Thursday, April 29, 2021

Benar News: Kegusaran Awam: Malaysia Henti Guna AstraZeneca Dalam Program Imunisasi (28 Apr 2021)

 Lim Chee Han, seorang pakar kesihatan dari kumpulan pengkaji Third World Network, berkata ia adalah satu langkah bijak oleh kerajaan untuk memberikan vaksin AstraZeneca kepada mereka yang inginkannya secara sukarela.

"Saya ingin menyatakan bahawa kerajaan cuba melakukan kawalan kerosakan (damage control) dengan mengambil satu langkah kebelakang, sebelum mara lebih jauh lagi selepas ini.

"Ia akan menjadi satu situasi menang-menang jika penerimaan secara sukarela itu menunjukkan tiada banyak komplikasi. Ia menjadi satu keuntungan kepada mereka yang sukarela mengambil AstraZeneca kerana dapat vaksin lebih awal berbanding dijadualkan, dan situasi menang untuk Kementerian Kesihatan juga yang telah mengeluarkan belanja bagi mendapatkan vaksin tersebut serta prosedurnya.

"Ini dapat meningkatkan keyakinan masyarakat yang lain, menunjukkan kepada mereka bahawa vaksin itu sebenarnya adalah selamat berbanding apa yang mereka sangkakan. Saya sendiri sanggup mengambilnya dengan senang hati," kata beliau kepada BenarNews.


Punca berita: https://www.benarnews.org/malay/berita/my-astrazeneca-henti-210428-04282021143441.html

Thursday, April 22, 2021

大马新冠肺炎疫情与疫苗接种反应 (4月22日)

 东方上电台

发布于 2021年04月22日 16时31分 • 最后更新 5小时前 • 报道:林淑芸

尽管卫生部长拿督斯里阿汉峇峇强调我国目前仍处于第三波冠病疫情,尚未进入第四波疫情;但感染生物学博士林志翰却有不同的看法,因各种数据显示,我国已有进入第四波疫情的趋势。

林志翰说,根据卫生部公布的新冠肺炎基本传染数,我国在今年4月9日开始又维持在高于1.0的状态,代表一度降温的疫情又开始恶化。

他说,从那时开始,我国就已经算是开始进入第四波疫情,因已没有回头路。

“至于卫生部长表示,只有第三波疫情清零才能算新的一波,那恐怕是因为他没有听过‘一波未平一波又起’。”

他说,尽管疫情有恶化迹象,但若及早做出一些措施及全民努力去压下来的话,它也可以成为一个小波。

因此,林志翰在连线《东方》与AiFM合作的“开讲东方议题”谈我国新冠肺炎疫情与疫苗接种反应的课题时,促请政府当局制定一些政策,让民众尽量配合一起把疫情曲线压下来。

至于有没有必要再去落实严格的行动管制令,林志翰则建议,政府应该逐步收紧疫情恶化的跨州甚至跨县标准作业程序,以限制群聚人流。

他说,在这个第四波当中,目前疫情严重的州属,分别是雪隆、砂拉越及吉兰丹,因此应尽快施加一些比较严格的抗疫举措,包括停课等及早控制,因我国接下来会有佳节的压力。

他说,卫生部长也已表示卫生部将建议禁止庆祝开斋节的跨州活动,因这的确存在很大的风险,因雪隆区疫情仍严重。

据林志翰的观察及判断,政府有必要规划及公布每一波的趋势走势演变,以让民众清楚地看到疫情的发展,这样更能让大家更加了解实际情况及配合政府的抗疫措施以渡过难关,否则当疫情加剧严重时,我国的前线人员及公共卫生系统也会面临很大的压力。

感染生物学博士林志翰(右)电话连线开讲东方议题,剖析我国新冠肺炎疫情情况。左起丘淑霖及谢劲程。

此外,林志翰认为,除了政府与民间的沟通之外,政府内部沟通也很重要,因我国有一些政策往往因为内部没有很好沟通导致民怨沸腾最后被逼收回,这会让人留下政府没有做好准备就实行的印象。

他说,在抗疫等政策上,政府内部有更多沟通的话,大家可以向民众解释有关政策的必要性。

另外,他早前提到,我国的第三波疫情是因去年9月20日沙巴选举期间爆发,到去年12月初时,疫情一度放缓与有好转的迹象,因此政府当时几乎所有了所有跨州的活动,但是也推波助澜导致第三波的病例又开始飙升,在今年1月杪时,曾经多日连续单日破5000宗,而到了2月10日时,活跃病例最高达到5万2186宗。

他说,在今年3月20日时,今年首次出现单日确诊病例降至三位数,这算第三波疫情的转捩点,但到了4月7日时病例又开始上升,接著就一直仍压不了。

一有疫情就关校?专家促应先了解病例起因

在学校陆续出现新冠肺炎确诊病例引起关闭学校的舆论,感染生物学博士林志翰提醒,他明白家长的担心,但却必须清楚了解实际情况,究竟是学校内部出现感染群,或者是师长在外面感染病例。

林志翰指出,校园有新冠肺炎疫情的课题上,不能单从数量来关闭学校,更科学的做法是看病因 ,就是让卫生部官员,用科学及专业的方式去追踪有关确诊病例。

他直言,在未追查缘由与接触对象,单单只因出现一个确诊病例就关闭学校的做法较倾向“安抚民心”,不见得是科学的做法。

他说,我国中小学小学在3月及4月初返校后,实际上社会几乎已几乎复工复产,路上车水马龙的景观,各行各业逐渐恢复正常操作,而学校疫情一定程度上也反映了社会的一种现象,而学校要遵守好校园抗疫标准作业程序。

