Lessons learnt for pandemic preparedness in Malaysia ― Chan Chee Khoon

1. Undocumented migrants in novel infectious outbreaks

‘Malaysia, sadly, is reaping the consequences of decades of corrupt mismanagement of the “supply chain” for foreign labour, viz. a persistently large pool of undocumented migrant workers, often in congested workplaces and dormitories, who have strong incentives to avoid contact with government agencies. 

‘Already fearful of detection, arrest, and deportation in pre-pandemic times, undocumented migrants’ insecurities were exacerbated by the policy reversals of the Majlis Keselamatan Negara (MKN) and its contradictory messaging over an offer of temporary amnesty to facilitate Covid testing, contact tracing, isolation & treatment, and vaccination.

‘This deeply rooted problem with undocumented migrants, which persists despite repeated rounds of amnesties, will prolong our catastrophic experience with Covid-19 (and future pandemics as well).’

2. Local manufacture of vaccines

‘The major bottleneck was vaccine supply.  The likelihood of further variants and endemic Covid emphasises the importance of local capacity for manufacturing vaccines and other pandemic essentials, as part of Malaysia’s pandemic preparedness.’

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

Include migrant workers in Covid-19 vaccination or face disaster – P Gunasegaram

‘A decades-old problem studiously ignored by successive governments – despite so many articles written and questions raised in Parliament and elsewhere – is going to come back and bite us on our backsides as we desperately deal with increasing numbers of infections and deaths from the Covid-19 pandemic.

‘Unless and until the problem of migrants – specifically migrant workers, both documented and undocumented – is properly considered and included in any Covid-19 mitigation programme, things will continue to get worse even as more people are vaccinated. And there is no telling how long the problem will be around us.

‘The only way to overcome this major roadblock is to simply remove it and wholeheartedly include as many as six million migrant workers (which is about a third of the documented and undocumented workforce of an estimated 18 to 19 million) into the vaccination programme – the only workable solution right now to mitigate the pandemic and get back to some form of normalcy.’

Read here (The Vibes, July 29, 2021)

10 Covid-19 vaccine vexations to ponder on – P Gunasegaram

‘It’s a rather trying time for all of us, and many are the aspects of the pandemic in Malaysia that remain unanswered despite frequent questions from the public. Today, we will focus on 10 Covid-19 vaccination vexations. There are more, but the 10 main ones will do for now.

1. Why were we late to vaccinate people?
2. What will be the total cost of vaccination?
3. Is there a breakdown?
4. Are middlemen involved, and who are they?
5. Are mega vaccination centres necessary, how much do they cost, and are they sources of infection?
6. Are there alternative distribution channels, and why were they not used?
7. Are migrant workers being vaccinated?
8. What about undocumented workers?
9. Is there a black market for vaccines?
10. Why are people getting blank jabs?

Read here (The Vibes, July 22, 2021)

Malaysia enforces requirement for improved worker lodging to rein in Covid-19

‘Malaysia has gazetted an emergency ordinance compelling employers to provide lodging with sufficient living space and amenities for migrant workers to effectively control the spread of Covid-19, the Human Resources Ministry said on Thursday (Feb 18).

‘It is among the first emergency ordinances - laws that do not require prior parliamentary approval - to be enforced since a national emergency was declared on Jan 12 to curb the coronavirus spread.

‘Covid-19 infections in Malaysia have raged among migrant workers who typically work and live closely, with an outbreak at world's largest glove maker Top Glove becoming the largest cluster in the country in December after more than 5,000 workers were infected.’

Read here (Straits Times, Feb 18, 2021)

Khairy: Non-citizens to receive free Covid-19 vaccines to ensure everyone is safe

‘Malaysia will only be safe from the Covid-19 pandemic if the people, including foreign citizens living here, receive the vaccines, said Science, Technology and Innovation Minister Khairy Jamaluddin. He said that even if Malaysians were to receive the vaccines, it would not mean they are safe because Malaysia has about three million foreigners who are likely to cause the virus to spread and infect Malaysians.

“That is why this (giving free vaccines to non-citizens) needs to be done because we are not safe until everyone is safe. In vaccine science, if there are more vaccine recipients, then we are safe and the virus cannot infect others. As such, we are targeting 80 per cent of the population to create group immunity and form enough antibodies so that the virus does not infect people in the country. If we (locals) are the only recipients, we will not be safe because they (foreigners) may still infect us, or the virus could spread among the foreigners. That is why it is important that we protect everyone. This is the right decision for the sake of humanity,” he said.’

Read here (Malay Mail, Feb 12, 2021)

Prevalence and outcomes of SARS-CoV-2 infection among migrant workers in Singapore

‘There were 43 dormitories housing 198 320 migrant workers with a median occupancy of 3578 (interquartile range, 1458-6120); 99.8% of residents were male, with a median age of 33 years (interquartile range, 28-39 years). As of July 25, 95.1% of all residents had at least 1 SARS-CoV-2 test, including 63.6% with PCR and 68.4% with serology. There were 111 280 residents with a positive PCR or serology result, for an overall infection prevalence of 56.1% (95% CI, 55.9%-56.3%) (range per dormitory, 0%-74.7%; median, 52.9%). 

