By Dr Rebecca Lee Pei Ern and Dr Khor Swee Kheng
Since Malaysia’s National COVID-19 Immunisation Programme (PICK in the Malay acronym) kicked off in February, some of the most popular conversations among the rakyat are “Have you registered?”, “Are you vaccinated?” or “Which vaccine do you want?”. This indicates significant demand for vaccines, and this demand was dramatically proven by the over-subscribed offer for the 268,000 doses of the AstraZeneca vaccine when an opt-in system was opened to the public on May 2.
This example shows how important it is to adopt a whole-of-society approach to ensure the success of PICK. The rakyat are eager to be part of this national movement, not as passive recipients of the vaccine but as active participants in the programme. To recap, Malaysia targets to vaccinate 80% of the adult population by February 2022. After three months, only approximately 3% of adults have been fully vaccinated. To vaccinate the remaining 77% in just nine more months, the government must build a Rakyat Vaccine Team of 32 million active participants, guided by the five principles of effective teamwork.
The first principle is transparency. While the government is providing daily reports on total registrations and vaccine doses administered by each state, the rakyat are very curious about data specific to each recipient group and other data related to vaccination. How many percent of medical frontliners and essential workers have been vaccinated? How many senior citizens and high-risk groups are registered so far? What are the turn-up rates and the number of wasted vaccines? How many and what adverse events following immunisation have been reported?
These data should be regularly updated in a publicly accessible online registry or dashboard. For example, Norway has an online dashboard with vaccination data segregated by age and sex, and weekly reports of suspected adverse reactions. Malaysians are also hoping for more transparency on the additional RM5 billion allocation for PICK announced on April 27, including a clearer breakdown of each expense, contract awarding and deliverables so that the rakyat can monitor and scrutinise the spending.
The second principle for successful teamwork is communication. For example, many senior citizens are asking the government why they are not scheduled for vaccinations yet despite having registered since February 2021. Some people facing technical issues with registrations have highlighted their attempts to contact MySejahtera but were only met with scripted responses. When these questions are left unanswered, many people will understandably feel anger or frustration. The government should be prepared to respond to questions and constructive feedback from the rakyat in a timely manner, as these questions reflect our genuine interest in being vaccinated.
The third principle is a shared and clear goal. Phase two of PICK is targeted to vaccinate 9.4 million people over four months. Since phase two started on 19 April, close to half a million people received at least one dose of vaccine. With the slow progress and possible delay of phase three vaccinations, many of us are worried that we cannot vaccinate 80% of adults by February 2022. We want to know whether the targets will be reached and the Plan B if we do not receive new vaccine doses as expected. Ideally, there should be periodic updates on the short-term goals of PICK based on different scenarios so that the rakyat are aware of the latest direction and can tune our expectations accordingly.
The fourth principle is accountability. When questions were raised about vaccinating employees in the tourism sector in phase one, the government set a good example with prompt explanations and public statements. All parties should be ready to explain their decisions or mistakes when questioned, for example the decision to vaccinate the staff of an oil and gas company or cases of technical glitches in the MySejahtera app leading to vaccine appointment cancellations or rescheduling. On May 11, Brunei’s Ministry of Health apologised for the overbooking of vaccination appointments due to technical glitches. Such accountability is crucial; human beings can be forgiving of mistakes, but we must own up to mistakes and provide assurances that they won’t repeat. However, accountability works both ways. Some Malaysians have not shown up for their vaccine appointments, some of them without valid reasons. If the rakyat wants to be treated as active participants with full control and agency, then they too must demonstrate personal responsibility.
The final principle is inclusion. Vaccines and its related information must be made easily accessible to all, including vulnerable communities such as rural populations, refugees, asylum seekers, stateless persons and migrants, documented or not. Recently, the story of two Orang Ulu women in their 80s staying in a rural district of Sarawak braving rivers and rain to get their vaccinations have inspired Malaysians and simultaneously raised concerns about the accessibility of vaccination in rural areas. The registration and vaccination process should be made easy for communities who live far inland and face challenges in transportation and cost.
Separately, many refugees and migrants are still fearful of being arrested when they show up for vaccinations even though the government has promised a safe passage and plans to engage NGOs. Outreach efforts should begin as soon as possible to educate these communities and gain their trust. For example, Nepal is the first country in Asia Pacific to vaccinate refugees (in their case, from Tibet and Bhutan). Since March 2021, refugees aged 65 and above are vaccinated in the phase two of its national vaccination rollout by working with local authorities and refugee leaders.
The era of ‘government knows best’ is over, and the rakyat today are critical thinkers who do not follow instructions blindly. We are still in our early days for our vaccination programme, and we need a Rakyat Vaccine Team that is a true all-of-society effort. Building such a team can utilise the five principles of effective teamwork, in order to instil vaccine confidence and a clear sense of ownership. When the rakyat become active participants instead of passive recipients, we will do whatever we can to support the government’s efforts, because it is ‘our’ programme. By upholding the principles of transparency, communication, clear goals, accountability, and inclusion, our Team of 32 Million can make PICK a success.
Dr Rebecca Lee Pei Ern is a medical graduate with an interest in public health.
Dr Khor Swee Kheng is a physician specialising in health systems & policies, and global health.