Vaccines: Are Kampung Folks Getting It Too?

In light of the recent scramble for the AstraZeneca vaccine registration for residents in Johor, Kuala Lumpur, Selangor, Penang, and Sarawak, the nation says thousands of Malaysians battled for over an hour to secure an appointment and many were left disappointed without one. While there were frustrations, it showed a large chunk of Malaysia’s population pushing hard and fast to participate in herd immunity. 

Similarly to other countries, Malaysia’s COVID-19 immunization programme is to be carried out in phases^[1]. Phase one was to give priority to frontliners. Phase two to the vulnerable communities, like the elderly and the OKU. Phase three covers everyone above eighteen years old and phase four for outbreak management^[1].

Upon approval by the drug control authorities, Minister of Science, Technology & Innovation, Khairy Jamaluddin stated that phase five is in planning, focusing on teenagers aged twelve onwards receiving the Pfizer vaccine. During a recent webinar with The Oxford & Cambridge Society Malaysia, the minister also stated that the nation aims to achieve herd immunity by December 2021^[1].

As of 16^th June 2021, roughly four months since the vaccine roll-out, a total of 14,637,437^[2] out of 32,657,300 people (Malaysia’s Population, 2020)^[3] have registered for the vaccine online, of which 3,632,195 have been vaccinated^[2]. This translates to a little over 44% of the nation registered online for the vaccine, and 11.1% having received at least one dose.

There are also offline vaccine registrations to which Minister Khairy Jamaluddin stated that roughly 59.1% of the population had registered with an estimated 3.5million people having received their first dose, and 1.4 million their second^[1]. The minister stated that since May, the government has pushed to increase the national daily capacity to 200,000 doses of vaccines per day in order to meet the deadline at the end of the year^[1]. While this is progress, it is still far from achieving herd immunity, where Malaysia needs to vaccinate over 80% of the population or 26.5 million people^[2]. 

The fact of the matter is that the road to herd immunity is still a rocky one. And with the nation experiencing its third lockdown, a better understanding of the status of the Immunization Programme is necessary. These challenges are on both ends of the spectrum, with both getting people on board, as well as technical issues and supply. 

Disparity Between Low And High Income Nations 

In April 2021, only 2.2% of Malaysians had received at least one dose^[4], it was identified that despite the slow rollout, Malaysians had received roughly 1.56 million doses of vaccines, making the utilisation rate about 75%^[4]. This number falls in line with the US, Europe and Canada meaning that Malaysia’s problem was not in the distribution of the vaccine, but in the lack of availability^[4]. As a matter of fact, compared to neighbouring Asian countries of Indonesia, Thailand, the Philippines, and Vietnam Malaysia displays high populations of people who have received at least one dose, second only to Japan^[1].

However, when comparing to high-income nations, Malaysia is far far behind. The minister stated that early in 2020, many of these western powers of Canada, the United Kingdom, the United States, and the European Union had purchased enough vaccine supplies to vaccinate their population several times over^[1].

The inability to meet demand may be due to Malaysia not getting in line for the vaccines as fast as other countries did. For example, Japan had its first agreement with Pfizer in July 2020 when the pandemic was still raging^[4]. Near the end of 2020, countries within the European Union and Australia, Vietnam, Brazil, Kazakhstan, India, and Saudi Arabia already had agreements with multiple vaccine manufacturers in place. Malaysia was slightly late to the party^[4].

What is clear in this race to obtain vaccines is the disparity between high income and low-income nations in their ability and resources to fight against COVID-19. 

According to the World Health Organization (WHO), those living in high income, developed nations had a one in four chance (25%) of getting at least one dose of a vaccine. In low-income nations, only one in five hundred people had a chance^[4]. 

The World Health Organization on Monday branded the growing gap between the number of coronavirus vaccines administered in rich and poor countries a global “moral outrage”. High-income nations have bought more vaccines than necessary, while less than 1% of low-income nations can access vaccines^[4]. 

Malaysia’s challenge in achieving herd immunity is not only in the procurement of the vaccines but along with logistical issues especially for those living in rural areas. For example, distance from healthcare care and vaccine centres, the need for more medical workers or volunteers and difficulties in transporting vaccines due to extreme storage requirements^[5]. 

Above and beyond these issues, many Malaysians are still hesitant and not on board with taking the vaccine. These are some of the reasons: 

Rural areas have a lower uptake of registrations than their urban counterparts

When the vaccinations were first announced, the ministry mentioned four ways to register for the vaccine. These included the MySejahtera App, COVID-19 JKJAV website, Hotline phone number, Manual Registrations, and door to door registrations^[6]. 

