Pandemic management: Current and future budgetary considerations

Budget 2021 budget was initially thought to be sufficient, but various health and economic factors, internal and global challenges, may have impacted the actual quantum needed.

Though current budget has taken into account previously excluded groups, such as teenagers, allocations may need to be expanded to include infants, toddlers, and young children. There are speculations that children are an overlooked “trojan horse” of the pandemic, reportedly able to carry a higher viral load and transmit it despite being asymptomatic.

It’s been reported that both Pfizer and Moderna have started clinical trials on children age 6 months to 11 years old. Other producers are likely to follow suit and if test results support the hypothesis, it would increase the number of doses to be procured.

As more findings emerge from vaccination campaigns globally, there could be a reshuffling of vaccine pipelines, and therefore, impacting the overall forecasted budget.

We have observed the removal of Astra Zeneca’s vaccine - which is widely thought to be one of the cheaper vaccines - from Malaysia’s National Immunisation Programme (NIP), and observed an increase in Pfizer-BioNTech vaccines to 32 million doses (with an option for another 12.8 million doses), from an initial 25 million. That’s roughly 50 to 70 per cent of Malaysia’s population. Current Pfizer vaccines are known for its high efficacy, but have not gained a reputation as the most affordable, or the easiest to be handled. Of course, this may change in the future.

If other vaccines under consideration such as Sputnik-V and CanSino vaccines are not approved or is delayed in approval, the health and economic pressure to vaccinate as many people as possible would drive governments to move ahead with other approved vaccines, even if the price could be higher and logistics could be harder (and costlier).

Thus, for current and future expenditure, its best to assume a scenario whereby more expensive vaccines take the bulk of the national coverage, accounting for more frequent than expected booster shots (due to shorter immunity retainment) and/or updated batches (for emerging strains). That said, Malaysia must be careful to ensure it’s not part of the global vaccine scarcity problem.

It’s also obvious we need a generous expenditure now to counteract emergency response deficiencies, which should be reflected in Budget 2022 as there is no guarantee the pandemic would not extend itself deep into next year.

Malaysia’s healthcare facilities have been pushed to the brink, with maximised ICU beds, and more patients needing ventilator support. According to data from Johns Hopkins University presented in Our World In Data, Malaysia’s daily new confirmed Covid-19 cases per million people, as of May 23, calculated as a rolling 7-day average, surpassed India.

Despite Covid-19 taking centre-stage, non-Covid care shouldn’t be pushed to the back. Non-communicable diseases (NCDs) and preventive care will remain a crucial part of public health. It is true that the healthcare budget for 2021 has increased by 7.8 per cent to RM31.9 billion from RM29.6 billion in 2020, but the minimum healthcare budget called by most health groups is the elusive “4 per cent of the national GDP”, which Malaysia has struggled to achieve.

The World Health Organisation recommends at least 7 per cent of a country’ GDP to be allocated for healthcare.

Also, in addition to vaccines, there needs to be a budget allocated for drugs and chemicals. Recent developments have shown potential additional arsenals against the pandemic such as the pre-existing anti-parasitic drug Ivermectin (currently undergoing clinical trials locally for the repurpose use in fighting Covid), and the chemical nitric oxide with studies reporting antiviral action on the respiratory system.

A special allocation should also be made for healthcare workers and frontliners by increasing their hardship allowance, providing sufficient high-grade personal protective gears, and other workplace amenities for better safety and comfort. Considerations for permanent positions, longer contracts, or other forms of career positioning should be considered for contract medical professionals as both a reward for their services, and as a morale-boosting incentive.

No doubt, its easy to ask for increased expenditure and higher budget allocation. The challenge is finding the right way to sustainably fund it. On this matter, it’s obvious that we can’t rely on nationwide total lockdowns alone, which hurts the economy.

Above a certain threshold (a combination infection, death, and recovery rate, healthcare capacity etc.) the issue tips in favour of saving lives, and lockdowns can be considered as a short term “circuit-breaker”, but it is crucial to detect and isolate carriers in the community.

Without a mass testing and isolation programme to match short-term targeted lockdowns, these carriers re-join the community once movement restrictions are relaxed, sporadically igniting clusters and cumulatively triggering the next wave.

It is therefore crucial to ensure sufficiency of current expenditure and future budget on cheaper updated test kits (valid for the latest variants) and the necessary infrastructure and manpower. Speed, sensitivity, accuracy, mobility, and cost of these test kits are crucial elements for success. Isolated asymptomatic cases must be adequately quarantined, and perhaps be given any available home treatments of viral infection, if and when available. Of course, re-testing before release from individual quarantine is a must.

More investment is needed in better technology infrastructure to support predictive technologies such as the Hotspots Identification for Dynamic Engagement (HIDE), in order for the pandemic management to be more proactive and forward-looking, instead of knee-jerk reactive measures.

A successful HIDE system can assist in early warning measures, and could provide guidance for targeted movement control orders (MCOs), instead of a blanket one. Current and future resources must be allocated to ensure the safety and integrity of data quality gathered by apps such as MySejahtera. As with any systems based on artificial intelligence, the quality of its output is significantly dependent on the quantity and quality of the data provided.

All of the above-suggested (and non-exhaustive) measures must fail, before a blanket nationwide total lockdown should be considered.

As a key tool to ensure business and education continuity in this pandemic and future crisis, the push for digital connectivity for urban and rural areas, and 4IR transformation for small and large business alike, must be continued well into subsequent years.

The mass migration into cyberspace has to be supported with the implementation of the National Digital ID through an ethical regulatory framework. Careful reopening of the economy may consider vaccine passports as one of the “bubble” mechanisms, so long as the immunological uncertainties, socio-ethical concerns, and operational issues have been addressed.

Future considerations may also include assisting people and businesses to use air filtration and purification technologies, given increasing reports of airborne transmission route of the virus.

For future preparedness, it’s imperative to combine health security and national security against future pandemics, chemical and biological threats. In an increasingly volatile and conflict-ridden world, this is a real consideration. Knocking on the doors of nations and corporations asking for vaccines may not work in the future. Internal development and production capabilities is a must.

As this will take time, budget allocations and investments for catalytic actions in the near term have to be considered. This may include bringing in vaccine manufacturing, know-how, and the necessary capacity building – such as the offer from Russia on its Sputnik-V vaccines.

Relatedly, since BioNTech has chosen Singapore as their regional hub, it’s a reasonable strategic move for Malaysia and vaccine producers from China, Russia, and other nations to consider win-win projects, capitalising on Malaysia’s biodiversity and geographical nature in balancing Pfizer-BioNTech presence in the region. Despite geopolitical sensitivities, the collective result of more production facilities is beneficial for global availability of vaccines.

Perhaps the government can ride on the momentum of the proposed National Vaccine Centre under the 12th Malaysia Plan, to kick-start the development of a vaccine and bio-chemical defence hub, as an "exchange" for health and defence capabilities, catalysed by local vaccine manufacturing, development and technology transfers.

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Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.