Zarina Zainuddin and Muhammad Sinatra
first published in Observer Research Foundation (ORF) India on 11 March 2021
Malaysia’s roller coaster experience in managing the COVID-19 pandemic offers both best practices and cautionary tales to external observers. A strong performance during the quasi-lockdown measure (entitled the Movement Control Order [MCO]) in the first half of 2020 successfully flattened the infection curve to manageable figures—low enough for the country to gradually open up the economy and travel in the third quarter of the year.
Sadly, this impressive feat was not sustainable as evidenced in the subsequent waves that lasted longer than the first. The number of cases reached four digits and smashed new record highs, painting a situation that is much worse than when the MCO was first instituted in March 2020. Factors contributing to this grim situation include super spreader events (such as the local election in Sabah), lockdown fatigue, the rise of asymptomatic patients, and continued poor practices on foreign worker housing, amongst others.
Malaysia has reached that point in the crisis which Indonesia had arrived at much earlier in the timeline: The near-absolute dependence on a vaccine to obliterate the raging coronavirus.
Malaysia commenced its national immunisation programme on 26 February 2021, with the Prime Minister Tan Sri Muhyiddin Yassin receiving the first shot. The vaccination rollout as well as details pertaining to the vaccine is outlined in the recently released National COVID-19 Immunisation Programme handbook.
The vaccination will comprise three phases for a time period of 12-18 months starting from end of February, with healthcare workers and other essential frontliners, followed by the vulnerable population of elderly individuals, patients of chronic illnesses, and persons with disabilities. The remainder of the residents who are 18 years old and above will receive vaccine shots starting May this year. The populace in COVID red zone areas will also be prioritised.
Malaysia has opted to procure a variety of vaccines either through direct purchase or via the World Health Organisation (WHO)’s COVAX Initiative. According to Minister of Science, Technology, and Innovation, YB Khairy Jamaluddin, the assessment of vaccine portfolio is based on “how fast the vaccine can be obtained, how affordable it is and as well as the vaccine’s safety and efficacy.” Malaysia has also adopted the view that herd immunity could be achieved faster by immunising with a variety of vaccines.
So far, Malaysia has secured vaccines to cover about 80 percent of residents. About half of the population will be vaccinated with the Pfizer-BioNTech vaccine, about 20 percent with AstraZeneca and Sinovac, and the remainder will be split equally between CanSinoBIO and Sputnik V.
Malaysia may be able to procure vaccines to cover all its residents as talks are currently underway with Johnson & Johnson for vaccine procurement as well as exploring the possibility of locally manufacturing the Russian Sputnik V.
Issues and challenges
Despite these positive developments, some challenges and opportunities have arisen, which need to be recognised.
The first concerns foreigners and migrant workers in Malaysia. The year 2020 saw a pandemic-induced uptick in negative sentiment against this group, which only invited further media interest into their lives. For example, some outbreaks are noted to have occurred in places with poor living standards for foreign workers, such as workers’ living quarters, workplaces, and even immigration holdings. It was also reported that 49 foreigners had committed suicidebetween March and October last year due to pandemic-linked pressures, thus, further underscoring the imperative to adopt an all-inclusive principle in the vaccine deployment strategy.
Fortunately, the government of Malaysia has announced that vaccines would also be distributed to non-Malaysian citizens free of charge. This step would elevate foreigners’ confidence in the government and confer diplomatic goodwill to Malaysia’s relations with the migrants’ origin countries. Foreigners are likely to get vaccinated late in the second phase, if not the third, as only the excess doses—or the remaining extra supplies after Malaysians are vaccinated—would be allocated to them. Positive gestures such as this could inspire similar pro-migrant workers narratives in the future, such as the demand to improve their living or housing conditions and their inclusion in existing mental health campaigns.
Another notable issue is vaccine acceptance in Malaysia. According to a survey by the Ministry of Health (MoH), only two-thirds of respondents have a positive attitude towards vaccines. This suggests that the government needs to go the extra mile to persuade more people to accept vaccines, especially if herd immunity is to be achieved at a time when new COVID-19 variants are emerging. Reasons for this lack of confidence include concerns over the vaccines’ halal status, fear over potential side effects, and the belief that the disease can be prevented effectively by following strict protocols and engaging in healthy living. Furthermore, misinformation about the vaccines may also have influenced members of the public to develop resistance against the serums, such as the assertion that vaccines are unnecessary to achieve herd immunity. There are strategic steps that Malaysia could undertake to alleviate this problem, such as opening communication lines with religious authorities in Indonesia to develop a common narrative to address questions over the vaccines’ halal status.
The third challenge relates to the issue of logistics, including vaccine storage, infrastructure, transportation, and deployment. Despite the stated 95 percent efficacy rate of Pfizer’s vaccines, which make up 50 percent of procured vaccines in Malaysia, they come with the price of logistical challenges as these vaccines must be stored in the extremely cold temperature of -75°Celsius. This entails the provision of special storage facilities that could sustain the integrity of these vaccines. While urban centres might not have difficulties to address this, it could constitute a problem for the vaccine distribution process in remote and rural areas, where electricity supply and infrastructure might not be sufficient. This is on top of the extra transportation modes that will be needed to ship out the vaccines to these areas. Careful planning must be instituted in these areas so as to sustain vaccine quality and ensure candidates’ turnout during the deployment process, otherwise these vaccines could be wasted.
While Malaysia is new to vaccine manufacturing, discussions are underway with several interested parties from Russia, India, and China on the possibility of setting up domestic production of the COVID vaccines, especially to market Malaysia as the halal vaccine hub for Southeast Asia and other Muslim markets. This interest is prompted by the desire to cater to a lucrative under-served halal market, and Malaysia was chosen due to the brand recognition of its halal certification. Investments in vaccine manufacturing would advance and boost Malaysia’s pharmaceutical and biotechnology industry.
One of the few positive consequences of COVID-19 is the cumulative enrichment of knowledge pertaining to the pandemic, ranging from effective medical treatment during the initial outbreak, to proper standard operating procedures (SOP) and the gathering of facts and information on the vaccines as immunisation rolls out. This benefit is not limited to the medical and scientific community alone, but also to Malaysian society.
In recent years, Malaysia has been experiencing a glut of medical officers. For example, as of December 2018, 54.3 percent of its medical graduates and 23.9 percent of its pharmacy graduates were waiting to find placement with hospitals. The situation continued throuogh 2019, as Malaysia continued to produce over 5,000 new doctors annually. This surplus of medical officers became an unexpected boon to Malaysia as it added to the much needed manpower to assist during the various stages of the COVID-19 containment plan. As the government continuously invests in its medical infrastructure and personnel, the government increases Malaysia’s medical and scientific capacity and capability tremendously.
There are many challenges—economic, social, financial, and political—that await Malaysia as it moves ahead, but with the vaccine rollout around the corner, it gives Malaysians a glimmer of hope towards a return to normalcy.
This article was first published in Observer Research Foundation (ORF) India on 11 March 2021.