专家：未来一周单日确诊将破万 · “全面封锁是必要措施” （星洲日报采访：2021年5月29日）

感染生物学博士兼群议社政策研究员林志翰表示，昨日的全国冠病基本传染数升至1.15，按照该指数计算，10天内，单日确诊病例将会破万。

“（全面封锁）这两周不一定能看到病例显著的减少，如果有减少，也是行管令（MCO3.0）的一些效果。”

他指出，政府宣布的全面封锁分为三个阶段，即如果看到疫情有改善，才会进入下一个阶段。

“接下来2周反映的是之前的接触史和感染史。行管令3.0期间，社交场所和学校都已关闭，社区感染群应该要看到下滑的情况，但我在前几天的数字没有看到，是有点担心。”

他表示，由于行管令3.0期间，民众还是可以到宗教场所膜拜，因此有不少来自宗教感染群的病例。

林志翰指出，政府决定实施全面封锁，反映政府已经意识到疫情的严重性。

他希望全面封锁期间，雇主在等待政府的经济援助计划时，也要让员工保住饭碗。

“在特殊的非常时期，借贷、举债更多也没办法。虽然人命关天，但生计也很重要。希望政府能改进援助方案，向受影响的目标群体发放援助，确保真正需要的人拿到补助。”

林志翰说，过去一年多，民众并非没有防疫意识，而是在很多情况下疏忽，没有采取严谨的防疫措施。

“面对自己熟悉的同事、朋友就放下戒心，一起吃饭、讲话不戴口罩。从工作单位感染并传染给家人，这很难避免，因为民众在家里不会戴口罩，但是在工作场所，是可以避免受感染的。”

新闻全文：

https://www.sinchew.com.my/content/content_2485281.html

新国联合早报和晚报转载：

https://www.zaobao.com.sg/news/sea/story20210530-1150302

UNAM Youth: A discussion on Vaccine Distribution and Equity

 Speaker Series : Is getting vaccinated overhyped ?

A discussion on Vaccine Distribution and Equity

The event video is here:

https://www.facebook.com/UNAMalaysia/videos/3950034011700962

Social/health questions   

1)     What are your opinions on the COVID-19 National Immunisation Program? Is it effective and how do you define effective? (i.e. question of speed, equity, community engagement etc.)

CH: Government’s NIP has every good intention to vaccinate at least 80% population, and actually procure enough for everyone. The limitations are always with the vaccine supply and timing of their arrival. Malaysia is unfortunately not known as a vaccine development and production country, though now 2 local companies Pharmaniaga and Duopharma have upgraded their facilities handling at least the fill and finish production of Sinovac and Gamaleya’s Sputnik V vaccines, respectively. We are still depending on the overseas supplies and inputs.

Granted, up to 18 May, we have only 3.9% of the population at least have received one dose, the distribution in every state may vary from 2.5% to 13.7%, it is normally large and populated states which are lagging behind in terms of percentage of vaccination coverage. BUT economically lagging states such as east coast states, northern states and Sabah have particular low registration rates for vaccination.

These should show the community engagement has to be buck up if not at a later stage when there are more new supplies coming in, there we face an issue of not finding enough arms to get the shots!

4)    What are the ethical considerations of an immunity passport? What are some economic considerations? and how can the government balance these two - if at all possible?

CH: it may not be just ethical but also scientific considerations have to be contended with when adopting covid-19 vaccination record as for the basis of an immunity passport.

Let’s jump straight into the science first:

One needs to understand that, the current vaccines in the global market are all targeting the wildtype Wuhan SARS-CoV2 variant, and that the vaccine protection usually comprises of 3 levels: the most ideal is to totally protect you from infection, but at least should prevent severe disease and death due to COVID-19. Many of us here should be aware that there is a wide range of vaccine efficacy rate depending on the vaccine type and the clinical trial settings, that means even though vaccination could generally avert people from contracting the virus, but it is not always the case. Surely we also have heard that there are vaccinated persons being infected. Though the prevalent scientific evidence points towards the great reduction of disease transmission due to vaccination, the risk is not zero for passing on the virus.

