How to manage vaccine liability in Malaysia

‘While different systems vary in terms of elements of compensation and funding mechanisms, we can adapt the policies related to funding, proving injury and distributing compensation involving multiple parties. For example, we can set up a bespoke Covid-19 vaccine compensation programme. The programme could be co-financed by a mixture of public and private funds (eg. led by insurers), to achieve effective immunisation roll-out while providing a fair and equitable remedy and reduce overall costs to society.  

‘Two, Malaysia’s government can adapt the Singapore model and completely assume the financial costs of any serious adverse events from the vaccine. The list of serious adverse events that are covered, the mechanism of approval and the ministry which will pay are details that can be decided by a relevant committee. Given serious adverse events are rare, the overall cost should be manageable and represents a good investment for public confidence.

‘A third option is the Covax Facility’s no-fault-compensation scheme for indemnification and liability. The scheme proposed by Covax aims to set up a compensation fund for vaccine recipients in participating countries who might suffer any side-effects from COVID-19 vaccines. The scheme proposes a new mechanism to pay a lump-sum based on severity of harm to victims from Covid-19 vaccines associated side effects. The proposed mechanism would be funded by earmarking funds from high income countries or by charging taxes on pharmaceutical companies.  

‘There are reasonable solutions to the problem, and Malaysia must have a full-frontal and honest conversation about how to manage adverse events, no matter how unlikely they might be. All the solutions described above are not mutually exclusive. However, implementing them requires political will and courage. Covid-19 vaccination is a collective national effort, and we must do all we can to increase public confidence in the vaccine by providing appropriate liability protections.’

Read here (Malay Mail, Feb 11, 2021) 

MCO 2.0 should have been tool of last resort, says ex-deputy defence minister Liew Chin Tong

‘The current movement control order (MCO) would not have to be implemented if the Health Ministry (MOH) had properly conducted Covid-19 tracing and screening as far back as April last year, according to deputy defence minister Liew Chin Tong. The DAP senator said a whole-of-government approach from the start, rather than one that placed the burden solely on the MOH, would have prevented the current high number of infections in the country.

“To put it into context, it doesn’t inspire confidence if halfway into a war, the army general (in this case, the Health DG) complained to the media that the air force (the other health institutions/labs) has forgotten to provide for air cover,” Liew said on his Facebook page today. He was referring to Health director-general Tan Sri Dr Noor Hisham Abdullah’s recent statement that MOH labs have nearly reached their maximum capacity of 76,000 Covid-19 tests daily, even as there is a need to increase screening to between 150,000 to 200,000 tests daily.

“Dr Noor Hisham lamented that so far the testing capacity at university hospitals was at 27 per cent, private laboratories (31 per cent) and laboratories in the Malaysian Armed Forces hospitals (24 per cent). These facilities are underutilised and could increase their capacity up to 100 per cent to achieve the daily test target.’

Read here (Malay Mail, Feb 7, 2021)

Malaysia in Covid-19 crisis? — Musa Mohd Nordin

‘We are plagued with the Double Whammy. MCO + EO. A poorly managed Pandemic in bed with a poorly managed Politics. Pandemic + Politics. It cannot get any more worse! Yesterday Malaysia was in panic mode! Triggered by the humongous Covid-19 numbers Chill out Malaysia! It is NOT REAL TIME case numbers. These are just BACKLOG cases only just being reported

‘Contact Tracing is virtually at a STANDSTILL. An officer at a PKD had 600 contacts to trace and yesterday was slapped with another 700 to trace These are all the manifestations of a failure of the system. There is a breakdown in the FTTIS work flow! How much longer can we tolerate these failings and lackluster performance?

‘It has been SYSTEMS GO in Selangor over and above the efforts of JKNS. They are our buddies in Selangor to rid Covid-19. Please share this widely with your friends in Selangor.

