00:00 good evening everyone and welcome to the 00:02 00:02 advocate institute's twitter space on 00:04 00:04 sri lanka's kobe response 00:05 00:05 what is the role of the private sector 00:07 00:07 today we have learned that the delta 00:09 00:09 variant that has ravaged our neighbor 00:10 00:10 india is now in sri lanka with the 00:12 00:12 possibility of community transmission 00:15 00:15 sri lanka has been grappling with kobe 00:16 00:16 19 for over a year now 00:18 00:18 and at present we are facing a third 00:20 00:20 wave with travel restrictions rising 00:22 00:22 cases and concerns about hospital 00:24 00:24 capacity 00:25 00:25 now more than ever we need to be 00:26 00:26 utilizing all the resources that are 00:28 00:28 available to manage this crisis 00:30 00:30 and reduce the human toll that it is 00:32 00:32 taking we have with us today three 00:34 00:34 experts to discuss this very topic 00:37 00:37 so without further ado let me introduce 00:39 00:39 our speakers for today 00:40 00:40 we have with us dr ravindra rananelia 00:43 00:43 the executive director and fellow of the 00:45 00:45 institute of health policy 00:46 00:46 he has expertise in health systems 00:48 00:48 equity health financing and policy 00:50 00:50 and public expenditure he's a leading 00:52 00:52 international expert in health 00:54 00:54 expenditure estimation and projection 00:56 00:56 and in health account systems and has 00:58 00:58 collaborated extensively 00:59 00:59 with the who the world bank and the oecd 01:03 01:03 dr lockett peers is the president of the 01:06 01:06 association of private hospitals and 01:07 01:07 nursing homes 01:08 01:08 and is the managing director of hema's 01:10 01:10 hospital and the laboratory chain 01:12 01:12 he is a well-known leader in the health 01:14 01:14 care industry with over 20 years of 01:16 01:16 experience in health care related mncs 01:18 01:18 and sri lankan enterprises 01:21 01:21 and last but definitely not least we 01:22 01:22 have with us mr shyam sathya sivam 01:25 01:25 an executive director at sunshine 01:27 01:27 holdings plc enlisted conglomerate 01:29 01:29 a graduate of the london school of 01:30 01:30 economics he is responsible for the 01:32 01:32 consumer and healthcare sectors of the 01:34 01:34 group 01:34 01:34 and brings to the table extensive 01:36 01:36 experience to start off today's 01:38 01:38 discussion dr 01:39 01:39 could you start us off by telling us a 01:41 01:41 little bit about what the private sector 01:42 01:42 has done 01:43 01:43 so far like what has their role been so 01:45 01:45 far in 01:46 01:46 combating and addressing the pandemic 01:48 01:48 ibo and everyone and first of all let me 01:51 01:51 thank 01:52 01:52 advocate for inviting me and also my 01:54 01:54 appreciation to dr 01:55 01:55 rananelli and sham and anita so anita 01:58 01:58 kobe 19 01:59 01:59 pandemic has really impacted our 02:01 02:01 lifestyles 02:03 02:03 it is life-threatening livelihoods of 02:06 02:06 people 02:06 02:06 are being impacted and also most of the 02:09 02:09 corporates and their employees 02:11 02:11 are being impacted negatively and the 02:14 02:14 hospital industry 02:15 02:15 in particular was impacted due to the 02:17 02:17 decline in revenues 02:18 02:18 and increased cost and so on but where 02:22 02:22 the 02:23 02:23 private sector is concerned the private 02:26 02:26 hospitals industry 02:28 02:28 came together as one we were quite agile 02:31 02:31 extremely responsive in quickly 02:34 02:34 to provide safe top quality healthcare 02:36 02:36 services 02:37 02:37 and took stringent measures to mitigate 02:40 02:40 all risks as much as possible and by 02:43 02:43 putting into action 02:45 02:45 well thought out protocols that were 02:47 02:47 also shared by the ministry of 02:49 02:49 health the epidemiology unit the who and 02:52 02:52 also with you know experts in the field 02:54 02:54 of 02:55 02:55 infectious diseases to protect and save 02:59 02:59 the doctors the caregivers the 03:01 03:01 healthcare workers 03:02 03:02 the staff patients and the community and 03:05 03:05 everyone 03:06 03:06 who would walk through hospital doors 03:08 03:08 and we also put in place 03:10 03:10 a very robust governance structure 03:13 03:13 comprising of 03:14 03:14 steering committees to assess the 03:16 03:16 country's situation 03:18 03:18 new development on a daily basis we 03:20 03:20 engage with 03:21 03:21 all stakeholders such as the national 03:24 03:24 operations center for 03:25 03:25 prevention of kuwait 19 outbreak 03:28 03:28 epidemiology unit 03:29 03:29 moh the private hospitals association 03:32 03:32 itself 03:33 03:33 and like i said earlier we were quite 03:35 03:35 agile and quick to respond 03:37 03:37 to new needs for the convenience and the 03:40 03:40 safety 03:40 03:40 of people of sri lanka so in order 03:44 03:44 to help and support the government of 03:46 03:46 sri lanka in the battle against kuwait 03:48 03:48 19 we were very quick to put up 03:51 03:51 new pcr lads dr rananelia will tell us 03:54 03:54 that you know he has been advocating 03:56 03:56 more and more testing in sri lanka so we 03:58 03:58 were able to increase the capacity so 04:01 04:01 like i said you know we put up pcr 04:03 04:03 testing facilities and then we also 04:06 04:06 supported the government 04:07 04:07 in putting up intermediate care centers 04:10 04:10 for kuwait 19 treatment 04:11 04:11 adding capacity to the bed strength of 04:13 04:13 the country then also introduced 04:15 04:15 new things new areas such as home care 04:18 04:18 services telemedicines 04:20 04:20 and also hospitals like bigger hospitals 04:23 04:23 they put up fully fledged icu facilities 04:26 04:26 to also 04:27 04:27 increase the icu bed capacity so these 04:30 04:30 are some of the things in brief that we 04:32 04:32 have done but i can go 04:33 04:33 on during the discussion thank you dr 04:35 04:35 lucky so you mentioned 04:37 04:37 the role that the private sector has 04:38 04:38 played in increasing testing 04:40 04:40 dr rananelia could you jump in on that 04:42 04:42 and 04:43 04:43 give us your thoughts on the role the 04:44 04:44 private sector has in this particular 04:47 04:47 capacity 04:48 04:48 and also what we can learn from the 04:49 04:49 international experience 04:51 04:51 of how other countries have handled the 04:53 04:53 pandemic and 04:54 04:54 in particular what role the private 04:56 04:56 sector has had in doing so 04:58 04:58 sure no i i think the private sector the 05:00 05:00 whole has done what it can i think 05:02 05:02 that they they made a significant 05:04 05:04 contribution not only i think 05:05 05:05 to increasing testing capacity but i 05:08 05:08 think the other thing 05:10 05:10 that some of us were well aware of was 05:12 05:12 that they showed how 05:14 05:14 existing capacity could be used more 05:16 05:16 efficiently so 05:17 05:17 i mean i think there's clearly a case 05:18 05:18 that the ministry of health could 05:20 05:20 improve 05:20 05:20 uh output even within with its existing 05:23 05:23 facilities if it ran them and let's say 05:25 05:25 more efficiently and more extensively so 05:27 05:27 i think that's been a major contribution 05:30 05:30 i i think that i'm not sure whether dr 05:32 05:32 luckett mentioned because 05:33 05:33 i missed the early part what he was 05:34 05:34 saying but i think at the moment we 05:37 05:37 could probably do with more contribution 05:38 05:38 from the private sector but i suspect 05:40 05:40 it's not a private sector 05:42 05:42 uh decision to make i think that this 05:44 05:44 there's a policy constraint on on 05:46 05:46 allowing the private sector to 05:47 05:47 contribute more 05:48 05:48 and then overall globally countries who 05:50 05:50 tested more 05:52 05:52 earlier in the process as well have done 05:55 05:55 much better in controlling 05:56 05:56 the spread of the virus we have shown in 05:59 05:59 our own research and globally the 06:01 06:01 evidence is very clear that pcr testing 06:02 06:02 is the most 06:03 06:03 effective intervention the most 06:05 06:05 cost-effective intervention 06:06 06:06 to control this pandemic so i'm grateful 06:09 06:09 for the private sector but i think it's 06:11 06:11 more a public policy problem more than 06:12 06:12 the private sector's inability to 06:15 06:15 contribute more 06:16 06:16 thank you dr anania so why do you 06:18 06:18 emphasize the importance 06:19 06:19 of testing in pcr testing in particular 06:22 06:22 sri lanka has been 06:24 06:24 having a fairly how do we put it sort of 06:27 06:27 limited 06:28 06:28 vaccine response shall we say we've seen 06:30 06:30 waves of vaccines being available 06:32 06:32 different varieties in in different ways 06:34 06:34 as well 06:35 06:35 what do you think sri lanka needs to do 06:38 06:38 in order to 06:39 06:39 amp up its vaccine procurement and 06:41 06:41 distribution 06:42 06:42 and i'd like mr sathya sivam to also 06:45 06:45 jump in on this this question 06:46 06:46 but in your opinion should we be 06:48 06:48 focusing on pcr testing or should we be 06:50 06:50 focusing on vaccines so i think 06:52 06:52 both are necessary but i think we need 06:54 06:54 to be realistic 06:55 06:55 even if we had an effective vaccine 06:58 06:58 procurement program 06:59 06:59 it's going to take till the end of the 07:01 07:01 year to fully vaccinate most people 07:03 07:03 so during that time you know literally 07:05 07:05 hundreds of thousands of people could 07:07 07:07 die if we don't control the virus so 07:09 07:09 that the short-term priority 07:11 07:11 has been for more than a year we have to 07:13 07:13 control the virus spread 07:15 07:15 trying aim to get down to zero because 07:17 07:17 we don't want to have these things like 07:19 07:19 the delta variant 07:20 07:20 uh causing habit which i think it will 07:22 07:22 do and in the meantime we need to ramp 07:24 07:24 up vaccinations so that we can protect 07:26 07:26 the population against new outbreaks 07:28 07:28 and i think that that should be the plan 07:30 07:30 so i think both are needed but in the 07:32 07:32 short run 07:32 07:32 vaccination cannot prevent people dying 07:35 07:35 and it cannot prevent 07:36 07:36 tens of thousands hundreds of thousands 07:38 07:38 of people getting infected the the 07:40 07:40 short-term 07:40 07:40 defense has to be testing and then after 07:43 07:43 vaccination is achieved i think if you 07:45 07:45 look at the countries who are doing 07:47 07:47 thinking further like singapore and new 07:49 07:49 zealand australia 07:51 07:51 these countries realize that they're 07:52 07:52 