Despite multiple registration options, only a little over 59.1% of Malaysian’s registered. The states with the least number of registrations are Sabah and Kelantan. Only nine states have exceeded 50% registration, and only Putrajaya has succeeded in 100% registration^[2]. 

The influence of social media and fake news

Even if we often joke about “makcik facebook” or “akak whatsapp”, we fail to realise that many believe this information. Word of mouth travels even faster with modern-day technology. Health authorities and councillors had to go door-to-door and convince Malaysians to take the vaccination^[6]. 

Negative issues spun through social media about vaccination also play a big role in causing hesitancy among certain groups or communities to register. – Assistant Minister of Local Government and Housing Datu Dr Penguang Manggil^[7]. 

There are senior citizens who also changed their minds after being influenced by fake news about the vaccine spread by family members or friends or which had gone viral on social media. – Mentri Besar Datuk Seri Wan Rosdy Wan Ismail^[8].

Missed Appointments And Digital Illiteracy

As of May 27, 2021, there were a total of 52,000 people that had missed their vaccination appointments across seven states^[9]. Kedah has the most missed dates at 10,827 people, followed by Pahang (10,000), Kelantan (10,000), Perak (9,009), Negeri Sembilan (6,323), Melaka (3,612) and Perlis (3,000)^[10]. 

The Kedah health minister stated that these ‘no-shows’ stated that they were out of town, unfit to travel, not ready or undergoing quarantine^[10]. The Pahang Health Department stated that 10,000 Pahang residents did not show up for their Covid-19 vaccination appointments, and were unaware of their appointments as they didn’t check their MySejahtera app or National Immunisation Programme appointment^[8]. Kelantan stated most of their missed appointments were from the elderly demographic^[10]. 

One of the most commonly cited reasons for missed appointments is the lack of notification from the MySejahtera app. Whilst the MySejahtera app is great for users that are using smartphones, that have no problem with internet connections, it doesn’t cater to the needs of Malaysians in remote areas, or those that struggle with a stable connection. Let’s not forget those that do not have smartphones, to begin with. Many still rely on manually writing their names in stores rather than QR scanning. 

When it comes to getting updated information on the COVID-19 situation, those that don’t constantly check their app, are slow to receive important news updates and may miss their appointment entirely, potentially wasting the vaccine doses entirely.  

There are those that will try their very best to get to their vaccines. A family in Kuching, Sarawak hired an ambulance from Life Care Society for RM200 to get their 87-year-old grandmother to the vaccine centre for her first dose. needed to call an ambulance to get an 87-year-old woman to her first vaccine appointment^[11]. Efforts like these are more common in urban areas, however, those in rural areas do not have the luxury of the said transport to ferry elderly folk to vaccine centres.  

Besides that, many senior citizens are dependent on their children and when they receive delayed notifications, it is difficult for their children to arrange their leave to send their parents to vaccination centres on the date of the appointment. – Kota Bharu state health director Dr Zaini Husin

This is such a big problem for two reasons. One, some centres are forced to wait for ‘no-shows’ leading to congestion in the vaccine centres. After a year into the pandemic, anywhere with big crowds is a place to be avoided. Two, as soon as a vaccine dose is removed from storage, it has to be used. If not it is wasted^[12]. 

With all these challenges, we look to possible initiatives that can help to bridge the gap. The government has mentioned various plans to tackle each problem. 

Government Plans To Get Rural Communities Vaccinated 

In order to overcome the disparity in the remote and rural regions, the government has suggested that these communities wait a while longer for single-dose vaccinations such as the CanSinoBIO, and single-dose vaccine Sputnik V, from Russia^[13]. This suggestion is simply taking into account the transportation problems and storage concerns of those in rural regions. However, these doses have yet to arrive and a timeline has not been presented to the people^[13]. Currently, Malaysia has gained access to three out of the five vaccine types which include two-dose vaccines from Pfizer-BioNTech, AstraZeneca, Sinovac Life Sciences Co Ltd (Sinovac). 

According to Minister Khairy Jamaluddin, after the third wave, the government renegotiated with distributors to accelerate the vaccine deadline. A total of 25 million doses of Pfizer are expected to arrive within the third quarter of the year, and another 14 million by the end of the year^[1]. The government also secured 12 million doses of Sinovac by the end of July, and 4 million doses of Astra Zeneca^[1]. Cansino vaccines were also approved by NPRA on June 15, 2021^[1].

Another plan that was discussed is an implementation plan to do manual registrations in rural areas. A proposed partnership with the  National Disaster Management Agency (NADMA) and Malaysia Civil Defence Force (APM) plan to go door to door to convince this demographic to register^[14]. 

