More than seven months after the World Health Organisation declared the end of COVID-19 as a public health emergency of international concern - albeit not as a global threat - Malaysia and the world are grappling with an increasing number of cases, a trend that is unlikely to end as the world heads into end-of-year festivities.

As of Dec 17, there were 28,375 active cases nationwide, with 3,389 new cases reported on Dec 16. The positivity rate of tests is 11 percent while hospital space allotted for COVID-19 stood at 69 percent as of Dec 16.

Meanwhile, only 828,433 Malaysians have received a second booster out of 27,550,563 who have received two doses of the COVID-19 vaccine as of Dec 19.

While cases are rising, a Bernama check of medical non-governmental organisations and private and public clinics found that only the Sinovac vaccine, which targets the original version of the coronavirus, was available currently. Bernama reached out to the Ministry of Health for information on when other vaccines will be available but did not receive any response.

Studies have found Sinovac has not been as effective in preventing infection and severe illness as other vaccines such as Moderna, Astra Zeneca and Pfizer.

Health director-general Datuk Dr Muhammad Radzi Abu Hassan told reporters the government is in the process of procuring monovalent vaccines targeting the XBB1.5 Omicron sub-variant.

Experts said a less effective vaccine is still better than nothing, regardless.

Dr Muhammad Radzi also said Paxlovid, an antiviral that stops the replication process of the coronavirus and thus the damage it causes to the human body, is widely available but is perceived to be ineffective.

But as things stand now, uptake of the boosters has been very poor, the antiviral is considered not that effective and the more effective vaccines have still not arrived. It seems that Malaysia did not prepare for the usual year-end spike in cases as well as they could.

"Again, that is the planning, the management. We should have - we could have predicted this is the time when people would probably look for their boosters and supply," agreed Associate Prof Dr Rafdzah Zaki, an epidemiologist from Universiti Malaya.

She and other experts called on everyone to examine the factors contributing to the spike in COVID-19 cases and make changes accordingly.


TWO BATTLEFRONTS

Complacency regarding COVID-19 and misinformation are likely the biggest contributors to the poor uptake of vaccines and relaxed attitude towards the sometimes fatal illness.

Health experts said social media is the primary driver for the incorrect information on COVID-19 and mitigation, be it masks or vaccines.

"If I talked about masking (on Facebook), people would laugh at me (and say), 'What are you doing? Pandemic is over'," said Associate Prof Dr Vinod Balasubramaniam, a virologist at Monash University Malaysia.

At the height of COVID-19, Malaysian health messaging to counter anti-vaccination fake news was strong and on point. But as cases waned due to lockdowns and mass vaccination, so has the health messaging.

In the meantime, anti-vaccination rhetoric has increased, gaining support from people in all walks of life, including professionals in law, healthcare and government.

Hesti (not her real name) told Bernama a family member was diagnosed with cancer soon after getting the vaccine. She said he had had a clean bill of health previously. She added he deteriorated quickly and died a year later.

While saying she was not against vaccination, Hesti wondered if her family member could be considered as one of the people who "died suddenly" after getting vaccinated (against COVID-19).

"Died suddenly" refers to an online conspiracy theory that vaccines, rather than a prior COVID-19 infection or other illnesses, caused a person's death.

Dr Rafdzah said the situation surrounding the lockdowns, such as lack of activity and mental stress, contributed to a spike in diagnoses and bad health outcomes after the movement controls were lifted, not the vaccines.

"Other health services (were disrupted) as well, like the non-communicable diseases like hypertension, diabetes, cancer, all were affected. That's why when you see the impact after COVID-19 when suddenly people have a heart attack or suddenly have a stroke, it's because they had not been (controlling) their risk factors well," she said.

And as a new disease, there is increasing evidence that a COVID-19 infection damages the body, causing people to develop heart disease and diabetes earlier.

While the anti-vaccination misinformation has continued unabated, the fact-checking messaging has decreased, leaving many vaccine and health experts overwhelmed with the responsibility.

Universiti Kebangsaan Malaysia immunologist Associate Prof Dr Nazlina Ibrahim told Bernama she was exhausted trying to explain and correct people, especially when they refused to listen.

"The number of people who want to find the truth is not many," she said, adding she depends on her students to educate their parents and others.

Dr Vinod said misinformation can also come from health professionals so it has become even more difficult to counter now.

All said the best bet is for the government and media to power up the fact-checking messaging again and cut down on any anti-vaccine lies at the get-go.


PROVIDE EASIER ACCESS

People do consider COVID-19 as less serious now. In an August 2022 poll, global research company Ipsos found that Malaysians were more worried about inflation than COVID-19. Since the economy has reopened fully and everyone has resumed normal activities, it would stand to reason that fewer people are taking precautions against infection.

The public messaging has also quietened down on vaccinations until recently. Dr Nazlina said having Paxlovid available could be one of the reasons there is less focus on vaccinations.

But the oral medication is only effective if people were prescribed it in the first place and there is anecdotal evidence that doctors seem reluctant to prescribe the medicine.

An 84-year-old man, who tested positive for COVID-19, went to see a doctor for a Paxlovid prescription but was denied because "the doctor said he didn't need the Paxlovid because it was the fifth day (of his infection)", the patient's wife told Bernama. It was his second COVID-19 infection.

According to Dr Rafdzah, a patient should be able to get a prescription even on the fifth day but declined to comment on this particular case as she did not know the patient's details.

Under guidelines for Paxlovid use in Malaysia, patients should take the medicine within five days of symptoms onset and a positive COVID-19 test, especially "adults who do not require supplemental oxygen and who are at increased risk for progressing to severe disease".

While exact data is not available in Malaysia, a January 2023 survey conducted by Medscape on 1,500 health professionals in the United States found that a plurality of physicians and nurse practitioners were reluctant to prescribe Paxlovid to older adults. Forty-four percent of respondents were concerned the medication may interact with other prescription drugs that patients already take.

There have also been reports that some doctors may believe a patient is not sick enough to be prescribed Paxlovid, as seemed to be the case with the 84-year-old patient mentioned above. But Paxlovid, which works best the sooner one takes it, is supposed to prevent severe illness. It also prevents long COVID.

In a news report, Dr Muhammad Radzi said Paxlovid worked very well but some believed it did not work, blaming the belief partly on patients receiving the medicine late.

In the meantime, said Dr Nazlina, the public needs to step up non-pharmaceutical interventions such as masking and avoiding crowded areas while waiting for boosters.

"People will understand and appreciate the need for putting on masks. Some don't need to be told but some people just don't bother. But the people who don't bother are the ones who really need to be alert and be told why they need to do this,' she said.

All the experts said if possible, really vulnerable people should get a vaccine or booster now as some protection is better than none.

Dr Rafdzah said once the updated vaccines arrive, the government needs to make it easy for people to get them, like it was before with walk-in vaccination sites provided. Despite the anti-vaccination rhetoric on social media, she is confident Malaysia is not against vaccination for the most part.

However, some do not think being pro-vaccine is enough for Malaysia.

Dr Vinod said the fact that he has been struggling to convince people to take whatever medical interventions that are already here shows Malaysia has not learned enough from the COVID-19 pandemic. There has also not been much news on the promised home-grown vaccine research and development.

"We need to get ready for the next pandemic, (which is) inevitable," he said. He added most, if not all, of the infectious diseases with pandemic potential in the past few decades have had a zoonotic origin.

"Whatever puts humans in close contact with animals, there will be a spillover."



-- BERNAMA