gonna they're gonna combine vaccination 07:54 07:54 and testing uh 07:55 07:55 long term so a singaporean prime 07:56 07:56 minister recently said they will 07:58 07:58 vaccinate everyone 07:59 07:59 but then they will have some kind of 08:01 08:01 border security and every time they have 08:03 08:03 an outbreak they're going to use test 08:04 08:04 and trace to 08:05 08:05 basically crush it out so i think that 08:07 08:07 that has to be the long-term strategy 08:08 08:08 and 08:09 08:09 mr sham would you be able to jump in on 08:11 08:11 that and especially on on vaccine 08:13 08:13 procurement does the private sector have 08:14 08:14 a role to play there 08:16 08:16 thanks i think uh so primarily the 08:18 08:18 private sector was the largest player in 08:20 08:20 vaccine procurement uh till covet hit 08:23 08:23 and then 08:24 08:24 overnight i guess across the world is 08:26 08:26 given the scale of it 08:27 08:27 all governments jumped in but the 08:28 08:28 context is in terms of from 08:31 08:31 tracking from when it was announced in 08:33 08:33 terms of what products were going to be 08:34 08:34 coming to the market and sort of 08:35 08:35 understanding the supply chain dynamics 08:38 08:38 of you know ordering multiple ordering 08:41 08:41 on time 08:42 08:42 lots of dynamics right and i think the 08:44 08:44 government sector 08:45 08:45 managed but definitely a partnership 08:47 08:47 with the private sector 08:49 08:49 in my personal belief i think would have 08:51 08:51 had better results 08:52 08:52 but at this point in time i think we all 08:55 08:55 just need to rally together and make as 08:56 08:56 much 08:57 08:57 product available i think more and more 08:59 08:59 vaccines will come through i was just 09:00 09:00 looking at 09:01 09:01 who else is stuck like us you know it 09:03 09:03 seems like nepal and bangladesh are also 09:05 09:05 sort of short of the astrazeneca 09:08 09:08 at this point in time so while it's 09:10 09:10 painful for us 09:11 09:11 there are this is not an unusual 09:13 09:13 phenomenon right now 09:14 09:14 given what's happening across the world 09:16 09:16 the private sector of course 09:18 09:18 is firstly the producer across the world 09:21 09:21 right 09:21 09:21 so in terms of and we've been procuring 09:24 09:24 these products 09:25 09:25 in terms of across countries for 09:27 09:27 multiple years now 09:29 09:29 so what we need to i think uh quickly 09:31 09:31 get to is 09:32 09:32 here's you know we're in stage one where 09:34 09:34 we're looking at initial so it's very 09:36 09:36 much government to government but let's 09:38 09:38 start getting 09:38 09:38 ready for you know once this sort of the 09:41 09:41 next three months dies down 09:43 09:43 i think you will see more supply come 09:45 09:45 into the market and in that context 09:47 09:47 the same issue will be there for testing 09:49 09:49 i mean molecular biology or the pcr sort 09:51 09:51 of project wasn't a large 09:53 09:53 field till you know kobe hit and now 09:55 09:55 overnight 09:56 09:56 everybody is scrambling to sort of put 09:58 09:58 testing in place 09:59 09:59 for example germany does 58 000 10:03 10:03 tests a day of which fifty percent are 10:05 10:05 by the private sector 10:06 10:06 uh and you know either insurance or the 10:09 10:09 government covers it so i think 10:10 10:10 it's that sort of approach where we need 10:12 10:12 to sort of corral everybody around 10:14 10:14 participate in it whether it's testing 10:17 10:17 treatment or vaccination across 10:19 10:19 all three areas the private sector has a 10:22 10:22 large 10:23 10:23 role to participate in order to increase 10:26 10:26 capacity 10:27 10:27 and as well as for solutions we are 10:29 10:29 evolving 10:30 10:30 dr ranalia spoke about the delta variant 10:33 10:33 that is something you know of 10:35 10:35 significance that you know now you know 10:37 10:37 it's in sri lanka so we've got to figure 10:40 10:40 out what are we going to do 10:41 10:41 about you know treatment right or 10:44 10:44 prevention in in the first 10:45 10:45 instance right what do we need to sort 10:48 10:48 of participate in that area 10:50 10:50 testing between rapid tests pcrs has 10:52 10:52 been a whole slew of products 10:54 10:54 that you know we need to engage with and 10:56 10:56 yes some of the product 10:58 10:58 may not work as well and we need to 10:60 10:60 quickly move on so i think 11:02 11:02 it's in that context this constant 11:03 11:03 change that dealing with the dynamics 11:06 11:06 that's happening 11:07 11:07 and that's it i think really an area 11:08 11:08 where the private sector can access that 11:10 11:10 thank you 11:11 11:11 uh mr siva dr randall 11:14 11:14 next question to you i believe you 11:17 11:17 mentioned on twitter recently that the 11:18 11:18 mh does 11:19 11:19 have a decent vaccination schedule you 11:22 11:22 know 11:22 11:22 as a matter of routine the non-coveted 11:24 11:24 context but that we would need to 11:25 11:25 approximately 11:26 11:26 increase that by 10 times to to deal 11:29 11:29 with kovid 11:30 11:30 is the government able to do that alone 11:32 11:32 and what space is there for the private 11:34 11:34 sector to jump in 11:35 11:35 and and increase capacity yes i i think 11:38 11:38 there's a short-term need in a longer 11:40 11:40 term lead the short-term need is 11:41 11:41 in the next year or so to vaccinate 11:44 11:44 essentially everyone in sri lanka so 11:46 11:46 we're talking about giving 11:47 11:47 40 million vaccine doses and 11:50 11:50 my guess is we only do three or four 11:52 11:52 million a year normally 11:54 11:54 and it's the three four million go to 11:55 11:55 kids essentially 11:57 11:57 they don't go to adults so i think that 11:59 11:59 that only has to be a 12:00 12:00 very vastly increased supply but we need 12:02 12:02 quite different arrangements to reach 12:04 12:04 old people the the men and people like 12:07 12:07 this 12:08 12:08 and i don't think that can be done 12:10 12:10 through the existing 12:11 12:11 setup and we can see that even trying to 12:14 12:14 do that 12:15 12:15 is having problems so we we noticed 12:17 12:17 earlier that when the government tried 12:18 12:18 to 12:19 12:19 do mass vaccination they had to pull 12:21 12:21 stuff forth other routine work which 12:23 12:23 also needs to be done testing 12:24 12:24 also suffered so i think that we need to 12:27 12:27 think of more 12:28 12:28 longer term different arrangements 12:30 12:30 especially if we get into a situation 12:32 12:32 where we have to do booster vaccinations 12:35 12:35 every two years 12:36 12:36 because then we're essentially having to 12:37 12:37 do you know tens of millions of vaccines 12:39 12:39 on a regular basis and i think 12:41 12:41 that requires more diverse arrangements 12:44 12:44 i mean most countries if you think about 12:46 12:46 flu vaccination 12:47 12:47 a lot of it's offered through the 12:48 12:48 private sector um so 12:50 12:50 that's clearly a way of doing that using 12:52 12:52 gps in the private sector 12:54 12:54 except pharmacies etc i think we were 12:56 12:56 going to have to think that through 12:57 12:57 and i think at the current time with the 12:60 12:60 immediate problem i 13:01 13:01 i would say you know the government has 13:02 13:02 to buy the vaccines i mean i don't think 13:04 13:04 there is actually any supply for the 13:06 13:06 private sector to buy in significant 13:08 13:08 quantities right now 13:09 13:09 and i think that's going to remain the 13:10 13:10 case for the for the rest of this year 13:12 13:12 actually 13:12 13:12 if you look at the vaccine production 13:14 13:14 data so i think that the government has 13:16 13:16 to buy but i think the 13:18 13:18 private sector could certainly be used 13:20 13:20 to put jabs into people's arms i mean i 13:22 13:22 think there's i can't see why that 13:24 13:24 can't be done and why it shouldn't be 13:25 13:25 done 13:26 13:26 to reduce the pressure on the existing 13:28 13:28 public services 13:29 13:29 thank you dr anania dr lockett could i 13:32 13:32 ask you to jump in on that because 13:34 13:34 so while we have definitely seen across 13:37 13:37 the world as 13:37 13:37 dr ramananda mentioned that vaccine 13:39 13:39 procurement seems to be limited to the 13:41 13:41 government 13:42 13:42 but other countries have quite 13:43 13:43 successfully delegated the sort of 13:45 13:45 vaccine distribution 13:47 13:47 actually administering the shots to 13:49 13:49 private hospitals and even pharmacies so 13:51 13:51 and that has resulted in this 13:53 13:53 decentralization of access to vaccines 13:55 13:55 you know you can go to the pharmacy at 13:56 13:56 the top of the road and 13:57 13:57 get your vaccine you schedule it even 13:60 13:60 things like when vaccines are getting 14:01 14:01 close to the expiration date pharmacies 14:03 14:03 are 14:04 14:04 getting on social media and letting 14:05 14:05 people in the area know that they have 14:07 14:07 you know 14:08 14:08 20 shots available if you're in the area 14:10 14:10 come and get it 14:11 14:11 and people have been have been 14:12 14:12 discussing this as a fairly 14:14 14:14 decent system that has been put in place 14:16 14:16 does sri lanka have the space to do 14:18 14:18 something like this yeah anita i think i 14:20 14:20 think before we 14:22 14:22 get to the retail level i think 14:25 14:25 first of all the government should 14:27 14:27 identify 14:28 14:28 and understand that the private 14:30 14:30 hospitals are 14:32 14:32 ready and standing by to assist the 14:35 14:35 government 14:35 14:35 in kuwait 19 vaccine administration 14:38 14:38 efforts 14:39 14:39 and while we you know come in the 14:42 14:42 government on whatever the current 14:44 14:44 efforts we believe that if private 14:46 14:46 hospitals were authorized to act as 14:48 14:48 vaccination centers 14:49 14:49 alongside the existing ones delivery of 14:52 14:52 clarity 19 vaccination could be 14:54 14:54 expanded i think that should be the 14:56 14:56 first step that the government 14:58 14:58 should take and the ministry of health 15:01 15:01 should realize 15:02 15:02 and we as private hospitals have 15:04 15:04 repeatedly 15:05 15:05 told the moh and and all these 15:08 15:08 stakeholders and 15:10 15:10 decision makers that the private 15:12 15:12 hospitals 15:13 15:13 are ready to help the government in the 15:15 15:15 vaccination drive but we haven't heard 15:18 15:18 anything positive yet sri lanka has been 15:21 15:21 relatively i mean a good country in 15:24 15:24 terms of 15:24 15:24 uh usual vaccination programs but 