Commentary: What’s behind no-shows in vaccination centres across Malaysia?
Vaccine hesitancy, concerns over specific vaccines and choosiness over which vaccine to take may be causing unnecessary delays in Malaysia’s vaccination programme, says Monash University Malaysia’s Dr Vinod RMT Balasubramaniam.
KUALA LUMPUR: There is much riding on Malaysia’s vaccination programme as the country fights its biggest wave of infections since COVID-19 became a full-fledged pandemic.
While the extended Movement Control Order (MCO) restrictions have been critical in getting new daily cases down to just below 5,000 from a high of 9,020, these lockdowns are not a lasting solution when they have upended lives and destroyed livelihoods.
Frustrations regarding the futility of new rules and the poor government response expressed over social media have been on the rise, possibly leading the Agong to meet political parties over the past week and to subsequently urge a reconvening of Parliament.
Malaysian rulers also issued a statement on Wednesday (Jun 16) highlighting that they do not see a need for the state of emergency to be extended past Aug 1.
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RAMPING UP VACCINATION KEY TO EXITING PANDEMIC
Prime Minister Muhyiddin Yassin knows millions of lives are on the line and his own political survival hangs in the balance. He has therefore outlined a four-phase COVID-19 exit plan, in which vaccinating 60 per cent of the Malaysian population by October is key.
To ramp up vaccination, five mega vaccination centres have been set up around Kuala Lumpur, with more planned in Penang and Johor, Science Minister Khairy Jamaluddin announced two weeks ago.
A total of 300 more vaccination centres are planned to be open, with 16 million doses expected to arrive over the next two months, PM Muhyiddin pledged last week. Mobile vaccination units will be deployed in nine states and automatic registration is even being considered in light of technical issues.
While Malaysia had approved three vaccines for use in its National Immunisation Programme (mRNA-based vaccine Pfizer-BioNTech, the Oxford AstraZeneca and Sinovac’s CoronaVac), conditional approval has just been given to China’s CanSino Biologics and US Johnson & Johnson on Tuesday (Jun 15).
But while getting vaccination logistics right is essential to meeting this new surge plan, authorities must also pay attention to public attitudes and hesitancy about vaccination.
PUBLIC CONCERNS ABOUT VACCINATION AMID SWIRLING MISINFORMATION
In a survey by Ministry of Health Malaysia conducted in end-December, 17 per cent of respondents said they were unsure of the vaccine. Up to 78 per cent of those in the uncertain group also had less confidence the vaccines would work, while 71 per cent thought they would be unsafe for use.
About one in six said they would not agree to getting vaccinated, with over 96 per cent in this group citing side effects as the main reason, while close to 85 per cent were suspicious of its ingredients.
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Only two in three of the surveyed 212,000 said they would accept the COVID-19 vaccine.
Vaccine hesitancy has been particularly high in low-income communities. More than a third of those living in public housing projects in Kuala Lumpur (Projek Perumahan Rakyat) surveyed by the United Nations said they were unwilling to be inoculated despite vaccination being free.
An ordinance that imposes the threat of fine and jail on those spreading misinformation was passed in May, which recognised that vaccine hesitancy were likely fuelled by an underground anti-vax movement using Facebook and WhatsApp that have fanned public anxiety.
Some of the myths perpetuated include the strange idea that the COVID-19 vaccine has a secret tracker microchip implanted, that it changes people’s DNA or that it has long-term effects on a women’s fertility.
So-called experts from a purported “Covid Research Centre” in Kuala Lumpur have also hijacked mainstream media late last year to Malaysia’s detriment.
They made false claims that COVID-19 can be dealt with by improving natural immunity through “herbal and other natural treatments” while creating fear by citing the US’ Food and Drug Administration’s report of two deaths in Pfizer’s clinical trials, omitting the fact that the victims had died from diseases unconnected to the vaccine.