‘STFO is the Operations arm of STFC [Selangor Task Force on Covid-19] led by Public Health Physician, Prof Farhan [Asst Prof Dr Mohammad Farhan bin Rusli (Consultant Public Health Physician, International Islamic Universiti Malaysia)] to bust Covid-19. It aims TO FLATTEN THE CURVE IN THE COMMUNITY WITHIN 4 WEEKS. The MCO + EO has interrupted STFO operations. With JKNS they are resuming with vigor with the blessings of the State Government.

STFO Blueprint of Action

1. ALL +ve or household that is +ve to register under SELangkah (so that state govt can provide home kits
2. ALL high risk and household with HIGH risk persons, to pre register SELangkah: (a) for B40, we provide voucher (FREE testing) to go to nearest Selcare clinic panel (static) or mass screening (mobile); (b) for non-B40, encourage them to do testing (we provide list of participating Selcare panel clinic)
3. Community mass screening (mobile) to HIGH RISK RANK areas (from ACURA) to HIGH RISK individuals OR HOUSEHOLDS with HIGH RISK individuals (from pre-register SELangkah) e.g. (a) Old folks home (b) Hemodialysis centers (c) Nursing homes for the elderly 
4. Mass screening (mobile) to HIGH RISK super spreaders e.g. (a) communities living in crowded spaces (b) families in PPR flats (c) migrants (d) refugees. Data obtained from community leaders, refugee/migrant centric NGOs, UNHCR.
5. State / Selgate to buy RTK-Ag in bulk. To provide at minimal cost to Selcare Clinic panel. Participating Selcare Clinic panel to provide at standard low cost price. At least 2 participating Selcare panel per district.
6. To encourage ADUN to subsidise the cost and liase with respective participating Selcare clinic panels
7. To increase  Health Education Advocacy to do testing and isolate: (a) SYMPTOMATIC individuals with +ve close contacts must ASAP do testing & treatment (if needed) at nearest KKM's facility. Call 999 if severe symptoms (b) ASYMPTOMATIC individuals with +ve close contacts, encourage to do testing at nearest participating Selcare Clinic panel (c) SYMPTOMATIC inviduals with NO +ve close contacts, must do testing at nearest KKM's facility (or participating Selcare clinic - if KKM reject testing)
8. Activate GEOFENCING via SELangkah AND communicate SELamat warning system
9. Home Kits provided by STFO: Face Masks, Hand sanitiser, Information pamphlet,  Foodpack / vouchers -- for B40, unemployed, does day jobs,  SpO2 monitors include training and monitoring (for high risk patients only)

Read here (Malay Mail, Jan 31, 2021)

What about the Chinese Covid-19 vaccines? — Dr Musa Mohd Nordin

‘The Chinese vaccines are rapidly making inroads into the Malaysian vaccine market place. After the 39 per cent Pfizer-BioNTech, 10 per cent AstraZeneca-Oxford and 10 per cent COVAX vaccine advance bookings, there is now reported, a 22 per cent booking of the Sinovac vaccine. 

‘China’s Sinovac Lifesciences Co Ltd, manufactures the inactivated vaccine, CoronaVac which is administered intramuscularly, two doses, two weeks apart. And can be stored in a standard refrigerator at 2-8 degree Celsius, unlike the arctic temperatures required for the mRNA vaccines...’

Read here (Malay Mail, Jan 29, 2021) 

If it ain’t broke, don’t fix it — Musa Mohd Nordin

‘The data shows that the MOH is doing relatively well. The risk of a Covid-19 death per population n Malaysia is 1 per 50,000. This compares favorably against the Global average of 1 per 3,676.b It is worse in the UK and US, 1 per 700 and 781 respectively...

