This article first appeared in The Edge Malaysia Weekly on December 27, 2021 - January 2, 2022

THIS has proved to be another challenging year for the nation as the Covid-19 pandemic raged on, owing to the emergence of new variants. Although Malaysia got off on the wrong foot in its vaccine rollout, it managed to pull out a win in the end.

The government received criticism for its handling of the spike in cases and its vaccine procurement strategy going into 2021. As vaccination against Covid-19 was being rolled out in countries across the globe from early December 2020, Malaysia only started administering vaccines to its population two months later, due to initial delays in the approval of the procurement of vaccines by the National Pharmaceutical Regulatory Agency (NPRA).

The country’s top health official, Health director-general Tan Sri Dr Noor Hisham Abdullah, said at the time that it would take between 90 and 120 days for NPRA to study the safety data on the Covid-19 vaccine produced by pharmaceutical company Pfizer — even as neighbouring Singapore received its first shipment of the Pfizer-BioNTech vaccine.

The government’s move to place the country under a state of emergency in January for the next seven months to curb the spread of Covid-19 didn’t sit well with the public either. Critics argued that then prime minister Tan Sri Muhyiddin Yassin, who is president of Parti Pribumi Bersatu Malaysia, was using the emergency proclamation as a way to cling on to power at a time when his Perikatan Nasional (PN) government had weakened.

The criticism didn’t stop there however. The country’s slow initial vaccine rollout caused further frustration, with only about 2% of the 33 million population having received at least one dose as at April 19. By comparison, more than 23% of the population in Singapore had received at least one dose and in Indonesia, the figure was 4%. The percentage was much higher in the US (40%), the UK (49%), Canada (25%) and the EU (19%), while the average in Asia stood at 3.6%.

Health Minister Khairy Jamaluddin, who served as the coordinating minister of the National Covid-19 Immunisation Programme (PICK) under the PN government to spearhead the country’s vaccination drive, had blamed the slow vaccination rate on insufficient supply, as pharmaceutical companies prioritised rich countries. Malaysia had purchased Covid-19 vaccines from Pfizer-BioNTech, AstraZeneca, Russia’s Gamaleya Institute, China’s Sinovac and CanSino, as well as via global vaccine sharing plan Covax.

In May, Noor Hisham warned that Malaysia’s healthcare system, which was coping with more than 40,000 active cases of Covid-19 then, was under severe pressure. On May 23, Malaysia surged past India to record one of Southeast Asia’s highest Covid-19 infection rates, with deaths per capita exceeding those of India and Indonesia.

ProtectHealth Corp Sdn Bhd CEO Datuk Dr Anas Alam Faizli recalls, “In early to the middle of this year, Malaysia faced vaccine supply/logistical issues caused by delayed deliveries. But once the supply came in, we managed to rapidly scale up vaccination nationwide by opening dozens of mega vaccination centres every week.”

The large amount of misleading and false information on the virus, especially on social media, and anti-vaccine and ivermectin lobby groups also stymied progress in the efforts to curb Covid-19.

“While Covid-19 cases were going up, the Ministry of Health (MoH) had to deal with vaccine hesitancy and misinformation by some quarters. [Nevertheless] our mission was to vaccinate as many people as possible regardless of their background, location and condition, and let data and science work by itself,” Anas tells The Edge.

And there was no playbook for the authorities to work from.

In fact, amid controversies about the safety concerns of the AstraZeneca vaccine, the government pulled out the vaccine from PICK only to reinstate it two months later due to the overwhelming response from the public. Malaysia had initially diverted the AstraZeneca vaccine into a parallel voluntary vaccination programme following reports of rare blood clots.

During this period, serious shortcomings in the RM70 million national online vaccination registration and tracking portal MySejahtera were discovered as hundreds of thousands of Malaysians struggled to register online for the AstraZeneca vaccine.

Nevertheless, after an initially slow rollout, Malaysia’s vaccination programme made impressive progress to achieve its goal of fully vaccinating 90% of the total adult population in October, which saw the government lifting the ban on interstate travel (except for authorised purposes) that had been implemented since mid-January. In November, the country was ranked No 10 among countries with the highest percentage of full Covid-19 vaccination by The New York Times’ CodeBlue vaccination tracker, after the UAE, Portugal, Malta, Singapore, Chile, Cambodia, Spain, Qatar and Iceland.

In addition, Malaysia managed to pull off what would be the nation’s biggest vaccination programme in history, despite a political tussle that saw the resignation of Muhyiddin in August after 17 months in power. Then deputy prime minister and Umno stalwart Datuk Seri Ismail Sabri Yaakob was appointed the country’s ninth prime minister in September.

While the government could have done better in response to the pandemic, public health expert Professor Datuk Dr Adeeba Kamarulzaman says the country’s PICK is something “we can be very happy about”.

“At last check, we have well over 75% of the population over 12 years old fully vaccinated and 97% of the total adult population fully vaccinated. These are figures that we can certainly be very proud of. It is a testament to the entire vaccine programme led by our current health minister [Khairy], with MoH working together with other health sectors and civil society that saw the programme roll out relatively smoothly,” she says in an email response to questions from The Edge.

Consultant paediatrician Datuk Dr Amar-Singh HSS agrees that while the authorities had a slow start to the vaccination campaign due to supply issues, it was impressive how quickly both the adult and adolescent populations were vaccinated.

“Sadly, this same impetus has not been seen with boosters, due to community concerns about side effects, mixing boosters and fake news. We need to follow the data and science, and share this with the public to help them make better informed decisions,” he says.

