Saturday, December 25, 2021

Social Inclusion - RMK-12 : To What Extent is it Prosperous, Inclusive and Sustainable? (19 Nov)



GBM Webinar: Social Inclusion - RMK-12 : To What Extent is it Prosperous, Inclusive and Sustainable?
Organiser: Social Inclusion Cluster, GBM
Date: 19/11/2021
Time: 8.15pm-9.30pm
Guest Speaker: Dr. Jayakumar Devaraj
Commentator: Dr. Lim Chee Han

Watch the live video recording here:


https://www.facebook.com/watch/live/?ref=watch_permalink&v=1069912527173150




Friday, December 24, 2021

How to read and analyse a Federal Budget and Financial documents (20 Dec)

 


In this video, I am going to introduce and explain about a few important Federal financial reports in Malaysia, namely Financial Statements, Auditor's General's reports, Federal Budget (Economic Outlook, Fiscal Outlook and Revenue Estimates, Federal Expenditure Estimates). This talk is an update to the Federal Budget workshop series which I had personally conducted since 2018, in English and Mandarin.

No holdbacks: Addressing Health Taboos in Malaysia. (Organised by Charisma Movement) -- Nov 27

 



Host/Organiser: Charisma Movement Event: No holdbacks: Addressing Health Taboos in Malaysia. Focus: Community Health 27th Nov 2021 Event description: Equal access to quality healthcare is a human right, regardless of race, gender identity, age or socioeconomic status. Listen as our speakers discuss how an inclusive healthcare system is vital to the overall development of society.

Original live video link: https://www.facebook.com/charismamovement/videos/914472686109342

Thursday, December 23, 2021

PHF joint statement: Say 'Yes' to implementation of Medicines Price Regulation Phase 1 (14.12.2021)

 


Joint Statement led by the People's Health Forum on 14 DEC 2021 in Kuala Lumpur

For public health and affordability, Say ‘Yes’ to implementation of Medicines Price Regulation Phase 1
We, the undersigned 25 organisations and 30 individuals are very concerned about the questionable study sponsored by the private industry dubbed as Cost-Benefit Assessment (CBA) 2.0 on the impact of the Medicines Price Regulation (MPR) policy.
The policy was approved by the Cabinet of the Government of the day in April 2019, tabled by the Ministry of Health (MOH) in collaboration with the Ministry of Domestic Trade and Consumer Affairs. Under the first phase of the policy implementation, the Government will impose an upper limit of mark-ups at the wholesale and retail levels in a regressive manner (i.e. higher priced items will have a smaller mark-up upper limit), for about 600 single-sourced prescription medicines. But almost 3 years later, the policy is still not implemented.
To our utter surprise we learnt recently that the CBA 2.0 study’s preliminary findings, as presented by the Malaysian Productivity Corporation (MPC), entirely overlooks the role of and benefits to patients, their family members and support groups as well as consumers. The public was not even consulted to provide insights and feedback regarding the benefit the new policy might bring. The strong voices of the demand side, especially the most affected and disadvantaged groups and individuals needing specific medicines badly were not included. Thus, how can this study be “comprehensive” and “unbiased” and not lopsided if it has only computed the costs and losses from the supply side? Even those costs and losses cannot be independently assessed due to the lack of information on the methodology of the CBA.
We are particularly concerned over the serious conflict of interest in this “collaboration project between public sector (MITI, MPC) and the private sector (PhAMA, APHM, MOPI, MMA, PhRMA)” especially because the CBA 2.0 is funded by industry, and some of its members even sit on oversight committees.
We would like to reiterate and reaffirm the important principle of ‘people before profit’ in matters of health. Public interest and public health must come first before the private healthcare sector’s goal of maximising profits. Here we would like to point out some major flaws with the CBA 2.0, as compared to the CBA 1.0 conducted by MPC under the appointment of the MOH.
While CBA 1.0 had studied the impact of regulating single-sourced prescription medicines, about 600 active substances that are usually the most expensive due to the monopolistic nature of the market, CBA 2.0 studied the policy impact related to 5,000 pharmaceutical products, details of which are not disclosed. As a result, the exaggeration of the price impact is a real problem. Why did CBA 2.0 enlarge the scope and automatically assume the implementation of subsequent phase(s)?
Furthermore, CBA 2.0 claims that 33% or 2,600 private clinics will close due to the impact of the new policy. How does the study arrive at this number? Most private clinics do not even sell or rely on the sale of the 600 listed single-sourced medicines in the first phase of the proposed MPR policy.
CBA 2.0 also claims that private hospitals’ revenue will drop by 35-40% due to the implementation of the proposed policy. This is another problematic exaggeration. Private hospitals had contributed a total of RM14.55 billion in health expenditure in 2020 (Malaysia National Health Accounts 2020 preliminary data). A 35% revenue drop would be a shocking RM5 billion per year! If this claim were true, this would represent an obscene amount of excess profits that they would have profiteered from the sale of medicines alone.
We also would like to express our strong reservation with the CBA 2.0 study that seems to intend to drive a wedge to divide society by showing that the MPR policy disproportionately benefits the T20 households instead of the B40 households. This moral narrative as an argument against the MPR policy is mischievous and is besides the point. The policy certainly will bring great benefits for many B40 patients who will finally get access to life-saving or life-enhancing medicines that are not provided by public hospitals. Furthermore, the whole of society will benefit, as even M40 and T20 households do not deserve to be overcharged for much needed medicines.
We strongly urge the Government and general public not to give weight to the preliminary findings from a disputed CBA 2.0 study, but to implement the Cabinet-approved policy for the first phase that has already been delayed for the following additional reasons.
First, 35% or RM23.15billion of total healthcare expenditure had come from out-of-pocket (OOP) expenditures in 2020, of which 15% (or RM3.39billion) were for pharmaceutical purchase. Compound Annual Growth Rate (CAGR) of the OOP expenditures is at 7.28% from 2010-2020, meaning that OOP is growing faster than GDP. Private hospitals alone have already taken 45% share of OOP. If the government does not intervene, OOP expenditures could continue rising and maybe faster, due to high mark-up practice for the medicines. Many life-saving medicines, especially the expensive cancer drugs, are not even provided by the Government. Hence people have to risk financial catastrophe to buy them or forgo treatment. This is unacceptable and unethical just because of the industry’s goal of maximising profits.
Secondly, people are already hit hard by the COVID-19 pandemic with major job losses among the B40 and even M40 populations. With the current high prices of many essential goods and services already causing hardship, people should not be burdened even more with expensive medicines.
In conclusion, we must keep in mind that the Government has a responsibility to protect people’s health, and to provide a strong social safety net for the wider population, especially with the aim to reduce poverty and vulnerability in society. The Government needs to consider medicines as a basic need, and not another commodity in the market.
We urge the Government to keep their promise, as stated in the 12th Malaysia Plan: under Strategy B2 “Ensuring Financial Sustainability for Healthcare”, where it clearly states “a price control mechanism for medicines will be introduced to protect consumers from unfair pricing” (Page 4-22). People have been waiting for the implementation of the Phase 1 Medicines Price Regulation for far too long.
The Government must consider people’s benefit and interest as its first priority. There is no better time than to do it now.
Endorsed by:
Organisation:
1) People’s Health Forum
2) Health Equity Initiatives (HEI)
3) Citizens’ Health Initiative (CHI)
4) Agora Society Malaysia
5) Third World Network
6) Parti Sosialis Malaysia (PSM)
7) All Women's Action Society (AWAM)
8 ) Aliran Malaysia
9) Breast Cancer Welfare Association Malaysia (BCWA)
10) Consumers' Association of Penang (CAP)
11) Crisis Home
12) Family Frontiers Malaysia
13) GERAK (Pergerakan Tenaga Akademik Malaysia)
14) IKRAM Health
15) Malaysian Consumers Movement
16) Malaysian Women's Action for Tobacco Control and Health (MyWATCH)
17) North South Initiative
18) Persatuan Sahabat Wanita Selangor
19) Positive Malaysian Treatment Access & Advocacy Group (MTAAG+)
20) Prostate Cancer Society Malaysia (PCSM)
21) Sahabat Alam Malaysia (SAM)
22) Saya Anak Bangsa Malaysia (SABM)
23) Sustainable Development Network Malaysia (SUSDEN)
24) Together Against Cancer (TAC)
25) Women’s Aid Organisation (WAO)