主持人谢劲程则认为,安抚人心也属于政策的一部分,避免大家更有压力。

此外,林志翰在连线《东方》与AiFM合作的“开讲东方议题”谈及疫苗接种的问题时则指出,根据科学、工艺及革新部长凯里的说法,我国目前有27万2019前线医护人员完成疫苗接种,当中仅有9人或0.003%受感染,说明了疫苗的效用。

他说,我国目前使用的疫苗是瑞辉及科兴疫苗,皆为较为稳定及都没有太多负面新闻的疫苗。

至于主持人丘淑霖则提到,人性当中有一个盲点就是会放大负面或异于平常的信息;对此,林志翰认为,这需要去宣导,以让民众有信心,因此政府需要确保提供资讯透明化及正确的资讯。

主持人:AiFM谢劲程、丘淑霖
开讲嘉宾:感染生物学博士林志翰

《开讲东方议题》 :我国疫情趋势与疫苗接种反应 (22/04)

 



*第四波疫情?*

大家都在谈第四波疫情已来到,因为各种数据已显示这个趋势,虽然卫生部和政府至今没有表明第四波是否已开始了以及该从哪个日子算起?
我们知道的是第三波疫情从9月20日算起,那时沙巴正举行州选。当疫情在十二月初刚出现放缓和好转的时候,政府开放所有的跨州活动,推波助澜第三波的更高峰。单日新增病例最高的那天是在今年1月30日,有5728宗病例;若以活跃病例来计算的话,我国医护前线人员最黑暗承受压力最糟糕的极点是在2月10日,国内有52186活跃病例。
来到了3月29日,单日新增病例在今年首次跌至三位数,那算是转捩点;活跃病例最低降至4月7日的14097个病例,然后就从此往上飙升。若参考政府的R指数推算,4月9日以后就处于高于1.0的状态,所以第四波应该已开始了。至于卫生部长说要看到新增病例归零阻断后才有新的一波的说法,我觉得这不可取,他应该没听过什么叫‘一波未平一波又起’的说法吧?
至于为何在四月我国的疫情又反弹?卫生总监说,这也是目前的全球趋势,听起来好像没错,因为4月18日那天全球疫情似乎抵达第三波的巅峰即单日新增病例达83万,可以媲美一月初的第二波数据。当中印度和巴西疫情恶化一再创新高,而我们的东南亚邻国也面临灾难。菲律宾在4月初屡创新高;连去年抗疫表现标青的泰国,也在最近的一波控制不住,上个周日达1767宗单日最高新增病例。可是,有人却问,为何不提纽西兰、澳洲、台湾、越南甚至是新加坡这些成功控制疫情的国家?里面除了越南之外,其余的都是岛国,我认为这样的比较在某个程度上不太公平。
我国在3月8日开始重开校园让学童返校学习,除了跨州禁令和一些人数限制的活动,这其实也宣告各行各业已几乎没有太多其他限制开业和操作,家家户户的成员开始出来见面、交流和活动,车龙重现。而疫苗接种阶段还未到第二期,意味着绝大部分人口仍未接种疫苗,那么,更多人与人之间的接触,再加上遵守防疫SOP的松懈等,所以不难明白为何单日新增病例止跌回扬,特别是当社区感染病源在较早前仍未完全根除。目前我国面临较严峻的考验是如何防止变种病毒在我国大肆散播,这些病毒比我国正流行的病毒病种更易散播。至今我国有接到一些零星的报告,一切还在监督和控制当中。
卫生部长已说明今年的开斋节恐怕游子又再次无法回乡过年。最近政府正控制着跨州人潮流动,避免红区州属把病源进一步散播。目前第四波疫情的重灾区是雪隆一带,还有砂拉越和吉兰丹。
我认为政府应该逐步地缩紧措施,特别是人潮控制和行动范围限制,再加上针对特定疫情恶化的州属地方施加更加严格的行管令,包括停业停课指令,如果当地疫情开始失控急需立刻降温。
公共医疗压力确实正在逐步增加:活跃病例如今攀升快速,需要重症加护病房和呼吸机的人数也显著增加。虽然比起第三波在2月初的时候,现在的数字基本上卫生部还可以应付,但如果疫情进一步恶化就很难说了。
*****
*疫苗接种反应与最新发展*
我国的疫苗接种计划已来到了第二期,可是截止前天的数据显示,已登记接种的只有910万人,仍少于四成合格的18岁以上全国人口。已至少接种一剂疫苗的人数目前仅有75万人,离要达至的80%人口全民群体免疫目标还差很远。
不否认近来有关疫苗的新闻或多或少影响一般民众的观感,甚至降低他们登记疫苗接种的意愿。
可是很多人存有对疫苗的误解,认为接种疫苗后仍会受感染,那么为何还要接种。
首先,确实疫苗不是仙丹,不能完全杜绝新冠病毒的感染。卫生部最近发布的数据显示,大约27万医护前线人员已接种疫苗,仅有9名在接种两剂疫苗两个星期后仍受感染。部长凯里强调这是0.003巴仙的病例,而且确诊的他们甚至没有出现任何症状,这其实正彰显疫苗的功效,而不是质疑疫苗。已有全球相当巩固的证据显示疫苗保护接种者免受严重疾病和死亡,同时能显著减少病毒的传播。如此一来,你就保护了自己和别人。
还有,很多人以为刚打了一剂疫苗就会立刻起保护作用,其实不然。第一剂打了以后的第一个星期,那人与没接种者在抵抗感染方面其实没有差别,疫苗的作用要比较迟才开始发挥,最好的效果必须是在第二剂打完后的两个星期。因此任何接种者在这段时间内都要切记这点,要继续遵守标准作业SOP防疫。卫生部的数据也说明有173名医护前线人员在这段时间内受感染,印证了我说的这点。
除了这个,更多乐龄人士担忧的是所谓的疫苗副作用,特别是当新闻报道说牛津/阿斯利康疫苗受到质疑会导致一小部分人出现凝血障碍问题,科学界还在研究调查此事。目前我国还没领到这个疫苗的订货,原本预计是在6月抵达,现在政府将检讨是否应该继续使用这疫苗。但目前我国使用的辉瑞和科兴疫苗至今没有什么出现任何严重副作用的案例,基本上是安全使用的。
要宣导疫苗接种,就要给民众正确和透明的资讯,更要强调已知的疫苗接种好处,鼓励害怕者放心,因为政府会照顾他们确保没事。事实上,很多人都打了没事,这些疫苗接种者可以成为宣导大使安抚那些仍害怕和抗拒的人。如果家里有老人,最好自己也充实了资讯后跟他们讨论,尤其是当他们收到了很多极可能错误或误导性的讯息。


