KUALA LUMPUR, Dec 13 – Dzulkefly Ahmad’s return as health minister was welcomed – with much relief – by the medical fraternity, after a tumultuous year under his predecessor, Dr Zaliha Mustafa.
Dr Zaliha – who was transferred to the Prime Minister’s Department as minister in charge of the Federal Territories in a Cabinet reshuffle yesterday – made several new policy decisions during her tenure as health minister that ranged from the downright harmful (removal of liquid nicotine from the Poisons List) to potentially affecting the public health service with rising attrition of doctors.
The number of contract doctors who quit the Ministry of Health (MOH) spiked to 1,354 resignations in 2022, exceeding the 1,279 resignations in the two previous pandemic years combined.
Following the end of the acute phase of the Covid-19 pandemic – when Prime Minister Anwar Ibrahim’s government could focus on the welfare of burned out health care workers – Dr Zaliha’s outright refusal to implement reforms on key issues, such as raising doctors’ weekend on-call allowance or clear selection criteria for permanent positions, likely demotivated doctors even further.
Dr Zaliha told the Dewan Rakyat last month that a whopping 10 per cent – which she deemed “not that high” – of more than 4,200 medical officers who were offered permanent positions last July 31 had rejected their offers, or 426 doctors, as of last September.
Here, CodeBlue lists three issues that require Dzulkefly’s urgent attention over the next six months, including one that needs intervention in less than a week:
Forced Resignations On Contract Doctors, Pharmacists, Dentists
The MOH has instructed more than 1,000 contract doctors, over 400 contract pharmacists, and an unknown number of contract dentists from the October 2 cohort to tender “irrevocable” resignations effective next Monday on December 18, the same day when they report for duty in their new location as permanent appointments.
Medical groups have condemned the new policy made under Dr Zaliha’s tenure, saying that this would prohibit contract health care professionals from claiming for interstate transfer allowances.
The salary grades and promotion of UD43 medical officers will also be affected as their years of service under contract are not taken into account, besides potentially affecting doctors’ eligibility for study leave and specialist training.
Contract pharmacists are worse off than their doctor peers because pharmacy officers who are currently in the UF44 grade under contract will be demoted to UF41 upon entering permanent service.
Should Dzulkefly allow the policy of forced resignations to continue, it would likely set a precedent for future batches and drive up resignation rates among doctors in permanent positions.
A source said a permanent medical officer at a government hospital in Perak retracted his resignation notice upon Dzulkefly’s appointment as health minister.
“He is a hardcore, no-nonsense type of fellow. He had set his mind to leave. Then he decided to withdraw it at 11.30am as soon as he heard the news,” the source told CodeBlue on condition of anonymity, as he works in the MOH.
Updated Covid-19 mRNA Vaccine Boosters
Like other countries in the region – such as Singapore, Indonesia, and the Philippines – Malaysia is currently experiencing a surge of the Covid-19 epidemic.
According to the KKMNow site, Covid-19 cases spiked to about 1,800 new cases on average last December 9, surpassing an earlier mid-May peak this year and reaching infection levels a year ago in December 2022.
The number of hospital admissions and intensive care unit (ICU) cases due to Covid-19 have also risen, though not as fast as infection rates.
Last December 9, about 166 Covid patients were admitted on average, going back to June levels, while about 12 cases on average were hospitalised in ICU, going back to July levels.
As for Covid fatalities, since last November 27, about one person died from Covid in Malaysia on average every day, going back to June fatality rates.
Even though many Malaysians last had their Covid-19 booster jab about 18 months ago in mid-2022, the MOH has yet to announce the arrival of new stocks of mRNA vaccines or to issue a new Covid-19 vaccine advisory, unlike Singapore.
The bivalent vaccines for Malaysia – which were previously announced last June but haven’t arrived – have now been surpassed by updated formulations of the Covid mRNA vaccine for 2023-2024 manufactured by Pfizer and Moderna that includes a monovalent (single) corresponding to Omicron variant XBB.1.5.