And now we have emerging virus variants of concern such as those originated from the UK, South Africa, Brazil and India. There are also scientific indications that the current vaccination does not work as well and produces weaker responses against the South African variant in terms of neutralising antibody titres. Though the cell-mediated immunity induced by the current vaccination is still good enough to give people the necessary protection, we may not know in future what would happen if other more potent virus variants emerge. Studies also show that the current vaccination protection level is still sufficient after 6 months, but we do not yet know for how long more the vaccination could protect, 1 year or 2 years?. What if one needs a booster dose later? Then should the health authority use a rapid diagnostic test kit to find out about one’s specific antiviral antibody level to validate the so called immunity passport?

With all these in mind, I tend to agree with the WHO’s position for not recommending the immunity passport due to too many uncertainties surrounding the vaccines, at the same time the vaccine production and supplies are still limited, thus immunity passport is never fair or equitable even within the population. WHO also rightly said that vaccination record does not mean that the authority should forgo other pandemic control measures.

To me, one can treat COVID-19 vaccination as a piece of medical record evidence, nothing more than that. The authorities should not use it solely to discriminate against unvaccinated persons. It is not fair due to global supply issues and the long waiting queue for the vaccination programme, and some even deemed unfit for vaccination. 

Economic/socio-economic questions:

1)     Vaccine administration is challenging. Reaching marginalised groups--especially groups in the remote rural interiors of Malaysia--are a major impediment to herd immunity and a crucial consideration for vaccine equity. There are various anecdotes about digitally-illiterate older citizens or Malaysians in remote interior rural areas without adequate internet access or marginalised Malaysians who fall through the cracks due to a lack of knowledge, access to infrastructure, or transport/mobility.

How do we ensure equitable vaccine access to these marginalised or underserved populations? What has been done so far and what are some policy avenues that can help avoid underserved marginalised groups fall through the cracks? Are there avenues to  partner with local health care institutions, community organizations, and other trusted sources to promote vaccine awareness and uptake within local communities?

CH: on registration and administration of vaccination, if those populations have barriers coming and walking into the government or community facilities to get the vaccines due to physical distance constraints or fear of authority, then the government should consider coming to them while collaborating with the community leaders or familiar local faces to urge people to come forward to receive the doses.

Government should try to arrange mobile clinics and vaccination medical teams.

2)     Commentators often highlight the trade-offs between infection containment (lockdowns) and economic activity. A key component of the ‘reopening prioritisation’ requires a cost/benefit evaluation of the level of transmission risk based on the nature of work, and we know that certain sectors of the economy carry higher economic benefits.

Could there be tweaks to the national vaccine strategy A.k.a. moving from prioritising age (and mortality) vs prioritising younger workers who are more likely to be active members of the workforce and more likely to have a higher amount of social interactions--or moving from spreading more first doses throughout the population--is this something that would be feasible or desirable for Malaysia? (overall socio-economic costs of pandemic vs solely focusing on death risk)

CH: The current phases of NIP are reasonable enough, because the main objective of getting people to vaccinate is to protect themselves from getting severe diseases, hospitalisations and death. Thus, the design of phases goes according to the risk profile.

However, in reality, those who are most risky and most severely affected by COVID-19 tend to be the most conservative and reluctant to get the jabs. The government says that they will wait for no one when speeding up to provide vaccination coverage for the population.

Hence, the clever design of the ‘opt-in’ programme for AstraZeneca vaccine is a thumping public-relation and publicity success, this could boost the public confidence in the vaccine which some people have reservations about. It is a win-win situation, coz the younger generation could also get the vaccine faster than originally planned.

That is the tweak of strategy like you suggested. Other than that, effective and responsive waiting list for people to come forward to get the vaccines is also important, the last thing the government wants is to have vaccine wastage due to absentees or refusal to take certain vaccine.

I would agree and support the government to include economic frontliners to get vaccinated first, especially those working in a more crowded condition or having many interactions with clients or customers.

 

3)     Besides issues of domestic vaccine equity, perhaps a larger more immediate issue is the issue of global vaccine equity. Data shows that some developing countries have managed to fully vaccinate all their frontliners and are close to achieving herd immunity in the coming months--while developing and poorer nations have far higher numbers of infections and deaths, and very low vaccine coverage.