部分内容出现在爱FM节目里的《开讲东方议题》访谈

Saturday, April 17, 2021

Al Jazeera English News interview - 17 Apr 2021: new virus variants and vaccine

We’d like your views about the new coronavirus variants, 

According to the US CDC's classification scheme for variants of SARS-CoV-2, there are 3 categories:

variants of interest, variants of concern and variants of high consequence

Currently CDC listed 3 for variants of interest, 5 for variants of concern and none for variants of consequence.

What are the attributes of a variant of concern:

There are evidences of impact on diagnostics, treatments and vaccines, increased transmissibility or increased disease severity. On the vaccines, we are concerned with the possibility of reduced vaccine-induced protection and efficacy.

Each of these variants has a number of mutations, and some of these are key mutations in critical regions of the viral genome. Because the spike protein is required for the virus to attach to human cells, it carries a number of these key mutations. In addition, antibodies that neutralize the virus typically bind to the spike protein, thus making the spike sequence or protein a key component of COVID-19 vaccines.

 

how concerned public health experts are, 

The 3 variants of concern circulating in the wider world are: the B.1.1.7, which originated in the U.K (now found in 108 countries).; the B.1.351., of South African origin (found in 69 countries); the P.1., first seen in Brazil (found in 35 countries).

Several reasons why we should worry about these variants. 

First, the variants of concern generally transmit from person to person at least 20 to 50% more easily. This makes them infect more people in a shorter time hence spread more quickly and widely, eventually becoming the predominant strain.

For example, the B.1.1.7 U.K. variant has raked up more than a quarter of all cases by mid-March, in about just 3 months after the first detection. The P1 variant that emerged in Brazil killed at least 60,000 deaths in Brazil just in the month of March.

So, at this point, we also concern that the new variants could lead to more severe disease and increased hospitalizations and deaths. Recent publications in Nature and BMJ showed that the B.1.1.7 variant causes more severe illness and mortality in the UK.

Our next concern is whether these new variants can escape the immunity elicited by natural infection or vaccination-induced effort. We are worried that antibodies from recovered patients or vaccinated persons may not be able to bind as efficiently to a new variant virus, and this could lead to reinfections and lower the effectiveness of current treatments and vaccines.


what impact this could have on vaccination drive and herd immunity goals.

The current data, though limited, but worrying. For example, AstraZeneca vaccine-induced antibody response when they meet with the new variant from South Africa, it can get weakened up to a factor of 86 times until complete immune evasion. Vaccine efficacy also plunged from 66% against the first Wuhan variant to just 22% against the South Africa new variant. Moderna and Pfizer's vaccines also have their induced-antibody neutralization activity attenuated up to a factor of 8.6 times.

However, another study shows that the T-cell immune responses, either elicited by natural infection or vaccination, can recognise all three UK, South Africa and Brazil variants. That means there will still be some degree of protection conferred by vaccination against such variants.

In a recent survey of global epidemiologists general consensus, the majority of them believed that within a year current vaccines could need to be updated to better handle new variants, and that low vaccine coverage will likely facilitate the emergence of such variants. We should assume the current SARS-CoV-2 variants will likely continue to evolve and adapt. Vaccine researchers and manufacturers would have to include some other more constant region of virus as vaccine targets, other than spike protein, for example, nucleocapsid protein.

So, what is important for the general society and government to do is to keep the disease transmission low and vaccinate as many people in as many places as soon as possible to reduce the number of cases and the possibility for the virus to incubate and generate new and potent variants which can further evade immune responses. Currently, we have to address the vaccine hesitancy issue in this country and ensure the global vaccine supply is equitable and timely accessed for everyone.




Friday, April 16, 2021

《透視大馬》 訪問 - 4月14日

 确诊人士逐渐年轻化 职场感染群激增与防疫不足成肇因


感染生物学博士林志翰告诉《透视大马》,确诊的青年年龄层属于劳动高峰期。

“20岁以下还没有工作,而超过50岁以上的则没有工作,少出门,所以感染风险自然低。”

他援引医疗资讯网媒“CodeBlue”的数据,即我国爆发第二波疫情时,累计病例中年长者占了25.2%,而这次50岁以上的年长者,占14.2%,有减少迹象。

“但是防不胜防,因为当劳动阶层出外工作后,还是不小心把病毒带回家,导致被感染。”

他说,随着各领域重启后,包括教育领域开放,国内的基本传染数有一点停滞迹象,没有很明显再下降。

“我担心,或许为未来我们会看到更多各年龄层,尤其20岁阶层有更多机会受到感染。”

...

林志翰说,政府接种疫苗进展确实缓慢,但未必与政府有关,而是与疫苗供应有关系。

“我们需要进口疫苗,需要时间安排和等待,所以在(等待疫苗)空窗时间还是需要靠人民的自律。否则疫情失控,人们恐会失去工作和自由。”

因此,他继说,卫生总监诺希山总是不断提醒大家遵守标准作业程序,因为这是唯一控制疫情的方法。

Wednesday, April 07, 2021

Antagonistic moves backfire on Umno

  

Two days of the Umno AGM produced fireworks and created ripples across political parties and alignments, ensuring intra- and inter-party bickering will persist and not be resolved soon.

