Low vaccination rate: taking a closer look

THE national Covid-19 immunisation programme kick-started with a lot of fanfare.

Prime Minister Muhyiddin Yassin received his first vaccine in public on February 24.

Three months later, the people expressed their dissatisfaction and complained that the vaccination rate was too low, alleging that it is mainly due to the government being slow and incompetent.

Often, the ‘betters’ they cite are Singapore, European Union countries, the United States, Israel and so on.

I would like to offer an objective perspective on the national vaccination programme.

Often, the public judges a policy or a programme by its immediate outcome. In this case, the current number and percentage of people vaccinated or have received at least one dose of vaccine.

However, you must first consider the programme’s process in its entirety to understand the outcome, including the procurement, registration and delivery of the vaccines, the registration of participants, and finally, the administration of the vaccines.

We should understand that the government has allocated funds to procure 66.7 million doses from five sources – Pfizer, AstraZeneca, Sinovac, CanSino and Gamaleya/RIDF (Sputnik V) – covering 110% of the population.

Currently, the first three have obtained product registration approval from the National Pharmaceutical Regulatory Agency (NPRA), which is responsible for ensuring the safety, efficacy and quality of all pharmaceutical products before they can be used in Malaysia.

The government has set the target timeline to vaccinate at least 80% population by February 2022.

source: https://www.vaksincovid.gov.my & nst.com.my

Undoubtedly, the current vaccination rate is not as fast as many expect to see, especially during the recent wave of severe infection sweeping across the country.

As of May 20, 2.6% of people have been vaccinated, with 4.2% having received at least one dose.

Based on the current vaccination rate, one projection shows that Malaysia would need about five years to vaccinate 80% of its population.

Is that a fair assessment of the situation?

On April 12, the special committee on ensuring access to Covid-19 vaccine supply (JKJAV) published the timeline of vaccine supply.

It is clear that we were facing a vaccine shortage in the early stages but the same scenario is happening to many countries globally.

Malaysia is not too far from the average of Asian countries, and is even ahead of Japan and Thailand.

When some vaccine manufacturing countries declare bans or restrictions on vaccine exports, like India and the European Union, these will disrupt the scheduled supply to many countries.

Prior to the pandemic, Malaysia did not have the capability for vaccine manufacturing, except for Duopharma’s fill-and-finish facility.

Since then, Pharmaniaga has set up its fill-and-finish capacity. While the two GLCs are tasked to do this last manufacturing step for Sputnik V and Sinovac vaccines respectively, thus lowering costs, they still need to import the bulk inputs from China and Russia.

It is pointless to talk about faster vaccination rates when local manufacturers cannot guarantee to deliver the vaccines as planned.

The demand for such precious resources is tremendous, and the production is insufficient. It is not that the government lacks resources to set up vaccination centres to speed up vaccine administration; that would require just two to three days to do so.

Meanwhile, the registration rate for vaccination in Malaysia is still not satisfactory. As of the May 20, only 43% of eligible adults have registered.

That means that even if the federal government was to receive all of the vaccine orders today, there would be more than half of those doses with no takers.

Apart from the less than satisfactory registration, it is also not difficult to understand why the public harbours the sentiment that the vaccination programme is going too slow.

The current percentage of those who received at least one dose of the vaccine among the registered population is 13.3%, which means 86.7% of people are still in the waiting queue.

We can understand that they get frustrated with the current situation.

The states/federal territories with more than 50% of its population registered for the vaccination programme are Putrajaya, Kuala Lumpur, Selangor, Sarawak, Labuan and Penang.

However, states like Selangor, Johor, Penang and Sarawak fall below the national average in terms of percentage of registered participants who have received at least one dose of the vaccine.

Yet, these states have received the most compared to other less populated states in terms of the actual number of administered doses.

This might explain why certain states feel like they need to take matters into their own hands to ‘speed up’ the vaccination campaign.

On May 16, the Sarawak government announced that it had procured 1 million doses of the Sinovac vaccine, expected to arrive soon in two batches.

On May 18, programme co-ordinating minister Khairy Jamaluddin stated the conditions under which the state governments are allowed to procure their vaccine supplies.

A day after the minister’s statement, the Selangor government announced its own Selgate Covid-19 Vaccination Programme.

This programme aims to register employers in Selangor to vaccinate their employees with the Sinovac vaccine for RM190 per dose.

On the same day, the Penang Chief Minister Chow Kon Yeow and former finance minister Lim Guan Eng famously criticised the federal government in a press conference for blocking a private donor from contributing 2 million doses of Sinovac vaccine to Penang.

The conditions Khairy laid down were clear. First, the products must be registered and approved by the NPRA.

Second, if the procurement source is from the same pharmaceutical company as the programme, federal government takes priority before any other parties from Malaysia.

This was an agreement with the vaccine manufacturers to ensure that the national vaccination programme is not compromised.

Third, if the supplier is not involved with the programme, state governments or the private sector can freely procure vaccines provided they have received NPRA approval.

Therefore, the apparent win-win situation is when a state government secures alternative vaccine sources outside the programme vaccine portfolio.

However, based on what we saw in the past week, the three state governments are considering the Sinovac vaccine.

They are going for the same vaccine pool, therefore directly competing with the federal government.

Suppose these states receive the vaccines before the federal government’s remaining order. It will come at the expense of other states that do not have the financial resources or wealthy donors to access the vaccine quickly.

Setting this precedent will open Pandora’s Box. Other state governments may follow suit to demonstrate to their voters that they can also get ahead of the queue.

It will result in something that we must avoid: the politicisation of the programme.

Imagine if states go their own way. Eventually, this could create a chaotic situation for the programme and probably undermine it.

What is worse, this could erode the social solidarity and the consensus to allow citizens and residents with health vulnerabilities (and thus carry a higher risk of Covid-19) to receive the vaccines first.

You should not only think about vaccine procurement but also consider the logistics and execution of vaccination. Who administers the vaccines?

The programme currently involves private healthcare facilities to help. Would the state governments also compete with the federal government over the human resources required for vaccine administration?

If this affects the national programme, who will pay for it? The programme is free of charge at the point of vaccine administration; this is different, for example, from Selangor’s proposed programme.

As the latter signals that those employers who can pay can get the vaccine first, what does it say about the social solidarity over vaccination priorities?

At the height of the current pandemic, we should be wary of opportunistic political upmanship that feeds on public frustration (often due to misinformation) and desperation for faster vaccination.

Instead, we should call for patience and a better understanding of the process and issues related to the programme.

Most importantly, people should stand in solidarity to fight the pandemic together, not just thinking for themselves. – May 23, 2021.

By : Dr Lim Chee Han (A public health policy researcher at Third World Network and co-convener of the People’s Health Forum Malaysia) – THE MALAYSIAN INSIGHT

* This is the opinion of the writer or publication and does not necessarily represent the views of The Stringer.

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