This article first appeared in The Edge Malaysia Weekly on October 18, 2021 - October 24, 2021

AS Malaysia reaches a crucial milestone with 90% of the adult population fully vaccinated and prepares to enter the endemic phase of Covid-19, the time has come for people to be responsible in managing their own health, says ProtectHealth Corp Sdn Bhd CEO Datuk Dr Anas Alam Faizli.

“The government has released policies and guidelines [for people] to follow under the National Recovery Plan (NRP). We can have the standard operating procedures and regulations, but I don’t think the government can continue [to keep a close eye on the Covid-19 situation by] setting up roadblocks and checking on all individuals via their MySejahtera. It has to come from the people now. It is time to empower people to take charge of their own health,” he tells The Edge in an interview.

“The eventuality of endemic means Covid-19 is something we’re going to have to live with. People may not realise it, but there are already several endemic diseases in the country, such as dengue and malaria. We can’t continue to keep our economy locked down.

“Everybody needs to be more responsible. Unvaccinated people should be responsible for not spreading the virus and infecting others. We have to move away from direct control to getting Malaysians to self-regulate. It has got to be an individual’s responsibility. Now that the government has done its part, it is our turn to play our role,” says Anas.

On its part, ProtectHealth has been busy. Incorporated in December 2016, it is a not-for-profit company set up under the ambit of the Ministry of Health (MoH). In February this year, it was tasked with getting private medical practitioners to participate in the National Covid-19 Immunisation Programme (PICK).

This follows MoH’s realisation early this year that as the country grapples with vaccinating its population, it would put additional strain on public healthcare resources and capacity already stretched by the pandemic in 2020. Thus, in January, ProtectHealth started discussions with MoH to enlist private sector participation in PICK.

Anas says ProtectHealth was the natural choice given its experience as the administrator of the PeKa B40 scheme, an MoH initiative that offers free health services to the bottom 40% (B40) household income group. ProtectHealth was the first in the country to successfully purchase such services from both the public and private sectors.

“We were appointed by MoH to be the implementer of private medical practitioner participation in PICK in late February. On March 8, we announced that private general practitioners (GPs) would be onboarded under PICK [as vaccinators],” Anas notes.

“Back then, there was no playbook. We were all facing a pandemic that we had never faced before and so, we would meet with the Covid-19 Immunisation Task Force (CITF) twice or thrice a week (to deliberate on Covid-19 matters). Of course, we also looked to the experience of other countries such as the UK and Israel, but at the end of the day, we did what was most suitable for Malaysia. We just had to push ahead and do it. To be fair, everything was on a pilot basis. There was no time to waste and we were just trying and trying every day and hoping everything would go well,” he says.

According to Anas, dealing with the private sector is not the same as dealing with the public sector.

“When dealing with the public sector, you can just issue a circular to all the (government) health clinics and start offering vaccinations. However, with the private sector, you first have to onboard the GPs, register them and then train them on the different types of vaccines. We also need a system to track each dose administered because the vaccines belong to the government. How do you track the vaccines? How do you track the number of people vaccinated by the private sector? How do you arrange the logistics for vaccine pickups? Do we deliver the vaccines to the GPs? Or do we have the GPs collect them from vaccine storage facilities? At that time, we were also discussing (running) mass vaccinations. So all these things had to be sorted out quickly,” he says.

Initially, ProtectHealth saw just 1,000 GPs registering for PICK before things started picking up. On April 12, the company received the green light to expand the PICK programme to include private hospitals, followed by specialist clinics and ambulatory care centres on April 30.

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

Anas says from day one, the challenge was the supply of vaccines.

After the government saw public resistance to Britain’s AstraZeneca vaccine, it purchased more of the US-made Pfizer and Chinese-produced Sinovac vaccines. “However, the delivery of the Pfizer vaccine was delayed,” Anas says, noting that Pfizer’s deliveries have been uneven even till today as it gives priority to rich Western countries.

“At that point, there was some scepticism over the AstraZeneca vaccine and so, CITF made the decision to remove it from the PICK programme.”

As the opt-in programme for the AstraZeneca vaccine kicked off in May, one of the Covid-19 vaccination centres (PPVs) — the World Trade Centre in Kuala Lumpur — experienced crowd control issues.

“What happened was we had people with appointments for the AstraZeneca vaccine and, at the same time, we had to decide whether to offer walk-in shots as there were leftover vaccines to distribute at the end of the day and you didn’t want them to go to waste. My personal opinion has always been to maximise vaccine take-up. If there are people (who do not have an appointment) turning up at PPVs and it does not compromise vaccine doses for those who have appointments, I will always allow (them to get vaccinated),” says Anas.