One thing we can all be sure of is that we are going to have a snap election this year. It can hardly be deferred any longer given the resolutions passed at the AGM which give an ultimatum to the ruling pact to go to the polls as soon as the emergency period is lifted.

Truth is, the AGM did not much discuss national policies or any vision of new governance even though the party be ever so ambitious about becoming the dominant power again. On display were mostly posturing, blatant jostling for power and derogation of their political opponents.

Building on the Umno Supreme Council’s February decision, they insist they will not work with Bersatu, Anwar and DAP and on using their own BN logo while “going solo” in the general election. Even if that meant multi-cornered contests, including the prospect of facing PAS.

Another bombshell they dropped was: if the prime minister hasn’t announced the date of the general election by the end of the emergency period, Umno will quit the Perikatan Nastional government. 

Some say the Umno leaders, especially party president Zahid Hamidi, chose fierce words to hit out, which should imply that Umno is very confident in their own political might that they could secure a big win in the next elections, hence regaining the dominance in governance.

The major tune from the AGM sounded like this: never again shall Umno be subjected to the (rule of) Bersatu, which has a recent record of attempting to replace, divide and steal Umno’s political resources and territories.

However, if Umno was to depend on the BN grand old party brand as well as their grassroot support, would they then be able to perform as expected, gaining back their lost ground in 2018, including the hot seat of prime minister? 

Never mind that currently there is no clear indication or consensus of whom from Umno should be the prime ministerial candidate, as compared to the PN camp where they already have the current sitting Prime Minister Muhyiddin Yassin as a household name who has wide appeal and some proven track record.

If Umno had really presented a strong case, then why did they fail to install their own candidate as the chief minister during the Sabah state elections last year? The post was handed over to Bersatu instead.

This is despite Bersatu being only newly introduced into the state and they have no effective grassroot mobilisation, and yet they’ve won big in terms of seat number. Hadn’t the multi-cornered contests in 2018 shown that they benefited PAS and Pakatan Harapan?

Umno may overestimate their own popularity, but it is at their own peril to have underestimated their political opponents, and thus run afoul of a big taboo as the Chinese idiom would say, “arrogant soldier will be defeated”.

Compared to 2018, and especially if Umno quit the government, they would appear in the general election not as a caretaker government for the first time in history. This is no small feat as Umno would probably understand best the big (and unfair) advantage of being the incumbent. 

Bersatu under the leadership of Muhyiddin would be backed by government machinery, which would likely put them in greater command of the election campaign, especially during the pandemic.

Let’s say if the PN government intends to copy the playbook from the Singapore’s last year’s general elections campaign restriction rules, then this move could neutralise and diminish the greatest strength in both Umno and PAS in terms of grassroot mobilisation.

Furthermore, Umno’s dramatic efforts to bring down the government may also create antipathy among the middle voters who may feel that Umno is responsible for creating more political instability.

Some voters are not even ready for the general election during the pandemic. In such a situation, maybe more votes of sympathy could go to the Muhyiddin-led PN. 

If the third wave of pandemic is already under control, the national Covid-19 immunisation programme is executed as expected, and the economy shows good signs of revival, then the voters might give credit to the PN government for the feel-good factor. If Umno already sever ties with the PN, they might find themselves harder to claim the credit as much.

Umno forcing PAS to pick a side has also backfired. PAS has subsequently announced that it will work with Bersatu in the PN coalition thereby ditching Muafakat Nasional.

It is perhaps a rational choice based on political interest and careful calculations instead of principles. By sharing the PN platform and the electoral pact, PAS could secure more votes, claim the credit from the recent governance success and access to the PN government’s resources.

If PN loses, probably PAS could still win more seats than the previous GE. In the likely event that BN could not govern on its own, PAS would be in a stronger position when it comes to negotiating power sharing.

However, if PN could win, then naturally PAS’ position within the winning coalition would be higher than that of aligning with the domineering partner Umno. 

All in all, the louder noises the Umno leaders make and them hitting at their political opponents from within and outside, do not suggest that they are more likely to emerge victorious in the upcoming election.

Instead, the loud moves might even reveal more strategic weaknesses and errors in situational judgment. Anwar Ibrahim has demonstrated time and again that this is counterproductive.

The one who wins is the one who makes the brilliant moves – stealthily and decisively.

47th article for Agora@TMI column, published on The Malaysian Insight, 5 Apr 2021

Kenapa Kerajaan patut iktiraf cleaner sebagai frontliner?

 From  Kesatuan Pekerja Swasta Hospital Kerajaan

Kenapa Kerajaan patut iktiraf cleaner sebagai frontliner?
petugas cleaner bukan maid, mereka adalah profesional dalam tugas pembersihan. Jika tidak, doktor-doktor dan nurse-nurse lain cubalah bersih. Cleaner juga frontliner, semua dalam perahu yang sama.



Full script:
Kenapa?

petugas cleaner takde kerja di tempat frontliner juga berada ke?
Cleaner takde berjumpa dengan pesakit2 ke? 
Siapa kendalikan benda-benda atau tempat-tempat yang telah dicemari oleh para pesakit dan petugas kesihatan lain?
Petugas cleaner bukan maid tau? mereka adalah professional dalam tugas pembersihan, jika tidak, doktor2 dan nurse2 lain cubalah bersih
Kena respect rakan pekerja setempat, bagilah pengiktirafan sikit, #cleanerjugafrontliner ,semua dalam perahu yang sama, kitajagakita

The Science Behind COVID-19 Vaccines (13-3-2021)

 Event poster:

Actual day live recording:




Event description: 