15:28 15:28 like dr rananelia says that you know we 15:30 15:30 need to get 15:32 15:32 into top gear and really expand if we 15:34 15:34 are to 15:35 15:35 vaccinate the people of sri lanka 15:38 15:38 much faster and the current process is 15:40 15:40 too slow 15:41 15:41 understood so a concern that's often 15:44 15:44 raised when the role of the private 15:46 15:46 sector is discussed especially 15:47 15:47 in something like healthcare we're 15:49 15:49 talking about an essential service and 15:51 15:51 the 15:51 15:51 status even we also kind of mentioned 15:53 15:53 this when you when you spoke about how 15:55 15:55 in germany 15:56 15:56 but the 50 coverage that the private 15:59 15:59 sector covers actually 16:00 16:00 is also taken care of by medical 16:03 16:03 insurance 16:04 16:04 please correct me if i'm wrong but i 16:05 16:05 don't think sri lanka has a very 16:07 16:07 strong medical insurance base for people 16:10 16:10 to fall back 16:11 16:11 on so when it comes to involving the 16:13 16:13 private sector 16:14 16:14 in this situation how do we think about 16:17 16:17 the equity angle 16:18 16:18 so i think you can take a different 16:20 16:20 approach i think 16:21 16:21 in england the nhs is pretty much just 16:24 16:24 engaged with the entire private sector 16:26 16:26 i wouldn't go as far as saying commander 16:28 16:28 but pretty much engage with the entire 16:30 16:30 private sector 16:31 16:31 to sort of ensure that all of their 16:33 16:33 capacity was available 16:34 16:34 for kobe treatment so it could be the 16:36 16:36 same for 16:38 16:38 uh testing for example a if the 16:40 16:40 government is willing for 16:42 16:42 uh for all capable private sector to 16:45 16:45 engage in testing to their capacity and 16:47 16:47 that 16:48 16:48 you know and and they're monitored to 16:50 16:50 whatever standards that they need to do 16:52 16:52 then what all of us uh as citizens have 16:54 16:54 is the opportunity 16:56 16:56 uh to get tested you know across the 16:58 16:58 board right 16:59 16:59 and you know in multiple locations so i 17:02 17:02 think it's in that 17:03 17:03 context yes uh insurance medical 17:05 17:05 insurance is still at a corporate level 17:08 17:08 yet i don't think it's significantly 17:09 17:09 deep 17:10 17:10 you know in the private and that's also 17:12 17:12 to do with the fact that we've had this 17:13 17:13 free health care service so most 17:15 17:15 i think of the population relies on the 17:18 17:18 government healthcare service 17:19 17:19 on a day-to-day basis and so at a crisis 17:22 17:22 like this where you know 17:23 17:23 you have a new sort of technology coming 17:26 17:26 in 17:26 17:26 and where the private sector is probably 17:28 17:28 able to scale up quite fast 17:30 17:30 on this particular one you we have to 17:32 17:32 sort of channel 17:33 17:33 them in that direction uh which which i 17:35 17:35 think is very much possible you know and 17:38 17:38 some of it is it's about you know 17:39 17:39 working with the private sector so such 17:42 17:42 models 17:42 17:42 exist and some of this we're seeing 17:44 17:44 happen but it could scale up 17:46 17:46 significantly i also agree with lucky 17:49 17:49 that 17:49 17:49 at this stage i think cost private 17:51 17:51 hospitals or private clinics clearly 17:53 17:53 where we can expand 17:54 17:54 retail will come a little later 17:56 17:56 especially i presume the whole booster 17:58 17:58 and all of that when it works through 18:00 18:00 i mean any of us who had a flu shot 18:02 18:02 overseas i've had mine 18:04 18:04 many years ago in a walmart in chicago 18:06 18:06 you know you showed up you got it you 18:08 18:08 moved out 18:08 18:08 so and that's the way you know where you 18:12 18:12 love for that sort of engagement where 18:14 18:14 you create more points 18:15 18:15 of access yeah so i think that's where 18:18 18:18 we sort of see 18:19 18:19 the approach coming through so mr satya 18:21 18:21 simon i know that this this topic has 18:23 18:23 been touched on before but we've gotten 18:25 18:25 a question in 18:26 18:26 asking about whether there is a 18:28 18:28 possibility to procure vaccines i 18:29 18:29 believe doctor anna nelly mentioned not 18:31 18:31 really for this year but 18:32 18:32 going forward is there a possibility for 18:34 18:34 the private sector to procure vaccines 18:37 18:37 uh what is the process and what are the 18:39 18:39 vaccines that we can expect 18:40 18:40 to enter the sri lankan market so i i 18:43 18:43 think you know 18:43 18:43 there is i don't think there's any 18:45 18:45 capacity for private sector to purchase 18:47 18:47 directly from manufacturers the the 18:50 18:50 the demand versus supply is at multiplex 18:54 18:54 in terms of what's available so i think 18:56 18:56 in that way 18:57 18:57 you know dr nelia said it all in terms 18:59 18:59 of i don't see us till 19:01 19:01 you know end of q1 next year being able 19:04 19:04 to procure directly 19:05 19:05 from the large manufacturers what you 19:08 19:08 are seeing is the second wave of 19:10 19:10 manufacturers coming on board 19:12 19:12 i mean right now the top three vaccine 19:14 19:14 manufacturers in the world 19:16 19:16 glaxosmithkline merck and sanofi windows 19:20 19:20 haven't come on board so what you're 19:22 19:22 seeing is you know 19:23 19:23 there's been new players come on board 19:25 19:25 in the first wave 19:26 19:26 the second sort of generation of 19:27 19:27 vaccines 19:29 19:29 in terms of the second wave will be from 19:31 19:31 newer manufacturers 19:32 19:32 uh who have not yet entered so you will 19:34 19:34 see capacity coming on board at that 19:36 19:36 stage 19:37 19:37 and similarly uh we'd like to think if 19:40 19:40 for example the large players in china 19:42 19:42 uh sign up farms i know 19:44 19:44 if they've covered a significant volume 19:47 19:47 in the domestic population they will 19:49 19:49 have the 19:49 19:49 greater export capacity so that sort of 19:52 19:52 volume can come down to but 19:54 19:54 broadly i would think into the q3 q4 you 19:57 19:57 know end of the year 19:58 19:58 sort of perspective so that's where i 20:00 20:00 think where the process is this has a 20:02 20:02 supply chain lag effect of 20:04 20:04 you know those who made decisive calls 20:06 20:06 six months ago 20:07 20:07 have product for the next six months you 20:09 20:09 know it's just the nature of you know 20:11 20:11 supply chain and it will take a couple 20:13 20:13 of more months but i think it 20:15 20:15 tends to get better i think in the 20:17 20:17 context of 20:18 20:18 more and more sort of product coming 20:20 20:20 onto the market from 300 candidates i 20:22 20:22 think we're down to about 20:23 20:23 12 to 13 candidates who are of realistic 20:27 20:27 stages 20:28 20:28 of which you're seeing i mean sri lanka 20:30 20:30 has had only about 20:31 20:31 three products coming yeah so we've had 20:33 20:33 the astra we've had the sputnik we've 20:35 20:35 had the cyano 20:36 20:36 farm come in uh you know we should get 20:39 20:39 pfizer 20:40 20:40 i mean moderna has done significantly in 20:43 20:43 most 20:43 20:43 western markets i mean cyanobac is out 20:46 20:46 there 20:47 20:47 the johnson johnson product is out there 20:49 20:49 so i think there is 20:51 20:51 more options but it given where we are 20:54 20:54 in the queue per se 20:55 20:55 of orders we'll have to in that context 20:58 20:58 but 20:59 20:59 i saw good news today i think gsk is 21:02 21:02 going to 21:02 21:02 fill and finish the nova wax vaccine so 21:05 21:05 that should increase capacity 21:07 21:07 so i think the next three months will 21:09 21:09 will reveal a lot more in capacity 21:12 21:12 that will become available to the rest 21:13 21:13 of the world thank you mr satyasvivam 21:15 21:15 i'd like to remind our listeners that we 21:17 21:17 are open for questions so 21:19 21:19 if you would like to speak directly and 21:22 21:22 ask a question of one of the 21:24 21:24 panelists today you can just request to 21:26 21:26 speak and i'll be able to give you 21:27 21:27 access 21:27 21:27 or if you would prefer to just tweet and 21:29 21:29 ask a question 21:30 21:30 through that mode that's also an option 21:32 21:32 dr alan elliott did you want to jump in 21:34 21:34 there yeah 21:35 21:35 yes i mean just to put this into 21:37 21:37 perspective so people understand because 21:38 21:38 i know people say oh 21:40 21:40 they're desperate to get the vaccines 21:41 21:41 and they're asking why can't the private 21:43 21:43 sector buy i mean 21:44 21:44 to put this in context there are some 21:46 21:46 very rich countries 21:47 21:47 in the world like australia taiwan who 21:50 21:50 basically 21:51 21:51 don't think they can vaccinate their 21:53 21:53 populations before the end of this year 21:55 21:55 right so these are countries that i mean 21:56 21:56 economies with very huge purchasing 21:58 21:58 power 21:59 21:59 and even they cannot get their hands on 22:01 22:01 enough vaccine fast enough 22:03 22:03 so i think you need to understand in 22:04 22:04 that context it's 22:06 22:06 it's very unrealistic that for a 22:09 22:09 developing country even for the 22:10 22:10 government or the private sector to be 22:11 22:11 able to get vaccines it's very damaging 22:13 22:13 for pharmaceutical firms in the west 22:15 22:15 to sell vaccines to private buyers when 22:17 22:17 they can't meet the demand from their 22:19 22:19 government clients uh so i think that's 22:22 22:22 that's the context that we're 22:24 22:24 dealing with and i think i think that's 22:25 22:25 going to remain the case pretty much 22:27 22:27 this year 22:28 22:28 so i think the other thing about placing 22:29 22:29 orders government placed orders 22:31 22:31 relatively late 22:32 22:32 the countries who got who did a bit 22:34 22:34 better and i think israel is the most 22:36 22:36 obvious example our countries have 22:38 22:38 placed orders very early and they put 22:40 22:40 cash up front they didn't just place the 22:41 22:41 order they 22:42 22:42 handed over the money and they were 22:44 22:44 often willing to pay 22:45 22:45 above the market price so those 22:47 22:47 countries ended up getting uh first in 22:49 22:49 the queue 22:49 22:49 understood so correct me if i'm wrong 22:51 22:51 but then what sri lanka needs to be 22:53 22:53 focusing on would be just ramping up 22:56 22:56 testing and and possibly 22:58 22:58 our contact tracing until we're in a 23:00 23:00 position where we have access to more 23:02 23:02 vaccines so whatever 23:03 23:03 yeah i mean whatever the speed