Individual:
1) Anne Jamaludin
2) Chan Chee Khoon
3) Chan Yit Fei
4) Chang Yii Tan
5) Chee Heng Leng
6) Chee Yoke Ling
7) Czar Lee
8 ) Danesh Prakash Chacko
9) Jeremy Kwan
10) Jeyakumar Devaraj
11) Kwadwo Osei Bonsu
12) Lim Chee Han
13) Lim Mah Hui
14) Lim Su Lin
15) Liza Ali
16) Mark Cheong
17) Mary Cardosa
18) Mary Shanthi Dairiam
19) Meenakshi Raman
20) Ng Siu Kiam
21) Ramachandran Ramasamy
22) Ravindran Raman Kutty
23) Sazlina Binti Shariff Ghazali
24) Shangeetha Thirumayni
25) Sharralah Sundramurti
26) Sharuna Verghis
27) Tan Khim Woon
28) Vasudiwan a/l Narayanan
29) Venugopal Menon
30) Yap Tuan Gee

* The People's Health Forum (PHF) is a platform created in April 2019 by several not-for-profit organisations and individuals who are committed to the principle of Health for All, i.e. universal healthcare as an entitlement based not on the ability to pay, but on the basis of need.

Sunday, December 19, 2021

Understanding the amendments to Act 342 (20 Dec 2021)

 Amendments to the Prevention and Control of Infectious Diseases Act 1988 (Act 342) have triggered heated reactions within the Dewan Rakyat and also from the public, where netizens and activists have mobilised to oppose the amendments to Act 342. The arguments largely (if not solely) focus on penalties for offences under the Act: (1) the maximum amount of compound fine to be issued to an individual and a corporation; and (2) increasing the maximum fine and jail sentence in a “general penalty” provision.

I would like to share my views after going through all the amendments proposed in the amendment Bill for the first reading in Parliament.

It is important to first consider the objectives and functioning of all the amendments and to understand the existing weaknesses, limitations and gaps of the parent Act 342. This 32-year-old law has had 6 amendments in the past, but all merely to add new infectious diseases to the list in the First Schedule, the latest being Coronavirus Disease 2019 (COVID-19) in June 2020. Now it is time to update some practical and necessary changes to the Act.

To be fair, the proposed amendments to Act 342 are a response to COVID-19 because this still ravaging virus with its various mutations is very much unlike the other 29 diseases on the list. The challenges are massive – it is unprecedented, a disease which has claimed more than 31 thousand lives and infected 2.7 million people in Malaysia. There are numerous complaints or grievances against government officials regarding the handling of the pandemic, namely in terms of testing, tracing, quarantine, surveillance and monitoring of the disease, as well as enforcement of Standard Operating Procedures (SOP). The Ministry of Health (MOH) workforce has been severely strained in terms of performing their duties on all these procedures.

When the Emergency was declared in January, the National Security Council (Majlis Keselamatan Negara, MKN) was the chief decision-making body. Confusion and conflict often arose in public due to many inconsistent policies that were churned out owing to multiple considerations besides public health. These sometimes compromised or undermined the effectiveness of COVID-19 disease prevention and control measures under the jurisdiction of MOH. Now, the emergency period is over, the emergency ordinance has ceased to be in effect, and Act 342 leaves MOH with inherent constraints and uncertainties.

Overall, the nature of the proposed amendments indicates that MOH is seeking to fill the gaps based on the lessons learnt from battling the pandemic over the past 2 years, while preparing for the new challenges ahead. The emergence of the Omicron variant is a stark reminder that COVID-19 is far from being under control. In its present form, Act 342 is insufficient to deal with present and future pandemic-related health threats. The amendments are thus necessary to allow the MOH to act in the current crisis and in other new or emerging public health crises.

At the same time, SOP flouting and non-compliance among certain sections of society (e.g. some individuals, corporations and organisations or groups) has caused many cases, clusters and even deaths. The risks and consequences associated with cases of SOP flouting are well-documented. Without good and effective disease control, the burden of public resources to Find-Test-Trace-Isolate-Support and the unnecessary loss of lives are the sources of public frustration and distrust of government. No Act will be taken seriously if it does not ensure the proportionality of penalties (i.e. right amount of deterrence) on those who do not comply, and if the law is not enforced reasonably, fairly and effectively.

 This background understanding of the issues is crucial to assess the urgency for the amendments to be adopted within this Parliament sitting. The rapid transmissibility of the Omicron variant looks increasingly obvious.  In South Africa, it has totally dominated and ‘dethroned’ the Delta variant. As of 18 December, 13 Omicron cases were reported in Malaysia. A new wave of the pandemic is looming on the horizon, especially now when more people have started to socialise and mingle more freely due to gatherings and events in the holiday period.

Although the disease severity caused by the Omicron variant is reportedly lower, if the spread of the disease (even among fully vaccinated persons) is not well controlled, the price of negligence will be a surge in devastating new transmission peaks, and rising death numbers, once again adding to the social cost and disruption. The public must do its utmost to safeguard against COVID-19 “fatigue” - extra vigilance is now a key priority.

Let us now look at the amendments. The amendments to Section 2 update the definitions of the responsible officers, replacing ‘health inspector’ with ‘Environmental Health Officer or any suitable person’. This new definition retains local authorities to help in enforcing the Act.