Since the arrival of the first batch of COVID-19 vaccines on 21st February 2021, and the subsequent public announcements about immunisation by the Prime Minister, Muhyiddin Yassin, and the Director-General of Health, Dr. Noor Hisham Abdullah, on 24th February, Phase 1 of the National COVID-19 Immunisation Programme kicked off.
Frenzied discussion and speculations about the COVID-19 vaccination have since ensued: whether one should fear the side effects, which vaccine is most efficacious, why it is taking so long to vaccinate the whole country etc. Often, nationalist sentiments override scientific considerations depending on the use of an anti-West or an anti-China lens. This is exacerbated by the global trend of vaccine nationalism as well as misinformation campaigns by anti-vaxxers leading to distrust of the COVID-19 vaccine. Unfortunately, the content of such discussions is frequently not informed by the science, rendering a vacuous and distorted bickering leading to nowhere.
Agora Society and the People's Health Forum are pleased to provide an opportunity to gain an in-depth scientific understanding of the first generation of vaccines in the upcoming online workshop on 13th March (Saturday), 2pm.
Speakers
Dr. Lim Chee Han, a scientifically trained immunologist, infection-biologist, and current health policy researcher, will walk you through the fundamental knowledge and rationale behind the vaccine design, in the simplest layperson language possible.
Dr. Jeyakumar Devaraj, co-convener of the People's Health Forum and current chairperson of Parti Sosialis Malaysia, will respond to the panelists, providing his expert perspective. Dr.Jeyakumar is a specialist in General Internal Medicine and a member of the Royal College of Physicians to the UK and Ireland.
The workshop will cover the following topics:
- Global trends related to the COVID-19 pandemic and progress in vaccination
- The battle of virus versus host immunity
- Vaccine types, design, and their pros and cons
- Vaccine development, clinical trials, and what 'efficacy' means
- Side effects of the vaccine
- Eligible groups for vaccination
- Vaccine protection: what should one expect
No prior knowledge of biology or medicine is required.
Come with your questions. Your queries will be answered. We hope to provide you with a knowledge enriching and empowering session.
Come join the workshop! Free Registration: http://bit.ly/vaccinescience
Date: 13 March 2021 (Saturday)
Time: 2 - 4pm (2 hours)
Language: English
Venue: Zoom meeting
Speaker: Dr. Lim Chee Han (PhD Infection Biology, MSc. Immunology)
Respondent: Dr. Jeyakumar Devaraj (Co-convener of People's Health Forum)
Host: Chan Yit Fei (Founding member of Agora Society)



Event 'Thank You' credit from Agora Society:
We would like to thank you for participating in the workshop last Saturday afternoon. The response was overwhelming and very encouraging, we are delighted that many actually showed strong commitment to learn more about the vaccine issue.
We would like to express our special thanks to the speakers Dr Lim Chee Han and Dr Jeyakumar Devaraj as well as the host/moderator Chan Yit Fei for their time preparing for the workshop. Also, not forgetting our back-end supporting team members, without them we would not have the event run as smoothly. We sincerely hope that you have enjoyed the session and gained meaningful knowledge and insights on COVID-19 vaccines.
For those who who missed out the session or just want to revisit, good news for you! We have uploaded the workshop session video on our Agora Society YouTube channel, you may check out the video here: https://youtu.be/cJEckoG6Wig
We also welcome any feedback for the organiser or/and our speakers.
Once again, we thank you and appreciate your valuable support. We hope to see you next time in future events organised by Agora Society and the People's Health Forum.


Sunday, April 04, 2021

群議論點:巫統大會對政治時局的影響 (30-3-2021)

 


#群議論點 第九篇,社員林志翰撰寫

————-我是分隔線 ————

#林志翰:巫統大會對政治時局的影響
為期兩天的巫統大會在前天落幕,但炮火連連的大會激起了政黨聯盟之間的漣漪,似乎為今年的全國閃選提前下了戰書。大會裡甚少提出什麼國家政策和執政願景,有的反而是赤裸裸的政黨博弈喊話貶損政治對手等動作。
延續巫統最高理事會2月份的決定,他們堅決不與土團黨、安華和行動黨合作,並執意要用國陣的老招牌上陣來屆大選,即使陷入多角戰,包括對壘伊斯蘭黨,也在所不惜。另外一個重彈是,如果在8月1日緊急狀態屆滿了後,首相依然沒有宣佈大選的日期,届时巫統將集體退出國盟政府,以倒閣方式威逼大選。因此,全國閃選今年勢在必行,還沒登記為選民的,或未更換投票地址的,要請注意了。但目前18到21歲之間的年輕選民先要委屈和失望了(因為沒來不及投票)。
有人說,以巫統主席扎希為首的領袖如此措辭激烈揚言,意味著巫統非常深信自己的政治實力可以讓他們在來臨的選舉中大勝並重奪執政的主導權。本次的巫統大會高唱的主旋律是:不要再屈居於土團黨,特別是該黨企圖取代、分裂和盜取巫統的政治地盤與資源。
可是,真的憑國陣品牌和基層實力,巫統就一定能打響如意算盤重奪2018年敗走的執政相位寶座嗎?若真如此,為何在去年的沙巴州選,土團黨的表現仍如此標青還拿下州首長的席位呢?2018年的多角戰不是讓伊斯蘭黨和希盟坐收漁翁之利嗎?
巫統可以高估自己的實力,但一旦低估政治對手而輕敵,就犯下了驕兵必敗的大忌。比起2018年,特別是如果巫統倒閣全面退出政府,那麼他們也將在全國大選首次不能以 #看守政府 的姿態佔據政府資源的優勢。由首相慕尤丁掛帥的土團黨自然也不是省油燈,有了政府各機關的加持和宣傳,特別是在疫情期間,競選的主動權還是會在看守政府這裡。
因此,國盟政府若仿效去年新加坡全國大選的競選限制,那麼此招就可抵消巫統與伊斯蘭黨最具優勢的基層動員能力。再來巫統如此高調割席動作倒政府,可能會造成中間選民反感,覺得巫統不仁不義造成政局動蕩,反而導向催谷更多的同情票投給慕尤丁領導的國盟。如果到時第三波疫情已壓下了,疫苗接種計劃如預期般順利執行,經濟開始好轉,那麼選民可能把這些feel good factor(良好感覺)的政績歸功於國盟。若巫統與政府割席,這樣就難以同時領功勞又不感到汗顏。
巫統急於要伊斯蘭黨表態選邊站也不是辦法。依我看來,伊斯蘭黨若策略高明,他們應繼續與國盟結合換票、領執政功勞和資源備戰。即使國盟輸了,或許伊斯蘭黨可能還比上屆大選贏得更多議席而變得更強大。在國陣無法單獨執政的情況下,這對他們的 #選後結盟 組政府的談判條件更為有利。但如果國盟贏了,伊斯蘭黨的地位自然會比與巫統結盟來得更高。
總的來說,目前巫統陣營士氣高漲,強勢並高調喊話劍指對手看來勝券在握,但這姿態難免會讓他們在未來選戰陷入策略錯誤的維谷。