‘Despite the surging numbers of Covid-19 cases, the MOH infrastructure and services are holding up well and delivering good outcomes when compared to the US, UK and our southern neighbours. Therefore, if it ain’t broke, don’t fix it. It is in this context that the following suggestions are made:

1. The MOH should continue to operate with the 52 dedicated Covid Hospitals.
2. If these are inadequate to meet the current surge in Covid-19 cases, select private and government facilities can be transformed into dedicated Covid Hopsitals.
3. The concept and operations of Hybrid Hospitals should be avoided as much as possible. It compromises the Quality of Care, especially among the Category 4-5 patients, and the Safety of patients, HCW, other hospital staff and visitors, due to the real risk of nosocomial infection from this most transmissible coronaviruses.
4. The lay public is fast becoming very fearful of Covid and Hybrid hospitals and this has led to them shunning away from hospitals despite their need for regular hospital visits and review.
5. If they delay or miss their appointments, the management of Non-Covid illness eg NCD, Cancers, Immunization uptake, will be compromised.
6. The MOH has begun to decongest and create more empty General and ICU beds in Covid Hospitals by discharging Category 1&2 patients to Home Isolation with clear instructions on the use of Health Assessment Tools.’

Read here (Malay Mail, Jan 24, 2021) 

Key measures to reduce the Covid-19 raging fire ― Amar-Singh HSS

‘Many individuals and groups have voiced suggestions to manage our raging Covid-19 pandemic in Malaysia. However few appear to have been considered. Allow me to summarise five key measures we critically need to take to help put out the Covid-19 raging fire in our nation:

• Test extensively
• Restore contact tracing
• Support MoH staff
• Improve home quarantine
• Widen pick-up services

Read here (The Malay Mail, Jan 23, 2021)

FTTISI:The bedrock of Covid-19 infection control — Dr Musa Mohd Nordin and Dr Mohammad Farhan bin Rusli

‘The key element in the blueprint of action to mitigate this Covid-19 national emergency, must surely be a well executed Find, Test, Trace, Isolate and Support (FTTIS) system recommended by the WHO, which has fallen terribly short in national implementation.

‘The FTTIS system Finds and Tests hotspots of Covid-19 outbreaks. Rapid Isolation of cases and quarantine of close contacts through Tracing is extremely critical. Isolation will only work if the rakyat, especially the B40, receive Support during the MCO period with food security and financial Support.

‘The government through its relevant ministries and agencies must provide this social security net and support to this new policy of home isolation to ensure its success. Otherwise, the rakyat will fail to comply with home isolation, in order to search for and put food on the table and scour for basic home essentials. The government already has in place Low Risk Isolation Centres for households who are unable to effectively isolate at home.

‘Clinical support is also vital for monitoring the health of cases and contacts who are undergoing home isolation in the community.’

Read here (Malay Mail, Jan 15, 2021)

Khairy: If you’re a healthy Malaysian under 60 and not a frontliner, expect to be vaccinated only by Q3 2021 or even later

‘Malaysians who are not active frontliners, below the age of 60 and in relatively good health can expect to receive their dose of Covid-19 vaccinations only by the third-quarter of this year or later, the science, technology and innovation minister revealed today. Khairy Jamaluddin, also the Special Committee on Ensuring Access to Covid-19 Vaccine Supply (JKJAV) co-chair, said this is because the first batch of vaccines to arrive will be prioritised to inoculate those within vulnerable groups. 

“Frontline workers from the healthcare and security sectors will go first. Then senior citizens and people with chronic illnesses. Only then we will move on to the general population in order to get to a meaningful herd immunity threshold.’

Read here (The Malay Mail, Jan 14, 2021)

Covid-19: Thank you, Agong, for declaring national state of Emergency — Malaysian Medical Association

‘The Malaysian Medical Association (MMA) wishes to thank His Majesty Yang di-Pertuan Agong Al-Sultan Abdullah Ri’ayatuddin Al-Mustafa Billah Shah for declaring a national state of Emergency to bring the Covid-19 situation in the country under control.

‘We also support the government’s decision to implement the second MCO in six states — most affected by the surge in cases of Covid-19, the CMCO in six other states and the RMCO in Perlis and Sarawak. MMA will provide support in any way it can to assist the Health Ministry and the government manage the Covid-19 situation in the country. We urge the public to give their full support by fully adhering to the MCO’s SOPs that will be announced this evening.

‘A second MCO is indeed necessary as cases of Covid-19 have been consistently on the rise with no sign of improvement. There is also spread in the community and the infection rate has not come down from the current RO of between 1.1 and 1.2. There is also concern over the B117 Covid-19 strain known as the UK strain that has been detected in the country...’