of the 23:05 23:05 vaccination even if you could vaccinate 23:07 23:07 uh 80 of the population tomorrow or 23:09 23:09 whether it takes till early next year 23:11 23:11 which i think what the 23:13 23:13 government has indicated uh the reality 23:15 23:15 is we still need to carry on testing and 23:17 23:17 in fact 23:18 23:18 i think the with these things like the 23:20 23:20 variance the delta variant i mean the 23:21 23:21 problem with the delta variant that we 23:23 23:23 appear to have now 23:24 23:24 is that it is most the vaccines do not 23:27 23:27 have 23:28 23:28 that you know the efficacy is typically 23:29 23:29 much less than 90 often as low as 60 or 23:32 23:32 40 percent 23:33 23:33 so we will have transmission there will 23:35 23:35 be people who are not completely 23:36 23:36 who are not vaccinated in any situation 23:38 23:38 so that you know they will be very 23:40 23:40 susceptible 23:41 23:41 we need to have a strong test and trace 23:44 23:44 capability for the next three or four 23:45 23:45 five years till this is over 23:47 23:47 but in the meantime at least in the next 23:49 23:49 12 months if we want to stop people 23:51 23:51 dying if we want to stop people having 23:53 23:53 to go into icus in the private sector or 23:55 23:55 public sector or whatever i mean it's 23:57 23:57 great 23:57 23:57 the private sector can do this provide 23:59 23:59 the services but what we really need to 24:01 24:01 stop 24:01 24:01 is people needing those services and to 24:03 24:03 do that we have to test and trace that's 24:05 24:05 the only way 24:06 24:06 we can stop transmission vaccines are 24:09 24:09 not going to do that this year 24:11 24:11 this is a kind of open question any of 24:13 24:13 the panelists who'd like to jump in but 24:15 24:15 what we've been saying is although cases 24:17 24:17 have been rising 24:18 24:18 the sort of general commentaries that 24:20 24:20 we're not testing enough right now 24:22 24:22 especially maybe if we could hear from 24:24 24:24 dr lockheed on this 24:26 24:26 we've seen a lot of policy changes in 24:29 24:29 what criteria you have to meet in order 24:31 24:31 to be eligible 24:32 24:32 for a test and then this has changed 24:34 24:34 about three four times i believe 24:36 24:36 if not more how has this affected the 24:38 24:38 entire process of testing 24:39 24:39 in my view the government time to time 24:42 24:42 has changed 24:43 24:43 its policy its strategy and sometimes 24:47 24:47 we felt that you know whether the 24:49 24:49 testing capacity or the testing 24:51 24:51 is even restricted with some of the new 24:54 24:54 guidelines that we have seen for example 24:57 24:57 not allowing drive-through testing 25:00 25:00 then giving you know for example making 25:04 25:04 it mandatory for 25:05 25:05 any person who would want to test 25:08 25:08 themselves to have a prescription 25:10 25:10 in class restricting walking in people 25:13 25:13 for their own testing so these are 25:17 25:17 some of the areas that have really 25:20 25:20 restricted the testing and for example 25:23 25:23 if i tell you an example now before 25:26 25:26 these 25:26 25:26 very recent regulations came in which 25:29 25:29 restrict the private pcr labs to do more 25:33 25:33 testing the private sector was doing 25:35 25:35 almost about 16 000 25:37 25:37 tests per day with 10 labs being 25:41 25:41 approved by the ministry of health 25:43 25:43 and the epidemiology unit however with 25:46 25:46 the new government regulations that 25:48 25:48 that it just dropped down to half of 25:51 25:51 that 25:52 25:52 and is that the strategy that we want 25:54 25:54 for sri lanka 25:55 25:55 is needs to be revalidated so i'm also 25:59 25:59 in the opinion that testing has to be 26:01 26:01 increased we cannot look at this 26:04 26:04 in a narrow mindset but we need to 26:07 26:07 understand that 26:08 26:08 it's about testing tracing isolating 26:12 26:12 uh that will really save the people of 26:14 26:14 sri lanka 26:15 26:15 until such time that majority of our 26:17 26:17 people 26:18 26:18 are being vaccinated it's very important 26:21 26:21 because we also see 26:22 26:22 the mortality rates going up we see a 26:25 26:25 lot a lot of 26:26 26:26 late presentations and uh if 26:30 26:30 and and a lot of people going in for 26:32 26:32 hypoxia 26:33 26:33 and and some are dying so so these are 26:36 26:36 it's very important for us to you know 26:38 26:38 be consistent 26:39 26:39 with policy and increase 26:42 26:42 testing and all the precautionary things 26:45 26:45 in place and keep educating the people 26:47 26:47 of sri lanka so 26:48 26:48 if sri lanka is producing testing and 26:51 26:51 we don't have enough vaccines it seems 26:54 26:54 that we're 26:55 26:55 in rather a difficult position do we 26:57 26:57 have the hospital capacity 26:59 26:59 or if we don't have it right now do we 27:01 27:01 have the ability to 27:02 27:02 expand it rapidly both both in 27:04 27:04 government and private sector to meet 27:06 27:06 what is unfortunately very likely that 27:09 27:09 we would have a 27:09 27:09 increase in demand there yeah so what 27:11 27:11 the private sector has done 27:13 27:13 is uh it was a policy decision by the 27:15 27:15 government 27:16 27:16 and the private sector acted very fast 27:18 27:18 in setting up 27:20 27:20 intermediate care centers for kovid 19 27:23 27:23 treatment 27:24 27:24 and as of now we have almost 37 27:27 27:27 intermediate care centers operated by 27:30 27:30 about 27:30 27:30 15 private hospitals and and together 27:34 27:34 we have increased capacity to cater to 27:38 27:38 about 7500 patients 27:41 27:41 now this is about kobe treatment this is 27:43 27:43 about 27:44 27:44 asymptomatic or slightly symptomatic 27:47 27:47 patients with kovid positive but 27:49 27:49 what needs to be focused is also on 27:52 27:52 icu capacity increase by the by the 27:55 27:55 public sector 27:56 27:56 so in in little ways the private sector 27:58 27:58 can do 27:59 27:59 we have been able to expand the icu 28:02 28:02 capacity because we see 28:04 28:04 more and more people needing a high 28:06 28:06 dependency care or icu camp so this is 28:10 28:10 also an 28:11 28:11 area that we need to focus but the only 28:13 28:13 thing is that you know no 28:15 28:15 country will be able to expand 28:18 28:18 capacity in terms of infrastructure 28:23 28:23 if we uh drop our guard 28:27 28:27 that's the reason why everyone says that 28:30 28:30 it's important for us to 28:31 28:31 test more and more people it's very 28:33 28:33 important for 28:35 28:35 us to educate so that you know we make 28:38 28:38 sure that those behavioral changes 28:40 28:40 are there and all the precautionary 28:42 28:42 methods are being practiced by people 28:45 28:45 but there will always be limitation in 28:47 28:47 terms of 28:48 28:48 increasing capacity uh either by the 28:50 28:50 government 28:51 28:51 the public sector healthcare system or 28:53 28:53 the private healthcare system and 28:55 28:55 we cannot depend on increased capacity 28:57 28:57 with more and more people getting 28:59 28:59 infected 28:60 28:60 but rather we need to prevent people 29:02 29:02 getting from 29:03 29:03 uh getting infected can i just add 29:06 29:06 something there 29:06 29:06 go ahead uh doctor yes i mean i think 29:09 29:09 that 29:09 29:09 the thing to understand here is that the 29:12 29:12 virus spread if it's spreading it's 29:14 29:14 exponential 29:15 29:15 right so and what this delta variant is 29:18 29:18 going to do 29:19 29:19 it is going to increase the rate of 29:21 29:21 exponential transmission 29:22 29:22 right and if our current control 29:24 29:24 measures cannot control the existing 29:26 29:26 b117 they're going to have no chance 29:28 29:28 with delta 29:30 29:30 and the problem with exponential spread 29:33 29:33 is that there's no possible way that 29:36 29:36 even the richest healthcare system can 29:37 29:37 keep up with exponential spread 29:39 29:39 at some point the system will will break 29:42 29:42 and you could see that even in the 29:43 29:43 united states which you know has the 29:45 29:45 richest 29:45 29:45 best equipped healthcare system in the 29:47 29:47 world many of parts of the united states 29:50 29:50 in the end ran out of capacity you know 29:53 29:53 people died sometimes 29:54 29:54 without treatments and this is the 29:55 29:55 reality so i really have to agree dr 29:58 29:58 luckett the only way we can 29:60 29:60 we can go save us uh safeguard the 30:02 30:02 population 30:03 30:03 is to stop transmission we have to do 30:06 30:06 whatever we can 30:07 30:07 to control the spirit of the virus and 30:08 30:08 the mainstay of that has to be 30:10 30:10 testing tracing and isolation and i'm 30:12 30:12 glad also the private sector can 30:14 30:14 they're also contributing to the 30:16 30:16 isolation part because actually 30:18 30:18 in some sense they're providing these 30:19 30:19 intermediate care facilities to which 30:21 30:21 keep people away from the rest of the 30:22 30:22 community if i could just jump in there 30:24 30:24 anytime so the context is 30:26 30:26 is also about uh in a situation as 30:29 30:29 uh as wherein it's the issue of i think 30:32 30:32 basic economics right you focus on what 30:34 30:34 each one is good at if 30:36 30:36 if tertiary care needs to focus on the 30:39 30:39 fact 30:39 30:39 of icu beds etc they should love a lot 30:43 30:43 more 30:43 30:43 uh you know sort of sharing of expertise 30:46 30:46 uh in in the simpler areas you know 30:49 30:49 whether it's intermediate care we can 30:50 30:50 really scale that up 30:51 30:51 and you know i think if we were 30:53 30:53 approaching it a very 30:55 30:55 very you know in in baby steps you know 30:57 30:57 we should have 30:58 30:58 scaled it better uh if you're having 31:00 31:00 capacity issues with pcr 31:02 31:02 and when we can scale further but you 31:04 31:04 know globally rapid antigen testing has 31:07 31:07 been rolled out again as 31:08 31:08 it's not as accurate but it's one more 31:10 31:10 measure made 31:11 31:11 so there are good examples out there of 31:14 31:14 how everybody has coped you know 31:16 31:16 in in cycles so we need to be more agile 31:19 31:19 in in borrowing some of these strategies 31:22 31:22 as we go in and as we face 31:24 31:24 a more challenging time we can't you 31:27 31:27 know take forever to figure this out 31:30 31:30 for example regulatory coordination of a 31:32 31:32 product is already approved 31:34 31:34 uh you know usfda ema etc 31:37 31:37 i mean we've got to have it um 31:39 31:39 immediately