Low vaccination rate: taking a closer look
The
National COVID-19 Immunisation Programme (NIP) kick-started with a lot of
fanfare. Prime Minister Muhyiddin Yassin received his first vaccine in public
on the 24th of February. Three months later, the people expressed their
dissatisfaction and lamented that the vaccination rate is too low, alleging
that it is mainly due to the government being slow and incompetent. Often, the ‘better’
countries they cited 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, one must first consider the NIP 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 covering 109.65% of residents in the country from 5 sources:
Pfizer, AstraZeneca, Sinovac, CanSino and Gamaleya/RIDF (Sputnik V). Currently,
the first three have obtained product registration approval from the National
Pharmaceutical Regulatory Agency (NPRA) that 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.
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 the
20th of May, the percentage of vaccinated persons (who received two doses) and those
who received at least one dose is 2.6% and 4.2%, respectively. 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 the
12th of April, the special committee on ensuring access to Covid-19 vaccine
supply (JKJAV) published the timeline of vaccine supply (Figure 1). If we take
a look at the vaccine supply (green trend line), compared to current demand by
registration counts (yellow horizontal line) and the target vaccination
coverage (light blue line), it is clear that we were facing a vaccine shortage at
the early stage. The same scenario is happening to many countries globally.
Malaysia
is not too far from the average Asian countries and even ahead of Japan and Thailand
(see Figure 2). 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 vaccine manufacturing ability 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 the local and global 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.
Figure 1: Vaccine supply and demand status
Source: JKJAV
Figure 2: Share of people who received at least one dose of
COVID-19 vaccine by selected countries
Adapted from Our World in Data (the 22nd of May 2021)
Meanwhile,
the registration rate for vaccination in Malaysia is still not satisfactory. As
of the 20th of May, only 43% of eligible 18 years and above of the population have
registered. That means that even if the Federal Government were 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 pandemic 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 (see
Figure 3). But if one looks at the percentage of registered participants who
received at least one dose of the vaccine - states like Selangor, Johor, Penang
and Sarawak fall below the national average. However, these states have
received the most compared to other less populated states in terms of the
actual number of administered doses.
Figure 3: Percentage of registered >18yo population for
vaccination and those who received at least one dose, the 20th of May 2021
Source: JKJAV and author’s calculation
This
might explain why certain states feel like they need to take matters into their
own hands to ‘speed up’ the vaccination campaign. On the 16th of May, the Sarawak
state government announced that they had procured one
million doses of the Sinovac vaccine, expected to arrive soon in 2 batches.
On
the 18th of May, the NIP coordinating minister, Khairy Jamaluddin,
clarified the conditions under which the state governments are
allowed to procure their vaccine supplies. A day after the
minister’s statement, the Selangor state 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 the Penang
state government.
The
conditions clarified by Khairy Jamaluddin were clear. Firstly, the products
must be registered and approved by the NPRA that checks the vaccines’ efficacy
and safety profile according to laws and regulations that are based on
stringent standards of the WHO and OECD countries. Secondly, if the procurement
source is from the same pharmaceutical company as the NIP, the Federal Government
will be prioritised to receive its supplies before any other parties from
Malaysia. This was an agreement with the vaccine manufacturers to ensure that
the national vaccination programme is not compromised. Thirdly, if the supplier
is not involved in the NIP – the state governments or private sector can freely
procure them provided they have received an approval by the NPRA for the
vaccines concerned.
Therefore,
the apparent win-win situation is when a state government secures alternative
vaccine sources outside the NIP 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 the Pandora 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 NIP.
Imagine if states go their own way – eventually, this could create a chaotic
situation for the NIP and probably undermine the national programme. 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.
One
should not only think about vaccine procurement but also consider the logistics
and execution of vaccination. Who administers the vaccines? The NIP currently involves
private healthcare facilities to help with the public vaccination programme.
Would the state governments also compete with the Federal Government over the
human resources required for vaccine administration? If this affects the national
programme, at whose expense will it be? The NIP 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 NIP. Most
importantly, people should stand in solidarity to fight the pandemic together,
not just thinking for oneself first but also for every one of us.
*Dr. Lim Chee Han is a public health policy researcher,
currently Senior Researcher at Third World Network and co-convener of the
People’s Health Forum Malaysia.
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