Read here (Malay Mail, Jan 12, 2021)

Where is Malaysia headed with Covid-19? Dr Amar-Singh HSS

‘For Malaysia to have a hopeful 2021 where Covid-19 is concerned we need the following changes in outlook and behaviour.

• Transparency is crucial: ‘If we want to move forward then there must be transparency. We must not learn about things first from whispers on social media and cries for help on Twitter or Facebook. We must learn it first from the authorities, no matter how unpalatable the situation...’
• Stop blame shifting and take responsibility: ‘Stop putting the entire blame on the public for the failure to control the pandemic. It is time to stop fining and arresting the average citizen for SOP violations. The failure of some elected representatives in government to maintain effective SOPs and the lack of penalty for them is a major thorn in the side of the public...‘
• We need many voices: ‘We need many people with ideas to speak up. We need many divergent views to be aired and discussed. We need an ongoing national dialogue to chart the best way forward...’ 
• More support is required: ‘The amount of resources and support we have put into dealing with this pandemic is still limited. We need to ramp up our support and initiatives. We urgently need to absorb all the health manpower that is available (before we lose them to our neighbours)...’

Read here (The Malay Mail, Jan 1, 2021)

European Commission embarrassed by Covid-19 vaccine price leak

‘The tweeted information gave the following price per dose for each vaccine maker, in either euros or US dollars according to the respective contract:

1. AstraZeneca: €1.78
2. Johnson & Johnson: US$8.50
3. Sanofi/GlaxoSmithKline: €7.56
4. Pfizer/BioNTech: €12.00
5. Curevac: €10.00
6. Moderna: US$18.00’

Read here (Malay Mail, Dec 18, 2020) 

PM Muhyiddin: Govt to order more Covid-19 vaccine to cover 60-70pc of Malaysians

‘The government has plans to increase its purchase of the Covid-19 vaccine to cover the immunisation needs of about 60-70 per cent of Malaysians compared to 30 per cent currently. Prime Minister Tan Sri Muhyiddin Yassin said this was because some nations had purchased doses exceeding their population.

“As for Malaysia, we have already got 30 per cent. I have instructed Health Minister Datuk Seri Dr Adham Baba along with Khairy Jamaluddin Abu Bakar (Minister of Science, Technology and Innovation) to negotiate and increase it from 30 per cent to 60 or 70 per cent.’

Read here (Malay Mail, Dec 13, 2020)

Polls reform panel hails govt review of electoral process for Covid-19 era

‘The Electoral Reform Committee (ERC) today welcomed the government's willingness to review create laws concerning elections during the pandemic. Its chairman Tan Sri Abdul Rashid Abdul Rahman said it is high time a comprehensive review be conducted on existing laws for the electoral process, whether it is for by-elections or for a general election. “This is especially to determine if elections can be suspended in times of crises, including those related to health, public disorder, natural disaster, or in situations which threaten national security,” he said in a statement.’

Read here (Malay Mail, Nov 3, 2020)

We need fresh ideas to handle the Covid recession — Jeyakumar Devaraj

‘What is the most appropriate budget for Malaysia to navigate the economic recession that the Covid pandemic has precipitated? This is the crucial issue we should be discussing so that appropriate solutions can be found. Each country needs to develop a national consensus on how the finite financial capacity of the nation should be deployed to limit the health and economic fallout of the ongoing pandemic. Unfortunately, we in Malaysia have been distracted by political intrigues for far too long.

‘The PSM would like to share our analysis of the current recession and put forward a set of ideas on how we should tackle the economic fallout of the Covid Pandemic. We need a clear understanding of the situation we are in so that we can plan coherently for the coming year...’ 

The analysis and suggestions come under seven headings:

1. We cannot “talk up” the economy
2. Pumping in more credit into the system is not going to work
3. The government has to take the lead role in managing the economy and protecting the rakyat
4. This is not going to be a V-shaped recession
5. More targeted relief for the poorest families
6. A “Green New Deal” for Malaysia
7. The government should use “debt monetisation” as one of the methods to raise funds for the programs mentioned above.

