Malaysia reached two Covid-19 milestones in May 2021. On May 31, its position in the global ranking of cumulative cases reached 39, an increase from position 85 on November 18, 2020. It also surpassed India in the daily number of newly confirmed per million population on May 23.
These speak volumes for the management of Covid-19 in Malaysia.
Although vaccination is not the silver bullet, much hope has been placed on it to help the country get to grips with the devastation that Covid-19 has brought.
The goal is to vaccinate the population in the shortest possible time. But there is nothing to shout about the vaccination rate in Malaysia, which has been glacial.
The role of the private sector in this effort has been recognised, albeit very belatedly.
ProtectHealth Corporation Sdn Bhd (“ProtectHealth”), a not-for-profit company of the Health Ministry, was appointed to implement the participation of the private sector in the National Covid-19 Immunisation Programme (PICK).
Private hospitals started vaccination in mid-March 2021. The assistance of general practitioners (GPs) is being sought to participate in the government’s vaccination efforts.
The scope of work of the GPs involves pre-vaccination assessment of the recipient, counselling, taking the recipient’s consent, vaccination, observation for any adverse event after the vaccination, and management and reporting of vaccine stock, use, wastage and disposal.
The GP’s clinic has to be registered under the Private Health Care Facilities and Services Act. The GP has to adhere to ProtectHealth’s vaccination manuals and to undergo specific Covid-19 vaccine training provided by ProtectHealth.
The GP has to provide his or her own appropriate personal protective equipment (“PPE”) to be used during vaccination. The clinic has to have suitable IT devices with internet access and has to use the Health Ministry’s vaccination programme system i.e. MyVAS, VMS & VCS.
In addition, the clinic has to have adequate numbers of appropriately trained medical and non-medical staff; and provide appropriate emergency equipment to manage emergencies related to Covid-19 vaccination.
The clinic is required to ensure secure storage of the vaccine and have proper cold chain equipment e.g. cold box, electronic temperature data logger and pharmaceutical fridge (2-8 degrees Celsius).
The clinic is responsible for the safety of the vaccines upon receipt and storage. The clinic has to order and collect the vaccines from the nearest assigned Ministry of Health (MOH) facility.
The clinic is required to have adequate waiting space for recipients and observation after vaccination in accordance with physical distancing requirements.
The clinic has to maintain all documents including consent forms; recipients vaccination records; vaccine storage temperature log; vaccine breakage, spillage and loss; adverse reactions management and reporting; and vaccine record form.
ProtectHealth has the right to conduct on-site audit from time to time.
A circular from ProtectHealth, dated June 2, 2021, received by GPs, permits a clinic to inform that is a vaccination centre. In doing so, the clinic is required to include the logos of the MOH, Ministry of Science, Technology and Innovation (MOSTI) and ProtectHealth, with the logos of MOH, MOSTI and ProtectHealth no smaller than the clinic’s logo.
There is, however, no clarity on the medico-liability in the event a recipient suffers an adverse event. Will ProtectHealth accept liability or will be that of the GP who has complied with all of ProtectHealth’s requirements?
Few GPs Are Providing Covid-19 Vaccination
There are more than 7,000 GP clinics nationwide. Of the 2,500 registered with ProtectHealth, more than 1,800 had attended ProtectHealth’s mandatory training.
However, only 184 were providing Covid-19 vaccination as at June 1, 2021. This hold-up has been attributed to audits of the clinics ordered by state committees of the JKJAV (Special Committee for Ensuring Access to Covid-19 Vaccine Supply) prior to the clinics being permitted to provide vaccination.
However, the root cause of the paltry participation by GPs is ProtectHealth’s onerous requirements; the sheer red tape in the processes and logistics issues. In addition, the messages received by the GPs have been confusing, to say the least.
Will The Rakyat’s Covid-19 Vaccination Be Protected?
GPs have been providing vaccinations for most infectious diseases since time immemorial. Apart from the Pfizer Covid-19 vaccine, there is nothing special about the vaccines to be administered in the GP clinics. Why are there so many onerous conditions before GPs are permitted to perform Covid-19 vaccinations?
Vaccination is a straightforward process. Ask any mother and she will state that her child got the childhood vaccinations at the clinics of GPs and paediatricians without any hassle. The vaccinations will be documented in a booklet provided to the mother. No one from MOH has been doing audits of these vaccinations.
The Covid-19 vaccination programme has been converted from what should be a simple process into a complicated one with micro-management by parties with scanty, or more likely, no knowledge of what happens in the real world.
The red tape, logistics issues, and confusing messages, which have already been highlighted by medical associations, do not augur well for the vaccination programme.
It raises questions whether the government will achieve its target of 150,000 vaccinations daily in June 2021 — when in June is also an important question.
Another recent issue is the unresolved dispute about ProtectHealth charging malls RM30 for two doses of the vaccines. The question is why should ProtectHealth, a non-for-profit MOH company, charge when the vaccine cost has already been borne by the government.
At a time when urgent action is needed, there is only dilatoriness and confusion.
It is inevitable that questions are raised about the degree of cooperation between MOSTI and MOH in the Covid-19 vaccination programme.
Will the rakyat be protected against Covid-19 by ProtectHealth’s onerous requirements?
Will someone step in to stop the throwing of spanners into the rollout of the national vaccination effort? What are the numbers of cases and deaths that will spur such definitive actions?
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.