There are two amendments to Section 10(2): First, medical practitioners are required to report any suspected case of infection to the health authority, even if it is not yet confirmed with a laboratory test. This would allow time for the health authority to respond faster with a quarantine order to prevent further spread of a disease. There are, however, concerns that failure to do so could trigger a compound fine.

Secondly, the restrictive reference to ‘the forms (‘borang’) determined by the regulation orders under the Act’ is replaced by ‘whichever form (of document) determined by the Director-General (DG) of Health’.  In rapid responses to many new situations where more documents have to be produced for different functions, it makes sense to not have to wait for the Health Minister to gazette new regulations for various forms.

The current Act only recognises ‘quarantine station’ while home quarantine is now an acceptable part of COVID-19 pandemic response. Hence, the addition of a new Section 14A.  There are concerns that under Section 14A(2), ‘an officer is given authority to use necessary force (‘kekerasan’)  to ensure the (quarantine) order is complied with’.  To be fair, this is already in the existing Section 15(2). The government could consider adding another word ‘reasonable’ (‘munasabah’) and give examples in the regulation concerning the new Section 14A(2).  While there are documented cases of home quarantine orders being disobeyed thus posing infection risk to the local community, allowing the use of force has to be accompanied with checks.

Next, a new Section 15A is proposed to order confirmed patients, or suspected cases or any (close) contact to wear a tracking device for monitoring purposes. This is an important tool for monitoring the compliance of home quarantine orders, and this was not envisaged 32 years ago when Act 342 was passed.

The new Section 21A (in Part IV of the Act concerning controlling the disease spread) empowers the DG of Health to give any general or specific instruction to any individual or group for preventing the disease spread, and any violation of such instruction is considered an offence. This allows some flexibility for the health authority to give new instructions adapting to changing situations. While there are concerns that this can be abused, however there could also be situations where the DG has to act swiftly and intervene by giving instructions; how does one deal with non-adherence with the instruction order then?

There is a new Part IVA called Enforcement (‘Penguatkuasaan’) which confers the necessary investigation power to the officer enforcing the Act, following Criminal Procedure Code (subsection 21B), as well as requiring people to provide any information relating to disease control and prevention to the officer (subsection 21C). This new Part IVA seeks to empower officers of MOH and others under the Act to contribute to more effective enforcement with relevant and important information to help contain the disease spread.

The new Section 22A creates a new category of offenders: body corporate (pertubuhan perbadanan). The current Act 342 only covers individuals who are responsible, thus there is no legal ground to take action under the Act against a company which consists of many decision makers including directors and managers who should be responsible for the non-compliance of SOP and subsequent consequences. Section 22A(2) also covers the person or agent in charge of workers, and they have to take individual responsibility. The current Act does not distinguish among these categories of actors, so the maximum compound fine is only RM1,000 for a responsible individual.

Last year, when a glove factory in Klang was reported for flouting SOP, they could only be slapped with RM1,000 fine, and this incident had sparked public outcry. The Prime Minister’s 100 day report card event organiser could also only be fined RM1,000 recently for clearly violating SOP, and the public also fumed and cried ‘double-standards’. But that is the maximum compound fine. If we factor in general inflation, RM1,000 in 1988 would have been RM2310 today (by Oct 2021).

So that is exactly the shortcoming of the current Act, and most, if not all, of the public agree that a RM1,000 fine is ridiculously low for such a scale of SOP violation. So, I would expect that most would agree to raise the penalty amount, but what is in contention is only the quantum. It is important to acknowledge this common understanding first, that a law needs to have proportionate penalties imposed on the offenders so that the law would have some reasonable deterrent effect and serve justice by ensuring that those who irresponsibly pass risk and public health threat to the local community are made liable.

Concerns have also been raised on the reversal of burden of proof in Section 22A. Again this is common in laws that establish corporate liability. The check is that the corporation can prove the offence was committed without its knowledge or consent and it had taken all reasonable steps and made all appropriate efforts to prevent the occurrence of the offence and this is provided in Section 22A, too.

Now we come to the final 3 amendments that have seen the most protest.

The first draft proposed to amend Section 25 for the health authority to issue a compound fine for the offence committed by an individual (maximum RM10,000) or corporation (maximum RM1 million). The government has since revised down to RM500,000 for corporations and RM1,000 for individuals as of 16 December.

The draft to amend Section 24 on General Penalty for ‘any persons who commit an offence under the Act for which no penalty is expressly provided’ proposed that for an individual, the fine amount does not exceed RM100,000 or 7 years’ imprisonment or both. In response to concerns and protest, MOH on 16 December offered to lower this to a maximum of RM2,000 or 2 years’ imprisonment or both. The penalty for corporations is a fine not exceeding RM 2 million.

Lastly, Section 31 deals with the power of the Minister of Health to make regulations. The first amendment draft proposed to add a new Subsection 31(3) whereby any violation of regulations can be an offence which carries a fine not exceeding RM50,000 or 2 years’ imprisonment or both. The government has now proposed to adjust the amount to a maximum of RM1,500 or 2 years’ imprisonment or both for individuals. For corporations, the maximum fine is RM 1 million.

It should be noted that except for compound fines, the other penalties are imposed by the Courts, meaning that the individual or corporation concerned will have to be charged with an offence under Act 342 and a trial then follows.

Perhaps what seems to have escaped public attention is the fact that the MOH will use a three-tiered penalty system for compound fines, according to the seriousness of the offence. That means, most people might be wrongfully assuming that they would be imposed with the maximum fine compound for small offenses such as not wearing a mask in a public mandated area or not registering one’s information for checking in premises (e.g. using MySejahtera). Let us not assume that the maximum fine will be imposed in every case.

For clarity and to quell public concerns, the government could provide an indicative list of offence categories and the corresponding range of compound fines. However the latest compromise is RM1,000 maximum compound fine for individuals.

Some objections compare the maximum penalty with Penal Code such as homicide attempt and causing death by negligence, implying that the maximum penalty quantum is unjust, excessive and disproportionate. I beg to differ here.

From March to September 2021, just for workplace category alone there were 2,369 clusters, resulting in 195,130 cases and 522 deaths. On average every cluster has seen 82 cases, resulting in one death for 4.5 clusters. The largest outbreak during this period was the Senawang Industry Cluster, with 2,178 cases and 15 deaths recorded.

Could there not have been SOP violations or negligence on the part of employers which caused the loss of lives and the suffering of their employees or their loved ones? Any corporation or employer responsible for this harm or loss to their staff also violates an established principle of the Right to Life and Livelihood, i.e. that working conditions must be safe, healthy, and not demeaning to human dignity. What if the extent of harm was high in terms of hospitalisation, ICU and even deaths? And what if the employers are frequent or repeated offenders? Is the maximum penalty being proposed really disproportionate or excessive compared to a case of causing death by negligence?

