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Can COVID-19 Vaccines Reach Rural Areas In Time?

Everyone is counting down the days till the COVID 19 vaccinations are administered to the public. As of April 4, 2021, a total of 801,773 doses of the vaccine has been administered[1]. Unfortunately, there may be a delay in some Malaysians getting their doses. This isn’t because of distrust in the vaccination, some Malaysians will have a hard time getting the vaccine because of where they live.

Distance Is A Real Issue

Whilst Malaysia takes pride in universal healthcare access, 6.5% of Malaysia’s population live more than 5km away from any healthcare facility[2].  This number is much higher for states like Sabah and Sarawak. With more rugged terrains, one-third of their population is far away from a hospital[3].

A 2015 study from the Ministry of Health found that the average time to reach a hospital for rural residents was 30.65 minutes compared to 16.71 minutes for urban residents[4]

Source: The Star

For rural communities road conditions, transportation options and current weather conditions become determinants of whether they make it to the hospital or not. In the case of a medical emergency, this could mean life or death. What this means is that patients, medical specialists, and even necessary medical supplies take double the amount of time to reach a proper medical facility.

Lack Of Professionals

Another factor to take into account is that Sabah and Sarawak are severely understaffed when it comes to medical experts.

The two East Malaysian states have an extremely high doctor-to-patient ratio (1:1357 and 1:957 respectively), whereas the average doctor-to-patient ratio in all of Malaysia is 1:633[5].

Hospitals in East Malaysia and rural hospitals may be struggling with a lack of resources, particularly the lack of manpower.  

Source: The Sun Daily

More Complex Than Polio Vaccine Distribution

Previously when there was a  polio outbreak in Sabah, with a total of four children affected, the Malaysian government took no time in sending healthcare workers to restart the immunisation campaign in Sabah[6]

Source: Code Blue

Arranging fixed sites for parents to bring their children for vaccination, drive-throughs, school immunization campaigns, and even house to house visits were implemented. In Sabah, they also mobilised “The Flying Doctor Service” so that the immunisation services reach the rural corners of the state[7].

“…the frontlines who make it their mission to reach every child with the polio vaccine. They climb mountains, cross rivers and seas, and drive through the bumpiest roads to make sure that we stop the polio outbreak in Malaysia.” -Dr Lo Ying-Ru Jacqueline, WHO Representative to Malaysia, Brunei Darussalam and Singapore[7].

As of October 2020, coverage for the first and second dose of the polio vaccine (bOPV) campaigns were 98% and 96%, respectively. [7] 

If these professionals were able to do it for polio, why not for Covid-19?

Extreme Storage Requirements 

The Covid-19 vaccines are incredibly high maintenance and do not last more than a few days in inadequate conditions. 

The vaccines that are currently being distributed throughout Malaysia are Pfizer BioNTech, Moderna and Sinovac. Whilst thousands of Sarawakians and Sabahans have already received their first and second doses of the vaccine, transportation of the Covid-19 vaccines is no simple task. 

The delivery itself requires a consistent cold-chain requirement. If these requirements are not maintained the vaccine’s efficiency will most likely be affected.

Source: Nikkei Asia

During a webinar discussing the delivery of Pfizer-BioNTech vaccine, President Alvin Chua, (Federation of Malaysian Freight Forwarders (FMFF) stated that Pfizer and Moderna are not suitable for Sabah and Sarawak[8].

There are a total of five warehouses for the vaccine throughout Malaysia. It is here that the vaccines are repackaged and distributed to the relevant hospitals, and clinics in each state. Throughout the journey, the vaccines need to be stored at sub-zero temperatures. However, when it comes to remote and rural regions this is extremely difficult[8]

For example, there are 75 remote clinics in Sarawak that can only be accessed by river. There is no way to access them through the land. Logistics to these clinics will be challenging. 

“..land transportation to remote areas from Kuching and Kota Kinabalu, Sabah, can take up to 12 hours. The situation in Sabah and Sarawak is different compared to West Malaysia, especially when you talk about climate change, the flood, rain, landslide, that will affect land transportation.” – Ts Hj. Ramli Bin Amir, president of The Chartered Institute of Logistics & Transport (Malaysia)…

To overcome this problem, the Minister of Science, Technology and Innovation (MOSTI) Khairy Jamaluddin stated that rural Malaysians would most likely receive the AstraZeneca Covid-19 vaccine. This type of vaccine can be distributed using existing logistics and stored in normal refrigerators. Unfortunately, this vaccine is only available in the second quarter of 2021, meaning will be a definite delay in the delivery[3]

Source: Nikkei Asia

So to sum it up, the road to a vaccinated nation against COVID-19 is going to be a long one, especially for those in rural and remote Malaysia. East Malaysian states like  Sabah and Sarawak, known for their rugged terrains and poor infrastructure are going to be especially difficult to transport working vaccines. Not only does it take double the time for any medical supplies and officers or even patients to reach remote regions, but these hospitals are not equipped with the necessary cold storage facilities to keep the vaccines. 

Malaysia plans to get nearly 27 million people vaccinated by March 2022. For that plan to become a reality, EMIR Research has a few recommendations[3]

  1. Ensure that the newly hired medical professionals are also distributed to East Malaysia as well. 
  2. Joint efforts between federal and state governments to ensure transportation efforts are needed. 
  3. Financing flying doctor services to reach the remote areas faster.

We hope that all Malaysians, rural or urban will be given a fair chance to receive their vaccination in time.

Explore Our Sources:

  1. JKJAVMY. (2021). Daily Report Vaccine Doses Administered by State, 4 April 2021. Link.
  2.  Khazanah Research Institute. (2020). SOCIAL INEQUALITIES AND HEALTH IN MALAYSIA THE STATE OF HOUSEHOLDS 2020 PART III. Link.
  3. A. Yeo. (2021). Vaccination Challenges In Rural Sabah & Sarawak. Emir Research. Link.
  4. Ministry of Health. (2012). National Health And Morbidity Survey 2011 Volume III Healthcare Demand and Out-of-Pocket Health Expenditure. Link.
  5. Bahardin, A. (2016). Suturing the gap – the urban-rural health dilemma. Malaysiakini. Link.
  6. V. Pillai & A. Thanaraju. (2020). Fourth Polio Case Hits Malaysia, Unvaccinated Foreign Sandakan Boy. Code Blue. Link.
  7. WHO. (2020). Going the extra mile to protect children against polio during the pandemic. Link.
  8. K. Batumalai. (2021). Last-Mile Covid Vaccine Delivery Far From Perfect In Sabah, Sarawak. Code Blue. Link.

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