Revisit vaccination coverage in Malaysia

According to the National Covid-19 Immunisation Programme (NIP) Coordinating Minister Khairy Jamaluddin, only 42.20% of the population (10,232,913 individuals) had registered for vaccination as of Monday (May 17). It is still far from the country’s desired target – to inoculate more than 80% of the population (nearly 27 million out of 32 million Malaysians) by the end of this year.

With limited vaccine supplies across the globe, there is an increasing concern that Malaysia could not kickstart Phase 3 of the NIP as scheduled and could not cope with the rising number of Covid-19 cases in the country.

To date, Phase 3 of the vaccination involves a 13.7 million population, where both citizens and non-citizens aged 18 years and above are eligible for vaccination and will kickstart from this month till Feb next year.

However, many developed nations are acting on their self-interests. Several wealthy countries acquired more doses than required to inoculate their entire population, causing a slower vaccination rollout in developing countries like Malaysia.

According to the World Health Organisation (WHO), one in four people in the developed world has received at least one dose of vaccine, compared with one in 500 for low-income nations.

As of Feb 2021, the European Union (EU) ordered 1.6 billion doses for its adult population of roughly 375 million, whereas the UK ordered 219 million complete vaccinations for its 54 million adults.

It is a worrying scenario as Malaysia has reported over 2,000 daily new Covid-19 cases for three weeks since April 15. As of yesterday (May 18), the total Covid-19 cases per one million population in Malaysia (14,648 cases) exceeds neighbouring Southeast Asian countries like Indonesia (6,333) and the Philippines (10,413).

Although India’s population (1.391 billion) is 43 times larger than Malaysia (32 million), the total Covid-19 cases per one million population in India only consists of 18,317 cases, as shown in Figure 1.

Despite the NIP has outlined the usage of mobile vaccination clinics, the majority of sites are still concentrated within urban areas along the west coast of Peninsular Malaysia. This can be seen when Sabah and Sarawak received low vaccination rate as of Monday (May 17), which are 2.44% and 4.38%, as shown in Figure 2.

Figure 3 below shows the total percentage of the population that have received their first dose as of May 17 further revealed different vaccination coverage levels across all Malaysian states.

Among the states with larger population size such as Selangor, the number of people receiving the first dose as a proportion of the total number vaccinated with the first dose nationwide is the lowest – 13.22%. Population wise, 20.03% of Malaysians residing in Selangor. This coincides with a low vaccination rate of 2.49% as shown in Figure 2.

In contrast, remaining states with smaller population sizes such as Penang, Perak, Terengganu, Negeri Sembilan, Melaka, Pahang, KL, Perlis, Putrajaya and Labuan have a higher percentage of first dose vaccination administered compared to their population.

This is particularly obvious in Labuan when the number of people receiving the first dose in Labuan over the total vaccinated with the first dose nationwide is 1.11%. But only 0.30% of Malaysians reside in Labuan, which gives it a high vaccination rate of 13.69%.

To summarise, both Figures 2 and 3 illustrate that it is relatively easy for the states with smaller population size to mobilise vaccine corps volunteering in the vaccination programme.

Vaccine corps refer to the those who could deliver vaccine shots, monitoring individuals who had just been vaccinated or scheduling second doses for the vaccines to be fully effective.

On the other hand, states with larger population size would have to mobilise a large number of vaccine corps driving through muddy, uneven roads besides having a boat ride to reach the remote or rural population who live beyond 5km of any kind of health facility. A lack of specialists and medical equipment would also hinder the progress of vaccination.

As of May 17, only 12.47% (1,234,630 individuals) out of 9.9 million targeted population nationwide received their first dose of the Covid-19 vaccine during Phase 1 and 2 of the vaccination. With the recent rise of Covid-19 cases in the country, there is an increasing concern that the vaccination coverage remains low in some states such as Sabah, Selangor, Johor, Kedah, Sarawak and Kelantan.

Although it is a good sign that 268,000 people in Kuala Lumpur and Selangor registered their interest for the AstraZeneca vaccine voluntarily on May 2, the current administration might face challenges to inoculate more individuals outside of Klang Valley during the coming weeks. The NIP Handbook indicated a relatively low number of Vaccines Administration Centres (VACs) allocated in states such as Kelantan, Terengganu, Pahang, Johor, Sabah and Sarawak.

As mentioned in my previous article on “Vaccination coverage: A crucial factor in achieving herd immunity in Malaysia” (Malay Mail, March 30, 2021), JKJAV perhaps could look into several policy recommendations by EMIR Research, enhancing vaccination coverage in all Malaysian states during this year:

1. Enhance coordination between the federal government and state governments to ensure the vaccines are distributed according to the population needs and logistical requirements; 2. Mobilise a large number of vaccine corps to volunteer in the vaccination programme. Besides medical, nursing and pharmacy students, vaccine corps could be formed by community grassroots, comprising retired or unemployed clinicians; 3. Allocate more vaccines to the areas that were identified as red or orange zones. Red zones are the areas with more than 41 confirmed Covid-19 cases whereas orange zones are the areas that have between 21 to 40 cases. For instance, the current administration can allocate more vaccines in seriously infected states such as Selangor, Johor, KL, Sarawak and Kelantan; and 4. Mark and include all the semi-urban, rural and interior areas onto the map, ensuring an effective house-to-house community outreach programme that will be implemented by the National Disaster Management Agency (Nadma) with the involvement of the military. This would ensure citizens in these areas receiving vaccination sooner.

As suggested by The People’s Health Forum (PHF) on “Is vaccination against Covid-19 really necessary?” (Malay Mail, March 22, 2021), a mass vaccination programme would help Malaysia to achieve herd immunity as scheduled. A lower R-naught value (below 1.0) would also enable Malaysia to gauge the right balance between lives and livelihoods, protecting citizens from infecting deadly epidemics.

In a nutshell, it is crucial for the current administration to constantly monitor the vaccination coverage across all Malaysian states, giving Malaysians the chance to enjoy normalcy and help Malaysia’s economy recover gradually.

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Amanda Yeo is Research Analyst at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.