AS of Aug 17, 34% of Malaysians had received both doses of Covid-19 vaccines. That is virtually full protection against severe illness from the virus, requiring hospitalisation, thus reducing pressure on our presently overburdened healthcare services.
We need to ramp up the uptake to other low-coverage states to prevent a replay of the messy experience in the Klang Valley. Unvaccinated persons take up more than 95% of our hospitals beds.
We still run the risk of breakthrough infections, with a conservative estimate of 0.29% of fully vaccinated persons. That is 32,000 breakthroughs, milder than similar infections in unvaccinated persons. But these may pose a danger to larger communities within the context of the more transmissible and virulent Delta variant. And we must also be prepared for the Lambda and other VoC (Variants of Concern) that may follow subsequently.
First, those vaccinated and unvaccinated may continue to create clusters and outbreaks in low-coverage states, and even in high-coverage states, as seen in Sarawak recently. Though to a lesser extent, Delta can still be transmitted by a vaccinated person.
Therefore unlike the US, the UK and Israel, we have been smart to persist with the mandate on masking, both indoor and outdoors. This would prevent the dispersion of the Delta variant to those unvaccinated, namely children and the vulnerable and immuno-compromised.
As we have seen in the highly vaccinated nations like Chile, Seychelles, Uruguay, Mongolia, UAE, Bahrain, the US, the UK and Israel, the Delta virus can readily unleash another Covid-19 wave due to its ease of transmission.
There is too much hope and hype placed in the vaccine basket. We must be holistic in our crisis management and utilise every other anti-pandemic tool at our disposal.
And that is why our failure to ramp up testing to the basic minimum of 250,000 tests per day is not helping. At best, we were averaging 150,000 tests per day, and our positivity rate has hovered around 12%-15%, which according to WHO (the World Health Organisation) means that our pandemic has been out of control since May 2021.
FTTIS (find, test, trace, isolate and support system) is a vital component of the exit strategy, and the authorities need to seriously consider a national testing policy, which among others must undertake the following course of action, in the short, medium and long terms.
The slow, piecemeal and reactive responses of the authorities in its testing protocols have only fostered the sporadic spread of the virus and enhanced the proliferation of VoC.
This has led to an explosion of daily cases, which is overwhelming our hospitals and intensive care unit facilities, the quarantine centres, leading to exponential death rates and brought in dead (BiD) cases.
The FTTIS framework of action needs to be communicated carefully and thoroughly to other agencies responsible, notably:
-> International Trade and Industry Ministry Safe@Work campaign
-> Education Ministry Safe@School policy
-> Home Affairs Ministry Safe@Prison protocols and others
Better ventilation of public amenities should be spearheaded by Human Resources Ministry (Akta 446), Safety and Health Department, and close collaboration with the Housing and Local Government Ministry.
The âSâ of FTTIS, encompasses social, financial, psychological support, which should be jointly coordinated across the various agencies, notably:
-> Finance Ministry
-> Health Ministry
-> Social Welfare Department
-> State Pusat Zakat and Baitul Mal
-> Relevant non-governmental organisations.
And for those who are unable to isolate in their homes, better quarantine facilities should be made available by the relevant agencies to prevent the spread and spillover of infections into larger communities.
On the vaccination front, the Special Committee for Ensuring Access to Covid-19 Vaccine Supply needs to be more proactive and consider promptly new strategies to better boost our population immunity. These among others include:
-> Single-dose mRNA and adenovirus vector vaccines in persons post-Covid-19, in a bid to save on vaccine use and supply,
-> Heterologous prime boosting vaccine regimens (mix and match of vaccine types) to increase the immune response in the face of the Delta virus,
-> Consider boosters for those with two doses of inactivated vaccines,
-> Enhance uptake of vaccines in 12-17-year-olds and those under 12 with co-morbidities,
-> Better vaccination of gravid mothers across all stages of pregnancy,
-> We do not agree with mandatory immunisation policies. For the Malay Muslims, whom we think are the majority of the vaccine deniers and hesitant, there is enough provision in the fatwa which states that immunisation is harus (permissible) but it is wajib (mandatory) for those whom the government deem as high-risk individuals. But we would like to recommend vaccine mandates, which would tie to employment in high-risk occupations e.g. healthcare workers, caregivers in nursing care homes, prison wardens, army personnel etc.
Dr Musa Mohd Nordin, Paediatrician and Asst Prof Mohammad Farhan Rusli, Public Health Physician. Comments: [email protected]
