillance and reporting of data pertaining to the virus situation in the country
[36]. Elaborating on this, the Ministry of Health and Indigenous Medical Services
issued a circular to all hospitals declaring COVID-19 as a ‘notifiable condition’
and setting out the requirement for the mandatory notification of COVID-19 cases to
the Epidemiology Unit [45]. Upon the receipt of notifications from all hospitals,
the Epidemiology Unit compiled daily situation reports. In these reports, data pertaining
to the total number of confirmed cases [both imported cases and local cases], the
total number of deaths, the number of recovered cases and the total number of suspected
cases were reported [14]. The reports were shared with the DGHS and other relevant
officers at 10 am on the following day [36].
It is also important to note that an integrated information system named the ‘the
National COVID-19 Surveillance System’ was established by the Ministry of Health and
Indigenous Medical Services as a platform for COVID-19 designated hospitals to enter
their daily resource review, individual case information, data on equipment requirements
and laboratory information. Specific deadlines for entering the data were also established.
The data gathered through this system was used for decision making and media briefings
by the Ministry of Health and Indigenous Medical Services [36].
Further, the Epidemiology Unit produced a weekly update on the global situation of
the pandemic sourcing data from the WHO. Both the daily report on the local pandemic
situation and weekly global report were made available on the Epidemiology Unit's
official website. The Epidemiology Unit also sourced articles form journals, the WHO,
Centre for Disease Control and Prevention [CDC] and other reliable institutional sources.
Such data was archived in the web to be used by interested parties [36]. In situations
where cases of community transmissions were identified and reported, the Epidemiology
Unit monitored aspects such as the geographical spread of the virus, disease trends,
transmission intensity, characterization of virologic features and impacts on health
care services [34].
Furthermore, collection of relevant data and analysis of such data was vital for detecting
vulnerable communities and tracing case origins to assist decisions on imposing lockdown,
isolation, central quarantine and self-quarantine measures on individuals and communities
[34]. Elucidating this, vulnerable communities were detected using mechanisms like
big-data analysis and verification of records with agencies like Immigration and Emigration
and voter registration. On the other hand, tracing of case origins was carried out
through big-data analysis, performing record checks, analysis of boarder control data
and reference to information from sources like Telcos and hotel reservations. Collection
and analysis of data pertaining to detecting and tracing were conducted with the dominant
involvement of stakeholders such as the State Intelligence Service, Police Special
Branch and the Directorate of Military Intelligence [34].
Similarly, the Health Information Systems Program [HISP] of Sri Lanka introduced the
District Health Information Software – DHIS2 Tracker for surveillance of COVID-19
pandemic in the country (dhis2, 2020). The software was used to track and register
travellers coming into Sri Lanka from countries with a high risk of COVID-19. The
software enabled the entry and analysis of individual level data which could be eventually
aggregated for national reporting purposes. Further, a DHIS2 custom web app was developed
which allowed for the visualization of the potential spread of the virus across a
cohort of cases and their contacts. Such visualization of data was used to inform
public health interventions and epidemiological investigations [13].
6
A summary of Sri Lanka's response to COVID-19: key strengths and limitations
The Government of Sri Lanka's [GoSL's] response to the pandemic could be viewed as
proactive. Relevant steps were taken in advance of the advent of the pandemic into
the South Asian region. Further, the GoSL emulated a multi-sectoral approach to tackling
the pandemic with the involvement of diverse stakeholders ranging from various institutions
under the purview of the Ministry of Health and Indigenous Medical Services, the military,
police, sub-national level government officers to the private sector. Apart from this,
the effects of the pandemic situation were managed in a decentralised manner, whereby
sub-national level administrative authorities, like District and Divisional Secretaries,
were able to make independent decisions to resolve endemic local issues and draw on
local resources, thereby contextualising their response to the local pandemic situation.
Sri Lanka has been able to utilise its robust health system to respond to the pandemic
situation effectively. Risk communication was effective and there were no significant
concerns regarding reliability of data communicated. Rumour identification, verification
and monitoring were identified as essential components of risk communication. Recent
developments in technology were adopted to collect, compile and analyse data to inform
national level decision making with regard to curtailing the spread of the virus.
Steps have also been taken towards immediate response to adverse economic and social
impacts of the virus.
However, lack of Personal Protection Equipment, a shortage of trained health care
providers, unavailability of updated population registers at the local level and lack
of consistency in circulars issued by the government, have stood as some of the major
challenges to the country's response to the pandemic. Further, steps taken by the
government to establish new structures without a legal basis and where actors under
existing legal and institutional frameworks could have been effectively utilised,
remain unjustified. The GoSL's reliance on institutions with political interests for
technical guidance and advice, as opposed to policy making institutions, is questionable.
Similarly, stringent measures such as police curfew imposed when an emergency situation
was not declared by the GoSL, raises human rights concerns. In addition, the disproportionate
involvement of military personnel in the GoSL's multi-sectoral approach to tackling
the pandemic has been criticised for being indicative of militarization of the government's
response to the pandemic. Furthermore, the GoSL's efforts to address economic and
social effects of the pandemic have been predominantly geared towards emergency relief
and response. Adequate attention has not been paid to building social and economic
resilience.
7
Conclusion
This paper has examined Sri Lanka's response to COVID-19 paying specific attention
to three aspects: 1) trends and impacts, 2) risk governance and 3) science-policy
interactions. Measures taken to address the trends and impacts of the pandemic can
be commended on the basis that they had been proactive, multi-sectoral, decentralised
and stringent. In terms of risk governance, the Ministry of Health and Indigenous
Medical Services, as the accountable authority, had taken measures to enhance not
only the reliability but also the inclusivity of risk communication. The tendency
for compound events and specific vulnerabilities establishes the need for a multi-hazard
and localized approach to pandemic risk governance in the country. With regard to
science-policy interactions, political decision making of the government had been
informed, to a significant degree, by scientific expertise and evidence.
However, limitations in physical, human and information resources; lack of consistency
in government's decision making; establishment of haphazard structures; short term
orientation prioritizing emergency relief and concerns raised regarding militarization
and human rights violations hint at the lack of preparedness for pandemics and the
absence of a national framework to guide such preparedness in Sri Lanka. The findings
of this paper lead to future lines of inquiry in the field of Disaster Risk Management,
providing impetus to delve into: 1) the current status and gaps of pandemic preparedness
in Sri Lanka; 2) economic and social resilience building in the context of pandemic
preparedness; 3) the role of the private sector in preparing for pandemics: the current
status and areas for improvement; 4) ways of fostering community participation in
pandemic preparedness and response and 5) the current status and gaps concerning preparedness
for compound events.
Author statement
•
Prof. Dilanthi Amaratunga, Global Disaster Resilience Centre, University of Huddersfield
UK: Conceptualization; Funding acquisition; Methodology; Project administration, Resources
•
Dr. Nishara Fernando, Social Policy Analysis and Research Centre, University of Colombo,
Sri Lanka: Data curation, Supervision; Validation; Roles/Writing – original draft
•
Prof. Richard Haigh, Global Disaster Resilience Centre, University of Huddersfield
UK: Writing – review & editing, Conceptualization; Funding acquisition; Methodology
•
Ms. Naduni Jayasinghe, Social Policy Analysis and Research Centre, University of Colombo,
Sri Lanka: Formal analysis; Visualization, Roles/Writing – original draft
Declaration of Competing Interest
None.