After two years of the Covid-19 pandemic that has claimed more than five million lives and affected billions more, it is tempting to think that we, at least here in Malaysia, are finally reaching the endpoint.
With almost the entire adult population having received at least two jabs of a vaccine, this country is extremely privileged when compared to its counterparts in the Global South. Many are still struggling to deliver the first doses.
For Malaysians, 2022 will bring about the real possibility of post-pandemic life. So, how will this look like?
Omicron will replace Delta as the dominant variant within the first quarter of 2022. Even with this variant reportedly causing less serious disease, the fact that it is at least 25 percent more infectious and able to evade prior immunity leading to more breakthrough cases, will see a high burden of disease. This will place a severe strain on the country’s health care systems.
In spite of Omicron and its past, present and future sister variants, the SARS-CoV-2 virus will likely become endemic, merging into the cornucopia of diseases which form the backdrop of everyday life. Covid-19 will remain dangerous, just like the flu which kills hundreds of thousands of people around the world.
As Covid-19 will likely become seasonal, people will need to keep up with vaccinations or annual boosters to gain protection from serious illness and hospitalisation.
Wearing masks, regularly washing hands, and maintaining physical distancing in high-risk settings, are likely here to stay and be part of social practices. It will not be necessary to come up with new interventions. In the pre-Covid-19 period, people who became sick may have insisted on going to work anyway.
This will change as they will now be expected and pressured to work from home, arguably a positive development. The use of test kits will be normalised but not likely to be used consistently due to pandemic fatigue and incomplete understanding of its utility.
Malaysia’s health care system has had a lot of experience in dealing with endemic diseases. Dengue, which has been endemic in Malaysia since 1902, saw 130,000 cases in 2019, with 176 lives lost. Tuberculosis remains a serious problem with an incidence rate of 92 cases per 100,000 population. with no significant change made over the past several years.
Strains of influenza have circulated freely, necessitating seasonal vaccine jabs, which most Malaysians fail to take. At the same time, Malaysia is on the cusp of being declared by the World Health Organization to be malaria-free after three consecutive years of no detected case of indigenous human malaria.
However, in any scenario for the future of the Covid-19 pandemic, much depends on the ways in which society responds to issues such as human rights and fair treatment during a public health emergency.
The key rights that are often implicated in public health emergencies include the right to health, the right to privacy and confidentiality, the right to movement and liberty, the right to employment, the right to non-discrimination, freedom of assembly and expression, and the right to information.
Last year, as tighter and more severe restrictions, and enhanced measures were introduced in response to the Covid-19 crisis, the government and the Malaysian public appeared to be determined to support trading their liberties and those of others for some semblance of safety and security.
The hope was that by doing so the crisis would end soon and everything would go back to “normal”. People and governments in other countries were also making similar choices and compromises.
However, trading human rights and dignity amidst a public health emergency that has been securitised will have long-lasting and often permanent consequences.
Hard-won lessons from the HIV pandemic, which is where my work in public health began, affirm that successful public health responses are grounded firmly within the human rights framework.
While human rights law does allow for the limitation of rights for legitimate reasons, approaches which depend on broad punitive measures may undermine public health objectives while also violating human rights. They may actually do more harm than good, especially when implementation is hampered by double standards practiced by enforcement bodies.
There are three areas which we can do better in Malaysia.
The criminalisation of behaviour intended to enforce measures such as the Movement Control Orders (MCOs), CMCOs, lockdowns etc which moved from warnings to compounds and later prosecution in court, should be viewed with serious concern. Today, there is intent for this to be used to get the last remnants of the population who are hesitant or opposed to being vaccinated. The term “mop-up” has been used many times by various authorities.
Research and our own experience from other epidemics have shown that this approach of the stick versus the carrot is not an evidence-based response to public health issues. The use of criminal laws and other punitive approaches often undermines public health by creating barriers to prevention, testing, care, and treatment.
Consider how the daily reports of compounds issued, arrests, detention and those charged in court became acceptable, showed off, and even seen as a mark of progress.
We were and are punishing people for having low levels of health literacy, when we have for decades underinvested in health promotion and communications. Yet today, we find it acceptable to punish people for being unable to comply with something that they may not fully understand; this also includes vaccination.
Heavy-handed fines and arrests to enforce public health measures often have a disproportionate impact on the poor, marginalised, and most vulnerable.
There is an overwhelming dependence on the language of shame. While social pressure is useful to encourage the public to comply with whatever public health measure was being introduced, it has transitioned into public shaming or “pandemic shaming”.
Thousands of people, mostly on social media, were and still do blame, and shame others for their improper pandemic practices: at the beginning of this crisis, it was walking outside, being on the road, not wearing a face mask, visiting constituents and so on. Somehow during this public health emergency, cyber-bullying became acceptable.
It would not be surprising that those who did not get vaccinated then got sick, are now afraid to share their health status, get tested and seek treatment.
Patients who have since recovered have reported experiencing discrimination, stigma and abuse by their surrounding communities. Some are being blamed for getting themselves infected. Today, that is being extended to those who are unvaccinated.
Finally, a key lesson from the HIV response is that exclusion and punitive laws do not work. Neither does securitisation and militarisation of the response. From the onset, government officials and the media have used the language of war and security to describe the response to the pandemic.
Language matters. The use of military metaphors such as “going to war”, “invisible enemy” and “win the war” is often intended to convey a sense of urgency and to mobilise resources. However, in the long run, they breed fear and acceptance of a “good guys and bad guys” narrative. Blame becomes common and fear is misused.
It has created an atmosphere of fear and resentment towards authorities, especially with the appearance of double standards, unfairness, and anxiety about the accompanying stigma and the possibility of discrimination. Many, particularly those who were vulnerable and from lower income backgrounds, such as students, low wage earners and retail workers, became victims of subjective enforcement.
Much of this has undermined the usefulness of such laws. The authorities must be seen to be fair and just in the applications of such regulations to ensure that it would not end up victimising and unfairly punishing people and businesses. Gaining and rebuilding trust and public support are critical for the year ahead.
This is a public health emergency, not a war. There are no winners or losers, good sides or bad sides. The vaccines work. About 98 per cent of the adult population have now been fully vaccinated.
We are in the top 20 countries in terms of complete vaccination coverage. We need to work on convincing the remaining through better information and hard work through education. There are no shortcuts.
The pandemic is forcing legal and policy decisions to be made quickly and with very little external oversight. Individuals questioning such decisions, expressing contrarian opinions, or showing dissent have been attacked and portrayed as being disloyal to the Covid-19 response.
A successful response to the Covid-19 public health crisis must protect the health and human rights of all people.
We need to be prepared but also ensure that our commitment to the protection of human rights and dignity remains intact. There will be future pandemics. It is essential that we understand that no one is safe until we are all safe, and such commitments to human rights are critical to making our communities safer and healthier.
Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.
Mr Azrul’s 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.