As the world watches the emergence of new pathogens and the relentless rise of antimicrobial resistance (AMR), there’s a quiet revolution happening in the United Kingdom’s National Health Service (NHS).
Through a national genomic strategy, the UK has integrated an ultra-fast metagenomic sequencing capability directly into the frontline of its hospitals, turning cutting-edge research into a routine standard of care.
Despite our comprehensive experience battling outbreaks like Nipah and Covid-19, most Malaysian hospitals — including our leading private institutions — still rely heavily on conventional microbiology and targeted PCR panels.
A patient in septic shock or a child with meningitis typically enters a diagnostic black hole, where physicians must administer broad-spectrum antibiotics blindly while waiting three days for a culture result.
It is time for Malaysia’s health care sector to look to the UK and adopt metagenomic sequencing as a national standard.
Metagenomic next-generation sequencing (mNGS) is fundamentally different from standard tests. While a standard PCR costing RM25 to RM100 can only detect a single, pre-selected pathogen, and multiplex PCR costing RM500 to RM1,000 can detect a limited panel of known bugs, mNGS — costing roughly RM1,000 to RM3,000 — performs a complete, unbiased census of all the genetic material in a sample.
This allows physicians to detect bacteria, viruses, fungi, and parasites simultaneously in a single test. This capability is transformative for three critical reasons.
First, it is our only defence against Disease X, namely, the novel or unknown pathogen that inevitably triggers the next global pandemic.
In a world where the Health Ministry remains on alert for unknown diseases, metagenomics can identify emerging threats without needing to know what to look for first.
Second, it operates in the six-to-seven hour window. In an NHS pilot across 30 UK sites, patients with severe respiratory infections received a definitive diagnosis in a median of just 6.7 hours, compared to the previous norm of three days.
Most importantly, for a nation battling AMR, mNGS provides the exact genetic blueprint of the microbe. By reading the precise antimicrobial resistance genes it carries, doctors can bypass weeks of try-and-see antibiotic matching and prescribe the exact weapon needed on day one.
In the NHS rollout, for severe ICU respiratory infections, the test successfully detected the causative pathogen in nearly 30 percent of cases where traditional standard cultures failed entirely, directly altering and optimising antibiotic use and de-escalating therapy where possible.
The immediate concern is cost. At Rm2,000 per test, mNGS appears expensive compared to a standard culture.
However, every extra day stay in the ICU costs RM5,000 to RM10,000. Faster and exact mNGS diagnosis shortens ICU stay, enables the use of targeted, cheaper antimicrobials and is proven more cost-effective.
The UK has successfully transitioned from “highly successful multi-centre pilots” to a “universal standard of care” within the NHS.
Our Malaysian health care providers, whether in the public or private sector, has the responsibility to consider this revolution in precision medicine in Malaysia.
By delivering rapid, highly accurate diagnoses for complex or unknown infections, mNGS is actively shifting the health care landscape towards a value-based health care (VBHC) model by directly optimising patient outcomes, lowering long-term health care costs consistently and systematically.
There must be the political, and clinical will to invest in the platforms and bioinformatics necessary to bring precision metagenomics to the Malaysian bedside.
Waiting three days for a result in the age of superbugs is no longer acceptable. We have the technology. The UK has proven it works. It is time for Malaysia to step into the future of precision infectious disease diagnostics and therapeutics.
Dr Musa Mohd Nordin and Prof Azizi Haji Omar are paediatricians and Dr Nur Abdul Karim is an emergency physician.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
