Compliance: Too difficult of a pill to swallow?

In past health security crises, the military and police have played a role to mitigate and solve issues. COVID-19 is unprecedented in that it restricts movement across the nation. With shifting goalposts and ambiguous definitions for full compliance, would society be able to achieve the 100 percent wanted? And is full compliance the only component to flatten the curve?

By Izzah Khairina Ibrahim and Farlina Said

Panic – that was part of the mayhem that awaited enforcement officers ensuring civil protection measures are enforced. Malaysia’s Movement Control Order (MCO) was announced at 10pm on 16 March 2020 with full enforcement commencing at the stroke of midnight on 18 March. With less than 48 hours of notice, combined with a lack of clarity, conflicting information sources and ambiguous limitations of the order, it sparked a flurry of intrastate and interstate movement.

The growing demand for manpower to ensure compliance saw the mobilisation of the Malaysian Armed Forces on 22 March. They joined state security councils, district management centres and RELA personnel, who were all given similar jurisdiction as their police counterparts.

Conversations on the implementation and timeliness of the MCO aside, the order placed a hefty task on the enforcement forces of Malaysia. The order to restrict movement was pursuant to the Prevention and Control of Infectious Diseases (PCID) Act 1988 and Police Act (PA) 1967, which includes measures intended to control the spread of the disease – including addressing the movement of vehicles and people.  Shortly after, the Attorney General’s Chambers released a federal gazette providing enforcement specifics for the MCO, specifying a penalty up to RM 1,000 and/or up to six months in prison for those disobeying.

There is a correlation between the severity, utility and role of armed forces in the case of health security. During the 1999 Nipah virus outbreak, the army and the police were utilised. At its peak, Malaysia had 265 Nipah virus cases with 105 deaths. However, as the source of the outbreak was livestock and the legislation used was the Animal Ordinance 1953, the armed forces were intended to control the movement of pigs and cull the animals infected. The police sealed areas with the assistance of the people’s volunteer corps (RELA) while the army was dispensed to eliminate infected animals.

In other experiences, Malaysia’s borders were briefly closed to countries displaying high infection rates to navigate the SARS outbreak. Malaysia had reported only 5 cases with 2 fatalities then. The 2009-2010 H1N1 pandemic painted a different experience. Malaysia had 14,912 cases with 88 deaths in a period of about 14 months. Malaysia had declared a health emergency four months after the first confirmed case landed on Malaysian soil. However, as the mortality rate of H1N1 did not breach the threshold stipulated by the Ministry of Health, no national curfew was applied. Rather, the Ministry warned of taking court action against those who defy self-quarantine orders or were caught without a mask on the streets. Additionally, schools with infected students were closed. As such, neither of the past health crises necessitated a large role for the armed forces.

In comparison, on 31 March, Malaysia has 2,766 COVID-19 cases with 43 fatalities. Yet, concerns for a lack of action sparked fear in authorities given that Italy reported growth from approximately 100 cases to more than 10,000 cases in over two weeks. This is primarily due to how one individual infected with the coronavirus is said to be capable of transmitting it to three people, thus measures to break the chain of transmission becomes necessary – particularly as hosts of the virus can be asymptomatic or would only develop symptoms later. In comparison, Malaysia’s approach to H1N1 relied on the display of influenza-like illnesses.

Early delivery of the MCO restricted overseas travels by Malaysians, a complete ban of large gatherings including religious activities, as well as the closure of all government and private premises except for those involved in providing essential services. There are several exceptions to movement, among them being purchasing food, hosting small funerals or wedding solemnisations, or if you are a part of the food supply chain. A method of measuring the success of the MCOs is through the number of cars available at roadblocks. With commuting being indispensable to some aspects of the Malaysian life, authorities are challenged to drive this figure down.

By 30 March, several areas were elevated to the Extended Movement Control Order (EMCO) status due to the display of a higher degree of cases and stricter standard operating procedures (SOPs) were implemented for other areas. The EMCO is a complete restriction of movement with zero ability to leave homes or conduct business activities, while basic foodstuffs will be supplied by the Social Welfare Department.

In order to uphold national security and ensure civil order, it is imperative for key decision-makers and frontliners to effectively enforce compliance to the MCO. The scale of this crisis goes beyond immediate movement control, and will require coordination across all relevant government bodies. While respective ministries have diligently provided regular updates, packaged into neat numbers and appealing percentages to indicate civil order and national security are being kept, the question is how are we certain that measures are being captured accurately?

For example, it was reported that by 28 March more than 1,000 people have been arrested since the start of the MCO, a mere 10 days earlier. This is seemingly at odds with information reported into the sixth day of the MCO, where official reports stated that the MCO has achieved a 95 percent compliance rate. This emphasises how compliance is not an easily measured figure, especially in a continuously changing and unpredictable crisis situation. Complicating matters is that different states have different procedures for compliance, which can affect what qualifies for successful deliverables of the MCO. For instance, Terengganu has a rotation for cars on the road based on the number plates, while Melaka had limited trading hours even before the MCO.

This highlights the importance of not just the transparency, but the clarity, of such information. While raw data and infographics painting productive efforts have circulated throughout the commencement of the MCO, the context and the means to interpret the information remain uncertain. Little in-depth analysis has been made with these figures, notably the means to numerically determine areas of progress and areas requiring improvement.

The subsequent dilemma that follows is the way to interpret the increased reports of law enforcement taking disciplinary measures. Is the greater number of those punished for disobedience a marker of effectiveness? Or is this an indication of the broader difficulty found in the enforcement methods of the MCO? These considerations can be further complicated given the ongoing changes to the punishments for given offences over time.

The intentions to indicate fruitful progress and assurance against confusion without the supporting information would be a disservice to both the country and those working towards containing the virus. Producing such figures are important to be transparent in their efforts to contain the spread of the virus, but Malaysia cannot afford false positives nor a false sense of security in our compliance.

A nationwide restriction of movement has not occurred to those born in this generation. In mitigating H1N1, the Nipah virus and SARS, restrictions were highly specific and did not encompass daily routines. Information dissemination and public education has proven themselves invaluable, particularly in the case of handling the Nipah virus and H1N1. It should be the go-to approach for the government, relevant institutions and anybody seeking to better prepare themselves against this pandemic or any future pandemics. These are especially important for enforcement bodies as compliance is better achieved when authority figures can effectively control these gaps of information in a timely manner and, hence, become the guiding hand for its citizens.

While the current security arrangement is in line with the law, it does not negate the significant power distances and trust issues between the armed forces and the general public. This has been evident in the number of misdemeanors that were related to resistance to authority. As Malaysia braces for the peak of transmissions, it would not be surprising if the present role of the armed forces shifts. However, such changes need to be justified and clearly articulated. Escalation of action should not be made to chase an arbitrary goal. The goal is to flatten the curve and defeat COVID-19, not perpetually tighten restrictions.

There is a difference between hysteria and heightened awareness, and the journey to the latter can be difficult to canvass for the entirety of Malaysia. Regardless, striving for transparency, communication and cooperation can go a long way for society and its security forces to mitigate the virus.

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