One estimate for low-income countries suggests that only 2 percent of the population in these countries are vaccinated. Meanwhile, research has shown that there are large negative economic externalities to vaccine distribution in poorer countries--low vaccination rates in lower-income and middle-income countries create negative economic impacts for higher-income countries through lower trade demand and increased chances of new virus variants (India example). Does Malaysia have a role to play in ensuring global vaccine equity? Is there a political-economy rationale for sending our vaccine stock to poorer nations?

CH: Yes, Malaysia has international obligation and interest to ensure global vaccine equity, especially in supporting the call for TRIPS-waiver on the COVID-19 related medical products. It is time to rake up worldwide production and not be bound by the intellectual property barriers. Malaysian governments should show global solidarity supporting the cause to achieve equity of access of COVID-19 products.

In Malaysia, we do have very competent pharmaceutical industry and medical products manufacturing sectors. Therefore we can be part of the global production line for many life-saving medical products, not limited to just vaccines.Once we have the technology transfer and know how, we could at least ensure self-sufficiency and if we have excesses, could contribute in closing the gaps of global shortage. 

4)     There have been anecdotal reports about private channels for companies for vaccine procurement--how some firms and organisations are able to procure vaccines for their employees that bypass or circumvent normal vaccine access channels in Malaysia (example: UN agencies, Genting, etc). Is there truth to these anecdotal reports, and is there an economic rationale for private channels (i.e. if the extra amount companies pay for priority access can be redirected to procure more vaccines for the general population)

CH: I do not think the access issue is about money or the ability to pay, but equity and social solidarity for the national programme given that the vaccine supply is the limit and constraint.  

So, One thing is about the procurement, but you also need someone to administer the vaccine, right? Ok, one may go find private healthcare practitioners to help out, maybe would be competing with the current workforce deployed to help out the public national programme. Also, if they procure the vaccines from the same pool of supply, then again if they get them earlier than the government, it will be at the expense of other people in the queue.   

I would be ok if the employers all apply for priority access to vaccines if they can justify. Most importantly, why not the private sector and the state governments invite other vaccine manufacturers to register their products here and procure the vaccines from them?

一周新闻点评（2021年5月24日）

 

24/05 星期一《一周新闻点评》节目

主题：一周新闻点评
1）政府宣布紧缩行动管制政策
2）州政府的疫苗购买和捐赠课题
3）AZ疫苗开放让乐龄人士登记

嘉宾：政策研究員，林志翰博士

主持： Jc 劲程

https://www.facebook.com/AiFM.Malaysia/videos/521515392218882

新加坡8视界《十分访谈》直播访问- 2021年5月28日

官方鏈接在此：https://www.8world.com/vodcasts/episode/full/hellosingapore-mco-3-1492756

1.  马来西亚约两个星期前，开始实施第三轮行管令。您当时受访时曾谈到两个星期后，病例应该会逐渐减少。但最近的情况却不是如此。为什么会这样？目前的防疫措施足够吗？

首先，我先聲明，兩周前我說的是，即使行管令可以奏效，國家需要大約兩周才會看到每日新增病例到達巔峰數字（意思是停止增多而不是減少），因為這些病例都反映出行管令前的感染和接觸史；同時我們需要一個月才能看到是否疫情數字走下坡。

然而現在我們看到的是，馬來西亞疫情目前沒有放緩的跡象，可以說有多重原因。

首先，第三輪的行管令可能不太有效。從近來新的感染群來分析，過去一周有136個，社區及宗教感染群也有65個，加起來比工作感染群總數還多出了一個。因此很可能病毒在社區傳染還很猖獗，特別是在人口密集的雪隆區的幾個縣市，及柔佛新山。照理來說行管令關了許多社交場所，應該要大量減少社區感染群才對，然而目前我們還沒看到這個跡象。

再來，政府並沒有決心大力削減出外工作的勞動力。允許私人界留下6成的員工在辦公室或工廠里，或許也沒有改變太多在外的人數。我還是可以看到雪隆區早上車水馬龍的現象。這是一個大隱憂，因為常常這裡的大馬人在工作場地面對熟悉的同事會放下戒心和方便。因此如果防疫措施不再收緊，預料工作感染群數量依然會很多。

