Friday, August 21, 2020

愛FM《名師早點》:全民免費注射新冠疫苗 - 點評內容(21/8/2020)

名師早點,多知一點。大家好,我是志翰,群議社政策研究員。今天要和大家談談全民免費注射新冠疫苗課題。

前天科學工藝及革新部長凱里就宣佈,一旦新冠疫苗成功研發推出市場,他將向內閣建議給國民免費注射。對目前還很緊張疫情或已厭倦“新常態”生活的人來說,這似乎是個振奮人心的消息,迫不及待那天來臨。
接下來最緊要的問題是:這疫苗可以多快研發出來,以及多有效抑制冠病蔓延?
首先,各位得先了解疫苗是什麼和伴隨著的科研挑戰在哪裡。
疫苗是意圖通過刺激人體產生抗體對付某種疾病形成免疫力的生物製品。無論疫苗是用整個減毒病毒或病毒蛋白製品部分,目前兩個最大的變數就是正在肆虐傳染的病毒變種,和人體產生的抗體和免疫細胞反應是否真正有效對抗真槍實彈的活病毒。
疫苗進入我們的身體,提供‘教材’給免疫細胞學習辨識入侵的毒物,但我們每個人和每個細胞辨識了疫苗製品的不同部位後反應並不一致,不能擔保產生的抗體一定有效(但我們期望至少其中有幾個細胞能生產精準高效的抗體)。前提是正蔓延的病毒不會把疫苗鎖定目標的部位基因突變更換了。
所以,研發疫苗對付超會突變的病毒是極大的挑戰。過去與新冠病毒同類的冠狀病毒如SARS和MERS,多年來都沒找到疫苗;艾滋病毒從80年代研究開始至今也沒疫苗,骨痛熱症從20年代就開始研究,到了2016年才終於有世衛組織認證的疫苗,但效果也不怎麼好。為什麼這次新冠病毒可能不同?
世界衛生組織透露,目前已有超過150種疫苗正研發,其中20多個已去到了人體試驗階段,有幾個已到了研發後期。或許因為全球都集中火力大量投入資源研發,這無疑增加了尋獲有效疫苗的可能性。故此,世衛組織積極拉攏各國加入“新冠疫苗全球獲得機制”(COVAX Global Vaccines Facility),共享疫苗研發成果。
對我來說,我還是比較悲觀消極看待目前的情況,擔心最終出現的是像對付“流行感冒”病毒般的疫苗,每年需要更新但不一定持久有效。
基於這新冠病毒突變性高,已出現了多個變種病毒正傳染人間,屆時即使可以全民注射疫苗,第一,到底政府可以多快能全面執行(要知道我國有3300萬人口啊)?第二,這疫苗的抗毒效果好嗎,免疫效果持久嗎?這些都是我的顧慮。
我看,大家還是保持社交距離,跟緊SOP和勤洗手吧,這是目前最好的疫苗。
謝謝。

Monday, August 17, 2020

Sabah vote’s coronavirus risks

 

On July 30, the Sabah Legislative Assembly was dissolved after Mohd Shafie Apdal, now the caretaker chief minister, put in a formal request to Governor Juhar Mahiruddin.

According to the state constitution, elections must be held within 60 days of the dissolution. So far, the nomination and polling dates have not been announced. The episode occurred as the world is ravaged by Covid-19, with the biggest single-day increase in cases – 297,133 – recorded just two days after Juhar’s announcement.

Following the Chini by-election on July 4 and Singapore’s general election on July 10, some would say the Sabah vote is doable and can use the previous two polls as a reference. Though the political need to hold snap elections is understandable, they may well exacerbate the coronavirus crisis. Here’s why.

From the day of the governor’s announcement until August 14, there were 25 new Covid-19 cases in Sabah and Labuan. These constituted only 12% of the country’s total fresh cases in that period, but the nature of the infections should cause worry to state health authorities. Thirteen cases were imported from the Philippines, with which Sabah shares a long, porous maritime border. It should be mentioned that daily cases in our Asean neighbour peaked at 6,725 on August 11, and the virus threat there is showing no sign of abating.

Meanwhile, eight of the 12 local transmissions in Sabah were detected in screenings at hospitals and detention centres, with the latest case reported on August 12. This implies that the disease is very much present and spreading in the community.

If we look at the local transmissions as of August 5, nine districts – three of which are major cities, namely Kota Kinabalu, Sandakan and Tawau – had at least one active case in the past 14 days. This persisted until August 10. The situation in Sabah is unlike the outbreak in Sarawak, which peaked on July 28, and with the infections largely concentrated and contained in Kuching.

Now, think of the mass movement of people in both urban and rural areas due to the Sabah elections. Keep in mind that the state’s population this year is estimated at 3.9 million.