BFM Interview: Supplementary Budget during the Emergency period (1-Apr-2021)

 WHY DEBATE AND OVERSIGHT ARE IMPORTANT FOR GOVERNMENT SPENDING (BFM)

Q: Could you walk us through the process of approving supplementary funds for the government?
Does the law require the government to always pass a bill before spending additional funds?
CH: First, we have to understand certain important provisions stipulated in our Federal Constitution.
Article 96 says that: No tax or rate shall be levied by or for the purposes of the Federation except by or under the authority of federal law. Article 97 says all revenues and monies raised or received (except Zakat, or other similar Islamic religious revenue), to be paid into and form one fund known as the Consolidated Fund. And most importantly Article 104 says that: no monies, except specified charged expenditure, shall be withdrawn from the Consolidated Fund unless they are appropriated or otherwise authorised by Parliament.
This should certainly apply to the Federal Budget (also known as supply bill) as well as the supplementary budget (known as supplementary supply bill). As recent as August 12th last year in the Dewan Rakyat, the Supplementary supply bill amounted close to RM12 billion was passed. The procedure is very much like the Budget, albeit shorter in process. The Finance Minister has to first propose the motion to table the bill to the Dewan Rakyat. As this is important government business, the speaker would arrange the bill in such a way to give the priority. First reading, second reading is a policy stage, debate would ensue and a committee would be formed. Third reading would be at committee level. If passed, that would be the new Act. That is the standard procedure.
Not only the Federal Constitution, we also have several financial laws governing the matters such as Government Funding Act 1983 and Treasury Bills (Local) Act 1946, these relate to procedures for application of moneys raised or received. For the latter, even if the Finance Minister wants to borrow money by issuing Treasury Bills in Malaysia, the government also need to go through the usual procedure requiring the Dewan Rakyat’s approval, before the government could channel money into the Federal Government’s Development Fund.
However, now according to the new Emergency Ordinance amendment, all these usual procedures would be suspended during the Emergency.
Q: Do any specific situations warrant this move?
Even in normal times, it seems as if the government does, by tradition, request for a supplementary budget. Why does that happen?
CH: Supplementary budget would be required for the situations when the amount allocated in the approved federal government’s Budget via the Supply Act is insufficient or when the money spent is more than allocated in the Budget or when a need has arisen for spending for a purpose which had not been allocated for in the Budget.
Several situations might arise warranting the supplementary expenditure: 1) when the revenue collection performs far below initial expectation and estimation – this could happen when the international crude oil price plunges or prices for major raw material exports, for example, palm oil, falls, or there is a drastic change in the domestic taxation policy such as abolition of GST last time. The shortfall of the revenue must be met.
Given that in the last Budget 2021 tabled, some economists and observers including myself feeling that the government’s estimate of the revenue looks too optimistic banking in the hope that the pandemic would get under control in the second half of this year, the global trade and supplies would bounce back significantly, hence overestimation of the GDP growth (in between 8.6 – 9.6% in current prices).
Secondly, the government might want to spend more for certain programmes which are not currently allocated sufficiently for. Many are still speculating what the new actual supplementary supply bill looks like, if the allocations for fighting pandemic was severely underestimated last November because the government did not expect the third wave of the pandemic loomed so big. There are quarters also found that the allocations for the Election Commission does not look like the government is prepared for a general election. So you know what that could potentially mean.
Q: How does this compare to the practice in other countries?
CH: For commonwealth countries, I would expect the financial procedures would be similar during the normal times. I do not know when it is under the Emergency, if other mature democratic countries would allow such important acts and laws being bypassed, especially when they could have their parliament in session.
Q: What kinds of processes will the new law bypass?
CH: According to the new law with the new provision titled ‘Temporary financial provisions’, not only the Treasury, but Menteri Besar and chief ministers of states in Malaysia could also approve additional spending in their respective government funds beyond the initial budget without having to get approval of their state legislative assemblies. Under Section 10A of the new law, the Treasury can approve any supplementary expenditure or withdrawals from the Federal Consolidated Fund without requiring the usual scrutiny by Parliament.
Q: Even in normal times, do we have strong enough mechanisms to oversee budget revisions, or the allocation of additional resources?
CH: Not really, currently there is no mid-term budget oversight mechanism in Malaysia, unless it is voluntarily done by the government of the day. Though MPs and ADUNs could raise questions to ask the Finance Minister or Chief Minister when parliament and state assemblies are in session.
Q: Overall, how could the fund-seeking process for the government be improved?
is it ok if we focus on improving the process during unique/urgent situations like the current pandemic?
CH: Given that now we are just stepping in the 2nd quarter of the year, I wonder why there is a rush to have the supplementary budget so early on. It would be difficult to comprehend too if the fund is already running out in such early stages.
Thus, it would be much better for the government to reconvene the parliament sittings for the Finance Minister to propose and clarify the matters in the Parliament. Supplementary Supply Bill is an important bill for the MPs and rakyat to scrutinize openly. How a democratically elected government uses the public monies for what public policies and programmes, and in what magnitude, is fundamental for our democracy, as well as our trust and confidence in the government handling our monies.
Therefore, this fund-seeking process, even if it is now unique or urgent situations like the current pandemic, should be transparent and open for public discussion. The era of the government knows best and know all is over, especially if the government still believes in ‘a whole-society’ approach.