available you know typically 31:41 31:41 we could wait a couple of years 31:43 31:43 in this situation we can't right we need 31:46 31:46 that sort of agility 31:47 31:47 uh so we've sort of hit a perfect storm 31:49 31:49 of this 31:51 31:51 you know uh non-agile government sort of 31:54 31:54 meeting a virus that's exponential right 31:57 31:57 so you're seeing the results play out 31:58 31:58 what we need to jump in is i mean 32:00 32:00 you know other than just comment uh from 32:03 32:03 the sidelines is 32:04 32:04 you know offer our services in terms of 32:07 32:07 here's product out there 32:08 32:08 let's engage it let's bring it on board 32:10 32:10 there will be a learning curve 32:12 32:12 but i think it comes from trust i think 32:14 32:14 fundamentally 32:16 32:16 uh there has to be trust and mutual 32:18 32:18 respect between the private sector and 32:20 32:20 government 32:20 32:20 if you know there are bad examples on 32:23 32:23 either side you know 32:24 32:24 but we need to move past that and start 32:26 32:26 working together more aggressively thank 32:28 32:28 you 32:28 32:28 mr sathya sivam i think we have one 32:31 32:31 question from the audience 32:33 32:33 thanks anita i just wanted to ask dr 32:36 32:36 lakit 32:37 32:37 and shyam when it comes to i think one 32:39 32:39 of the main complaints for the private 32:41 32:41 sector is the pricing factor 32:42 32:42 when most suppliers join why the prices 32:45 32:45 still remains as it is 32:47 32:47 or the pricing factor compared to the 32:49 32:49 other countries so how do you 32:51 32:51 see while the pricing of a pcr test 32:55 32:55 compared to other countries is there a 32:56 32:56 way that we can bring it down 32:58 32:58 is there any tariff for taxes which is 33:01 33:01 involved which will i think uh 33:02 33:02 embrace the private sector more that's 33:04 33:04 number one number two is 33:06 33:06 the pandemic at the very initial stages 33:08 33:08 we saw from the government 33:10 33:10 there's some sort of reluctance or some 33:12 33:12 sort of 33:13 33:13 i would say the correct word is 33:15 33:15 suspicion but because 33:16 33:16 the the initial pcr testing was not 33:19 33:19 allowed to done by the private sector 33:20 33:20 even like 33:22 33:22 patience management it came at a later 33:24 33:24 stage 33:25 33:25 so given the nature of the pandemic it's 33:27 33:27 it spreads so fast 33:29 33:29 and the couple of days delay could cause 33:31 33:31 an emo 33:32 33:32 enormous damage so uh what are your 33:34 33:34 thoughts on on on those two things on 33:36 33:36 the pricing factor as well as the 33:37 33:37 government's initial 33:39 33:39 reactions or reluctance to embrace the 33:41 33:41 private sector on the covet management 33:43 33:43 thanks in my view where the pricing is 33:45 33:45 concerned i think 33:47 33:47 the private sector also needs to act 33:49 33:49 responsibly to make sure that there is 33:52 33:52 no 33:53 33:53 undue profit hearing a situation such as 33:56 33:56 this 33:57 33:57 and make sure that you know you you try 34:00 34:00 your best to bring down prizes of 34:04 34:04 some of these essential services and 34:06 34:06 make it available 34:07 34:07 to a larger cross-section of people and 34:09 34:09 that should be our responsibility 34:12 34:12 and i believe that most of the private 34:16 34:16 players do abide by the regulations 34:19 34:19 of the regulator for example even though 34:22 34:22 as of now there is no 34:23 34:23 price ceiling on a pcr test the 10 labs 34:27 34:27 have 34:27 34:27 been in constant discussion with the 34:30 34:30 ministry of health 34:32 34:32 uh in in maintaining 34:35 34:35 uh a a price that is affordable to 34:39 34:39 the majority uh both in the corporate 34:42 34:42 sector 34:42 34:42 where they need to do more testing and 34:45 34:45 and it's a regulation 34:47 34:47 by the government to do uh testing for a 34:49 34:49 percentage of their employees 34:51 34:51 and also for walking patients 34:54 34:54 so it's the responsibility is there and 34:57 34:57 we as an association has 34:60 34:60 been you know talking to our memberships 35:03 35:03 in making sure that you know there is no 35:06 35:06 undue 35:07 35:07 benefits that the companies look at 35:10 35:10 at a point of a pandemic and i can give 35:13 35:13 you some examples 35:14 35:14 when these intermediate care centers 35:17 35:17 were open 35:17 35:17 the government gave a standard price 35:21 35:21 a rate that was approved and all these 35:25 35:25 37 icc centers do 35:29 35:29 abide by those price ceilings of the 35:32 35:32 government 35:33 35:33 so there is certainly needs to have 35:36 35:36 responsibility by the private sector 35:38 35:38 the second question is about getting the 35:40 35:40 private sector engaged 35:42 35:42 at an early stage we have seen right 35:44 35:44 throughout since sri lanka 35:46 35:46 is mostly driven by a public health care 35:49 35:49 system um 35:50 35:50 what we have seen even in the past is 35:52 35:52 that 35:53 35:53 public health care system would roll out 35:56 35:56 a program 35:57 35:57 and then at a certain point they do 35:60 35:60 engage with 36:01 36:01 the private sector so we saw this 36:03 36:03 rightly like you said 36:04 36:04 in pcr testing the government started 36:06 36:06 the pcr testing this was something new 36:08 36:08 they wanted to make sure that you know 36:10 36:10 they do it 36:11 36:11 right and then roll it out to the 36:13 36:13 private sector 36:15 36:15 in a more regulated framework same with 36:18 36:18 kobe treatment 36:19 36:19 the earlier it was only the public 36:21 36:21 sector that were 36:23 36:23 treating uh kovite patients but 36:25 36:25 understandably in a pandemic 36:27 36:27 we need to make sure that you have 36:30 36:30 mutual trust 36:31 36:31 and you engage your private sector to 36:33 36:33 take 36:34 36:34 a part of the burden out of the public 36:36 36:36 sector which the public sector has done 36:39 36:39 so like sham also said that i think 36:41 36:41 going 36:42 36:42 forward it's very important that we 36:45 36:45 build mutual trust 36:47 36:47 between the private sector and the state 36:49 36:49 sector and work together for the benefit 36:51 36:51 of all sri lankans 36:53 36:53 and without that collaboration without 36:56 36:56 that partnership without that trust 36:59 36:59 we will find it very very difficult to 37:01 37:01 battle against kobe 19. 37:03 37:03 yeah i think from from my side i would 37:05 37:05 only say you know open markets 37:07 37:07 competition 37:08 37:08 you know it has always been you know how 37:10 37:10 prices adjust if there is product 37:12 37:12 available 37:13 37:13 that the regulator approves and we have 37:15 37:15 more of that product in 37:17 37:17 in any form whether it's multiple pcr 37:20 37:20 products or multiple antigen testing 37:22 37:22 products or vaccines 37:24 37:24 you're seeing how markets have reacted 37:26 37:26 in that context 37:28 37:28 so i think what we need to do is create 37:29 37:29 more availability right if 37:31 37:31 internationally there is a lot more 37:33 37:33 product available we want to make sure 37:34 37:34 more of that product 37:36 37:36 is brought into the market and when 37:38 37:38 there is more of that availability 37:39 37:39 prices will adjust but you are also 37:42 37:42 seeing 37:42 37:42 prices of pricing of innovation for 37:45 37:45 example the fisa vaccine which is 37:47 37:47 globally 37:48 37:48 right now i think probably the lead 37:51 37:51 product 37:51 37:51 is also much more expensive than the 37:53 37:53 rest you know so 37:54 37:54 these are also issues we have to grapple 37:56 37:56 with we can't pick and choose 37:58 37:58 components of the private sector uh we 38:01 38:01 can't have all the 38:02 38:02 efficiencies of private at uh at very 38:05 38:05 low cost of public 38:06 38:06 you you've got to sort of you know pay 38:08 38:08 up for health care as well you know 38:10 38:10 when it comes to but definitely i think 38:12 38:12 transparency in pricing 38:14 38:14 you know the government regulators are 38:16 38:16 there to to review that 38:18 38:18 um look at you know face masks you know 38:20 38:20 from what prices we all used to buy them 38:22 38:22 a year ago 38:23 38:23 to what's available today right this is 38:25 38:25 what 38:26 38:26 happens when there is open competition 38:28 38:28 now quality regulation 38:30 38:30 also has to play a part because in 38:31 38:31 healthcare unlike any other product 38:33 38:33 quality has a far greater sort of impact 38:36 38:36 especially when it comes to you know 38:38 38:38 patient treatment 38:39 38:39 so it's a mix of the two thank you uh dr 38:42 38:42 rahman india do you want to weigh in on 38:43 38:43 this 38:44 38:44 um yeah i mean i i think the micro 38:47 38:47 colleagues have summarized well what's 38:48 38:48 happened 38:49 38:49 i mean i i guess the the difficulty the 38:51 38:51 government said is that 38:53 38:53 you know it's often used to i would say 38:56 38:56 ignoring the private sector and that's 38:58 38:58 fine you know 38:59 38:59 for things like polio vaccination the 39:01 39:01 public sector can do it but i think what 39:04 39:04 they 39:04 39:04 one of the weaknesses in in the decision 39:07 39:07 making has been 39:08 39:08 that it hasn't been geared to the to the 39:10 39:10 challenge of how you make decisions in 39:12 39:12 an optimal way 39:13 39:13 in an emergency like this and this is an 39:15 39:15 emergency which nobody in the health 39:17 39:17 ministry has ever experienced 39:18 39:18 to be fair right so if you take the 39:20 39:20 vaccination the vaccine purchasing issue 39:23 39:23 which is 39:23 39:23 one example of this you know i think 39:26 39:26 there was a tendency in the medical 39:27 39:27 profession is saying we need to wait 39:29 39:29 until we have all the evidence 39:31 39:31 and then approve the vaccine and then we 39:33 39:33 can purchase it right 39:35 39:35 but that's not a sensible thing to do 39:37 39:37 given the risks given the supply chain 39:39 39:39 problems given the delays 39:41 39:41 the sensible countries like the us like 39:43 39:43 europe what they did was they purchased 39:45 39:45 vaccines which didn't even exist you 39:47 39:47 know they 39:47 39:47 didn't even have a single clinical trial 39:49 39:49 but they purchased in advance because 39:51 39:51 they wanted to ensure guarantee so you 39:52 39:52 had to trade off between 39:54 39:54 secure supply and waiting till 39:56 39:56 everything is absolutely clear and all 39:58 39:58 the data's there before you making 39:59 39:59 decisions and that's