It does not help when leaders like Gua Musang Member of Parliament Tengku Razaleigh Hamzah quote former-Pfizer-executive-turned-anti-vaxxer-hero Mike Yeadon’s unfounded claims that COVID-19 vaccines were unnecessary as people globally are acquiring natural herd immunity to the disease.
Worse, such notions downplaying the severity of the pandemic were repeated by Malaysian Health Minister Dr Adham Baba who once claimed COVID-19 “doesn’t like high temperatures” and advocated drinking warm water as a means of prevention.
CONCERNS OVER SPECIFIC VACCINES
Among the vaccines currently in use in Malaysia’s National Immunisation Programme (NIP), Sinovac’s CoronaVac has been the most controversial.
Some Malaysians view it as an inferior product compared to mRNA vaccines like Pfizer-BioNTech’s due to its poor efficacy levels and large variations of trial results.
There is also a fear that anything made in China lacks quality and safety controls, and concerns whether these uncertainties have implications for its halal status when Saudi Arabia declared in May a list of vaccines pilgrims who aim to perform the haj should take - which excludes Sinovac. This is despite authorities like Defence Minister Ismail Sabri taking great pains to reassure people it is safe for Muslims.
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Public attitudes at best remain mixed when some proponents view Sinovac to be safer, as it uses the tried-and-true method of drawing off inactivated viruses, compared to mRNA vaccines and viral vector vaccines that employ relatively new technology.
Even then, Sinovac has seen better luck than Oxford’s AstraZeneca, initially removed from Malaysia’s national immunisation programme in May after rare incidents of blood clots caused a public scare.
Although the government is contemplating reinstating AstraZeneca, with a conditional approval granted for vials manufactured in Thailand, for now, eligible Malaysians who want this option must opt in.
The government does not want concerns over AstraZeneca to be a stumbling block when around 8,000 cancelled online vaccination registrations in May after finding out the vaccine would be part of the nationwide programme.
NO-SHOWS AT VACCINATION CENTRES
Does vaccine brand matter? That might be the case, as the reported disruption at a vaccination centre in Shah Alam Selangor by senior citizens who wanted to choose their COVID-19 on Jun 8 demonstrated.
While those who refused the COVID-19 vaccine jabs would be placed back into the system and given new dates for their vaccination appointments, the spokesman warned of delays as people are not given a choice of vaccine.
It would be a pity if poor attitudes compound the big logistical challenges in getting more shots in arms. Already, 12,000 in Kelantan missed their appointment in May for a wide range of reasons, many of whom could not be contacted.
Worryingly, the attendance rate among those who have registered is about 80 per cent on average, Khairy highlighted last week, meaning that even when people overcome their hesitancy to sign up, they might not even go down subsequently.
Authorities seem to think employing the stick can work, with fines to discourage Malaysians from skipping their vaccination appointments, after more than 52,000 no-shows in seven states in May. Officials are also considering the possibility of making vaccination compulsory.
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EXITING THE PANDEMIC
There are no easy answers in tackling these no-shows and the underlying vaccine hesitancy.
World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus identified such attitudes to be the key challenge behind fighting COVID-19 back in February 2020 before it became a pandemic when he said: “We’re not just fighting an epidemic; we’re fighting an infodemic”
Greater communication among authorities, healthcare experts and the public to tackle vaccine concerns and indications which vaccine would be employed by each vaccination centre people can book slots at, even if choice of vaccine is not given, can help.
Malaysians need to recognise that we are in the midst of one of the worst pandemics in mankind’s history. Our only salvation from this disease is vaccination. Vaccinating as many people until Malaysia can reach herd immunity is also the only way to stop more variants from appearing.
The clock is ticking every second. Let’s bear in mind that all current approved vaccines can prevent serious illness, hospitalisation and death from COVID-19.
(Listen to Malaysians in Sabah, Johor and Kuala Lumpur share how they have been coping fighting a new wave of COVID-19 infections in Heart of the Matter podcast.)
Dr Vinod RMT Balasubramaniam is a molecular virologist and senior lecturer at Monash University Malaysia.