還有，政府縮短商店的營業時間，非但不會減少顧客欲光顧的意願和次數，反而聚集了更多人潮，不利於防備社區感染。

馬來西亞一些地區縣市的疫情已陷入重大災區，目前政府仍沒進一步再縮緊措施立刻為當地疫情降溫，包括果斷地在這些地區指示區域針對性的全面封鎖。大馬政府財政部說他們不能再負擔再一次的全國全面封鎖措施，但我相信他們絕對有能力可以應付一些縣市的兩周或一個月的全面封鎖。

2. 马国卫生部长早前表示，政府需要为最坏的情况做准备。请问这个最坏的情况到底能有多坏？以目前的情况来看，什么时候病例数会达到峰值？

我認為現在的情況已很糟糕了，若不能再下兩周制止確診病例飆漲，恐怕會破萬。一旦如此，政府就難以負荷這樣的求診病人數量，就會有更多人因醫護素質下降而生重病或死亡。

根據過去的行管令記錄，一般上需要2周或以上才會到達疫情峰值。可是目前還沒有出現這跡象。也許是因為目前的疫情太嚴重，防疫措施不足以抑制；也或許目前大肆傳播的病毒是變種病毒。希望有更緊縮的行管令可以把疫情控制下來，希望這情況不會延續超多一個月。

3. 有马国民众在网上投诉患病后没有病床。不少医疗人员也认为现在医疗系统的负担已经很大。政府已经开始在网上招募年龄介于18到60岁的志愿者。您觉得，马国的医疗系统现在是否还能负荷？

昨天的活躍病例數字有靠近7萬人，比起二月時的最高峰多了靠近2萬人。目前的加護病房病人數目和新冠病床需求量持續增加，這絕對不能持續太久下去。雖然衛生總監諾希山曾說，若有需要，政府可以就地改裝和設立新的加護病房，但代價是會拿走其他非新冠肺炎病人的醫護資源。再況且政府醫院的病房病床不太可能短時間內大量增加，除非打造更多方艙醫院或征用私人醫院的資源。這並不理想，所以重點還是要回到控制疫情避免病人持續增加。

4. 马国卫生部长昨天还宣布，计划近期允许民众自行购买快速检测试剂盒，在家采集唾液进行冠病检测。请问这种快速检测试剂盒的准确率有多高？让民众自行在家检测的做法，能减轻医疗系统的负担吗？

這個使用唾液採集樣本的新款試劑盒，目前衛生部長也沒有詳細說明這新科技的特異性和敏感度。若這產品的效率與目前市面上的RTK-antigen試劑盒差不多，價格可以更便宜，那麼我相信這對僱主、社區和家庭會有用。自我篩檢為了提早能檢測確診和隔離，確實有助於防疫工作。

但如果你問是否能減輕醫療系統的負擔，這倒沒有。原因是越多的檢測，就會造就越多的確診結果。這也意味著政府需要更多人手來跟進病例：使用RT-PCR來確認結果、訪問來追蹤病例、安排隔離甚至治療護理（如果該人有嚴重症狀）。

所以如果有單位要進行大規模的社區篩檢，這最好配合當地衛生局的能力，因為如果有人確診了而得不到幫助是相當不負責任的行為。

客观看待疫苗接种速度

 国家疫苗接种计划（NIP）早在2月24日开跑。三个月后，部分人民开始不满，认为疫苗接种速度太慢，觉得主要是因为政府怠慢和无能。他们常引用来比较的模范国家有新加坡、欧盟国家、美国、以色列等。

一般民众更常以当下的结果作为他们对政策或计划的判断：目前完成疫苗接种或至少接种一剂疫苗的人数和比率，是他们最关心的最新进展。可是，我们必须了解疫苗接种计划的整个过程，才能掌握目前的情况如何。这个过程包括采购和注册疫苗、疫苗生产线、根据订单递交输送货物、登记自愿参与者，以及最后一步，即施打疫苗。

首先，我们必须明白政府已批准了财政预算购买6670万剂疫苗，这足以涵盖109.65%的国内居民。政府的采购名单上有五家公司：辉瑞、阿斯利康、科兴、康希诺和卫星5号。目前，前三个产品已获得国家药品监管局（NPRA）批准注册。NPRA负责确保所有的药品（包括疫苗）的安全性、有效性和品质符合规格和标准。政府也设定了期限目标，要赶在2022年2月为国内80%人口接种疫苗。