***

爱FM《爱生活》:民众对注射新冠肺炎疫苗的疑虑(1/4/2021)

 2月末的时候我在寂静禅林主办的线上讲座分享了疫苗科学知识后,爱FM电台DJ黄敏明听到了。后来她联系我,问我可不可以在4月1号在她主持的《爱生活》节目分享我的内容,游说和鼓励更多人登记疫苗接种。根据当时她所知,很多长辈们都不太愿意接种,因为他们可能有所不知或有错误的了解,希望我能透过这节目来厘清一些他们的疑惑。我很快就答应了,因为我也意识这公共卫生问题的严重性。

***
爱FM的听众,大家好!我是志翰,群议社社员及公共卫生政策研究员,也是免疫学硕士和感染生物学博士。今天要与大家分享有关疫苗接种的知识和看法。
截至3月30日,我国总共发出大约66万剂疫苗,其中18万8千人已完成了两剂疫苗接种。第一阶段的全国疫苗接种计划是在2月24日开始,由首相慕尤丁和卫生总监诺希山率先领跑给大家信心打气。首阶段是开放给高风险前线医护人员、国内治安和国防前线人员和民选政治代表等,但从4月19日开始疫苗接种计划即将进入第二阶段,也就是社区较高风险群比如60岁以上的乐龄人士、拥有慢性疾病患者、残障人士等可以接种疫苗。可惜科技、工藝和革新部長凯里在3月29日告知,符合资格的有大约9百万人,但7百万人还没登记疫苗接种。这趋势令人担忧,因为患上疾病最高风险,伤害最大的就是这个群体。
截至3月30日,全球已累计了大约1亿2700万确诊病例,死亡人数达279万人,死亡率大约2.2巴仙。我国呢,也累计了大约34万确诊病例,死亡人数是1265人或0.37%死亡率。这个死亡率数字,说白一点,就是每一千名病患当中,就有四个病死。虽说我国的死亡率比全球平均低了6倍,但大家不好忘记,我国的第三波疫情最糟糕最严重的时候,曾拥有最高记录327人进入加护病房和其中145人需要呼吸机。那个发生在今年2月2日。
根据卫生部今年2月17日的数据,新冠肺炎死亡病例有88%至少有一个慢性疾病或身体状况,比如高血压、心脏病、肾脏问题、高胆固醇、肺部疾病、癌症或肝病。去年11月22日的数据则说明,死亡病例当中有大约三分之二是年龄60岁以上。
即使被感染生了重病后康复了,但病毒对那人的健康伤害已造成:特别是肺部呼吸道的损伤,还可能包括肝脏,心脏,神经和大脑细胞等等的伤害。医学界已讨论所谓的‘长期新冠肺炎’现象就是这些康复者事后依然呈报不良生理状况如:不时呼吸困难、心跳不规律、胸口疼痛、疲惫和脑雾无法集中精神等。
难道我们应该无视病毒对人体侵略破坏,任由病毒感染给我们造成长期且可能永久的后遗症吗?
所以,目前当务之急,就是要保护最容易受伤害的高风险群体,比如60岁以上的乐龄人士和拥有慢性疾病的病患。第二阶段疫苗接种计划估计涉及940万人,所以他们最好尽快安排...如果你也认识那些符合资格的亲友,麻烦你也帮忙劝说游说他们,并帮忙他们登记疫苗接种计划。
接下来我会从科普角度为大家介绍和讲解疫苗的原理和种类。
***
刚才分享了新冠肺炎的感染风险,现在我简单谈一谈疫苗的原理,它们如何增强我们的免疫力。
疫苗,本身就是一个真实病毒的替代品,让我们的免疫系统可以借此辨识病毒并激活适应性免疫系统(英文是adaptive immunity)产生更为精准应付病毒的配备,如高度结合的抗体和免疫细胞介导对病毒的直接杀伤。另外一个疫苗接种的目的,就是让我们的身体产生免疫记忆细胞,在侦查到病毒感染的时候迅速作出免疫反应。控制病毒感染对人体的伤害,最重要的往往就是免疫反应的精准度、力度和时间迅速的掌握。大家可以想象在一场现代军事战争,如果能用导弹等特強武器先防御敌人的攻势,总比派遣本身的步兵和骑兵正面迎接来得更好。所以,不要听信有些人的传言说什么:我们只需要‘自然’免疫保护,不需要额外‘外物’的刺激。我说,这个所谓的‘自然’免疫系统,就是免疫学上说的先天免疫系统(英文是innate immunity),固然他们有一定的重要性,但是他们就是我刚才所说的步兵,规模和杀伤能力有限,不能保证能阻挡大量的病毒进攻。所谓的要‘锻炼’免疫系统,不是说要吃健康食品喝些什么草药汤包就可以了,我们身体的适应性免疫系统要见到病毒模样才能学习精准对付。
但若要遇到真实的病毒才来‘学习’,对我们身体的风险和伤害可能太大了,所以才要用疫苗。我国疫苗接种计划的疫苗供应组合目前有5个产品,涉及的疫苗种类只有3个,那就是:灭活病毒(科兴疫苗就是代表)、病毒载体(我们有英国瑞典的阿斯利康、中国的康希诺和俄罗斯的加马利亚疫苗),最后就是目前我国大量接种的辉瑞BioNTech疫苗,那是较新的科技:核酸mRNA型疫苗。我国现有的疫苗都是注射型——注射在手臂肌肉。除了中国的康希诺之外,其他的都需要两剂疫苗。