Read here (The Malay Mail, Oct 28, 2020) 

Use emergency funds for Sabah’s Covid-19 fight as donations will be slower, doctors tell federal govt

‘The federal government should allow emergency funds to be used for resources and equipment to tackle Sabah’s Covid-19 situation, the Malaysian Medical Association said today. MMA president Professor Datuk Dr Subramaniam Muniandy cautioned that waiting for donations for Sabah’s Covid-19 fight would not be time-effective when there is an urgent need for more medical resources in the state.’

Read here (Malay Mail, Oct 18, 2020)

Decentralise to manage increasing cases of Covid-19 — MMA

‘Now is the time to decentralise communication channels, ensure that each state take ownership of the exploding pandemic and are able to act independently with speed in their own jurisdictions’. MMA (Malaysian Medical Association) suggests the following:

1. State Crisis Command Centres to coordinate all activities and ensure needs of the state are met on all fronts.
2. NGOs and public are coordinated to assist the state efforts.
3. All relevant data including equipment, manpower, bed strength, testing capacity etc are displayed on the State Command centre dashboard for stakeholders to coordinate, in particular to include data on shortages and needs.
4. Private sector hospitals, clinics and doctors are engaged in the fight against the pandemic.
5. For federal government to channel all support urgently including funds, resources and manpower.

Read here (Malay Mail, Oct 8, 2020)

Covid-19: Protecting our children ― Amar-Singh HSS

‘This recent infant death will have alarmed parents and those of us working with children. We want to know how we can protect our children better. The clear message is that we cannot protect our children without controlling the pandemic in the community; these two are intricately linked. I would like to offer some suggestions of what we can do in the face of the extensive community spread that is currently occurring in the country.’

• Improve SOPs at schools, taskas, child care facilities
• Strengthen our contact tracing with data transparency
• Advocate for health support to be ramped up with regards to (1) testing (2) use of rapid antigen detection tests (3) boost of manpower at MOH (4) injection of funds at MOH for equipment, PPEs, etc
• Stop poor leadership by example that hampers population compliance

Read here (Malay Mail, Oct 7, 2020)

Ministry: Malaysia will join Covax initiative to ensure Covid -19 vaccine acquired quickly at affordable price

‘The Ministry of Science, Technology and Innovation (Mosti) today clarified that Malaysia will be signing up for the global Covid-19 vaccine development platform Covax. The ministry in a statement today said that the government is currently discussing the terms of joining the Global Alliance for Vaccine and Immunisation (Gavi), which is managing the Covax initiative.

‘Yesterday, the Malaysian Medical Association (MMA) today urged the government to explain why Malaysia has yet to join the Covax Vaccination Plan co-led by the World Health Organisation (WHO). MMA president Dr N. Ganabaskaran said the association believes even if Malaysia has its own bilateral negotiations for a vaccine, signing up for the Covax Vaccine Plan can be an added option that will guarantee access to vaccines for Covid-19.’

Read here (Malay Mail, Sept 19, 2020)

With RMCO extended to Dec 31, here’s a (gentle) reminder of what you can and cannot do

‘Bearing in mind the strict standard operating procedures (SOP) enforced by the National Security Council (NSC), here are some of the things we can and cannot do until New Year’s Eve, or when the government announces otherwise.’ 

Read here (Malay Mail, Sept 11, 2020) 

There is no ‘new normal’: We were not normal to begin with

‘We would like to say that there is no ‘new normal’ because we were not normal to begin with. We have been abnormal as a society for a very long time. The coronavirus has helped to unmask our sick society and systems that we have developed and evolved over many decades. Greed, corruption, power hunger, control, oppression, lies and self-interest have become the hallmarks of our present society, and in most nations. While there are altruistic individuals and some who are trying to improve the situation, many are caught in the chase for wealth and power. Most have become cynical, hope-less and weary.’

Read here (The Malay Mail, August 30, 2020)