ProtectHealth’s Anas deems PICK a successful national programme involving all levels — from the government to the private sector and the people — coming together to ensure the implementation runs smoothly and in the fastest possible way.

“It is also the largest ever public-private partnership (PPP) in healthcare in terms of the number of people involved and within a short time frame, where ProtectHealth has been given the chance to lead the partnership,” he says. The not-for-profit company, set up under the ambit of MoH, was tasked with getting private medical practitioners to participate in PICK in February.

On its part, ProtectHealth has raised PPP to new heights as PICK is the fastest and largest by scale that involve the public and private sectors under one national programme. “Indeed, it is a successful partnership and could be an example for future reference,” says Anas.

To date, ProtectHealth has managed to enlist more than 2,200 private medical practitioners under PICK, including 1,635 general practitioners (GPs), 122 private hospitals, 31 specialist clinics, 25 ambulatory care centres and 153 outreach programmes.

Anas points out that Malaysia has given 52 million doses of Covid-19 vaccines, of which 48% was administered by private medical practitioners and healthcare non-governmental organisations (NGOs) registered under ProtectHealth.

“We are satisfied with the implementation of vaccine equity where Malaysians are given vaccines based on need and priority versus social standing. Everyone was vaccinated as per their need, and it was an equitable situation where all walks of life would be vaccinated as per the appointment regardless of whether it was a public or private facility,” he says.

It should be noted that the vaccines were given free to Malaysians and foreigners in the country who had registered with MySejahtera.

Adeeba, who is professor of medicine and infectious diseases at the University of Malaya, says an area that perhaps could have been done better by the government during the vaccine rollout was to prioritise high-risk groups apart from their age-density housing, worker dormitories and prisons earlier than we actually did.

“Perhaps we should also have worked with private GPs and pharmacists in a much bigger way and earlier to roll out the vaccine programme, as well as mobilise the NGOs to reach out to marginalised communities who were afraid to come forward because of the mixed messages coming out of MoH and the Ministry of Home Affairs.”

Amar concurs, noting that there was an unacceptable disparity in vaccination supply between states that left some regions less well protected initially, especially Sabah. “The continual double standards practised by those in government and VIPs compared with the average person on the street also hampered our Covid-19 prevention programme,” he says.

He points out that the government’s risk communication, to address vaccine hesitancy among individuals for primary vaccine and now booster doses, has also been limited. “We should offer honest and transparent local data on vaccine side effects to the public. This includes putting online all the serious vaccine side effects reported locally and their investigation findings. Our mechanism for the public to report serious vaccine side effects was also not easy.”

Amar notes that there has been no concerted national push to improve ventilation in all buildings such as offices, schools and hospitals to limit the spread of Covid-19, despite the enormous amount of data on its importance.

He is also of the view that large vaccination facilities or mega vaccination centres (PPVs) should be avoided in the future as they are potential sites for Covid-19 spread. “We should rely on and utilise existing vaccination infrastructure such as maternal and child health clinics, school health teams, GP clinics and private hospitals,” he says.

While the inoculation process was ramped up across the country, large crowds and long queues raised concerns about adherence to standard operating procedures and physical distancing, as this raised fears of the emergence of new Covid-19 clusters. Pictures and videos of foreign workers waiting in long queues for their vaccinations also went viral on social media. This was due to their irresponsible employers, who did not drop off their workers after or much earlier than their vaccination date.

ProtecthHealth’s Anas believes the appointment system is the way forward in order to plan and maximise vaccine utilisation according to demand and supply. “One can book their preferred date and time, as well as the facility, according to their availability and preference in advance.”

As the New Year approaches, the threat of the Omicron variant to public health looms large across the globe. Many health experts say it is still too early to make a call on the severity of the strain, but already countries such as Sri Lanka, Singapore, South Korea, Indonesia and Thailand have barred travellers from southern Africa, where the variant was first reported.

On Dec 1, Malaysia joined the list of nations barring the entry of travellers from eight countries — South Africa, Botswana, Eswatini, Lesotho, Mozambique, Namibia, Zimbabwe and Malawi.

In 2020, the pandemic response focused on lockdowns, and on vaccinations this year, says Malaysian Health Coalition co-founder Dr Khor Swee Kheng. “Malaysia’s vaccination programme in 2021 has been successful, and must now be complemented by a long-term booster strategy and a basket of public health measures in 2022.

“In the long term, until 2023 and onwards, it is important for Malaysia to develop an endemic strategy that can manage the threat of variants, allow the resumption of normal life, and the domestic production of vaccines so we develop self-sufficiency.”

In September, the government predicted that Malaysia would move from the pandemic to an endemic phase by end-October as more than 75% of the country’s population would have been fully vaccinated by then.

But earlier this month, Defence Minister Datuk Seri Hishammuddin Hussein said Malaysia had decided to delay the transition to the endemic phase as there was too much uncertainty on the recent spread of the new variant. On Dec 16, the country detected its second case of the Omicron variant.

Anas says that while Malaysia’s healthcare system has been acknowledged internationally as successful, the authorities are apprehensive that the current system may not be sustainable in the long term, with the country’s ageing population, increase in chronic diseases, rapid rise in health expenditure and high out-of-pocket spending.

“The pandemic has tested the Malaysian healthcare system and it has shown us the reality. We need to widen the healthcare financing source as well as build up capacity and mechanisms to strategically purchase services from the private sector when rapid escalation of capacity is needed,” he adds.

“Sustainable healthcare financing through a national-scale strategic purchasing agency could be one of the ways to ensure our healthcare system is resilient and adaptive that can withstand such a crisis.”

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