‘There were 24 197 clinical cases (12.2% of all residents; 21.7% of infected) from 42 dormitories and 87 083 subclinical cases (43.9% of all residents; 78.3% of all infected) (Table). Of all clinical cases, 20 cases required ICU admission (0.08% [95% CI, 0.05%-0.13%]), with 1 COVID-19 attributable death (case-fatality rate, 0.004% [95% CI, 0.0002%-0.027%]).’

Read here (JamaNetwork, Feb 9, 2021) 

The vaccine, migrant workers and herd immunity -- Jeyakumar Devaraj

‘Let us look at the numbers - our population is 31 million. We have six million migrant workers and another 200,000 refugees. So altogether there are 37.2 million people residing in Malaysia. 

‘The government has said that children and pregnant women will not be given the Covid vaccine - that is about six million children 12 years and below and 0.5 million pregnant women. 6.5 million is 17.5 percent of 37.2 million.

‘In other words, we could achieve our 80 percent immunisation rate if all migrant workers also took the vaccine. But if all of them didn’t, then we would have 12.7 million not vaccinated - children, pregnant mums, migrant workers and refugees - and 12.7 million is 34 percent of 37.2 million. We only achieve a vaccination rate of 63 percent - far short of the 80 percent we need to get herd immunity!’

Read here (Malaysiakini, Jan 30, 2021)

The worst of Malaysia's Covid-19 measures is yet to come: Sin Chew Daily columnist (Straits Times, Jan 25, 2021)

‘According to the government, this is to prevent a full-fledged impact the lockdown will have on the country's economy. Finance minister Tengku Zafrul has said the first MCO imposed nationwide last year cost the country RM2.4 billion (S$787 million) a day, but only RM600 million a day this time. While allowing key economic sectors to operate as usual could help arrest the daily economic loss, there is nevertheless a hefty public health price to pay...

‘To break the infection chain, we cannot afford to take things for granted. If the government eventually decides to extend the current MCO, it must tighten the SOPs, even to the extent of locking down all economic activities, or we will stand to lose even more if MCO is extended over and again. The situation now is indeed alarming.

‘From infection clusters mostly linked to migrant workers, factories, shopping malls, prisons and detention centres, we now have new clusters emerging in workplaces and even medical centres. All this highlights the fact that the virus has not only penetrated our communities but is fast expanding its reach, and may soon come to you or your family members, colleagues and friends.’

Read here (Straits Times, Jan 25, 2021)

Pandemic forces Malaysian palm industry to rethink reliance on foreign labour

‘Malaysia's palm oil producers are embarking on a rare recruitment drive to hire locals and accelerating industry mechanisation as they grapple with a severe shortage of foreign labour due to the coronavirus pandemic. As the September-November peak production season approaches, companies are erecting banners near plantations and posting online job advertisements boasting free housing, free water and other perks of estate life in a bid to lure workers to do everything from driving tractors to harvesting.’

Read here (Reuters, August 18, 2020)

One in six foreign workers in dorms contracted Covid-19, based on official tally

‘About one in six foreign workers living in dormitories contracted Covid-19, a calculation based on Singapore's official tally showed, but the true infection rate in the dormitories is likely to be higher than this, experts say. If accurate, however, an infection rate of one in six would not be enough for herd immunity to develop in the migrant worker population, they added. A total of 52,425 out of 323,000 workers had been infected as of Wednesday.’

Read here (Straits Times, August 14, 2020)

Long and hard battle to clear worker dorms of Covid-19

On August 7, Singapore finished testing all 323,000 workers in dorms for Covid-19 -- a "massive undertaking" that has taken four months. This story with a video shows how the Sungei Tengah Lodge, a worker dormitory for 23,000, has been cleared of Covid-19. It provides some images of the living conditions there (after they have been cleaned up) and reveals how various agencies as well as the dorm operator have worked together to clear the virus.

Read here (Straits Times, August 8, 2020) 

Dengue fever, second wave: What are the hurdles Singapore faces in its coronavirus fight?

(1) Clearing the Covid-19 disease from worker dormitories remains the biggest challenge. ‘The testing in dorms is now in the “final stretch”, with 232,000 cases confirmed as recovered or virus-free as of July 16.’
(2) Singapore’s second challenge comes from imported cases, although the city state has limited this risk by shutting its borders.
(3) Singapore also faces the risk of a resurgence in infections triggered by a failure to comply with safe-distancing rules, which remain in place despite the lockdown being lifted.
(4) The fourth challenge is the simultaneous onset of dengue fever in Singapore, which has seen some 19,000 cases so far this year.

