The National Covid-19 Immunisation Programme (PICK) started on February 24, 2021 and the government’s strategy was to ensure that as many people in Malaysia are vaccinated as quickly as possible, to reduce the risk of death from the Covid-19 infection, whilst ensuring our healthcare system is able to cope with a reduced surge of hospitalisations. The vaccine is provided free of charge to all Malaysians and non-Malaysian citizens, whilst adhering to the principles of justice and vaccine equity.
To increase access and accelerate vaccination rates, the Ministry of Health Malaysia (MOH) had appointed ProtectHealth Corporation Sdn Bhd (ProtectHealth) as the implementer for private medical practitioners’ (PMPs) and health care non-government organisations’ (NGOs) participation in PICK.
One of our roles was to develop an in-house proprietary software – Vaksin Control System (VCS) platform – that connects all PMPs for registration, management, training materials, reporting, and various other functions. This is also linked to MyVAS which allow us to make prompt payment to all our providers.
Equally important, we also assist MOH to monitor vaccination activities, investigate incident reports, training, reporting, performing audits, providing special support lines and facilitating assistance at the vaccination centres (PPVs) involving our providers. We help to enhance and ensure the quality of vaccination services provided by PMPs and health care NGOs.
Challenges as the Implementer
Malaysia has over 8,000 PMPs spread all over the country. In the beginning we required the buy-in and support from all the providers. It was not easy and straightforward. It took various engagements and much persuasion to be where we are today.
Simultaneously, we had to be ever ready with the capacity needed to support the vaccination programme and time was definitely not on our side. Next was the need to build a proprietary system to link all PMP registrations, management, training, and to monitor the vaccine administration (as mentioned above), and again, in such a short time frame.
Another critical challenge was the logistics and the fluidity of the vaccine supply, utilisation, and cold-chain management. There were situations where the supply of one type of vaccine runs low, and the other is in abundance. MOH had to identify and distribute them accordingly to avoid wastage, which also requires ultra-cold chain storage throughout the country. It is noteworthy that there is no playbook on carrying out a nationwide vaccination programme.
Operationally, in supporting vaccine equity, this was also a challenge in the beginning, with the non-uniform facility standards at all our providers, when we began with the elderly requiring more assistance than the younger crowd. All these really took us to task, where we had to adapt fast in managing public expectations.
All in all, the PICK execution is a majestic implementation of health care equity, where every vaccinee is given their dose based on priority and needs, versus social standing. Vaccinees can be scheduled at either a public or private facility, and the workload is shared across equally – a fair and equitable implementation.
PMPs under ProtectHealth commenced vaccinations on May 4, 2021 through the Vaccine Centre (PPV) of private clinics (GP) to support MOH in the vaccination programme. On May 5, three Mega PPVs involving PMPs under ProtectHealth were opened at World Trade Centre Kuala Lumpur, University of Malaya, and Universiti Kebangsaan Malaysia through the voluntary AstraZeneca vaccine booking programme. These PPVs mushroomed throughout PICK to ensure that all vaccines received were immediately delivered to the arms of the vaccinees.
Subsequently, starting June 14, was the opening of PPV Industri (PPVIN) to provide vaccines for critical economic sectors, where ProtectHealth worked closely with ministries, such as the Ministry of International Trade and Industry, Ministry of Domestic Trade and Consumer Affairs, Ministry of Works, Ministry of Agriculture and Food Industry, Ministry of Plantation Industries and Commodities, Ministry of Transport, and other government agencies.
Apart from this, to meet the vaccination needs of the underprivileged, MOH extended the programme to health-related non-governmental organisations (Health NGOs) to conduct vaccination via drive-through PPVs for the disabled (OKU), home vaccinations, outreach programmes and Program Mobilisasi Vaksin Komuniti (MOVAK) or mobile PPV. These programmes increased accessibility and maximised vaccinations for groups such as those bedridden, the homeless, stateless foreigners, indigenous people, and the rural population. In addition, the mopping-up programme is still carried out to ensure that no one is left behind.