The COVID-19 pandemic is already a tragedy for many families. If there are some irresponsible parties that caused or contributed to this, why is it not just to impose higher compound fines or haul them to court with higher penalties? If the maximum quantum is not just, the objectors should propose and justify their numbers as well. Expanding the scope of the Act to corporations can also be accompanied with fairness, distinguishing small businesses from big corporations.

It is understandable that there is distrust of the enforcement authorities, as seen from the instances of maximum compounds for minor offences and double standards in treatment of politicians during the Emergency period. While I do not condone arbitrary use or abuse of power, I also recognise the urgent need to ensure that Act 342 provides the necessary legal basis and proportionate penalties to deal with epidemics and pandemics.

In conclusion I urge the public to look at the Act 342 amendments holistically, understand and support the need for the amendments. The government, opposition lawmakers and civil society groups can still discuss the quantum for the maximum general and compound penalties, as well as other concerns, but the clock is ticking. To face the next impending wave of the pandemic, the government definitely needs the amendments by Monday, not next March.

 

 Published also in:

The Malaysian Insight

The Malay Mail

The Sun Daily (Part 1) (Part 2)


Supported by Hafiz Hassan in his column article on 20 Dec 2021

Wednesday, December 15, 2021

Suaram Podcast: Edisi COVID-19: Episode #3 - Isu Kesihatan di Malaysia Semasa Pandemik (14.12.2021)

 


Podcast URL: https://open.spotify.com/episode/5t5M11ebF1jILC1Hch7CYC

Episode Description

Malaysia juga suatu ketika pernah diancam dengan kes-kes wabak seperti virus Nipah, virus Zika, Chikungunya, selesema burung dan beberapa lagi lain. Ini bermakna negara kita mempunyai pengalaman dalam menangani wabak yang pernah berlaku. Di dalam Episod #3 Podcast SUARAM - Edisi Covid-19, Amirah menemu bual Dr Lim Chee Han, seorang Penyelidik Kanan kepada Third World Network - sebuah organisasi antarabangsa. Episod kali ini akan membincangkan tentang isu-isu kesihatan yang berlaku di Malaysia antaranya dari segi fasiliti, kakitangan kesihatan, bajet kesihatan serta penerimaan vaksin sebagai satu hak atau kewajipan.

***

1.       Dahulunya, Malaysia pernah diancam dengan kes-kes wabak seperti virus Nipah, virus Zika, Chikungunya, selesema burung dan beberapa lagi lain. Berdasarkan pemerhatian Dr, boleh Dr ceritakan pengalaman Malaysia dalam menangani wabak ini terdahulu?

 CH:

Memang benar bahawa Malaysia pernah menangani wabak-wabak yang membawa derita mahupun maut kepada masyarakat sejak kemerdekaan negara. Contoh-contoh wabak penyakit pada zaman dulu berleluasa seperti campak, tibi, batuk kokol, pertusis, polio dan lain-lain, semua ini kini telah dalam kawalan kerana wujudnya vaksin yang berkesan dan diberi kepada kanak-kanak sejak awal.

Benar juga bahawa wabak penyakit baru yang lebih kontemporari terutamanya Nipah dan SARS memberi cabaran yang besar kepada pihak pemerintah negara kita. Semuanya dikendalikan dengan agak baik, kerana ciri-ciri penyakit berbeza dengan COVID-19, orang yang dijangkiti lebih mudah dikesan dan dikuarantinkan.  Hanya 5 kes SARS dan 2 kes MERS dilaporkan kepada WHO yang telah dikendali oleh Malaysia, adalah dianggap penyakit telah dibendung kerana wujud unit aktif terhadap pemantauan penyakit dengan kerjasama antarabangsa dalam pengkongsian ilmu pengetahuan and informasi.

Susulan dan hasil daripada wabak SARS , Malaysia telah menetapkan satu dasar strategi yang komprehensif yang berjudul: Malaysia Strategic Workplan for Emerging Diseases (MySED Workplan) pada 2012. Versi kedua dikemaskini dan dikeluarkan pada 2017 susulan ancaman wabak Zika, dalam versi dasar strategi ini, Crisis Preparedness and Response Centre (ataupun lebih dikenali sebagai CPRC) telah ditubuhkan. Ini telah menyediakan Malaysia menangani COVID-19 pada peringkat awal dengan lebih bersistematik, dan Malaysia adalah di antara negara-negara pertama yang dapat mengesan virus SARS-CoV-2 dengan secara PCR dalam laboratori.

 

2.       Setahun yang lalu, negara China mengumumkan kematian Covid-19 yang pertama (Januari 2020). Kini wabak ini adalah antara 10 wabak yang membawa maut disenaraikan di dalam sejarah dunia. Pada pandangan anda, adakah Malaysia sebenarnya bersedia untuk menghadapi situasi pandemik sedemikian?

a)       Dari segi fasiliti (keperluan dan kemudahan kesihatan)

CH:


COVID-19 adalah antara wabak penyakit yang sukar ditangani. Ia jauh lebih mudah dijangkiti dan memberi risiko maut yang berkali ganda lebih tinggi daripada selsema influenza.

Oleh kerana konflik aktiviti manusia dengan alam semulajadi kerap berlaku dan komuniti masyarakat semakin berpeluang berinteraksi dengan haiwan liar , adalah dijangka wabak-wabak penyakit seperti COVID-19 akan berlaku dengan kekerapan yang lebih tinggi berbanding dengan zaman dulu.

Walau bagaimanapun, COVID-19 wujud atau tidak, fasiliti kesihatan di KKM haruslah dipertingkatkan, kerana kapasiti sekarang telah jadi sukar memuaskan  permintaan orang awam yang semakin tinggi. Sebelum pandemik, sesiapa yang kerap pergi melawat hospital pakar kerajaan ataupun hospital besar negeri, akan tahu bagaimana sesak dengan orang ramai dalam fasiliti tersebut. Bilangan katil juga tidak mencukupi di sesetengah hospital; banyak alat peralatan perubatan perlu diperbaiki ataupun dibeli yang baru bagi menaikkan taraf ataupun “upgrade”; lebih banyak hospital ataupun klinik dibangunkan terutama di kawasan bandaraya yang sering menghadapi kesesakan.

COVID-19 adalah lawan yang luar biasa. Dengan jangkitan yang berleluasa ataupun hilang kawalan pada peringkat komuniti tempatan, tiada negara boleh menampung permintaan rawatan penyakit kalau setiap hari ada kemasukan beribu-ribu pesakit baru harus dijaga. Jadi, dari pengurusan dan kawalan penyakit, fasiliti yang lebih penting dan diperlukan adalah seperti apa yang telah diumumkan oleh kerajaan dalam bajet baru-baru ini: Institut Penyakit Berjangkit di Bandar Enstek Negeri Sembilan.