Read here (South China Morning Post, July 22, 2020)

Do not discriminate against migrant workers, Health DG warns

‘With Covid-19 infection clusters emerging in three immigration detention centres, Datuk Dr Noor Hisham Abdullah has said that negative sentiments against detainees must not be amplified and must not be a catalyst for discrimination in saving lives. The Health director-general said that the whole of government and whole community approach should work together to fight the virus.’

Read here (The Star, May 25, 2020)

In Taiwan’s ‘container houses’ for migrant workers, coronavirus not the only health risk

‘While Taiwan has avoided a huge outbreak, activists doubt the government’s readiness to protect migrant workers, some of whom live in dorms of 30 people a room. Aside from the coronavirus, packed dorms located within factory grounds leave workers at risk of fire hazards.

‘In Taiwan, there are more than 718,000 blue-collar migrant workers. The highest number – nearly 280,000, or about 40 per cent of the migrant worker community – comes from Indonesia, followed by Vietnam (221,400), the Philippines (158,700) and Thailand (58,700). They mostly work in the manufacturing and caregiving sectors, as well as agriculture, forestry and fishing.’

Read here (South China Morning Post, April 26, 2020)

The Achilles heel of Malaysia’s Covid-19 battle

‘There is a major “Achilles Heel” in our Covid control programme that has yet not been addressed comprehensively – the six million or so migrant workers in our country, two-thirds of who are undocumented, and the majority of whom live in crowded unsanitary conditions.

‘The PSM has been advocating since March 19 that the government reaches out to this community and win their trust as our main weapons for containing Covid-19 – case identification, contact tracing, isolation of cases and contacts – will be resisted by the migrant community because they will be afraid that, after the two weeks of quarantine in a government facility, they might be charged for immigration violations, flogged, jailed and/or deported.’

Read here (Malaysiakini, April 18, 2020)

From ‘gold standard’ to a coronavirus ‘explosion’: Singapore battles new outbreak

‘There were warning signs before the new outbreak. On Feb. 10, after a Bangladeshi labourer became the first to be infected with the virus, lawyer Dipa Swaminathan, founder of It’s Raining Raincoats, an initiative that works with migrants, wrote a Facebook post warning that ‘the spread among them could be rapid, given the cramped conditions in which they live, work and are transported.’

‘Health officials said the man had visited Mustafa Center, a giant shopping complex in Singapore’s Little India district that is popular with foreign workers.

‘But as recently as two weeks ago, shoppers were going in and out of the building without temperature checks, and few employees were seen wearing masks. On Tuesday, the government said 86 infections had been linked to Mustafa Center.’

Read here (Los Angeles Times, April 14, 2020)

Health insecurity and its impact on refugees in Malaysia

Refugees and asylum seekers in Malaysia have always struggled with a lack of identification and healthcare. How have these issues impacted the Government’s response to Covid-19? What are some of the challenges that will still need to be addressed beyond the MCO?

Read here (ISIS Malaysia, April 10, 2020)

Making the invisible visible: Faces of poverty in Malaysia revealed under the MCO

This article, by Bridget Welsh and Calvin Cheng, is written in the context of the current movement control order (MCO) as a result of the Covid-19 outbreak. It concludes:

‘Moving ahead, a serious rethink of how to address vulnerabilities and the poor is needed, beyond cash transfers of assistance and other immediate relief measures. The poor as a whole need to be recognised and disaggregated, with more attention to how to treat those facing the most serious hardships. A key step is to start getting the numbers right and to stop leaving out the many different groups being affected.

‘Practically, a task force can be set up to look at different sets of policies that are more holistic in addressing needs and causes along the various dimensions, with greater collaboration with NGOs, academics and international organisations, notably United Nations High Commissioner for Refugees (UNHCR). This will allow for better targeting of available limited resources, offer opportunities to find new resources and importantly, allow for the framing of sound policies that will not just ameliorate problems caused by Covid-19, but also work to address the underlying social conditions that will inevitably worsen as the economy contracts.

‘A crucial part of the way forward is to make the reality of poverty more visible.’

Read here (Malaysiakini, April 4, 2020)

‘Rethink healthcare for migrant workers’

‘The government needs to rethink its healthcare policies towards undocumented migrant workers as the current policy drives them underground and made contact tracing and quarantine difficult for management of outbreaks, said epidemiologist Dr Chan Chee Khoon. He said Malaysia could not ignore its large pool of undocumented migrant workers as long as contact tracing (those who have come in close contact with those who have been tested positive with Covid-19) and quarantine remained as tools for managing the outbreak.

“The Health Ministry and Home Ministry need to rethink their policies towards undocumented migrant workers, which currently drive them underground rather than encourage them to come forth to seek treatment when afflicted with infectious and other ailments. It would be extremely difficult to carry out contact tracing when undocumented migrant workers have strong incentives to avoid contact with government agencies, ” he said.

Read here (The Star, Mar 3, 2020)