not always the 40:00 40:00 optimal thing to do 40:01 40:01 so i think on testing what happens i 40:03 40:03 think there was a reluctance to involve 40:04 40:04 the private sector and i 40:06 40:06 won't get into why but i think in a 40:07 40:07 situation where 40:09 40:09 ramping up testing is the overall 40:11 40:11 national interest 40:12 40:12 the public interest i would say you know 40:15 40:15 even if there are problems with the 40:17 40:17 private sector you know regulatory 40:18 40:18 problems quality problems pricing 40:20 40:20 problems 40:21 40:21 it is better to er on the side of 40:24 40:24 increasing 40:25 40:25 supply and then trying to fix the 40:27 40:27 problem instead of saying i think what 40:29 40:29 has sometimes happened which is you know 40:30 40:30 we'll restrict the supply and 40:32 40:32 because we can't trust the private 40:34 40:34 sector we can't figure out how to 40:35 40:35 regulate them to 40:36 40:36 to achieve this i think i think we have 40:38 40:38 to uh here on the side of increasing 40:40 40:40 supply and we have to take some risks 40:42 40:42 the policymakers have to be willing to 40:43 40:43 take some risks and to 40:44 40:44 and to handle things in a in a more 40:46 40:46 flexible way thank you so i'd like to 40:48 40:48 ask you mr satya simon one another side 40:51 40:51 of the whole pandemic 40:52 40:52 is that the healthcare sector has been 40:54 40:54 focused on 40:56 40:56 core bit 19. and people are generally 40:58 40:58 anywhere would anybody be falling in 41:00 41:00 like you know you would you would have 41:02 41:02 your gen your general medical concerns 41:05 41:05 coming up how has the private sector 41:06 41:06 been able to deal with this 41:08 41:08 deal with meeting demand for everyday 41:10 41:10 sort of medicine 41:12 41:12 procurement and distribution so yes 41:14 41:14 definitely i think 41:15 41:15 in the context of because kovit is being 41:17 41:17 front and center 41:18 41:18 lots of sort of treatment has been 41:20 41:20 pushed to the sides and and also depends 41:22 41:22 on capacity et cetera you know 41:23 41:23 especially in markets that haven't been 41:25 41:25 overwhelmed you're seeing this right uh 41:27 41:27 there is 41:27 41:27 everything else is pushed back uh sri 41:30 41:30 lanka so far we haven't faced that 41:33 41:33 in that context of you know systems are 41:35 41:35 managing as of now 41:37 41:37 uh in that context what we are finding 41:39 41:39 is while people have put off 41:40 41:40 elective care what they choose to do in 41:43 41:43 terms of 41:44 41:44 surgery etc we've seen it in waves as 41:47 41:47 well you know has 41:47 41:47 locked downs of ease you know there's a 41:49 41:49 sense of normalcy returns people trying 41:51 41:51 to get back 41:52 41:52 in there in terms of product our concern 41:56 41:56 in terms of making product available 41:58 41:58 that pharmaceuticals available has been 42:00 42:00 in the markets that we import from are 42:02 42:02 they going through issues for example 42:04 42:04 right now 42:05 42:05 india is going through significant 42:07 42:07 issues so our concern was 42:08 42:08 you know at the start of it cross you 42:11 42:11 know 42:12 42:12 pharmaceuticals medical devices etc the 42:14 42:14 industry 42:15 42:15 sort of ramped up orders you know 42:17 42:17 brought product in 42:18 42:18 uh anticipating you know supply chain uh 42:21 42:21 shortages in the from those markets that 42:23 42:23 we typically buy 42:24 42:24 a product from uh so there will be such 42:27 42:27 shocks i think 42:28 42:28 there's an element we can do but there 42:29 42:29 will be some product shocks 42:32 42:32 in that context but broadly so far we've 42:35 42:35 yet to face 42:36 42:36 significant headway thank you so let me 42:38 42:38 also check in 42:39 42:39 on this anita if i can yeah even when we 42:42 42:42 take the 42:43 42:43 private hospitals they continue to 42:46 42:46 provide 42:47 42:47 all healthcare services including 42:49 42:49 elective surgeries the laboratory 42:51 42:51 services 42:53 42:53 dispensing drugs through their 42:55 42:55 pharmacies which are operated around the 42:57 42:57 clock 42:58 42:58 i think a crucial role was played by the 43:01 43:01 private sector 43:03 43:03 and and that also catalyzed the wave of 43:05 43:05 digitization to ensure that 43:07 43:07 healthcare was made accessible and and 43:10 43:10 this this was despite 43:12 43:12 severe limitations caused by the 43:14 43:14 pandemic for example 43:16 43:16 hospitals went into home delivery of 43:18 43:18 drugs hospitals went into 43:20 43:20 a home lab sample collection 43:23 43:23 providing home medical camp introducing 43:26 43:26 telemedicine 43:27 43:27 etc and also these hospitals you know 43:31 43:31 continued to operate under very 43:33 43:33 stringent guidelines and protocols 43:35 43:35 and made sure that routine 43:39 43:39 access to routine health care was given 43:41 43:41 to people and and 43:42 43:42 and that is where the private hospitals 43:46 43:46 came in very strong when the government 43:48 43:48 public health care system was mobilized 43:51 43:51 to treat kobe patients it was a private 43:54 43:54 hospital that provided access to routine 43:57 43:57 healthcare 43:57 43:57 thank you dr lockheed we have another 43:59 43:59 question coming in from the audience 44:02 44:02 asking what is your viral opinion if 44:04 44:04 people are willing to take vaccines from 44:06 44:06 private hospitals if 44:07 44:07 available what are the factors that 44:08 44:08 people are going to 44:10 44:10 look at are they going to be thinking 44:11 44:11 about price and quality 44:13 44:13 the private sector has started vaccine 44:15 44:15 distribution i believe with the cyano 44:16 44:16 farm 44:17 44:17 vaccine is this something we need to be 44:19 44:19 thinking about so i think i think number 44:21 44:21 one 44:21 44:21 is that if the big question is if the 44:24 44:24 vaccines 44:25 44:25 are available in plenty like i said 44:28 44:28 earlier 44:29 44:29 private sector can administrate the 44:31 44:31 vaccine 44:32 44:32 and we have the know-how the capability 44:35 44:35 of doing that and also making sure that 44:39 44:39 it is it is not too much of a burden on 44:42 44:42 the on the wallet 44:43 44:43 as well and of course we 44:47 44:47 are not in the business of importing 44:48 44:48 vaccines even if it is 44:50 44:50 available out there in the market that 44:52 44:52 is there for 44:53 44:53 shaman and his team in pharma 44:57 44:57 so private hospitals are totally geared 45:00 45:00 to help the government 45:01 45:01 and the people of sri lanka in the 45:03 45:03 vaccination drive 45:06 45:06 so if i jumped in there i would you know 45:08 45:08 the context would be 45:09 45:09 for for example i think significant 45:12 45:12 corporates i mean industries have been 45:14 45:14 willing to find vaccination for their 45:16 45:16 staff and their families etc 45:18 45:18 i think those are the also alternate 45:20 45:20 ways of you know 45:21 45:21 funding and as and when product becomes 45:24 45:24 available i think 45:26 45:26 we should encourage that you know for 45:27 45:27 example the apparel sector or the 45:29 45:29 healthcare 45:29 45:29 private healthcare sector or any such 45:31 45:31 export industries feel like 45:33 45:33 it makes sense for them to invest in 45:35 45:35 vaccination of their staff 45:37 45:37 and i think those you know should be 45:39 45:39 allowed 45:40 45:40 to happen right so you will get a mix of 45:42 45:42 product being procured by the corporate 45:44 45:44 sector 45:45 45:45 as well as you know i presume under some 45:48 45:48 price regulation they can be available 45:50 45:50 in the private sector as well and i 45:52 45:52 think we'll have to evolve to that 45:53 45:53 in nature and and not see that as a 45:56 45:56 taboo you know the idea that you would 45:57 45:57 pay for your vaccine as long as it's 45:59 45:59 transparent 45:60 45:60 i think should be you know a 46:01 46:01 conversation that it's out there 46:03 46:03 if i can um just comment on that last 46:06 46:06 point i think there's a there's a 46:08 46:08 difficult problem here because 46:10 46:10 this is a bit different to say you know 46:12 46:12 flu vaccination in rich countries where 46:15 46:15 not everyone gets the flu vaccination 46:17 46:17 you can go to a pharmacy or a doctor and 46:19 46:19 pay for it and get it 46:21 46:21 the problem here is that in order to 46:23 46:23 control this virus 46:24 46:24 we need to achieve very high levels of 46:26 46:26 vaccination of the population and we 46:28 46:28 need to maintain it 46:29 46:29 and that can only be done through 46:31 46:31 through a substantial amount of 46:32 46:32 government uh financing 46:34 46:34 and so the and it's going to be a very 46:36 46:36 heavy cost i mean we're already talking 46:37 46:37 about 300 million dollars 46:39 46:39 i won't do the math into rupees here but 46:41 46:41 the issue is you know 46:43 46:43 the fear i have about the private sector 46:46 46:46 saying yes we'll pay for it we need to 46:48 46:48 make sure it's not done in such a way 46:50 46:50 that it undermines public financing and 46:53 46:53 remember the reason 46:54 46:54 one of the reasons the government has 46:56 46:56 delayed buying vaccines 46:57 46:57 is because we don't have enough taxes in 46:59 46:59 the country right and the private sector 47:01 47:01 i know the chamber of commerce a couple 47:03 47:03 of years ago said we should increase 47:04 47:04 taxes but they're not always very 47:06 47:06 consistent in that messaging so i think 47:08 47:08 you know it's good to the private sector 47:10 47:10 is willing to pay directly but i would 47:12 47:12 hope that the private sector 47:14 47:14 also understands the need to lobby the 47:16 47:16 policy makers to raise 47:18 47:18 overall taxation in the economy so the 47:20 47:20 government has the money to pay for 47:22 47:22 vaccines for everyone else 47:24 47:24 because if we only vaccinate half the 47:26 47:26 population who can afford it and not the 47:28 47:28 other half 47:29 47:29 then everyone is at risk vaccines are 47:32 47:32 not 100 47:32 47:32 perfect it's everyone's interest to 47:35 47:35 ensure that everyone is vaccinated so i 47:37 47:37 think we need to aim at that has to be 47:38 47:38 the goal 47:39 47:39 i think it's okay the price center 47:40 47:40 contributes but when the private also 47:42 47:42 has to have a responsibility 47:44 47:44 that they also need to make the case for 47:46 47:46 increased taxation to pay for thank you 47:47 47:47 dr ananilia 47:48 47:48 i believe we have