KUALA LUMPUR, Sept 29 — The National Cancer Society of Malaysia (NCSM) immediately initiated their planning strategies for the monumental task of vaccinating the vulnerable communities after the first shipment of Covid-19 vaccines arrived in Malaysia in February 2021.
Dr Meyharshnee Gunaseelan, the Community Health Project Manager at NCSM, stated that the organisation aimed to support and enhance the government’s vaccination campaign. The intent was to extend the reach of the Covid-19 vaccine to severely ill, bed-bound patients and people with special abilities – including those with cancer and other chronic diseases who are unable to travel to public vaccination centres to receive their Covid-19 vaccination. [1]
“Dr. Muralli was instrumental in reaching out to the broader population and vulnerable communities across different states,” Dr Meyharshnee shared in a recent interview with CodeBlue, referring to NCSM’s medical director, Dr M. Murallitharan.
“From the very beginning, Dr Muralli foresaw the challenge and considered how NCSM could supplement and add value to the Ministry of Health’s vaccination campaign,” she explained.
“When we launched the Covid-19 vaccination programme, our primary objective was to focus on these vulnerable communities, particularly our cancer patients. Understanding the broader landscape of cancer care, our patients were eager to receive the vaccine. They recognised their limited ability to leave their homes due to compromised immunity, and the fact that many of them were quite ill and bed-bound.
“They were immensely grateful and welcoming of our house-to-house vaccination programmes. We received expressions of gratitude not only from the patients but also from their caregivers. I think few civil society organisations have had the opportunity to navigate this space, taking on the responsibility to vaccinate these specific patient populations,” she added.
To date, NCSM’s Covid-19 Vaccination Support Programme has administered more than 151,000 doses of the Covid vaccine to vulnerable communities1.
The vaccination programme is split into two branches: the house-to-house (H2H) branch and the large community vaccination programme.
According to Dr Meyharshnee, the H2H programme was tailored to cater to individuals battling cancer, those with severe illnesses, and people with intellectual disabilities. The group programme, on the other hand, was designed to serve the needs of the general public, along with migrant communities and care facilities.
NCSM receives requests for its Covid-19 vaccination services either through its cancer network or from online applications made through the NCSM website.
“Requests for vaccinations typically reach us in a certain way. Individuals who are aware that they can schedule appointments with NCSM will do so directly. However, the majority of requests don’t come straight to NCSM; instead, they originate from inquiries to our cancer information systems. These queries often involve whether NCSM can provide vaccinations to a specific group at a particular location,” Dr Meyharshnee explained.
To deliver these services effectively, NCSM has needed to assemble a substantial team and procure extensive equipment.
Courtesy of private companies such as Berjaya, Etiqa, MCIS, and more, the organisation operates one van and three trucks that serve as ambulances. The mobile truck also functions as an emergency mobile clinic.
NCSM’s teams use these vehicles to deliver immediate treatments, including securing airways, supplying oxygen, and administering intravenous drips or emergency medications as necessary.
The trucks and van are equipped with the medical apparatus needed for the programme, such as a bed, IV lines, drips, Ibuprofen (IB), intramuscular (IM) medication, and other emergency drugs.
This equipment enables the team to manage any immediate side effects from the Covid-19 vaccination. Additionally, the trucks are fitted with mini fridges for vaccine storage, and the team uses cold boxes to transport the vaccine doses.
NCSM’s core team comprises five nurses and six doctors. They work in collaboration with numerous medical and non-medical volunteers to ensure adequate staffing when required.
Dr Meyharshnee said the vaccination teams would have a list of names, IC numbers, and contact information to follow up and schedule the next appointment with people getting the Covid jabs.
“Our operations somewhat resemble those of a call centre. We follow up with these patients and strive to schedule a date for their vaccination,” Dr Meyharshnee explained.
“For community vaccinations, we first coordinate with community leaders. We inquire whether they prefer on-site vaccinations or would like to schedule walk-in appointments at the National Cancer Society. When conducting community programmes in different states, we generally plan a follow-up visit for the second round of vaccinations. We make a second trip if needed.
“Even before I joined NCSM, I knew that the staff was tirelessly working around the clock. They were visiting different states almost daily for the primary vaccine dose and would subsequently send a series of teams, sometimes up to ten at a time, for follow-ups.”