He acknowledges the challenge of having many parties involved in running the PPVs. “The most important thing is to lay out the terms of reference. What do MoH, the Science, Technology and Innovation Ministry, People’s Volunteer Corps (Rela), the PPV manager and coordinator, and the private medical practitioner do? Also, every PPV would have five stations [to complete the vaccination process]. All these had to be carefully coordinated and we had to make sure we got them right from the beginning. Of course, there was criticism from the public on the handling of the PPVs but I think, overall, we’ve got it quite alright.”

Another challenge for ProtectHealth was the logistics to deliver Pfizer vaccines — which requires ultra-cold chain storage — throughout the country.

“The Covid-19 vaccine manufactured by Pfizer and BioNTech was the first to be declared safe for adolescents. Still, Malaysia did well when (Health Minister) Khairy Jamaluddin decided to procure vaccines not only from one manufacturer, but also from other vaccine manufacturers. For example, Sinovac’s Covid-19 vaccine saved us in June/July when deliveries of the Pfizer vaccine were delayed,” explains Anas.

He says Malaysia now has a sufficient supply of vaccine doses from Pfizer-BioNTech. The country will begin administering third doses to selected groups such as frontliners, the immunocompromised and elderly with comorbidities this month.

“As for booster shots, the government is still studying the need for them and will come up with a policy for everybody to follow,” he adds.

Considering that the country started its vaccination drive late due to supply issues, Anas says Malaysia did “quite well” in fully vaccinating its population, even pulling ahead of the US. “Everybody came together as a nation to make this (PICK) programme a success. That’s why when we hit 80% vaccination coverage, I congratulated Malaysians — because everybody came down to get their vaccinations.”

As at Oct 11, Malaysia had given 45 million doses of Covid-19 vaccines, of which 47% or 21 million doses were administered by private medical practitioners and healthcare non-governmental organisations registered under ProtectHealth.

Anas says ProtectHealth’s work is not finished yet. “There is still a lot on our plate. We want to expand the PeKa B40 programme and we will continue to support any initiative from the government. The 12th Malaysia Plan has outlined several health reforms and we believe ProtectHealth will continue to play a key role in ensuring that critical contribution from the private-public partnership is sustained.”

“Our role as a strategic purchaser and financier of health services will be incrementally heightened to ensure this [private-public] balance is maintained. The government spends about RM55 billion a year on healthcare. That is a massive number. I don’t think we can continue spending that much, subsidising public healthcare. We have to find a way forward. (For example,) a lot of these profits from the private sector and insurance companies can be used to ease this gap, especially to help the poor. ProtectHealth will continue to play that role, working closely with MoH to ensure that we are ready to solve the impending unsustainable healthcare cost problems,” he says.

While PICK has pushed ProtectHealth into the limelight in recent months, Anas admits that the level of awareness of the company among Malaysians is still low.

“To be fair, we are quite new, (we were established) in 2016 and we embarked on the PeKa B40 scheme in early 2019. So, the public only heard of us in 2019 or 2020 and also PeKa B40 is a programme specially targeted at the B40 population.

“Given the success of PICK, we hope to continue working with the private sector because there is so much more to be done,” he adds.

For one, ProtectHealth — which employs close to 100 people — will turn its attention back to the PeKa B40 scheme, which has seen uptake slowing down as priority was given to tackling Covid-19. Anas says about 550,000 people from the B40 group have registered for the PeKa B40 scheme since its rollout in 2019, accounting for a mere 10% of the total 4.9 million eligible recipients.

“We have managed to get approval from the government for each PeKa B40 recipient to enjoy free health screening every three years [as compared with] one-off currently, but on a first-come, first-served basis and while the budget allocation for the scheme is still available. Hopefully, now that more people are vaccinated, we are going to do more outreach programmes and promote PeKa B40, starting with Negeri Sembilan, which has transitioned to Phase 4 of the NRP,” he adds.

“Due to the pandemic, we have seen how people have changed their health-seeking behaviour, and hopefully, it will get more people to be more health-conscious and do better in at least taking care of their personal health. To me, individual health is not just the responsibility of the government but also the individual. It’s a collective responsibility. The government can only provide so much. If everybody is healthy, the country will be more productive and we can help improve our economy,” says Anas.

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