无可否认，目前的疫苗接种速度并不如众人所期盼，特别是正当目前严重的疫情横扫全国各地。截至5月20日，完成两剂疫苗接种的以及接受至少一剂疫苗的人数分别占我国人口的2.6%和4.2%。根据目前的速度，有人推算我国大概需要5年才能完成为八成人口接种疫苗。那是一个公平的算法吗？

疫苗全球供应紧张

4月12日，新冠肺炎疫苗供应保证特别委员会（JKJAV）发布了一个疫苗供应进程时间表（图表一）。若观察疫苗供应（绿色曲线），再比较当时已登记人数的疫苗需求（黄色平线）和疫苗接种目标（蓝色平线），一目了然我们可发觉早期我国确实面对疫苗供应短缺。其实这情况也同样发生在全球不少国家。

事实上，马来西亚的疫苗接种率与亚洲国家的平均值相差不远，甚至还排在日本与泰国之前（见图表2）。当一些疫苗生产国如印度和欧盟决定禁止或限制疫苗产品的出口，这已干扰了计划中的国家疫苗供应。

在新冠疫情来袭前，我国没有任何疫苗生产能力，除了联合药业（Duopharma）有灌封加工服务（fill-and-finish）设备，随后发马（Pharmaniaga）也加入了这行列。尽管这两家官联公司各别有能力完成卫星5号和科兴疫苗的最后加工步骤而降低疫苗成本，他们仍需进口来自俄国和中国的批量材料。

因此，若本地和全球制造商都无法保证能按照原定计划交货，要求更快的疫苗接种速度是徒然的。疫苗是目前全球珍贵的策略资源，有极高需求但生产有限。所以疫苗接种速度慢，绝对不是因为政府缺乏资源设立疫苗接种中心为疫苗接种加速，因为那只需两至三天时间就可。

疫苗登记率欠理想

至今疫苗接种登记率仍不理想。截至5月20日，只有43%符合资格的18岁以上人口已登记。换句话说，即使今天所有的订货已抵达，有一半以上的剂量没人要。

撇开欠理想的登记率不提，不难明白为何公众觉得疫苗接种计划进度蹒跚。当前已接种至少一剂疫苗人士占总登记人口的13.3%，这意味著高达86.7%的人还引颈翘望等待当中。如今疫情肆虐，我们可以明白一些人已感烦躁失去了耐心。

已登记超过50%人口的州属或地区包括布城、吉隆坡、雪兰莪、砂拉越、纳闽和槟城（见图表3）。若再观察那些已接种至少一剂疫苗的人数占各州总登记人口，不难发现一些州属如雪兰莪、柔佛、槟城和砂拉越的比率数字皆低于全国平均数。可是，比较起其他人口较少的州属，雪柔槟砂人民已获得数量相当可观的剂量。

这也许可以解释为何有些州属需要自己采取行动，“加速”疫苗接种计划。5月16日，砂州政府宣布他们将订购100万剂科兴疫苗，并预料很快将分两批运抵。

5月18日，国民疫苗接种计划协调部长凯里解释了允许州政府自行购买疫苗供应的条件。隔天，雪州政府宣布自家的Selgate新冠肺炎疫苗接种计划。该计划让有兴趣的雪州雇主们可以为他们的员工接种科兴疫苗，每剂190令吉。同一天，槟州首长曹观友及前财政部长林冠英在一场记者招待会上猛烈抨击联邦政府阻止有位私人捐赠者贡献200万剂科兴疫苗给槟州政府。

州政府自购疫苗条件

且回顾凯里部长所解释的条件。首先，该疫苗产品注册必须获得NPRA批准。根据我国的法律条规，NPRA核查监管的是疫苗的有效性和安全性，其严格标准参考自世界卫生组织（WHO）及经合组织国家（OECD）。第二，若订购的疫苗货源来自NIP接洽的相同公司，那么联邦政府将可优先获得疫苗供应，然后才轮到其他国内买方。这是一个与疫苗制造商达成的协议，以确保国家疫苗接种计划顺利进行、不被妥协。第三，如果供应商不隶属于NIP，那么州政府或私人界可以自由采购，条件是该疫苗产品注册已获得NPRA批准。