one more question from 47:50 47:50 the audience 47:52 47:52 hi um so this is just a general question 47:56 47:56 i believe it's actually a follow-up to 47:58 47:58 what dan and i mentioned earlier but 48:00 48:00 it's really on the possibility for 48:02 48:02 misallocation and misappropriation 48:05 48:05 when it comes to vaccines and even when 48:07 48:07 it comes to pcr tests i believe if i'm 48:09 48:09 not mistaken there were some stories on 48:11 48:11 uh how hospitals were mishandling it or 48:14 48:14 there were some issues with this 48:15 48:15 and i was just wondering because i know 48:18 48:18 that 48:19 48:19 it is uh in the bigger picture important 48:22 48:22 to prioritize distribution 48:23 48:23 and give hospitals the benefit of the 48:25 48:25 doubt especially the private sector 48:27 48:27 but in terms of regulation i was 48:29 48:29 wondering if the government has 48:30 48:30 the capacity to do anything about this 48:32 48:32 if the private sector themselves can't 48:34 48:34 do anything 48:35 48:35 to just ensure standards and just how 48:38 48:38 big of an issue it is 48:39 48:39 mishandling uh pcrs and vaccines thank 48:42 48:42 you very much 48:43 48:43 um yeah go ahead shine sure so on the 48:46 48:46 product side i 48:47 48:47 i leave the the care side too lucky 48:51 48:51 on the product side i think the context 48:53 48:53 is uh 48:54 48:54 i mean sri lanka has been a reasonably 48:56 48:56 well regulated market 48:58 48:58 in product in that context and we've 48:60 48:60 only had increased regulation in the 49:02 49:02 last couple of years 49:03 49:03 uh when it comes to a product like 49:04 49:04 vaccine yes it's it's unusual 49:07 49:07 in the context of you know universal 49:09 49:09 access therefore volumes and the 49:11 49:11 experience is new 49:12 49:12 so yes there will be hiccups and they 49:14 49:14 have been 49:15 49:15 and i think we have to be ready for 49:17 49:17 there will be even more right 49:18 49:18 in the context of where it is but we 49:20 49:20 have to move forward 49:22 49:22 and not get thrown off by a few hiccups 49:25 49:25 that happen because this is 49:26 49:26 you know a completely new territory that 49:29 49:29 we're all embarking on both private and 49:32 49:32 government and i think uh mutual trust 49:35 49:35 and sort of lu you know a feedback loop 49:38 49:38 recheck you know re-correct course 49:40 49:40 correct and move forward i think that's 49:41 49:41 what we'll have to do because if we 49:43 49:43 highlight every error and everybody gets 49:45 49:45 stuck right so then 49:46 49:46 they make no progress so i would think 49:48 49:48 we should love latitude or feedback 49:51 49:51 loops have a conversation 49:52 49:52 figure it out move forward are there bad 49:55 49:55 eggs in the system 49:56 49:56 there are there are i think you know but 49:59 49:59 we've got to move beyond it 50:00 50:00 i think uh what we're trying to resolve 50:03 50:03 is far greater 50:04 50:04 uh than that so we'll have to try new 50:07 50:07 areas take greater risks even in 50:08 50:08 disbursement 50:09 50:09 uh you know in that context is my view 50:11 50:11 yeah and also to chip 50:13 50:13 in uh we need to understand that 50:17 50:17 others healthcare is a regulated 50:19 50:19 industry and to answer your question 50:21 50:21 does the government have 50:23 50:23 resources to regulate yes they do have 50:26 50:26 the resources to regulate because 50:28 50:28 we have been a regulated industry but 50:31 50:31 just see i mean for example when the 50:32 50:32 pandemic came in 50:34 50:34 which was very new i mean see the amount 50:37 50:37 of 50:38 50:38 agility and and the speed at which the 50:40 50:40 private hospitals 50:42 50:42 uh responded in in putting up you know 50:44 50:44 safe 50:45 50:45 high quality health care services um uh 50:48 50:48 which we never knew that we we have not 50:52 50:52 experienced you know 50:53 50:53 for example if i if i let me briefly 50:55 50:55 explain you 50:56 50:56 some of the key measures that the the 50:59 50:59 hospitals took 51:00 51:00 because these are not being discussed 51:02 51:02 and sometimes 51:04 51:04 it's only the negative negatives that 51:06 51:06 may come up and we'll have 51:08 51:08 more publicity i mean for example the 51:10 51:10 moment that we were we were hit by the 51:12 51:12 pandemic 51:13 51:13 hospitals private hospitals had to 51:15 51:15 provide routine access 51:17 51:17 or access to routine healthcare but at 51:19 51:19 the same time we had to 51:20 51:20 keep our staff the communities that we 51:23 51:23 operate 51:23 51:23 uh safe the virus was unknown and 51:26 51:26 so the private hospitals came quickly 51:29 51:29 you know started 51:30 51:30 something called self declarations 51:33 51:33 started digital platforms 51:35 51:35 uh so that the the risk can be assessed 51:38 51:38 even before a patient would walk into a 51:41 51:41 hospital 51:42 51:42 uh they immediately came together and 51:45 51:45 thought that okay 51:46 51:46 it's extremely important to triage 51:49 51:49 a person before they walk into a 51:51 51:51 hospital 51:53 51:53 and they came up with a risk matrix to 51:57 51:57 you know categorize them and then 51:59 51:59 quickly observation 52:01 52:01 wards were put up spacers for 52:04 52:04 resuscitation and nebulization were cut 52:07 52:07 out fitted with hepa filters so 52:09 52:09 i mean then we came up with you know uvc 52:12 52:12 disinfection 52:14 52:14 equipment so likewise there is a lot 52:17 52:17 that the private sector has done 52:19 52:19 and even in the case of pci and i 52:21 52:21 totally don't see 52:23 52:23 any uh lab out of the 10 approved labs 52:26 52:26 deliberately you know giving a wrong 52:29 52:29 result or an inaccurate result 52:31 52:31 inaccuracy can take place whether it is 52:34 52:34 in the government sector or the private 52:35 52:35 sector 52:36 52:36 i think um as an industry 52:40 52:40 we are regulated and we focus on 52:42 52:42 self-regulation 52:43 52:43 as well and during a pandemic it's very 52:47 52:47 important that 52:48 52:48 mutual trust is being built uh 52:51 52:51 amongst all stakeholders i i would just 52:53 52:53 um 52:54 52:54 just add to that i mean i think shian 52:56 52:56 mentioned i think he mentioned two 52:58 52:58 two terms which are very important the 52:59 52:59 importance of having trust 53:01 53:01 and also feedback or feedback loops and 53:04 53:04 you know we need to realize in a in this 53:06 53:06 situation whatever the government does 53:08 53:08 there will be some harm right i mean 53:10 53:10 even if you think about the private 53:12 53:12 sector issues 53:13 53:13 i think some people are concerned about 53:14 53:14 there may be problems with bad quality 53:16 53:16 there may be problems of malfeasance and 53:18 53:18 people doing bad things sure 53:19 53:19 i mean that that is there but we have to 53:22 53:22 balance the harm from those things 53:24 53:24 against the harm and let's say in the 53:26 53:26 case of pcr testing of not testing 53:28 53:28 enough people and if we don't test 53:30 53:30 enough people 53:31 53:31 the harm is much greater so i think in 53:33 53:33 this kind of emergency situation 53:35 53:35 the correct public policy position has 53:37 53:37 to be to er 53:39 53:39 in away from the side of caution to take 53:41 53:41 more risk 53:42 53:42 and then it has to say well okay privacy 53:44 53:44 yeah there may be some problems 53:46 53:46 but then we just have to figure out if i 53:48 53:48 was in government we had to figure out 53:49 53:49 how we work with the private sector to 53:51 53:51 address the problems 53:52 53:52 and move on i don't think we should get 53:54 53:54 stuck in a paralysis of 53:56 53:56 where we can't do anything because we're 53:58 53:58 afraid of 53:59 53:59 some bad things happening we have to 54:01 54:01 think and keep in mind the much bigger 54:03 54:03 picture 54:04 54:04 the whole country that the public's uh 54:06 54:06 their lives and 54:08 54:08 their livelihoods are at stake and we 54:09 54:09 need to act in the national interest and 54:11 54:11 i think 54:11 54:11 most importantly we need everyone all 54:14 54:14 hands on deck to solve this problem and 54:16 54:16 that means including in case of 54:18 54:18 government working with the private 54:19 54:19 sector thank you 54:20 54:20 so i think we have a few more questions 54:22 54:22 coming in nominee has 54:23 54:23 sent her a question why i tweet i'll 54:26 54:26 just read her question out so 54:27 54:27 this is on vaccine procurement 54:29 54:29 regulators have stated that producers 54:30 54:30 and sellers only deal with governments 54:33 54:33 but agents are permitted to procure 54:35 54:35 provided they are authorized by the 54:36 54:36 government what is the real situation 54:38 54:38 can the private sector procure vaccines 54:40 54:40 i think this is a issue that has been 54:42 54:42 brought up repeatedly during today's 54:44 54:44 conversation 54:45 54:45 so if we can have a quick response from 54:46 54:46 the speakers yeah so let me 54:48 54:48 lead with that uh in terms of so 54:50 54:50 typically in a process 54:52 54:52 any product is represented local 54:54 54:54 companies so 54:55 54:55 you know many members of the sri lanka 54:57 54:57 chamber of pharmaceutical industry 54:59 54:59 represent 54:60 54:60 you know all of the global vaccine 55:02 55:02 manufacturers and then they would go 55:03 55:03 through a regulatory process 55:05 55:05 and either allow participate in the 55:07 55:07 government tenders or government 55:09 55:09 procures it or through the private 55:11 55:11 market in the space of 55:13 55:13 vaccines what's happened is the 55:14 55:14 government has stepped in very early in 55:16 55:16 to say that they will be the only ones 55:18 55:18 procuring this product and you know it 55:20 55:20 made sense that's what was happening 55:21 55:21 globally as well 55:22 55:22 but i think there was a role in 55:25 55:25 registration etc which we could have 55:27 55:27 played as well 55:28 55:28 at this point in time given global 55:30 55:30 demand 55:31 55:31 all manufacturers are swamped with 55:34 55:34 orders and primarily from 55:35 55:35 governments per se so that will be their 55:38 55:38 first port of call in terms of supply 55:40 55:40 uh what you have had heard in the recent 55:43 55:43 have been 55:44 55:44 sort of middle players you know who 55:47 55:47 claim to have access of product you know 55:49 55:49 because of all sort of supply chain i 55:51 55:51 guess there will be gaps you know 55:53 55:53 there's been context of excess product 55:55 55:55 uh and