Haruslah saya nyatakan juga, usaha menangani situasi pandemik dan rawatan bukan hanya tanggungjawab kerajaan sahaja, seolah-olah sektor kesihatan swasta boleh dikecualikan. Mereka juga diminta oleh orang awam untuk memikul beban bersama kerajaan juga, dan memberi kemudahan kepada pesakit yang dijangkiti ataupun dikuarantinkan. Dalam tempoh krisis kemanusiaan, usahlah mereka katakan menjaga keuntungan ataupun ‘bottom line’ mereka – pihak pengurus fasiliti perubatan haruslah diingatkan tentang Tanggungjawab bersama dan ‘People before profit’ – Kebajikan masyarakat didahulukan.


b)      Dari segi kakitangan kesihatan

CH:

Sudah pasti sekarang frontliners kita amat berpengalaman semasa menghadapi pandemik COVID-19, sama juga frontliners di seluruh dunia, tetapi wabak pada masa depan mungkin muncul dalam bentuk dan cara jangkitan yang jauh beza. Jadi, persiapan terhadap wabak akan datang adalah penting dari segi kawalan penyakit wabak.

Tidak dapat dinafikan bahawa lebih ramai kakitangan kesihatan terutamanya pengamal-pengamal perubatan ataupun ‘frontliners’ anggota-anggota barisan hadapan diperlukan untuk menjalankan tugas untuk menangani dan merawat jangkitan penyakit baru, tetapi lebih-lebihnya untuk memuaskan permintaan perkhidmatan kesihatan menjaga orang awam.

Untuk makluman anda, rancangan kerajaan untuk memperkembangkan tenaga kerja terutamanya untuk penjagaan kesihatan, telah ditetapkan dan sedang dijalankan. Langkah tersebut adalah untuk memenuhi permintaan servis penjagaan kesihatan atau perubatan yang semakin meningkat di Malaysia. Rancangan adalah mustahak dan munasabah, TETAPI masalahnya adalah pelaksanaan rancangan haruslah diberi kerjasama oleh pihak lain daripada kerajaan juga, seperti Jabatan Perkhidmatan Awam yang menentukan dan mewujudkan jawatan tetap rasmi kepada pengamal-pengamal perubatan yang menunggu. Situasi inilah adalah konundrum yang dihadapi oleh doktor kontrak.

 

3.       Berikutan keadaan pandemik ini, banyak kelemahan yang tidak dipedulikan mula timbul. Salah satu daripadanya adalah isu kontrak bagi kakitangan kesihatan. Seperti yang dapat kita lihat dalam laporan berita mengatakan bahawa adanya jurang yang besar antara kakitangan kesihatan kontrak dan kakitangan tetap. Dr boleh terangkan mengapa jurang ini berlaku dan apakah perbezaan antaranya? Dan mungkin Dr boleh kembangkan lagi bagaimana masalah ini berlaku? Apakah antara faktor disebalik isu ini?

 CH:

Status kakitangan kesihatan kontrak dan kakitangan tetap ada perbezaan dan jurang, ini sememangnya dapat dijangkakan. Manfaat dan kebajikan kepada kakitangan perkhidmatan awam sepatutnya hanya diberi layanan setimpal sekiranya anda adalah kakitangan tetap.

Tetapi, isu atau masalah kontrak ini timbul kerana dasar kerajaan yang tidak koheren, menyebabkan ramai yang berlayak diterima sebagai kakitangan tetap terpinggir kat luar sebagai kakitangan kontrak. Ini tidak adil pada titik permulaan, jadi, ini adalah tanggungjawab kerajaan untuk menjaga kebajikan doktor kontrak dan cuba memberi layanan yang hampir serupa kepada kedua-dua kumpulan, janganlah ada diskriminasi kerana status kerja yang di luar kawalan pengamal-pengamal kesihatan tersebut. Mereka bekerja sama panjang dan sama berat, sepatutnya diberi manfaat yang hampir sama.

Janganlah menyalahkan graduan perubatan yang ramai, ini semua adalah dalam jangkaan kerajaan  semasa buat unjuran jumlah permintaan jawatan dan jumlah graduan serta jumlah tenaga kerja yang diperlukan oleh sektor kesihatan. Kerajaan haruslah mengubahsuai dasar polisi bagi mengambil lebih ramai doktor kontrak ke dalam sistem perkhidmatan awam dan mengecualikan sesetengah bahagian dalam kementerian dalam rancangan optimisasi saiz kakitangan.

 

4.       Selain isu kakitangan kesihatan, berita seperti katil hospital tidak cukup, pesakit kongsi tangki oksigen juga turut dilaporkan. Adakah ini masalah yang turut dihadapi oleh negara–negara lain? Adakah fasiliti kesihatan di negara kita memang tidak mampu untuk menampung pesakit? Adakah ini masalah yang baru semasa pandemik atau masalah yang sedia ada sebelum pandemik berlaku?

 CH:

Ya, banyak negara mengalami masalah tersebut, ada yang menghadapi situasi jauh lebih teruk daripada Malaysia. Contohnya, India semasa dilanda dengan gelombang jangkitan Delta varian tahun ini. Bersyukurlah kerana Malaysia masih ada sistem kesihatan awam yang sempurna dan tidak bergantung banyak terhadap sektor swasta. Berfikirlah apa rupanya jika kerajaan haruslah sentiasa berunding dengan pihak swasta yang berbeza atas pelaksanaan program atau dasar memberi rawatan dan ujian COVID-19.

Memang benar bahawa pandemik COVID-19 kali ini, seperti apa yang berlaku pada bulan Julai dan Ogos tahun ini, telah memberi cabaran agak besar sampai melumpuhkan sesetengah sistem penjagaan di negeri-negeri dan hospital-hospital tertentu. Akibat daripadanya, ramai yang dijangkiti dan dikorban kerana tidak dapat rawatan dengan sempat.

Sebelum pandemik COVID-19, sudah diketahui bahawa bilangan katil di hospital KKM adalah agak penuh, sehingga semua hospital utama negeri sampai 70% dan ke atas.  Hospital Tengku Ampuan Rahimah di Klang telah pun mencapai hampir 90%. Tragedi kematian beratus-ratusan berlaku di Klang semasa bulan Julai-Ogos adalah sangat sedih dan mengecewakan. Jadi kerajaan haruslah mengutamakan isu kesihatan selepas apa yang telah berlaku di sektor kesihatan awam semasa pandemik. Malangnya, dari segi bajet 2021 dan 2022, saya tak nampak kemahuan politik yang kuat dan ketara berkenaan peningkatan pelaburan dalam sektor kesihatan awam.

 

5.       Dalam belanjawan yang baru, adakah Kerajaan memberikan lebih banyak bajet dalam meningkatkan fasiliti kesihatan dalam fasa pemulihan Covid-19?