由此可见，最明显的双赢方案是州政府采购NIP以外的替代疫苗产品供应。可是，根据上周观察所得，三个州政府都同时选择了科兴疫苗。这意味著他们向同一疫苗供应来源取货，直接与联邦政府竞争！假设这些州属都可在联邦政府的剩馀订单前取货，那么也意味著没有财务能力或有钱捐赠者的其他州属就只好接受落后的命运安排。

万勿政治化疫苗接种

打开先例形同打开潘朵拉盒——其他州政府预料也会有样学样效仿证明给选民看，他们也有能力“插队”。最后这将导致我们不愿看到的局面：政治化国家疫苗接种计划。可以想像，若所有州属都可各自行动，最终将制造混乱、破坏国家疫苗接种计划。更糟糕的是，这将侵蚀社会团结及社会共识让有健康问题、患上新冠肺炎风险较大的国民与居民优先接种疫苗。

其次，大家也该设想疫苗接种的通勤和执行方案，到底由谁来施打疫苗？目前的国家计划已涉及私人医疗中心和诊所协助接种疫苗。那么州政府要执行自己的计划，是否又会与联邦政府在人力资源上竞争？若国家计划受影响，那么又是谁的损失？毕竟国家疫苗接种计划免费提供民众，对比雪州提出的计划是要收费的。后者传达的讯息是，只要雇主有钱就可购得疫苗，那么说好的疫苗优先排列和社会团结呢？

当下疫情蔓延正处高峰，我们应慎防机会主义的政客趁机扮演英雄，利用目前公众焦虑为疫苗而抓狂的心态。同时，我们应要保持耐性，并对国家疫苗接种计划的整个过程有所了解。最重要的是，人民应该同心协力一起抗疫，不能只为了自己的利益著想。

刊登于《東方日報》東方文薈版《群議良策》專欄2021年5月26日

東方臉書貼文鏈接在此。

《群议论点》：短评紧缩行管令措施

 #群议论点 第15篇， 社员林志翰撰文

欢迎踊跃分享及参与讨论

#林志翰 ：短评紧缩行管令措施

如果说最新政策的目的是为了减少人民外出与其他人交流接触，从而降低社区感染的风险为飙升的疫情降温，我认为政府做得决心不足，而且著重点不太对。

首先，最为有用的是居家办公的指令：儘管公务员的数量庞大，而他们被指示8成要居家办公；但劳动力数量最多、工作感染群数量最大的是私人界僱员但却只是被指示4成的职员必须留在家裡而已。为何这个不能一视同仁，难道公务员的风险比较大？说穿了，政府投鼠忌器，深怕会影响经济。我认为政府其实可以有另外的方式去应对，比如说让MITI允许一些企业申请超过2成的劳动力留在办公室或工厂裡，而不是直接妥协底线。因为政府如此不坚决的决策，我大概可以预测出来工作交涉的人群不会改变太多，而工作单位感染群只会稍微减少而已。

另外，我不认为政府缩短营业时间对减少人民出来办事的次数和意愿，反而会有反效果。假设一个人决定那天终究要去杂货店或pasar malam，而缩短了营业时间不会改变绝大部分人出来的意愿的话，那麽就代表人数还是一样，但是因缩短了营业时间而大家更密集出现在同一个时间和地点，这其实增加了社区感染风险。所以这个政策的理由很不足，没有道理还很牵强。

而减少公共交通的一半的承载量方面，我要告知的是，比如说在疫情面临灾难的雪隆区，绝大部分人其实不乘搭公共交通。我本身早在MCO 3.0实施初期乘坐一次轻快铁，早已发现乘客稀少，根本不到2成或3成。更多巴士我看到的都是空荡荡的。所以，我不认为这个措施会有多少效应差别。

相關內容也出現在8度空間華語新聞5月23日報道中：

Straits Times interview: Asian Insider KL's balancing act between 'lives and livelihoods'... (24/5/2021)

... health experts believe existing restrictions will only be effective with strict enforcement - which is currently lacking going by the evidence of breaches that have gone viral - and, even then, will require a long period to significantly reduce infections.

"The government didn't show determination in reducing private-sector workers from interacting. Most work clusters are from there but only 40 per cent have to work from home," infection biologist Lim Chee Han told The Straits Times.