“They went almost every day [to] different states for the primary dose. And then after that, they would follow up with a series of teams, at most, about 10 teams will be going at once.”
During vaccine administration, NCSM staff provide thorough briefings to vaccine recipients and their caregivers about the typical post-vaccination experience. The primary aim is to ensure that patients and caregivers feel confident and comfortable throughout the immunisation process.
After administering a Covid-19 vaccine dose, NCSM staff wait for 15 to 20 minutes to monitor for side effects. If any side effects occur, the team quickly provides treatment from their mobile trucks.
“IV lines are set up in the mini Berjaya van. We administer drips or any necessary IV or IM medications outside. If we cannot resolve the issues on-site, we function as an ambulance service, transporting the patient to the emergency department. While such instances are extremely rare and have yet to occur, our preparedness for them exemplifies NCSM’s commitment to patient safety and the highest standard of care,” Dr. Meyharshnee explained.
NCSM Overcomes Vaccination Challenges
One of the most significant challenges NCSM faced in Covid-19 vaccination efforts was vaccine hesitancy. To address this concern, Dr Meyharshnee explained that NCSM provides on-site counselling services.
“We encountered responses like, ‘Saya tidak mahu menerimanya. Ia bukanlah sesuatu yang wajib. Covid-19 masih ada, dan saya tidak melihat bagaimana vaksin itu akan membantu‘.
“Some people were selective about which vaccine they received; this kind of hesitancy arose, I believe, because it was not mandatory to receive the booster vaccine,” she explained.
“For those who are hesitant or anxious about receiving the vaccines, our healthcare professionals, most of whom are volunteers, offer counselling,” she said.
According to Dr Meyharshnee, differences also exist between urban and rural populations when it comes to concerns about Covid-19 vaccinations. Urban residents often express worries about vaccine efficacy and side effects [2], whereas rural communities may have a rudimentary understanding, or even less, of Covid-19 vaccines and the necessity of getting vaccinated [3].
Therefore, NCSM’s Covid-19 vaccination outreach program not only ensures these communities receive the vaccine but also serves as an educational platform, empowering individuals to make informed decisions.
“In urban areas, many people are primarily concerned about the safety and efficacy of the vaccines,” Dr. Meyharshnee noted.
“But when we visit rural areas, we find that those with lower literacy levels may not even be aware that a vaccine for Covid-19 exists. Their understanding of the situation is quite limited. Some thought we were administering a routine intramuscular medication and didn’t realise it was related to Covid-19.
“In communities like these, we gather everyone in a central area with the help of community leaders. We then explain our intentions, the purpose of the vaccine, and the current state of Covid-19 cases in Malaysia.
“We spread awareness, followed by our vaccination drive.”
While NCSM’s vans and trucks can cover both urban and rural areas, reaching Orang Asli communities located in Malaysia’s forests required a different approach.
NCSM used four-wheel-drive vehicles and collaborated with partners for transportation. The cold boxes donated to NCSM ensured the vaccines maintained the necessary temperature until they reached their destinations.
A Tailored Approach For Intellectual Disabilities And Care Facilities
In cases involving individuals with intellectual disabilities, who may struggle to comprehend the situation, Dr Meyharshnee said NCSM collaborates with their caregivers to maintain a calm environment during the Covid-19 vaccination process.
For vaccinations in care facilities, NCSM ensures the primary caretaker or manager of the facility is present with recipients during the process.
“Our staff also helps to soothe these patients, explaining that the vaccination process will be brief and there is no need for fear,” she stated.
“We ensure they are comfortable before proceeding. They are given time to settle, and then we administer the vaccine. At all times, we require that the caregiver or person responsible for the facility be present.”
References
[1] National Cancer Society of Malaysia. Frequently Asked Questions For The House-To-House Vaccination Programme. Last accessed: 7 Sept 2023. Retrieved from: [link].
[2] Frontiers. Public Health, Sec. Infectious Diseases: Epidemiology and Prevention. Volume 11 – 2023. Changes in Covid-19 vaccine hesitancy at different times among residents. Last accessed: 14 July 2023. Retrieved from: [link].
[3] Frontiers. Public Health, 09 February 2023. Sec. Public Health Education and Promotion. Addressing Covid-19 vaccine hesitancy in rural communities: A case study in engaging trusted messengers to pivot and plan. Last accessed: 14 July 2023. Retrieved from: [link].
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