There are also some in rural areas who are not aware of the immunisation programme, so we need to step up our communication to increase the registration rate. – Minister Khairy Jamaluddin

Mobile Vaccinations are also up for discussion. Minister Khairy Jamaluddin has mentioned that mobile Covid-19 vaccination trucks will be used to vaccinate residents of Kuala Lumpur in certain areas. The programme also aims to work with management bodies of these residential buildings in Kuala Lumpur, Selangor, Penang and Johor to target PPR flats and dense urban poor areas. 

Finally, with the plans to procure vaccines and increase uptake, the government needs to plan ahead to ensure that there are enough personnel to administer the vaccines at vaccine centres throughout the nation. In order to do so, Kementerian Kesihatan Malaysia (KKM) has been actively looking for all types of medical volunteers that are willing to join the battle for covid. Doctors, nurses, dentists, and lab assistants are all in high demand throughout the nation^[15]. If the situation calls for it the government will also consider enlisting retired nurses and healthcare personnel, year 4 and year 5 medical students, housemen, medical postgraduates and medical students^[1].

And it isn’t just KKM that is searching. To combat the shortage of medical professionals, a call for both medical and non-medical personnel in each state has been made by local state governments and NGOs. The following are NGOs offering job opportunities to those willing to join the cause. While medical personnel will be assisting our current doctors and nurses, non-medical volunteers can be assigned to perform basic tasks like contact tracing, monitoring standard operating procedures, and disseminating health information, including in rural areas^[16]. 

• MyVAC (Malaysia Vaccine Support Volunteers) is a dedicated platform established in collaboration with the Ministry of Health (MOH), Ministry of Science, Technology & Innovation (MOSTI), Ministry of Youth & Sports (KBS), Ministry of Higher Education (KPT) and Malaysian Red Crescent Society (MRCS) to assist in the roll out of the government’s vaccination programme, by deploying willing individuals to be part of the vaccination team. 
• Mercy Malaysia is urgently looking for Medical and Non-Medical personnel for the National Covid-19 Immunization Programme in Wilayah Persekutuan Kuala Lumpur. They are offering the following Job Opportunities to be part of the whole project: Medical Doctors, Nurses, Medical Assistants and Non-Medical (Students/Fresh graduates).
• Borang Sukarelawan Menyertai Mobiisasi Pasukan Bantuan Kesihatan Bukan KKM: Is a volunteer drive from the medical community to support the nationwide vaccine programme. 
• The Islamic Medical Association of Malaysia’s Response and Relief Team (Imaret) is calling for volunteers and mobilising them to help at vaccine centers throughout Malaysia. 

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Explore Our Sources:

1. Oxford & Cambridge Society Malaysia. (2021). The Path to Herd Immunity: Close with YB Khairy Jamaluddin. Link.
2. JKJAV. (2021). Statistik Perkembangan Program Imunisasi Covid – 19 Kebangsaan. Link. 
3. DOSM. (2020). Current Population Estimates, Malaysia, 2020. Link. 
4. The Edge Market. (2021). Special Report: Why is Malaysia lagging behind in the vaccination rollout? Link.
5. Wiki Impact. (2021). Can Covid-19 Vaccines Reach Rural Areas in Time? Link. 
6. A. Wong. (2021). Here are 5 ways to sign up for COVID-19 vaccine in Malaysia. Soya Cincau. Link.
7. Malay Mail. (2021). Difficulty in registering for Covid-19 vaccine in rural areas worrying, says Sarawak assistant minister. Link. 
8. Malay Mail. (2021). Pahang MB: 10,000 residents said not checking MySejahtera, influenced by fake news among reasons for missed Covid-19 vaccine appointments. Link. 
9. S. Khalid. (2021). Fines, mandatory vaccination being considered after 52,000 people missed vaccination appointments. The Edge Market. Link.
10.  R. Loheswar. (2021). Report: Over 52,000 people across seven states have missed their Covid-19 jabs. Malay Mail. Link. 
11. Malaysiakini. (2021). Bedridden Grandma Gets Vaccine After Family Paid For Ambulance. Link.
12. Bernama. (2021). 799 who missed appointments caused congestion at Ipoh vaccination centre. Free Malaysia Today. Link. 
13. Bernama. (2021). Govt mulls giving single-dose Covid-19 vaccine to people in rural areas. The Edge Market. Link.
14. Bernama. (2021). Teams in rural areas conducting manual registration for Covid-19 vaccination says Khairy. The Edge Market. Link.
15. The Star. (2021). Volunteers needed: Health DG calling for medical professionals to help battle the Covid-19 pandemic. Link
16. The Sun Daily. (2021). Covid-19: Malaysia needs to mobilise one million non-medical volunteers to assist frontliners – Medical Expert. Link.