灭活病毒疫苗就是把真实病毒用化学物确保杀死,净化处理后加入佐剂制成疫苗。这种疫苗的好处是让免疫系统辨识整个病毒的架构轮廓。病毒载体疫苗则由其他的病毒种类如adenovirus携带着新冠病毒的核酸RNA信息,成功带入人体细胞后,借由我们的细胞生产病毒的刺突蛋白来让免疫系统辨识学习。刺突蛋白是病毒接触和进入我们人体细胞的一把钥匙,对准一些细胞的ACE2受体这个’门把’。而mRNA型疫苗则是使用脂质体来包装核酸,从而让人体细胞将它们吞入,制造病毒的刺突蛋白。因此,病毒载体疫苗和mRNA型疫苗比较类似,分别只是使用的载体不同,辨认物比较狭隘就只是对准病毒的刺突蛋白。
下一段,我会讲解疫苗的具体保护作用和功效。
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相信很多人想继续了解,到底新冠疫苗有效吗?疫苗功效数字该如何解读?再来就是它们安全吗?
首先,大家要明白,疫苗保护可分为三个级别:最完美的情况是该疫苗能让一个人完全避免感染,也就是说即使用RT-PCR筛检也无法查出感染;接下来的一个理想情况是,疫苗接种后虽然受感染,但无症状或出现轻微症状而已,不会再传染给他人;最低要求的保护级别是疫苗接种者即使受感染,会出现一些较严重的症状或会传染给他人,但不至于严重到有生命危险或需要进入加护病房。目前正广泛接种的新冠疫苗,已有很明确的证据显示它们几乎100%有效避免接种者染病死亡或入院的需要。简单来说,疫苗保护了接种者的健康和生命,让他们有免疫能力对抗和战胜病毒。
相信大家已听闻的数字是辉瑞疫苗的功效达95%,而科兴疫苗在土耳其只达83.5%,在巴西却只有50.4%。可能有人就很快下了定论说辉瑞疫苗比科兴疫苗有效,事实上可以这样比较吗?
鉴定疫苗功效的数字其实来自第三期的临床试验,主要来比较疫苗接种群体和安慰剂群体何者更能避免病毒感染。所以,不管是95%或85%,这些数字是这两群组之间的相对风险避免程度。95%的功效不是说有5%的人口还会染病,而是相对于没有接种疫苗的人,你有95%机会避免感染。但这个数字如何很大程度取决于这个临床试验把什么风险群体和多少比重的他们纳入试验。临床试验当时的当地疫情状况如何,以及正盛传的病毒变种与现有疫苗欲对付的病毒差异有多少,这些都会影响最后的功效数字。
比如说,科兴疫苗在巴西的试验之所以功效只有50.4%因为该疫苗试验用在感染风险最高的医护前线人员,当时也正值该国的疫情严重时期。再来我们看到美国强生疫苗的功效在美国是72%但到了南非却降至57%,为何?因为南非当时已盛传了新的变种病毒。无论如何,这些临床试验数据都显示疫苗接种强力保护该人免于严重疾病和死亡。以色列完成疫苗接种超过一半人口,控制疫情的效果十分显著,从一月最高峰的单日超过一万确诊病例和最高79人死亡降至3月27日的800多新病例,8人死亡。疫苗接种者因新冠肺炎而死亡相当罕见。
相信有人也很关心,打了疫苗后会有什么副作用?有可能的,一般常见的副作用是:肌肉疼痛、头痛、头晕、发烧、发冷或疲惫等等。如果是辉瑞疫苗,数据显示通常第二针的副作用会比较强烈。但这些症状都不会严重或危害生命。若有什么比较严重的过敏反应,通常都会在一两天内显示。如果一周过去了没事,通常就没事了。近来媒体广泛报道,全球关注的阿斯利康疫苗接种后的血板块降低同时凝血的事件,虽然发生率依然极低,但暂时科学和医药界需要更多研究去找出问题所在,不能排除阿斯利康疫苗与那些零星事件的关系。
没错,没有任何人能给什么保证接种疫苗后绝对不会有事,但要知道卫生部旗下的国家药剂监管机构(NPRA)在批准医药产品方面素来严谨和高要求,因此一旦能获得批准的疫苗,大家应可放心接种。再况且政府已愿意承担责任将全力照顾您的健康,为任何疫苗接种事故发生的可能作出赔偿,从5万到最高50万令吉。
如果您担心疫苗的副作用,您的风险评估应该考量到不接种面对感染的风险,何者更高。您绝对不是第一个或甚至首一万个接种该疫苗的人,目前已被批准的疫苗基本上是安全的,请放心去接种疫苗并事后密切检查自己的身体反应。只要您没有免疫力低下的问题,过去没有急促激烈的过敏性反应记录,目前18岁以上的大马居民,就可符合条件登记接种疫苗了。一些拥有某些医疗状况的个人包括刚移植器官、进行化疗、刚注射了其他非新冠疫苗、怀孕等的人,也可以先登记。有时,在一些情况下,您可能只是当下需要延后安排疫苗接种,并非您不可以接种。
政府雄心万丈要在明年2月前为至少我国80%的人口接种疫苗,以达到群体免疫效果,从而有效地阻断新冠病毒的感染链,避免国家一而再再而三地实施劳民伤财伤经济的行管令。我认为,接种疫苗除了保护自己也保护其他人,再加上政府为了公共卫生和大家的健康着想,已免费提供疫苗注射。符合条件的,人人都有份,包括移工和家佣,所以,您也一起来吧!请大家尽快在MySejahtera 应用程序, 或vaksincovid.gov.my官网或拨电登记,或协助家人登记。




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