 CH:

Dukacitanya saya maklumkan, Tidak, kerajaan gagal melabur secukupnya mahupun merentasi jangkaan minimum saya. Peningkatan peruntukan untuk KKM adalah terendah dalam 6 tahun, hanya sebanyak 1.5%, Ya, walaupun ada penambahan bajet bagi pengurusan ia hanya 3%, saya anggap jumlah ini hanya cukup bagi pelarasan seperti gaji kakitangan.

Apa yang sangat mengecewakan saya adalah peruntukan bagi bajet pembangunan. Sebanyak RM440 juta telah dipotong. Apa mesej yang hendak kerajaan hantarkan, sedangkan masyarakat, aktivis dan orang awam banyak menyatakan bahawa pelaburan serius haruslah dituju kepada sektor kesihatan awam, dan pembangunan serta naik-taraf fasiliti dan kemudahan KKM harus dirancang dan dilaksanakan. Mestilah anda tahu, jika nak bina satu hospital, ia akan ambil masa tempoh lebih kurang 5 tahun. Kalau lewat bermula projek, maka terlewatlah manfaatnya dibawa kepada masyarakat setempat. Kelewatan semua ini adalah berkaitan dengan peruntukan, dan ini bukan perkara yang remeh-temeh, tetapi melibatkan nyawa dan kesejahteraan orang ramai.

 

6.       Malaysia dijangka selesai memberi suntikan lengkap vaksin COVID-19 kepada sekurang-kurangnya 80 peratus populasi negara menjelang 3 Disember depan. Imuniti kelompok adalah harapan dalam memutuskan rantaian jangkitan wabak ini. Setakat 17 Nov lalu, tahap vaksinasi negara juga mencapai 76.2%. Walau bagaimanapun, ada sesetengah individu atau kelompok yang tidak mahu mengambil suntikan vaksinasi. Pada pandangan Dr, adakah seseorang mempunyai hak untuk menolak daripada divaksin atau ini merupakan kewajiban rakyat di setiap negara untuk ambil?

 CH:

Ya, seseorang ada hak untuk menentukan apa yang dimasukkan ke dalam badan sendiri. Tiada orang sepatutnya buat keputusan bagi seseorang, jika orang itu boleh berfikir dengan waras dan umurnya cukup matang. Konsen, ataupun ‘persetujuan’ individu adalah mustahak dalam pertimbangan etika perubatan. Sekiranya pembuatan seseorang tidak mengganggu ataupun menjejaskan hak orang lain, dialah yang harus bertanggungjawab atas keputusan dan tingkah laku sendiri. Dalam isu vaksin COVID-19, orang yang menolak vaksin mungkin berpeluang dijangkiti dan mengalami penyakit teruk sehingga risiko kematian, tapi mengikut pengetahuan sains terkini, orang yang divaksin ataupun tidak divaksin masing-masing ada peluang yang lebih kurang sama untuk menjangkiti orang lain. Jadi, orang yang tolak vaksin tidak harus dipersalahkan dan didiskriminasikan. Walaupun keputusan untuk tidak menerima vaksin, pada pendapat saya, saya tidak menggalakkan. Saya boleh memberi keterangan kenapa vaksin ada banyak manfaat, tetapi jika seseorang masih tegas atas pendirian itu, dialah yang akan menghadapi risiko dan mungkin akibat yang lebih besar. Saya tidak akan berasa simpati jika keputusan seseorang memudaratkan sendiri.

Akan tetapi, saya berasa kerajaan tidak wajar untuk menjadikan imunisasi COVID-19 sebagai wajib ataupun de-facto wajib. Seorang individu mesti ada hak untuk membuat keputusan terhadap apa yang dimasukkan ke dalamnya sendiri. Jika tidak, masyarakat ini adalah amat dahsyat jika seseorang boleh dipaksa.



TWN submission on the CBA 2.0 preliminary findings (6.12.2021)


Below are Third World Network’s initial issues and concerns regarding the CBA 2.0 preliminary findings. We strongly call for more details and information, especially with regard to the data and their sources, the CBA’s methodology and assumptions, the list of interviewees (categories if not actual individual names for personal privacy protection), and the interview questionnaires. We also put on record our concern that this CBA is conducted by a Ministry without the mandate nor competence, on a very important public interest issue that is the responsibility of other ministries, i.e. the Ministry of Health and the Ministry of Domestic Trade and Consumer Affairs. 


1) Identity of the Third Party Consultant: Who is it? What are the credentials for appointing this consultant? Who funded the study? Can the TPC make a declaration of conflict of interest, if any? (Update: the latest response from the UPC admin on 5.12.2021 still did not reveal the identity of the TPC, but admitted that the private industry has funded the study)


2) Conflict of Interest: The composition of the steering and technical committees both look very much driven by the pharmaceutical and private healthcare sector major players (PhAMA, MOPI, MMA, APHM and even US-based PhRMA) who have direct interest in stopping or reversing the Cabinet-approved Medicines Price Mechanism (MPM) policy. A Senior Industry Representative from PhAMA is even the co-chair for the technical committee. 


3) Need for a full study report with details and information: The preliminary findings are just results presented in numbers, without clear and specific methodology, assumptions, supporting data and calculation process for the public to validate and review each of the findings.


4) Misrepresentation of the MOH’s proposed Medicines Price Mechanism (Slide 8): The study used a two-tier margin system to calculate the mark-up margin (35% for < RM1,000 per unit drug; 10% for >RM1,000/unit), whereas the MOH has 4 tiers. Also, it is not correct to assume ALL other drugs in the market will have MPM mark-up control even in Phase 2 -- only prescription drugs will be covered. What are the 5000 medicines selected for the CBA2.0?


5) The first CBA was on Phase 1 of the proposed MPM, covering about 600 single-sourced prescription medicines available in the Malaysian market. Comparing that with 5000 (undisclosed list) medical products in CBA 2.0 is highly questionable.


6) Wrong assumption on the MPM model (Slide 10) : MPM policy is to regulate mark-up range at wholesale and retail levels, not ‘discount on cost of therapy’ as shown in the “Price-volume vs price scenarios” graph. In fact, in the CBA1.0, the study showed that 30% of medicines might even experience initial upward adjustments of prices; did the second study consider these gains for the wholesalers and retailers? 


7) The exclusion of consumer and patient advocacy groups for the interviews (Slide 11): The interviewees are industry-dominant, not taking account of the public health and well-being costs. In the Webinar-format ‘consultation’ conducted by MPC, we were told that the patients under the Patient Assistance Programme were interviewed instead of what it is written as ‘patient advocacy groups’ - the patients may not have medicine access issues because they are sponsored or subsidised by the pharmaceutical companies. Insufficient access to affordable cancer medicines is a major issue voiced by patient advocacy groups such as Together Against Cancer and this is absent in what was presented by MPC.