Malaysia has yet to authorise the updated monovalent XBB.1.5 vaccine – which also works against the EG.5 and BA.2.86 strains – that has been approved by both the United States’ Food and Drug Administration (FDA) and Singapore’s health regulators.
Singapore’s MOH recommended last October for all individuals aged six months and above to get an additional Covid booster dose for 2023/ 2024 with the updated monovalent mRNA vaccine. Eligible individuals may receive the additional dose about a year – and no earlier than five months – after their last shot.
Malaysians have complained about the lack of mRNA vaccines in the country, forcing some to travel to Singapore to get their updated booster shot for this and next year under Singapore’s private vaccination programme. One dose costs SG$158 (RM552).
Malaysia’s MOH has just told people generally to get a Covid-19 booster jab. This is likely the Sinovac vaccine. Neither ProtectHealth’s website nor the MySejahtera app list specific health care facilities that provide mRNA vaccines.
Dzulkefly will have to decide, fairly quickly, if the government should purchase the updated monovalent XBB.1.5 vaccine and make it available, fully subsidised, for a small percentage of the population to avoid vaccine wastage, or to at least allow Pfizer to register their product here so that the minority of Malaysians who want to get a Covid mRNA booster dose for 2024 can pay for it themselves at private GP clinics.
Vape Regulations and Possible Need to Relist Liquid Nicotine
The Dewan Negara is expected to debate the Control of Smoking Products for Public Health Bill 2023 later today.
Passage of the tobacco and vape control bill in the Senate is not guaranteed as it omits the generational end game (GEG) ban; the decoupling of the GEG from the bill had sparked fierce condemnation from both government and Opposition MPs in the Dewan Rakyat.
The government was forced to postpone the second reading of the Energy Efficiency and Conservation Bill 2023, under the Ministry of Natural Resources, Environment and Climate Change, in the Dewan Negara last Wednesday, after eight Sarawakian senators sought amendments to ensure equal rights to Sarawak.
Even if the Upper House were to approve the Control of Smoking Products for Public Health Bill, it will likely take months for the bill to become law after royal assent and gazettement into the statute books.
Until the new Act comes into operation, nicotine vapes will remain legally accessible to children and teenagers aged under 18, because of Dr Zaliha’s exemption order last March 31 that removed liquid nicotine from the list of scheduled poisons under the Poisons Act 1952.
While new tobacco control regulations under the Act can be copied from the previous Control of Tobacco Product Regulations 2004 (under the Food Act 1983 then), the MOH will have to come up with specific regulations for e-cigarettes and vapes to control nicotine content, vape flavours or descriptions, packaging, volume of e-liquids for retail, and other restrictions related to sale and advertising, sponsorship, and promotion.
It’s also worth noting that e-cigarette and vape devices are not controlled by the Control of Smoking Products for Public Health Bill, as Dr Zaliha previously told the Dewan Rakyat that the Domestic Trade and Cost of Living Ministry (KPDN) would regulate safety standards and the Ministry of Investment, Trade and Industry (MITI) would regulate manufacturing of such smoking devices.
Hence, Dzulkefly will need to take an active hand in drafting the vape regulations, including working with KPDN and MITI to ensure that vape devices themselves are controlled, and not promoted as an economic sector.
And should Dewan Negara postpone approval of the Control of Smoking Products for Public Health Bill to next year, it would be even more critical for the new health minister to decide whether or not to restore liquid nicotine into the Poisons List.
Relisting liquid and gel nicotine as a scheduled poison – so that nicotine vapes will be immediately illegal for retail, except by doctors and pharmacists for medical purposes – would require the Finance Ministry to postpone its tax collection on vape and e-cigarette liquids with nicotine.
Vape regulations, in this case, would be far more important than restoring the GEG policy in any future amendments, as the generational smoking and vaping ban for anyone born from 2007 has already been deemed by Attorney-General Ahmad Terrirudin Mohd Salleh to be unconstitutional.
Regardless who the health minister is, it would be farcical for the Attorney-General’s Chambers to reverse stance and proclaim the GEG to be constitutional (again), just as suddenly as it was declared unconstitutional.