so then there's been excitement 55:58 55:58 of sort of trying if we can get product 55:60 55:60 from elsewhere 56:01 56:01 that has not played out as a predictable 56:03 56:03 nature because these 56:04 56:04 these require significant cold chain 56:08 56:08 sort of uh you know data we just cannot 56:10 56:10 buy from some random player who claims 56:12 56:12 to 56:12 56:12 you know have the product so i think you 56:15 56:15 know while there was 56:16 56:16 a desperation from all quarters to sort 56:19 56:19 of get it 56:19 56:19 in different ways i think everybody's 56:21 56:21 come to the realization that 56:23 56:23 you the only secure way is through the 56:25 56:25 manufacturers 56:26 56:26 i think it's been good that you know 56:28 56:28 whatever was in excess orders across the 56:31 56:31 world is coming back via the kovac 56:33 56:33 scheme 56:34 56:34 so you know it's in that context so i 56:36 56:36 think it will only be 56:38 56:38 through the manufacturers uh at this 56:40 56:40 point in time thank you 56:42 56:42 so what will hopefully be our final 56:44 56:44 question for today 56:45 56:45 we have a question asking what do you 56:48 56:48 feel about the regulation that is being 56:50 56:50 done correct currently through the nmra 56:53 56:53 is it effective are there better models 56:55 56:55 looking at both regulation on medicine 56:57 56:57 as well as medical equipment in in the 56:59 56:59 context of the pandemic i let doctor 57:01 57:01 robert you're on an idea 57:02 57:02 i mean i i think i'll say i mean i'll 57:05 57:05 stick to the pandemic situation 57:07 57:07 i mean i think the nmra is you know 57:10 57:10 is structured in a reasonable manner to 57:12 57:12 make decisions i i think where i would 57:15 57:15 fault them but i'm not sure i would 57:17 57:17 necessarily remember this i would take 57:18 57:18 my words 57:19 57:19 i'm not sure i would afford the nmra 57:21 57:21 because i think this is a much higher 57:22 57:22 level policy decision 57:23 57:23 i think we we took a very conservative 57:26 57:26 approach 57:26 57:26 for example and you could see with this 57:28 57:28 with some of the vaccine approvals 57:30 57:30 where you know they were waiting for 57:32 57:32 lots of data and 57:34 57:34 that i think was and then we couldn't 57:36 57:36 make any purchases and i think the 57:37 57:37 government should either have said 57:39 57:39 well we don't really care about the 57:40 57:40 approval we will still purchase and wait 57:42 57:42 for the approvals later 57:43 57:43 or they should have uh being clearer 57:45 57:45 that the 57:46 57:46 the the the review process by the 57:49 57:49 experts should be 57:50 57:50 uh focused on certain things i mean so i 57:52 57:52 think we've ended up in a situation for 57:54 57:54 example where who approved vaccines even 57:56 57:56 before we approved vaccines even though 57:58 57:58 we were looking 57:59 57:59 at the same data i think so i think this 58:01 58:01 is 58:02 58:02 i'm not sure whether it's the fault of 58:04 58:04 the nmra i think it's a 58:06 58:06 probably more i would say an inability 58:08 58:08 to adjust to the needs of the moment 58:10 58:10 uh and to become more flexible i'll put 58:12 58:12 it that way i mean i'll leave aside the 58:14 58:14 routine 58:15 58:15 regulatory issues that occur 58:20 58:20 i mean the routine regulatory issues 58:21 58:21 that you speak of would 58:23 58:23 play a role right now as well if i'm not 58:26 58:26 mistaken because 58:27 58:27 everyone would need access to that 58:28 58:28 regular medicine 58:30 58:30 and medical equipment so i think on that 58:34 58:34 um i think we have a process i mean it's 58:37 58:37 based on 58:37 58:37 experts reviewing things i mean i think 58:39 58:39 you know we have only so much capacity 58:41 58:41 to regulate so i think 58:42 58:42 i i don't have any specific concerns 58:44 58:44 about that uh 58:45 58:45 my only my only real concern in the 58:47 58:47 regulatory space before 58:49 58:49 before the pandemic was i personally i'm 58:51 58:51 not in favor of the kind of price 58:53 58:53 regulation that's been attempted 58:54 58:54 recently but that's that's sort of 58:56 58:56 another 58:56 58:56 issue and i'd rather not go into that 58:59 58:59 discussion 58:60 58:60 yeah so if i just join the conversation 59:02 59:02 it will be about 59:03 59:03 the fact that uh what we need at this 59:06 59:06 point 59:06 59:06 is a lot more you know regulatory 59:08 59:08 coordination 59:09 59:09 especially with uh sort of what we call 59:12 59:12 reference countries markets that we have 59:14 59:14 similar 59:15 59:15 sort of uh policies with so for example 59:19 59:19 i mean uh 59:19 59:19 i think the uk mhra uh it was a good 59:23 59:23 example in terms of somebody who was 59:24 59:24 leading the world in sort of 59:28 59:28 vaccine you know reviews etc so how do 59:31 59:31 we in a pandemic situation 59:32 59:32 borrow from those ideas rather than try 59:34 59:34 to you know start all over again here 59:36 59:36 so i think what we need to do is i would 59:38 59:38 like the regulator to be more agile in 59:40 59:40 that context right 59:41 59:41 uh we can't replicate in the same way 59:44 59:44 you we used to do 59:45 59:45 yeah in the past we need to move on we 59:47 59:47 we need if a product is approved 59:49 59:49 by by any of our recognized sort of 59:53 59:53 global uh you know regulators we need to 59:55 59:55 make it then immediately available here 59:57 59:57 right 59:58 59:58 those are risks that we probably did not 59:59 59:59 take in the past we just we need to move 60:01 60:01 on and take them now 60:03 60:03 so that newer product is available uh 60:06 60:06 as soon as we as we can get access 60:08 60:08 because 60:09 60:09 when we come late to the party there is 60:11 60:11 no product available i mean right now 60:13 60:13 we're to go order 60:14 60:14 these you know high flow nasal oxygen 60:16 60:16 meters 60:17 60:17 we're late in the day you know globally 60:19 60:19 there's so much orders placed you know 60:21 60:21 we're 60:22 60:22 jumping in to procure product uh when 60:25 60:25 when it's a bit too late because you 60:27 60:27 know in terms of what uh 60:29 60:29 not recognizing you know where the curb 60:32 60:32 is heading 60:33 60:33 including in product so product has to 60:35 60:35 get regulated but we need to do it at a 60:37 60:37 much faster pace 60:39 60:39 and also borrow from you know those 60:42 60:42 relationships 60:43 60:43 we should have with these global 60:45 60:45 regulators 60:48 60:48 yeah if i could say a quick comment 60:49 60:49 observation i mean this is not just a 60:51 60:51 sri lankan problem 60:53 60:53 this is a global problem in procurement 60:56 60:56 and regulation and i would just 60:58 60:58 just share something that was shared 60:59 60:59 yesterday um in the uk 61:01 61:01 i mean the uk we just there was some 61:04 61:04 material released by dominic cummings 61:05 61:05 the former 61:06 61:06 prime minister advisor and he explained 61:08 61:08 you know they had to take the 61:09 61:09 procurement 61:10 61:10 of the ppe and the emergency staff and 61:13 61:13 the vaccines essentially outside 61:15 61:15 the uk health ministry because the uk 61:17 61:17 health ministry's 61:18 61:18 kind of regular process which is 61:20 61:20 probably very good 61:21 61:21 wasn't flexible or fast enough to react 61:24 61:24 and make decisions 61:25 61:25 in this emergency situation so this is 61:27 61:27 an emergency situation we sometimes need 61:29 61:29 to 61:30 61:30 adopt emergency uh measures and we need 61:33 61:33 to have a bit more flexibility and i 61:34 61:34 think and i think we probably suffered a 61:35 61:35 bit from that in the same way thank you 61:37 61:37 i think we'll 61:38 61:38 start wrapping up now uh i'd like to 61:40 61:40 thank everyone for joining today's 61:42 61:42 business discussion 61:43 61:43 and of course most importantly thank our 61:46 61:46 speakers today dr ravi rananelli dr 61:48 61:48 lucky peters 61:49 61:49 and mr shyam santa sivam we've come to 61:52 61:52 some 61:53 61:53 very interesting conclusions i believe 61:54 61:54 at the end of this discussion 61:56 61:56 one of the more pressing questions today 61:58 61:58 has been how does vaccine procurement 61:60 61:60 work 62:01 62:01 and i believe the answer that we've 62:02 62:02 received from this conversation today is 62:04 62:04 that it's going to have to be through 62:05 62:05 the government 62:06 62:06 for the next year or so but then there 62:09 62:09 will hopefully be scope for the private 62:10 62:10 sector to also 62:12 62:12 enter into vaccine procurement in the 62:13 62:13 years to come and 62:15 62:15 uh it will probably be required or 62:17 62:17 necessary that the 62:18 62:18 private sector jumps in there especially 62:21 62:21 if we're going to see 62:22 62:22 a need for things like biannual booster 62:25 62:25 shots etc 62:26 62:26 testing has come out as a priority in 62:29 62:29 terms of immediate solutions 62:30 62:30 to the pandemic in terms of both making 62:33 62:33 sure we have understanding of how big of 62:35 62:35 an issue it is where we're dealing with 62:36 62:36 right now 62:37 62:37 and also to to handle the problem and 62:40 62:40 reduce 62:41 62:41 the burden on the hospital system and 62:43 62:43 finally and 62:44 62:44 and arguably most importantly the 62:46 62:46 question is what is the role of the 62:47 62:47 private sector 62:48 62:48 here it seems the private sector has a 62:50 62:50 fairly essential role to play here 62:52 62:52 and what is crucial is that we have 62:54 62:54 better coordination between the 62:56 62:56 government and the private sector 62:58 62:58 to ensure that we are responding quickly 63:00 63:00 and effectively to the pandemic that 63:02 63:02 we're 63:03 63:03 having regulation that responds to 63:07 63:07 recent developments that we can see in 63:08 63:08 other countries as well as of course 63:10 63:10 playing an essential role in making sure 63:12 63:12 that we're meeting certain standards 63:13 63:13 with our care and then finally to make 63:16 63:16 sure that we start procurement processes 63:18 63:18 early so that we have access to 63:20 63:20 life-saving products and medicine 63:22 63:22 and that we get this into sri lanka in 63:25 63:25 time we're able to 63:26 63:26 address this pandemic best of our 63:27 63:27 abilities 63:29 63:29 so on that note i'd like to thank our 63:31 63:31 speakers again 63:32 63:32 and of course thank our listeners for 63:34 63:34 joining in and 63:35 63:35 engaging with today's discussion i hope 63:37 63:37 you all have a good night