Misguided Policies Damage A Valued Public Health System

Photo courtesy of Newsfirst

SHASHIKA BANDARA- 12/23/2020

Sri Lanka hit the lowest point in their COVID-19 response when a 20-day-old Muslim infant was cremated on December 9, 2020 against the wishes of his parents and against their religious faith. Islamic faith requires followers to treat the dead bodies with respect and prescribes burial of dead bodies. While the cremation of the infant caught the attention of the media, what is missing from the picture is months long targeted stigmatizing of the Muslim minority on social media that has spilled over to mainstream media – and a very slow response from the government of Sri Lanka to combat stigma.

As social media and mainstream media continues its sensationalizing and harmful contribution to the COVID-19 infodemic, many have started to believe that there is a scientific basis for these forced cremations and that such actions display government’s commitment to controlling COVID-19.

As Sri Lanka debates the righteousness of denying a family its last wish of respecting its infant son’s body, it is worth taking a deeper look into the science, international standards and, most importantly, what such actions mean to Sri Lanka’s COVID-19 public health response.

Scientific Evidence

The most common argument that the burying of the dead can somehow increase transmission of the disease has no scientific basis. The interim guidelines by the World Health Organization (WHO) updated on September 2020 have clear dos and don’ts on disposing a body of someone who was infected with COVID-19. Additionally, the guidelines also include instructions on how to safely allow the family to view the body. In addition to the WHO guidelines, scientific reviews on methods of body disposal clearly provide burial as an option for those who had passed due to COVID-19.

It is also important to note that Sri Lanka is not alone when combating misinformation and incoherent policies related to burial of those affected by COVID-19. In countries such as Cameroon challenges with regard to burials have been resolved with resorting to scientific guidance such as of the WHO and allowing the families to bury their dead within 48 hours. In resolving an incident in the central Java province, Indonesia has used a similar approach and highlighted the need for dignified treatment of the dead with proper funeral rites.

Therefore, if the government is using science to guide its COVID-19 response, it is vital that the government uses the existing examples, scientific reviews and interim guidelines of the WHO to guide its policies and allow burials as an option to respectfully dispose of the dead of those affected by COVID-19. The absence of coherent policies guided by science, fueled by misinformation violates international health regulations that the government has agreed to uphold.

International Health Regulations

International Health Regulations (IHR) revised in 2005 to be able to respond to global health security threats in the 21^st century is the principal international legal framework that govern response to global health security challenges. In its revision, IHR required countries to build technical and infrastructure capacity in preparation of disease outbreaks, to implement measures in response to disease outbreak similar to COVID-19. Sri Lanka remains a State Party to the IHR since 2005.

IHR clearly states under Article 42: Implementation of health measures that “Health measures taken pursuant to these Regulations shall be initiated and completed without delay, and applied in a transparent and non-discriminatory manner.” Additionally, IHR clearly requires countries to base their additional health measures on a) scientific principles; b) available scientific evidence of a risk to human health, or where such evidence is insufficient, the available information including from WHO and other relevant intergovernmental organizations and international bodies; and c) any available specific guidance or advice from WHO.

Sri Lanka, in this instance, did not abide by International Health Regulations and has ignored the interim guidance by the WHO. The implementation of mandatory cremation in a non-transparent manner without a scientific basis shows a clear gap in the COVID-19 policies of the government.

Policy Incoherence and Loss of Trust

Stigma has been an ugly byproduct of COVID-19 that targeted the Muslim minority and the government in its response has done very little to combat stigma.

In the instance of baby Shaykh, denial of a second test to confirm COVID-19 infection followed by forced cremation shows ineffective implementation of policies that causes further trauma to those affected by the pandemic. The President’s most recent request for the bodies of the Muslim to be buried in Maldives (a country with a Muslim majority) not only ignores the pain caused to the community but also highlights a strong policy incoherence and contradicts the science employed to explain forced cremations.

The forced cremations and the lack of a clear effort to combat months long stigma targeting the Muslim community erodes the trust between the Muslim community and the country’s public health system. Even with the vaccination Sri Lanka will need to rely on its public health system to inform and control the spread of the virus. Stigma in any outbreak is a clear threat to public health efforts for disease control. Coupled with selective application of the law that ignore gatherings that violate health guidelines by those in privileged positions or political connections causes further harm to COVID-19 response of Sri Lanka.

The damaging effects of erosion of trust in the public health system due to stigma and discrimination will not stop with COVID-19 pandemic. As research indicates lack of trust is a strong barrier to health care provision and can also create fertile ground for misinformation that causes further harm leading to poor health outcomes. As we combat one of the deadliest pandemics the world has seen in decades, it is crucial that we remember diseases do not have borders, do not selectively affect certain communities or the poor and vulnerable. Additionally, health emergencies, like many catastrophic events in human history, require policies that address both the physical spread of the disease and  mental health impacts. Trauma, isolation and fear caused by stigma needs to be key considerations in any government policies. It is not too late for both the government and the Sri Lankan community to consider the negative impact of stigma, listen to the science and be humane in our approach to understanding crises. In fact, it is our responsibility to push for humane, non-discriminatory and effective policies based on science and strengthen trust between the community and the public health system.