8) No counterfactual in the analysis: For example in Slide 15, the assertion made claiming that 33% or 2,600 clinics will shut down.  We do not know how the study arrived at that number. If it was based on interviews or a survey, we need to look at the questionnaire and response (sample size). The most damaging part of the assertion is that there is no counterfactual. We know that in recent years there were clinics shutting down, it was also the trend before the COVID-19 pandemic. If the study is serious, those clinics shut down in the counterfactual cannot all be attributed to the MPM policy.


9) Possible exaggerated claim in Slide 15: There is an assertion that the MPM policy will cause a 35-40% drop of total hospital revenue. According to the Malaysia National Health Accounts 2020 preliminary data, private hospitals contributed RM14.553 billion to the total health expenditure. 35% of total hospital revenue could mean a figure close to RM5 billion. Did private hospitals overcharge so much to the tune of RM5 billion a year, beyond the MPM proposed mark-up range? This admission of the difference is simply astonishing, we would like to understand how it is derived. 


Given that there are such good prospects in the projection in private healthcare industry stated in Slide 13 (ie. RM1 Trillion economic value, RM44 billion planned investments), it is baffling to understand why the CBA 2.0 result claimed that “hospital industry operates on tight margins” (Slide 15). The wordings claiming that the hospitals “consider shutting down outpatient wings” sounded unfortunately more like a public threat than what could be qualified or quantified in the study.


10) Baseline problem for the B40 households in Slide 16: It is wrong to assume an increase in private healthcare usage especially for the B40 households based on the current baseline -- this is because the current high price or unaffordable prices are probably keeping a significant number of the medicines out of reach for treatment. With the possible effect of the MPM policy resulting in more affordable pricing of medicines, more B40 households should be expected to get access. The analysis in Slide 16 seems to have the intention to pit T20 and M40 against B40 in a moral narrative. There is no need to do that, as we are talking about access to medicines for all, especially for B40 households. Furthermore, M40 and T20 households do not deserve to be overcharged or exploited for the industry’s higher profit margin. In any event, the B40 relies on the public health system while the price regulation mechanism seeks to particularly reduce out-of-pocket expenses of the rakyat.


The annual premium cost avoidance result in the same Slide 16 also suffers from similar prejudice, given that we know why not many B40 households are among the private health insurance purchasers, simply because they cannot afford it. And one of the major reasons why the premium could be prohibitively high for B40 households, is probably the medicine prices. Hence, there is no point in projecting the premium cost ‘avoidance’ based on the current scenario.


11) Doubtful Basis of the claim of fewer Innovative Medicine launches (Slide 21) : There is no counterfactual -- could it be due to the trend of the pharmaceutical industry having fewer new chemical entities? The MPM policy regulates the mark-up upper limit for wholesalers and retailers only, the medicines manufacturers should not feel deterred or discouraged to introduce their new medicines in the market. They can still declare and sell the products at their proposed prices. Given that these medicines would have certain healthcare demand in the country, would the companies really want to give up the Malaysian market entirely? So many other countries have some sort of Medicines Price Regulation policy, do they experience the same fate after the policy implementation?


12) Peculiar case of loss in medical tourism due to more affordable medicines pricing (Slide 19): The entire assumption seems based on loss of innovative medicine access (referring to the previous Point 11). If that is not logical, then it makes no sense to say that healthcare travellers would shun Malaysia as the destination if the medicine prices become lower. This MPM policy would instead increase the competitive edge of Malaysia against regional competitors such as Thailand for healthcare travellers.

Industry attempting to block medicine price regulation (7.12.2021)

MEDICINES are essential for the sick or injured, and can be a matter of life and death. It is not an ordinary commodity but a necessity for survival or recovery.

However, access to life-saving medicines can face the barrier of affordability because, unfortunately, medicine pricing in Malaysia is currently totally unregulated.
A 2019 study by University of Malaya revealed that 72% of cancer patients experienced financial catastrophe during the first year of treatment in private hospitals, while one-third of households became impoverished.
Cancer medicines are very well known to have exorbitant price tags, and mark-ups by the private hospitals on the originator drugs and generic drugs are also well-studied. Affordable medicines are a challenge if we leave it entirely to the market.
In April 2019, the cabinet approved the Medicines Price Mechanism policy proposal tabled by the Health Ministry (MOH) in collaboration with the Domestic Trade and Consumer Affairs Ministry. Under the first phase of the policy implementation, the government will impose an upper limit of mark-ups at the wholesale and retail levels in a regressive manner (higher priced items will have a smaller mark-up for the upper limit), for about 600 single-sourced prescription medicines. But almost three years later, the policy still has not yet been implemented.
Recently, I was shocked to discover that certain vested interests in the private healthcare and pharmaceutical sectors, who have strong objections to the policy, managed to persuade the International Trade and Industry Ministry (Miti) to have a go at conducting a cost-benefit assessment (CBA) on the medicines pricing policy’s impact on private healthcare.
On November 29, the preliminary findings of the study were uploaded to the UPC (Unified Public Consultation) website of the Malaysian Productivity Corporation (MPC). The presentation of the findings was conducted via Zoom using the Webinar format on December 1, in which participants were restricted to typing questions in the Q&A box without being able to see each other’s questions or find out who else was present in the meeting.
The so-called public consultation lasted about one hour, with many questions left unanswered or not adequately addressed. Some participants resorted to the Zoom Chat box to share their comments.
One of the most pertinent questions is the identity of the so-called Third Party Independent Consultant and the funder(s) behind the study. It was not revealed throughout the meeting nor in the document despite being repeatedly asked by a number of participants. What is the point of having public consultation then?
What I found most troubling was the direct involvement of the major private sector players in the steering committee and technical committee for this CBA study: the Pharmaceutical Association of Malaysia (Phama) comprising multinational companies, the Malaysian Organisation of Pharmaceutical Industries (Mopi), the Association of Private Hospitals of Malaysia (APHM), Malaysian Medical Association (MMA) and even the Pharmaceutical Research & Manufacturers of America (PHRMA) – they all have direct interest in stopping or reversing the new policy.
Should this not already raise the red flag of conflict of interest? Not surprisingly, the preliminary findings eventually produced questionable results, indicating the big negative impacts to the economy, especially to the private sector themselves.
However, the preliminary findings were just numbers presented without showing the supporting data and calculation processes. The methodology of the study was also sketchy in its details, and the interview questionnaire used by the consultant was not known.
Among the “expert interviews”, no one represents the consumer’s interests, and in response to which patient advocacy groups were interviewed, the answer was patients under patient-assisted programmes sponsored by pharmaceutical companies (meaning, they already have access to the medicines concerned at some reduced cost).
What is of concern is that the CBA might have misrepresented the Health Ministry’s original proposed mechanism, such as reducing the regressive mark-up (10-35% in four categories) to just two categories, hence exaggerating the price impact.
The study also showed the impact of “discount on cost of therapy” to B40-M40-T20 households. This is misleading because the proposed mechanism is a regulation of the mark-up upper limit, and not giving a “discount”. In fact, the medicine prices could also go up for some cases in the beginning, a possibility that the ministry presented in its own extensive consultations in 2019/2020.
There also seems to be an intent to divide the income groups, pit B40 households against M40 and T20 in order to show the benefits will go most to the T20. But even M40 and T20 households do not deserve to be overcharged or exploited for the industry’s greed.
The study might also miss the point that when medicine prices become more affordable and accessible to the B40, the utilisation volume will go up as well. In any event, the B40 relies on the public health system while the price regulation mechanism seeks to particularly reduce out-of-pocket expenses for the rakyat.
Probably the two most controversial and bold claims in the preliminary findings attributed to the Medicines Price Mechanism policy are: 1. It is said that there will be a 35-40% total drop in private hospital revenue. According to the Malaysia National Health Accounts 2020 preliminary data, private hospitals had contributed a total of RM14.55 billion in health expenditure in 2020. If the claim of a 35% hospital revenue drop was true, this means RM5 billion per year is forgone! Is this the admission of private hospitals that RM5 billion is the amount they have overcharged their patients following implementation of the new policy?
Secondly it was claimed that 33% or 2,600 private clinics will close. How does the study arrive at this number?
Hence, it is in the best interests of the public to examine the full study, especially to validate the numbers, methodology and the interview questionnaire involved.
The preliminary findings in the study also tells us that many healthcare travellers will not come to Malaysia, hence causing economic loss. This is contrary to our general expectation that the lowering of medicine prices would give Malaysia a competitive edge, vis-à-vis Thailand, in the region.
The basic assumption of the study is that Malaysia will lose 10-35% of new drug launch/access resulting in a drop of 54% in incoming healthcare travellers coming. Is the assumption plausible? Given the MOH’s new policy to regulate the mark-up for the upper limit only for the wholesalers and retailers, the fact remains that medicine manufacturers can still declare their preferred price for sale in Malaysia. So why wouldn’t they come to a market known for its demand?
Lastly, the Medicines Price Mechanism policy is a matter of public health and consumer price. Hence, under the policy purview and jurisdiction of MOH and the domestic trade and consumer affairs ministry. Miti should not overstep its own boundaries and competence and dictate the policy direction of other ministries. This industry-driven CBA study sets a dangerous trend, shows precedence to commercial interests, and subverts the decision already made by the cabinet.
Forget about the CBA’s self-claimed virtues of being “independent”, “data-driven”, “comprehensive” and “unbiased”. What was presented to the public is the opposite.
The Medicines Price Mechanism policy, in the long term, can ensure fair and transparent medicine pricing for patients in Malaysia. It is not true that the policy does not allow wholesalers and retailers to make profits.
Excessive profit at the cost of people’s health and lives is what the policy helps to safeguard against. Narrow, vested interests for profiteering should not trump public interest, let alone people’s health and lives.