For those who think Sabah is able to replicate Singapore’s low-risk election campaign, they need to understand the fundamental differences between the two places. Sabah is the poorest state in Malaysia in terms of median monthly household income, according to the Household Income and Basic Amenities Survey 2019. Of the 10 lowest-income districts in the country, four are in Sabah, of which three are bottom-most on the list. A third of rural households in the state don’t have an internet subscription, 10% don’t own a smartphone, and a third don’t even have piped water.

For Sabahans who do have internet access, a major issue for many is connection stability. In June, a Universiti Malaysia Sabah student made the news for having to stay in a tree to get better internet connection. It’s no surprise that she lives in Pitas, the poorest district in the country.

Sabah’s lack of infrastructure is the biggest obstacle preventing politicians from leveraging technology to campaign ahead of the polls. There’s no way they can make much of an impact through a virtual campaign outside of a handful of urban seats.

Also, there is a significant number of Sabahans living and working in the peninsula, and this group has far better connectivity and can sway the election results. It remains to be seen whether they will feel motivated enough to return to their home state to cast their ballots. With the Election Commission not planning to allow postal voting, Sabah’s Covid-19 quarantine rules are potentially a big factor in determining just how many will make the trip back.

The risk of infection is not only on polling day itself, but throughout the duration of the campaign, which usually involves a fair amount of personal interaction between candidates and the electorate – handshakes, hugging, kenduri, door-to-door visits, walkabouts in crowded places, ceramah, distributing leaflets and goods, etc. If the Health Ministry bans all these activities, how else will a candidate have a strong and effective campaign? Even if they are allowed with health and safety measures in place, there’s the question of who will conduct monitoring and take action should there be breaches.

The state elections are a high-stakes contest between Perikatan Nasional and Pakatan Plus, the alliance between Pakatan Harapan and its allies, including Parti Warisan Sabah. Leaders from the various parties will participate in the campaign, and programmes will surely not be held only in a few districts. The movement of campaign teams across a large number of areas increases the prospect of spreading Covid-19, and there are already as many as six districts with active cases in the last fortnight. This is a far cry from the Chini by-election, where only one seat was involved, making things easier to control.

There’s no better way to end the state’s political impasse than to conduct elections. However, now isn’t the best time as the virus menace lingers. The Health Ministry and EC must undertake preparations seriously and make sure candidates and party workers strictly adhere to the standard operating procedures.

Malaysians don’t want to see Sabah having to deal with fresh outbreaks. The state’s sociopolitical disarray has already given residents a massive headache.

15th article for Agora@TMI column, published on The Malaysian Insight, 17 Aug 2020

Monday, August 10, 2020

出生率下降,人口萎縮和老化

 7月31日,88tv的《活力加油站》邀請我上台來講解世界和我國人口的未來趨勢。

以下是我的訪談分享片段:

活力加油站 Living Delight (2020) | 2020年7月31日: 男性不育加剧!恐人口萎缩?

主持人:秦雯彬 陈俐杏 今日主题: ● 男性不育加剧!恐人口萎缩? ● 为何男性生育能力会降低? ● 如何治疗和改善? ● 瑜伽小学堂


***


1:男性不育加剧!恐人口萎缩?

  1. 我国目前的人口有多少?与往年相比是增加还是下降?(可对比几年)

 

根据国家统计局的数据,我国人口在去年大约有3250万。我国人口过去20年仍然是逐年增长,只是增长率趋势逐年放缓:2000年度增长2.5%,到了去年仅增长了0.4%,成了历史新低。今年的增长率预料将相似。

 

资料来源:大马统计局 (2020

 

其中一个主要的原因为何我国的人口数量是上升的,是因为出生存活的婴孩数量远大于死亡人口。2018年一共有大约50万婴孩出生,17万人去世。

 

资料来源:大马统计局

 

  1. 全球的人口数据是上升还是下降?为什么?

 

全球人口到了今年估计将达78亿,全球人口过去二十年也逐年增长。可是,人口增长放缓也是个国际趋势,到了今年估计全球人口平均仅增长1.09%

资料来源:联合国经济与社会事务部

 

各国之间的人口增长速度有分别,一般情况增长率与国家收入与先进程度呈反比:高收入国的2020人口增长率最低(0.47%),中高收入国紧接着(0.68%)。联合国估算我国的情况差不多接近中低收入国的平均值,但事实上我国统计局已预期我国近两年来的人口增长率可媲美高收入国。

 

资料来源:联合国经济与社会事务部

 

 

  1. 男性生育能力与往年相比增加还是下降?多少百分比?为什么?