Mr Lim, who is from Third World Network, an international research and advocacy organisation, also said that reducing the business hours of retailers would be counterproductive as it would lead to a concentration of patrons, while public transport utilisation was already well below 50 per cent hence limiting capacity would have little impact.

 Full article here: https://www.straitstimes.com/asia/se-asia/malaysia-shuns-stringent-lockdown-looks-to-vaccination-to-overcome-covid-19

李成金老師悼詞（2021年5月13日）

 李成金老師走了，也走得相當突然，知道消息的時候我還有些驚訝然後惋惜。

我本身和他沒有私交，在公事或社運方面也沒有什麼直接的合作關係，但我們倆彼此認識，見面了也會寒暄問候幾句。在我印象裡，他總是溫文有禮，親切笑容可掬，完全沒有架子和距離，他說起話來很有溫度。

接觸他比較多的時候應該是我在雪州政府短暫工作的那段日子。特別是李老師在趙明福事件發生後，我看到他積極跑動伸張正義。我博士念完回國在檳城工作，比較常去友人蔡依霖州議員的社區參與活動，在那裡也不時見到他。我從檳城搬回雪隆，在社運場合、大小會議和多場時事講座也偶爾能遇見他。

對我來說，李老師不止有文化、知識，還有滿腔的正義感和社會理想。我由衷欣賞和佩服他在社區文化上腳踏實地的建設，以及他的堅持精神。他關心的人民的福祉，不屑政黨政治的亂象與背叛--我一直認為，他很清醒知道自己正在做些什麼，為何而做，從不計較名利。這樣的社會理想工作者和身體力行的民間知識分子，在我國還有多少？李老師在我心中是其中一個可敬的模範/典範，我會向他看齊和學習，以他為榜樣。所以，我也會努力去實踐社會理想。

從那麼多人的哀悼詞裡看來，您已深深地影響了這社會許許多多人，您在這人間已埋下了意義。安息吧，李老師~

6點回應隆雪華堂5月20日文告

隆雪華堂文告鏈接在此。

6點回應聲明如下：

（1）疫苗接種進度緩慢，為何不過問疫苗來源是否及時和充足？我國依賴外國進口的疫苗貨源，在全球資源都緊張的情況下，這個是政府的錯嗎？除非你有證據顯示政府疫苗接種工作緩慢是純粹人手分配、通勤效率和組織問題

（2）拿一些先進國等的疫苗接種速度來比較，公平嗎？新加坡和以色列到底給了多少premium買了那些劑量（回到國內，不是會給國民說“買貴了”嗎？），以及他們與美國的關係是我國比較的嗎？我國的NPRA也嚴格地檢查了這些疫苗的產品登記，必須按照程序，不能因為新加坡、歐洲等國批了，就要自動批准。

（3）我國縣市的疫情風險警示顏色，除了紅和綠，還有橙和黃（那天確實沒有綠，但不是全部都紅）

（4）確實很多國外的局勢也一樣，第二、第三波的疫情形勢更嚴峻，又不能長時間把人民關在家裡不事生產，打開經濟活動和社交活動又有風險（不打開也不合理，會給人罵啊）。請問你的政策會是什麼，如何拿捏才是你說的“對症下藥”抗疫有力的政策。目前台灣和新加坡也有些危機和威脅，是否也應該接受同樣的批評？

（5）不懂事理的政治人物如衛生部長我就算了，衛生總監是衛生部公務員機關的總指揮，是技術官僚。他也得服從政府其他部門的指示，畢竟他只能盡他的專業能力執行和處理事務，不能作政策決定。你如何能指出他做了哪些嚴重的錯誤判斷和過失，以至他必須辭職或革職？換了其他人一定更好嗎？

（6）任何政策和措施，如果執行不到即使說要“強制”也沒有用。況且現在說要強制就要準備有人硬不服從的後果....你打算看到多少年長一輩的人被判罰，然後強行去打疫苗？這樣符合人權和尊重人民的意願嗎？在醫學上，consent是個人非常重要的權利，因為身體和健康是自己的，不屬於國家的。不然國家代表施藥就如納粹時期的醫生了。所以強制性政策會適得其反，不智

Low vaccination rate: taking a closer look

 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 18^th 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.

This article also appears in Malaysiakini and The Malaysian Insight