Covid-19 Vaccination Is Not A Zero-Sum Game

Malaysia can spread the burden of vaccinating the elderly and those with comorbidities across the public and private sectors, rather than lining up 9.4 million people under the government rollout alone.

The Malaysian government has set an ambitious, if near impossible, target of vaccinating 80 per cent of the population, or 26 million adults, against Covid-19 in less than a year by this December. Yet, the government appears reluctant to involve the private sector in the race to herd immunity.

Malaysia has a dual health care system, where public and private health spending are nearly equal. Excluding private health care providers from administering shots will only lead to slower vaccination progress for the nation as a whole.

If the issue is about limited supplies – such as with the Pfizer-BioNTech and AstraZeneca-Oxford University vaccines – then such vaccines can be restricted to the public vaccination programme. However, other Covid-19 vaccines – like Moderna, Gamaleya Institute’s Sputnik V, Novavax, and Chinese vaccines like Sinovac, Sinopharm, and CanSino – should be made available to private health care providers in Malaysia if there is sufficient supply, and upon approval by the National Pharmaceutical Regulatory Agency (NPRA). The NPRA yesterday approved the AstraZeneca and Sinovac vaccines.

Moderna’s Covid-19 vaccine has already been approved by American, British, and European regulators, while Sputnik V has been authorised for use in 10 countries. Novavax expects clearance from the US’ Food and Drug Administration (FDA) for emergency use of its coronavirus vaccine as early as May.

Since the Malaysian government has already placed vaccine orders to cover more than 100 per cent of the population, vaccine distributors would be obliged to fulfill government orders first ahead of those by private health care providers.

As it is, Pharmaniaga Berhad has already purchased two million Sinovac vaccine doses meant for the private sector, aside from the 12 million doses that the local pharmaceutical company is supplying to the government. CanSino’s local partner, Solution Biologics, also intends to supply the private sector, besides the 3.5 million doses of CanSino’s single-shot vaccine it is selling to the government.

Running a parallel private Covid-19 inoculation drive – with vaccines independently procured, distributed, and administered by the private sector – will ensure that more people are vaccinated faster, so that the economy can be reopened sooner, rather than later.

In fact, opening up separate Covid-19 vaccination programmes for the Education Ministry’s university hospitals and the Defence Ministry’s army hospitals could expedite inoculation too, rather than face a potential bottleneck in Ministry of Health (MOH) facilities. After all, the Defence Ministry and university hospitals procure their own drug formularies separate from MOH. Why should vaccines be treated differently?

Private health care providers would have the know-how to purchase vaccines from credible distributors that have long been supplying pharmaceutical products in Malaysia, like Pharmaniaga, Zuellig Pharma, or DKSH, amid non-medical companies popping up as Covid-19 vaccine distributors, like a bamboo flooring manufacturer, an engineering and construction company, or a digital government services provider.

The government fails to recognise that cost sometimes isn’t the biggest hindrance in health care. Time is money too. A delay in getting a free shot may cost more than paying for quick vaccination to people who are desperate to resume normal life as soon as possible.

Paying for vaccination in the private sector will just be seen as cost of business for companies that want to quickly inoculate their employees, particularly factory workers across nationality, to avoid closures and loss of human resources from coronavirus outbreaks at their premises. Most Covid-19 clusters have been reported in workplaces.

This would also help the government avoid backlash from xenophobic Malaysians who protest against giving free Covid-19 vaccines to foreigners. Undocumented migrant workers would more likely come out for jabs at their workplace, rather than at a public facility and risk detention and deportation.

On the issue of equity, a parallel private Covid-19 vaccine rollout does inevitably allow people with means to get inoculated ahead of those waiting in line according to the phases of the public programme.

However, it is too simplistic to argue that the middle class and the top 20 per cent (T20) benefit at the expense of low income earners.

Most of the bottom 40 per cent (B40) are probably willing to fork out a few hundred ringgit to get vaccinated early too, since this is far less costly than losing at least 10 days’ worth of income from hospitalisation or quarantine due to Covid-19 exposure.

Malaysia can also spread the burden of vaccinating the elderly and those with comorbidities – who are at highest risk of developing severe Covid-19 disease – across the public and private sectors, rather than lining up 9.4 million people under the government rollout alone.

Each person dropping out of the public queue for vaccination enables those behind them to move up the line. The shots that they give up from the public programme shouldn’t necessarily be seen as wastage either, as these can be used in the event vaccines get spoiled from improper storage.

If a private vaccine rollout is permitted, I don’t think private health care providers should be mandated to implement any sort of phases according to risk, like the public programme. Private facilities should simply open up vaccination to whoever wants the shots. I wouldn’t argue for ceiling prices on vaccines either; people who feel it’s too expensive to get vaccinated in the private sector can choose to wait for their free shots in the public programme.

The patient care factor shouldn’t be dismissed either. People may be more comfortable getting vaccinated by their personal general practitioner (GP) who knows their medical history. I myself have a long list of medical allergies scribbled by my GP.

All the government needs to do is to ensure that those who get vaccinated under either the public or private vaccination programme are registered in a common database. Since the government is using MySejahtera to keep track of people’s vaccination, then the app should be opened up to private health care providers to report the status of the people they vaccinate.

The key objective of the government’s Covid-19 vaccination strategy, according to Vaccine Minister Khairy Jamaluddin, is to reduce hospitalisation and death from Covid-19, hence the prioritisation of the elderly and people with underlying health conditions under the public rollout.

The secondary objective – or perhaps even the primary one for the government – is mass vaccination to achieve herd immunity. Prime Minister Muhyiddin Yassin said recently that state and international borders would only be opened upon certain vaccination coverage.

If that’s the case, then there is no reason to deny assistance from private health care providers. The government cannot try to claim all the credit for ending Covid-19, while refusing to accept blame for its various missteps in the management of the epidemic that completely sidelined the private sector. Covid-19 vaccination is not a zero-sum game.

Boo Su-Lyn is CodeBlue editor-in-chief. She is a libertarian, or classical liberal, who believes in minimal state intervention in the economy and socio-political issues.

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