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Letter: A Predictable Ultra-Long-Term COVID-19 Strategy

In this letter, I’d like to explain why Malaysia needs a very predictable (even boring) ultra-long-term COVID-19 strategy and propose how that strategy could look like.

Malaysia is tired from COVID-19 and its drama. It feels like we’ve been fighting COVID-19 for years, but it’s only been less than four months. Malaysia’s first COVID-19 case was on 25 Jan 2020. Since then, the Pakatan Harapan government fell on 24 February and the Perikatan Nasional Cabinet was sworn in on 10 March. The Movement Control Order (MCO) started on 18 March.

Although it’s only been less than four months of COVID-19, we’re tired. We’re not used to staying at home for so long, Malaysia’s social safety net is under strain, the B40 can’t rely on civil societies and #KitaJagaKita forever, and politicians are still bickering and acting irresponsibly. We’re tired of so much drama.

When will COVID-19 end, many are asking. The short answer is, when we find a vaccine and administer it to >80-95% of all human beings. This will be mid-2021 at the earliest, and perhaps even later. So, we’re still looking at another 12-36 months of COVID-19.

That’s a long time to be making decisions, especially during political uncertainty. Decision-making is tiring and prone to failures. Reactive and ad hoc government decisions that are inconsistent between ministries/ministers and prone to reversals are even more tiring.

Reducing fatigue is the first reason why we need a predictable ultra-long-term COVID-19 strategy. So far, Malaysia doesn’t have such an ultra-long-term strategy that takes us till 2021 at least. So far, we’ve only had a collection of reactive decisions, which are ineffective, dangerous and unfair. We can accept these reactive decisions in the initial phase because every country was also reacting.

But as time passes, it’s harder to defend or accept reactive and incoherent decision-making. As time passes, it becomes more important to have predictable and coherent ultra-long-term decision-making, at least until 2021. An ultra-long-term strategy is crucial not just to reduce fatigue, but for two other reasons.

The second reason for an ultra-long-term COVID-19 strategy is to move Malaysia into a bit more of an “auto-pilot” mode. A predictable ultra-long-term strategy is good for businesses to plan and citizens to adapt psychologically. 

Over a 12-24-month period, it’s likely that Malaysia will see more waves of infections (new waves were seen after loosening lockdowns in Germany and South Korea). Malaysia cannot yo-yo between high and low levels of restrictions. We need a smoother, less disruptive set of continuous low-level restrictions, which an ultra-long-term strategy can provide.

A predictable strategy will allow Malaysia to re-focus on nation-building. It allows us to allocate energy and attention to the political situation and make urgent repairs to the social safety net. An ultra-long-term strategy will give us breathing room to lay the foundation for health reforms to begin, so that we can strengthen the health service even as we continue using it. We can’t fight a long-term pandemic with yesterday’s health system.

The third reason for an ultra-long-term strategy is to improve the quality of our decisions. Depoliticized decision-making criteria and scheduled decision timepoints means that we eliminate useless or dangerous politics.

Decisions to re-impose MCO must be taken based on independent public health criteria, not the feelings of politicians, efforts of hidden lobby groups, or public pressure. If we have to reimpose an MCO, we should rely on facts, not feelings.

How does this predictable ultra-long-term strategy look like? There’s no magic solution, and the jigsaw puzzle has many pieces. The first three pieces are scheduled decision-making timepoints, using epidemiological criteria to decide the level of restrictions, and deciding based on districts, not states.

In practical terms, it could look like this: Decisions on which economic sectors to re-open or re-close in which districts are made every other Monday, using Health Ministry epidemiological data like “last 14 days moving total of new cases in that district”.

In other words, decisions are made using criteria that the public has received from the Health Ministry daily for the last three months. That strategy can be somewhat flexible with emergency decisions to reimpose MCO or impose EMCO being possible.

This means if Malaysia experiences a new wave of infections and we need to reimpose MCO, the decision timepoints and criteria are already in place so there’s no need to politicize the decision or waste energy criticizing the timing or criteria. This means that the economic and security agencies can’t decide based on their own whims and fancies of timing or criteria.

Using “districts” as the administrative and implementation unit is also a good strategy for a few reasons. Malaysians are already used to seeing district-based maps on a daily basis, from Health Ministry press briefings. Using districts sidesteps the politics of federal-state relationships.

Because it’s smaller and more targeted, any increased restrictions for one district will be less disruptive than restricting an entire state or entire country with a one-size-fits-all lockdown. By using apps like MySejahtera or MyTrace, a district-based lockdown can be effectively monitored.

That’s just for the economic side of public life. The social sector (religious activities, social gatherings and so on), the educational sector (schools and universities) and other sectors should reopen in phases, and this ties in neatly with the ultra-long-term strategy proposed above.

These suggestions are interdependent and must be implemented together. A predictable ultra-long-term strategy is crucial but it’s only one part of the solution. That ultra-long-term strategy does not resolve other problems like the health expertise in decision-making, quality of political leadership, political will, inter-ministerial coherence, and so on. These are other problems that require other solutions.

As Malaysia settles into the long-term fight against COVID-19, we need a predictable long-term strategy. It will give us some rest, allow a refocus on other equally important priorities, and depoliticizes decision-making. We need all that.

 

Dr Khor Swee Kheng
Physician & Public Health Specialist

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