A YEAR after Malaysia went into the first lockdown over the Covid-19 pandemic, vaccines have brought hope of an end to the health crisis but the country isn’t out of the woods yet, health experts said.

When the country exits the crisis will be determined by at least two variables – new virus variants and an overall pandemic management strategy, experts said.

This is because even with the availability of vaccines, it is unclear how long it will take to fully contain the coronavirus or for populations to achieve herd immunity.

Malaysian Public Health Physicians’ Association president Dr Zainal Ariffin Omar said Malaysia is in what can only be called the mitigation stage of the crisis.

He estimated it will take at least six months after the people are fully vaccinated to achieve full protection from the virus.

Epidemiologist Prof  Dr Awang Bulgiba Awang Mahmud of University Malaya agreed Malaysia isn’t out of the woods yet but there is light at the end of the tunnel, compared to a year ago.

For a start, the enemy is better understood now, he said.

“We know a lot more about Covid-19 than we did a year ago. We know more about how it spreads, how to prevent transmission, which treatments are likely to prove effective for severe cases, and new faster diagnostic tests are now available,” he said.

“We have seen the astonishing speed at which scientists have worked to produce vaccines using novel technologies and a number of vaccines have been approved for use in Malaysia and other countries.”

He said it will take some time before the effects of vaccination are seen.

“It is still very difficult to predict how long the pandemic will last as vaccines only form part of the solution. 

“There are also several other considerations that are likely to affect vaccination, such as supply, vaccine hesitancy and virus mutations.

“We hope that these will not affect the speed progress of our vaccination programme.”

New variants

On vaccine efficacy and new virus strains, Dr Awang Bulgiba noted a jab will not eliminate the risk of re-infection in patients who have had Covid-19.

However, it may reduce the risk of re-infection if the neutralising antibodies induced by the vaccine work even just partially against new virus variants. 

“There is already a lot of research going into determining whether the current approved vaccines are protective against the newer variants.”

“So far, the approved vaccines appear to work against the B.1.1.7 from UK but there are concerns about other variants like the 501Y.V2 (also known as the B.1.351 lineage) from South Africa, P.1 and P.2 from Brazil and L452R from Denmark.

“More research is needed. There is already talk of a need for third doses of the vaccine if newer variants prove resistant to the current vaccines,” he said.

Pandemic management

Apart from immunisation, other factors such as continued non-pharmaceutical interventions (NPIs) and  overall pandemic management strategies, will also determine how soon Malaysia will exit the pandemic, added Dr Awang Bulgiba, who is chairman of the Science, Technology and Innovation Ministry’s Covid-19 epidemiological analysis and strategies task force.

“Adherence to NPIs is a must even if we do have a good supply of effective vaccines,” he said, referring to measures that have become the new norm such as mask wearing, physical distancing, good ventilation and avoiding crowding.

“These NPIs must continue to be strictly followed for the foreseeable future but that is also dependent on other factors like pandemic fatigue and understanding of human behaviour,” he said.

Dr Awang Bulgiba said the pandemic’s effects will continue to be felt for a few more years as the economy, education and healthcare sectors will take time to recover.

A problem the government has not addressed a year into the pandemic is the lack of an integrated data collection system.

“One year on, Malaysia still does not have a good integrated data collection and syndromic surveillance for early warning. Throughout the health authorities have been reactive rather than pro-active.

“The closed data approach at the moment is hindering efforts to research and get the evidence needed to inform policy change.”

Syndromic surveillance entails detection of individual and population health indicators before a diagnosis is made.

Without such info, it is difficult to plan a clear direction to move forward in the overall pandemic management strategy, Dr Awang Bulgiba said.

“Abrupt changes seem to come about without any warning or rationale. There does not appear to be clear stages in pandemic management.”

He was also critical of the government’s crisis communication, which he said is confusing. 

This suggests that the messages disseminated by the authorities were not considered for clarity and the impact they would have on people.

Malaysia has had cycles of lockdown in the last year in attempts to contain the coronavirus. The harshest lockdown, called the movement control order (MCO), began on March 18 and lasted until May 3. A second MCO was imposed earlier this year in some states from January 13 until March 4.

The national immunisation drive began on February 24 with the goal of inoculating at least 80% of the population by February next year.

Director-general of health Dr Noor Hisham Abdullah, meanwhile said Malaysia should only expect to begin putting Covid-19 behind it when more data is available by the fourth quarter of this year.

“Then we can project our status and global situation,” he told The Malaysian Insight.

“Meanwhile, we are not out of the woods yet. No one is safe until everyone is safe. 

“My message to all is that we have to adhere and comply with the public health precautionary measures and to please register for vaccination. We need both approaches now. Only together can we end this Covid-19 pandemic.” – March 17, 2021.