Dr Ian Ellul

Dire Straits were an exceptional British rock band active between 1977 and 1995. Their song, Sultans of Swing, originally released in 1978, is particularly close to my heart. The lyrics, written by frontman Mark Knopfler, were inspired by his presence in a pub in South London where a jazz band was performing; the name of the band was Sultans of Swing. Knopfler noted the contrast between the expectations tied to their name and the reality of an empty pub.

Maybe the reason why I am passionate about this song is that I am very sensitive to such dichotomous situations. Aren’t we experiencing it in the manner in which the Covid-19 vaccine is distributed amongst countries? By the end of 2021 it is estimated that there would be 12.5 billion doses of vaccine which are enough to vaccinate the entire eligible population. Yet we see inequality all around us. Let us take Africa as an example. This continent trails behind, with only 10% of its population having received at least one dose. This goes beyond vaccine hesitancy but stems from the fact that Africa has little access to vaccines. The 10% vaccination rate is well below the WHO target of vaccinating 40% of the population of all countries by end-2021 and 70% by mid-2022. We are seeing this, even though it was apparent since Q2 of 2020 that the main challenge in the management of the pandemic waves would revolve around Africa. This mismanagement will inevitably lead to an African melting-point for different emerging variants which will then spill to the rest of the world, including Europe. We are literally shooting at each other’s feet, in a concerted effort. And we seem to gloat at this.

Interestingly, according to Covax – a global effort co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO to ensure equitable access to immunization throughout the world – around 100m of western countries’ vaccines will expire in December and could easily go to waste. It is thus commendable that Malta has sent close to 500,000 Covid-19 vaccine doses to Rwanda, Ghana, Iran and Libya in the past few weeks; this compares extremely well to much bigger countries who pledges much but donated little. In keeping with the above, an important consideration of donations is that vaccines are being given to poor countries within three months of their expiry date. In such cases the expeditious transferring of delivery dates is the best way to mitigate this; at the time of going to print, Switzerland has become the first and only country so far to swap places in the vaccine supply queue with Covax, expediting the delivery of Covid vaccines to lower-income nations.

Sadly, such behavioural polarity is also seen at home. We personally show such traits, maybe inadvertently, when dealing with people, including patients. We also invariably see it ingrained in specific trade unions who present themselves as Archangels who blazon patient empowerment but then stand out in crippling the health department with countless directives. I ask, who suffers the brunt of these actions? I answer, it is the underprivileged and the marginalised. And yet ironically, against this backdrop, all of us trumpet the importance of mental health. And here again, I repeat the questions which I asked earlier this year … Who is to blame for the countless industrial actions spanning across the entire healthcare? The various healthcare professional sectors by any presumptuous demands? Or the government by its inherent inertia on specific issues? Can, however, the blame rest on specific union leader zealots?

I thus end this year’s editorial with hope … that we truly discern what is good, what is important and what is crucial for us to survive harmoniously and truly live the Hippocratic oath … help the sick and abstain from all intentional wrongdoing and harm …