Vaccination Coverage: A Crucial Factor In Achieving Herd Immunity In Malaysia — Amanda Yeo

A mass vaccination programme with an emphasis on vaccination coverage across all Malaysian states is necessary.

Although the current administration will increase the funding allocation of the National Covid-19 Immunisation Programme (NIP) from RM3 billion to RM5 billion, low vaccination coverage in several Malaysian states might hinder Malaysia’s progress in achieving herd immunity by the end of this year.

Due to limited vaccine supplies, only 1,338 frontliners (60 per cent) in Sibu Hospital, Sarawak were vaccinated with the first dose in Phase One, as of March 22. As Sibu has 664 active coronavirus cases, the vaccination progress is considered slow, given that the NIP started on February 24. 

Despite the NIP outlining the usage of mobile vaccination clinics, the majority of sites are still concentrated within urban areas along the west coast of Peninsular Malaysia. This can be seen when Sabah and Sarawak registered low vaccination rates as of March 23, which are 1.05 per cent and 1.28 per cent respectively, as shown in Graph 1. 

Graph 2, which shows the total percentage of the population that have received their first doses as of March 23, further revealed different vaccination coverage levels across all Malaysian states. 

In states with larger populations such as Selangor, the number of people receiving the first dose as a proportion of the total number vaccinated with the first dose nationwide is the lowest at 13.61 per cent. Population wise, 20.03 per cent of Malaysians reside in Selangor. This coincides with a low vaccination rate of 0.89 per cent as shown in Graph 1.

In contrast, remaining states with smaller population sizes such as Penang, Perak, Terengganu, Negeri Sembilan, Pahang, Kuala Lumpur, Perlis, Putrajaya and Labuan have a higher percentage of first dose vaccinations administered compared to their populations. 

This is particularly obvious in Putrajaya when the number of people receiving the first dose in Putrajaya over the total vaccinated with the first dose nationwide is 1.07 per cent. But only 0.35 per cent of Malaysians reside in Putrajaya, which gives it a high vaccination rate of 4.07 per cent.

To summarise, these two graphs illustrate that it is relatively easy for the states with smaller population size to mobilise vaccine corps volunteering for the vaccination programme. 

Vaccine corps refer to those who deliver vaccine shots, monitor vaccinated individuals, and schedule second doses for the vaccines to be fully effective.

On the other hand, states with larger populations would have to mobilise a large number of vaccine corps volunteers driving through muddy, uneven roads, besides taking a boat to reach the remote populations who live beyond 5km of any health care facility. A lack of specialists and medical equipment would also hinder the progress of vaccination. 

Despite 86 per cent (430,368 individuals) out of a target of 500,000 people nationwide receiving their first doses of the Covid-19 vaccine during Phase One as of March 23, there is an increasing concern that the vaccination coverage remains low in some states such as Sabah, Selangor, Johor, Kedah, Melaka, Sarawak and Kelantan. 

Compare with Phase One, Phases Two and Three of the vaccination programme will involve more people – 9.4 million during Phase Two and 13.7 million during Phase Three.

To date, Phase Two of the vaccination comprises two categories and will start from the beginning of April until the end of August, covering the following segments: 

  • The remainder of health care workers as well as those in essential services and defence and security personnel. 
  • Senior citizens aged 60 and above, high-risk group with chronic diseases such as heart disease, obesity, diabetes and high blood pressure and people with disabilities (OKU).

Phase Three of the vaccination programme involves both citizens and non-citizens aged 18 years and above, and will run from May until February next year. 

Although the Special Committee on Ensuring Access to Covid-19 Vaccine Supply (JKJAV) plans to set up temporary vaccination centres by utilising stadiums, convention centres, community halls, universities and other appropriate facilities, the NIP Handbook indicates a relatively low number of Vaccines Administration Centres (VACs) allocated for states such as Kelantan, Terengganu, Pahang, Johor, Sabah and Sarawak.

Therefore, to enhance vaccination coverage in all Malaysian states during this year, EMIR Research has several policy recommendations for the JKJAV to look into: 

  1. Enhance coordination between the federal government and state governments to ensure the vaccines are distributed according to the population needs and logistical requirements; 
  2. Mobilise a large number of vaccine corps to volunteer in the vaccination programme. Besides medical, nursing and pharmacy students, vaccine corps can be drawn from community grassroots groups, comprising retired or unemployed clinicians; 
  3. Allocate more vaccines for areas identified as red or orange zones. Red zones are areas with more than 41 confirmed Covid-19 cases, whereas orange zones are areas that have between 21 to 40 cases; 
  4. As the current administration is planning to station 15,000 officers in 950 vaccination centres throughout the country, some of them can be stationed at the East Coast of Peninsular Malaysia and East Malaysia, providing helping hands in less-developed Malaysian states; 
  5. Mark and include all the semi-urban, rural and interior areas, ensuring an effective house-to-house community outreach programme that can be implemented by the National Disaster Management Agency with the involvement of the military. This would ensure citizens in these areas receiving vaccination sooner; and
  6. Consider the Sarawak state government’s plan to vaccinate all categories of people in rural areas at the same time, instead of separating them into phases. It would reduce travelling costs and save time. 

As suggested by the People’s Health Forum in the article “Is vaccination against Covid-19 really necessary?” (Malay Mail, March 22, 2021), a mass vaccination programme would help Malaysia to achieve herd immunity as scheduled. A lower R-naught value (below 1.0) would also enable Malaysia to gauge the right balance between lives and livelihoods, protecting citizens from any deadly epidemic. 

In a nutshell, a mass vaccination programme with an emphasis on vaccination coverage across all Malaysian states is not only necessary but needs to be implemented effectively and efficiently. 

Amanda Yeo is a research analyst at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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