The role of PMPs in the vaccination programme continues with the immunisation of adolescents aged 12 to 17 years. Adolescents were vaccinated through outreach programmes at schools, existing mega PPVs that were still operating, and private health facilities or those under MOH. As mega PPVs started to close and the vaccination programme continued to run, PMPs under ProtectHealth were responsible for implementing the booster dose administration.
Those eligible for booster doses or who missed their vaccination appointments can register on waitlists at PPVs registered under ProtectHealth. This approach facilitates and encourages eligible individuals to receive doses earlier without having to wait longer and will assist the government in ensuring that vaccines are not wasted, and usage is optimal. ProtectHealth has introduced new vaccination centre models for booster dose i.e PPV Offsite and PPV Outreach to ensure no one is left behind. These models would cover what was in the earlier implementation known as PPV Integrasi, PPV Industri or PPV Outreach.
As of December 19, 2021, PMPs and Healthcare NGOs under ProtectHealth have contributed over 28.8 million doses of vaccines, or 46.9 per cent of the total 61.5 million doses of vaccines administered involving more than 2,200 PPVs nationwide. The Ministry of Health vaccinated 51.4 per cent whilst 1.7 per cent were vaccinated through private purchase. The effectiveness and success of Malaysia’s “whole-of-government” and “whole-of-society” approach in the vaccination programme are evident and seen at the end of PICK.
Malaysia vaccinated 80 per cent of the adult population by September 19, five months earlier than the initial target set in February 2022. Through this achievement, the country recorded the highest daily vaccination rate of 581,000 doses, of which ProtectHealth contributed 57.7 per cent or 335,000 doses. Malaysia is among the most vaccinated countries globally. According to Our World In Data, Malaysia has the 15th highest share of the population fully vaccinated at 78 per cent as of December 19.
Covid-19 has put numerous stresses on our public health care system. However, the current environment presents not only challenges but also opportunities. One of the opportunities which came about was the acceleration of public-private partnership through the PICK implementation. PICK is by far the largest ever government programme ever executed in the country, in terms of the 26 million people vaccinated within a short span of its establishment and implementation. This has also been the largest public-private partnership in the health care sector which continues to grow.
ProtectHealth plays a vital role in bridging both the government and private sectors, particularly in the health care system, where ProtectHealth facilitates both parties. This has enabled us to better understand the priorities and limitations of both sides. By having insights from both points of view, ProtectHealth has developed a shared vision with all our partners, where we move towards one goal for the health care system to be fair and equitable for all.
Malaysia needs a healthier population that would be built from better health care literacy, awareness, and infrastructure. Health is a joint responsibility of each individual and the government. Malaysia’s health care system has been acknowledged internationally as a successful, modern government-regulated health system that provides effective health services.
But, health care costs are rising at inflation rates. The health care workload distribution is still heavy towards the public sector, while health care resources are abundant in the private sector. The challenge is to rationalise and redistribute this workload and reduce private health care costs. Despite that, we are apprehensive that the current system may not be sustainable in the long term, with the ageing population, increase in chronic diseases, rapid rise in health expenditure, and high out-of-pocket spending.
Developing affordable health care financing for all is the best way, and it would be a game-changer. We need to widen the health care financing source and build up capacity and mechanism to strategically purchase services from the private sector when rapid escalation of capacity is required.
Sustainable health care financing through a national-scale strategic purchasing agency could be one of the ways to ensure our health care system is resilient and adaptive that can withstand such a crisis. We will continue to be the main part and key driver of any plan for health reforms in the country in line with our slogan ‘Your Health, Our Mission.’
Anas Alam Faizli is the Chief Executive Officer of ProtectHealth Corporation.
Mr Anas’ article is part of an exclusive series of guest essays by experts in the health care sector for CodeBlue on their reviews of Malaysia’s 2021 Covid-19 response and their outlook for 2022.