Omicron是Delta后的剋星? (群議論點-12月8日) (愛FM《名師早點》12月6日)

#群议论点 第32篇,社员林志翰撰文

# 林志翰:Omicron是Delta后的剋星?
11月24日,这个变种毒株由南非通报而首次面世;两天后就被世界卫生组织列为需密切关注的病毒变体(Variant of Concern, VOC),并将之命名为Omicron。这是继5月的Delta后,最新的VOC。
Omicron为何会被视为一个极大潜在的威胁呢?根据基因排序报告,Omicron变种毒株的刺突蛋白被发现拥有32处基因突变,其中一半在受体结合域(Receptor binding domain)里,这其实是病毒侵入人体细胞的接触面。那意思是什麽?大部分我国人民接种的疫苗种类,除了科兴和国药,其他的疫苗只让我们的免疫系统辨识病毒的刺突蛋白而已。如此多的基因突变,除了有崭新的突变,还有过去被发现和证实可提升传播能力以及协助逃逸免疫反应的突变。因此各方有所顾虑和担忧,实属正常。
然而,Omicron已被证实危险了吗?坦白说,目前还言之过早,尤其是有关它的感染力和传播能力,以及它的伤害能力。由于这个变种毒株的发现还相当近期,一般上要在病患被证实感染的两周内才能知道它的实际威胁。现在我们已知道的事实是,截至12月4日,这Omicron已散播传开至全球的44个国家和地区,包括我国马来西亚,在12月3日发现第一宗病例。在南非,Omicron已成为主流传播的毒株,而该国自从发现了Omicron后,每日新增病例迅速飙升,诱发该国的第四波疫情。有科学家计算南非Gauteng省的病例增幅趋势,得出Omicron的传染力是Delta的3至6倍。
根据新闻报导,南非年轻人和小孩受感染的人数有所增加。由于南非是个人口相对年轻的国家,这不太让人惊讶,一般上这些年龄阶层的病患也比较健康能避免重病,所以新闻也报道目前Omicron受感染病患的症状轻微,还未出现死亡病例。但现在还是太早断定,因为卫生当局要担忧和提防的是高危且未疫苗接种的群体受感染。
不过,目前的数据显示不少曾冠病痊愈的病患也重新受感染,因此可推测疫苗接种者也相当有机会受感染。那么是否意味着疫苗已失效了呢?别慌,没有证据显示一般疫苗已失去了针对性免疫作用。预料抗体与Omicron毒株的结合度会减少,但不至于疫苗诱发的免疫细胞如T细胞无法辨识变种毒株。毕竟过去所有的变种毒株包括Delta,疫苗免疫反应还在,仍有一定成效保护疫苗接种者免于重病和死亡。无论如何,针对高危群体,若有机会,请你们赴约接受疫苗加强剂的保护。
大家也不应该太害怕太多基因突变的毒株,因为有些的基因突变对毒株来说未必有利或增强功能,反之有可能减弱。因此一下子突变太多,对病毒来说也未必是好事。
由于Omicron毒株与过去发现的毒株基因排序差别太大,科学界纷纷推测这毒株出现的源头以及变种进化演变过程,目前有三个解说:(一)出现在一个长期感染冠病未能痊愈的病患,(二)从一个与世隔绝的偏僻社区传开,(三)源自动物宿主。
无论如何,这次Omicron的发现,重新让全世界检视疫苗分配不公平不正义的问题,特别是非洲大陆国家的疫苗接种进展仍十分缓慢,面对货源短缺、疫苗採购价格高昂、或订单延迟交货等种种问题。发达国家若任由低收入国的疫苗接种问题延续将有可能再出现下一个威胁力更大的变种毒株,届时他们的经济也会继续受到全球疫情波及和影响。这次的Omicron出现就是一个严厉的警告。

(此分享同時出現在愛FM《名師早點》12月6日)