 

首先来看我国的总生育率(Total Fertility Rate, TFR),这数字代表该年每一位生育年龄(1549岁)的女性平均会生产的婴孩数量。在2001年,我国总生育率达2.71。自从2013年起,该数字下降到2.1以下。2.1是联合国定义为更替水平的生育率,小于这个数字未来将可预见人口开始趋平然后萎缩。到了2018年,我国的总生育率已降至1.84

 

资料来源:大马统计局

 

虽然数据显示我国总生育率下降,但若从族群角度来看,生育率还是有相当大的差别。撇开“其他”族群不看(里面也包含外籍人士),华裔无疑是生育率最低的族群,2018年仅达1.11,对比土著的2.41,后者是华裔的双倍以上。


资料来源:大马统计局

 

再看年龄层,生育的黄金时期似乎是中间的三个年龄层,其中最多婴孩诞生在妈妈还是2534之间,平均每10位女性超过1位在该年(2018)当妈妈。超过40岁,女性的生育率就大降,或已决定不再诞生更多孩子了。

 

资料来源:大马统计局

 

我国的总生育率比起全球平均、中低收入和低收入国家的总生育率来的更低。目前接近中高收入国家的总生育率,毕竟我国仍属于这个收入阶层的国家。全球的总生育率走低也是一个重要的趋势,我国绝不是例外。


资料来源:联合国经济与社会事务部

 

由于最终生产孩子的是妈妈,生育率数据的标准套用在生育年龄的女性,而男性生育能力出错或单身主义或无子主义的因素都被概括了。根据2014年的国家人口和家庭第五次调查,就有高达8.6% 生育年龄女性从未有生过小孩的经验。国家人口和家庭发展局总监Abdul Shukur Abdullah表示目前不育的女性很可能已达1012%

 

不育的定义是双方男女无避孕地尝试了一年女伴仍不受孕。但事实上,不育的生理理由有蛮多,得找出原因才知道哪个伴侣需要治疗。

 

1998年的一篇广为引用的学术研究论文就发现有不育问题和低生育能力的男性就各别占了不育伴侣的6%24%案例,换句话就是说大约三成不育的问题‘归咎’于男性。

  1.  

     

    1. 男性生育能力下降为什么会导致人口萎缩?

     

    事实上,任何会影响到生育率的因素,并导致总生育率持续拉低低于2.1,人口就可能会在将来萎缩。男性不育或低生育力问题肯定也包括其中,若未来问题变更严重了,那么或许将更快拉低我国的总生育率。毕竟要伴侣怀孕,一只手掌拍不响。

     

    根据国家人口和家庭发展局2018年报告指出,如果目前总生育率走低的趋势没改善、政府没插手,那么到了2071将会达到人口数目的最巅峰,即4600万人,随后人口就会在隔年开始萎缩。更早时,2030年预料我国将先迈入老人国(至少有15% 60岁以上的乐龄人士)。

     

     

     

    图文来源:国家人口和家庭发展局

     

     

     

    1. 为什么会有人口萎缩的情况?

     

    总生育率低于2.1的结果是,迟早有一天新生人口数量不足以替补过世的人口,除非移民政策大转变,大力鼓励外籍人士入境居留(例如新加坡),不然人口萎缩几乎是定局。

     

     

    1. 人口萎缩影响?(社会/国家/家庭等)

     

    人口萎缩的前奏是人口结构先老化(变‘老人国’),意味着老人数目比新生孩童数目更高。由于新生孩童比较少,这同时也意味着将来的劳动人口比率下降(看下图)。统计局预测2016年已是我国劳动人口比例的最高点(65.9%),然后往下滑到了2030年劳动人口比率将会是63.5%。经济若要大幅或快速成长,除非国家经济转型不再太依赖大量劳动力,不然劳动人口比率下降也许意味着国内生产总值将面对下跌的压力,毕竟目前大部分行业都需要劳动人手,不然就更依赖外劳替代。


    资料来源:大马统计局

    理论上小孩(15岁以下)和老年人(65岁以上)不在劳动人口范围内,因此需要有领薪的劳动阶级亲人“抚养”。因此有个指标称为“抚养比率”(dependency ratio)。近10年来,能抚养的劳动人口比率逐年下降,从2010年的47.8%到今年2020年的43.5%。由于生育率走低,因此抚养小孩的比率也下降,可是老年人口的抚养比率在这十年来上升了接近3%。三个趋势放在一起分析,未来生育率下降、劳动人口比率下降再加上老年人口持续上升,未来预料会有更少的孩子照顾年迈的父母。目前平均孩子数量是2人,未来要照顾父母两人,还有亲家父母两人,再加上经济也许不会更好、国人预期寿命会更长、照顾两家父母的医药费和专业服务费更高、孩子们的经济负担和精神压力或会增加,社会问题也接憧而来。政府也得先拟定政策先做好准备。


    资料来源:大马统计局