Khairy Jamaluddin must be clear as to when in June the government can achieve daily vaccination rate of 150,000 doses per day and whether it is the maximum or average vaccinate rate?

Media Statement by Yeo Bee Yin, Member of Parliament for Bakri, on Sunday 30 May 2021, in Bakri Johor.

Khairy Jamaluddin must be clear as to when in June the government can achieve daily vaccination rate of 150,000 doses per day and whether it is the maximum or average vaccinate rate?

With skyrocketing infection rate, vaccination rate should increase beyond 150,000 doses per day by involving private general partitioners and government clinics nationwide.

Government should simplify the registration and recordkeeping system of Covid-19 vaccination instead of over relying on MySejahtera and the current management system.

-------

1. Based on the previous estimation of supply and demand curve by the government, our cumulative vaccine administered should be at around 6 million by now (assuming 80% usage rate of the total supply of about 8 million by the end of May).

2. However, due to the hiccups in getting vaccine supply, as of 27th May 2021, only 2.7 million doses have been administered - 1,725,364 first dose and 987,012 second dose, which is about 63% and 37% of total vaccine administered respectively. In terms of percentage of population, only 5.4% and 3% of population receiving at least first dose and fully vaccinated respectively.

3. Based on the estimated cumulative vaccine administered of (1) and the same ratio of first and second dose distribution as (2), we are supposed to be at vaccination rate of 12% and 7% for first dose and full vaccination respectively.

4. What is the cost of the delay of our vaccination rollout? Maybe we can look into US case study and the impact of vaccination toward the number positive cases (US has similar ratio of first and second dose distribution as us). Between roughly 5.4% (first) and 3% (second) vaccination rate and 12% and 7% is more than 40% drop of positive cases!

5. Of course, we can’t compare directly as there are other factors involved such as movement of the people. However, what we can conclude is that the delay in our vaccination rollout has significant impact on the number of positive cases every day.

6. More than 1,000 people has died from Covid in just May alone. If our vaccination rollout were to run as what the government has previously planned, these people did not necessarily need to die! Many more did not necessarily need to go through the suffering Covid-19 sickness caused. Indeed, delay in vaccination has caused unnecessary deaths.

7. Therefore, I would like to seek clarification from the immunization minister Khairy Jamaluddin about his announcement of government plan to ramp up daily vaccination rate to 150,000 doses per day. Is it by 1 June, mid of June or end of June? This is because delay in weeks can be a matter of life and death to hundreds of Malaysians.

8. I would also like to know whether the 150,000 doses per day target is the maximum daily vaccination rate or the average? This is because I’ve noticed that the government tend to announce daily vaccination rate on the days when it was high or use the language of “daily vaccination rate up to xxxx” instead of giving 7 days average so to paint a better picture than reality on the ground. Image below shows Malaysia daily vaccination rate in the month of May. Note that whenever the ministers announced the daily vaccination rate, it was always on the days when the numbers are high.

9. Therefore, whether 150,00 dose per day target is the maximum or average makes a big difference in the total vaccination rate. If we can achieve vaccination rate of at least 150,000 dose per day on average for the month of June from 1 June 2021, we will be able to see vaccination rate of 14% first dose and 8% full vaccination by the end of next month and it will help to bring down the total number positives cases.

10. In fact, with the current skyrocketing infection rate, we should aim even higher than average of 150,000 doses per day by involving private general practitioners (GPs) and government clinics nationwide. As it is, almost all of them already have facilities to store vaccines except with Pfizer vaccine that need special storage.

11. The minister announced recently that there will be nearly 16 million more doses of vaccines supply in June and July, 12 million of which is Sinovac that only require normal refrigeration. Even if the government can achieve 150,000 doses on average from 1 June 2021 (that is a very big IF), at 80% usage rate, it will only need about 11 million doses of vaccine supply. In another word, there will be at least 5 million more extra vaccines that can be distributed to GPs and government clinics around the country.

12. Lastly, let’s just face it, the RM 70 million MySejahtera and vaccination rollout management system are incapable of coping higher vaccination rate. Even at the current vaccination rate, MySejahtera is already making errors in appointment arrangement and the hotline is always down.

13. In addition, the government has listed priority for Covid-19 vaccination for the second phase of the national rollout targeting the elderly and people with comorbidities, but until now, many of them that already registered still haven’t been assigned any vaccination slot by MySejahtera and when called, the hotline was down.

14. This still happen after 3 months of very slow vaccination rollout, what makes the government so confident that by next month the system will become efficient as we ramp up the vaccination rate? Is the team behind MySejahtera and the current management system really capable to revamp the system in such a short time frame? I doubt so.

15. Moving forward, we need a simpler system for registration and recordkeeping, perhaps a decentralized one. My 1-year-old toddler has been injected many vaccines since his birth and all we have to do was for the pediatrician to record them in a card and for the hospital to keep the vaccination records and report to the government. Why when it comes to Covid-19 vaccination, the process becomes so complicated?

16. At the very least, doctors in both private and public hospitals should be able to register their patients with comorbidities, request for vaccine supplies from the government and administer them accordingly. Then we can at least ensure the vulnerable groups are vaccinated, instead of just waiting for MySejahtera to finally get it right.

17. Our healthcare system is at the brink of breaking down. Unprecedented speed of vaccination with special attention to the yet-to-be-vaccinated vulnerable groups in June while the nation is locked down is a major step that we need to take to give breathing space to the healthcare system and to prepare us for opening up. I hope the government will finally take whole-of-society approach to make sure vaccination rollout ramp up really happen in June. Delay no more!

-End-

The government should seriously consider prioritizing first dose of vaccine in our vaccine distribution plan as we ramp up vaccinate rate.

The government should seriously consider prioritizing first dose of vaccine in our vaccine distribution plan as we ramp up vaccinate rate.

First of all, I would like to welcome government efforts on vaccination for pregnant and lactating mothers with KJ announcement that a new feature will be available on the MySejahtera app to enable pregnant and lactating mothers to register for vaccination and the assurance that suitable vaccines will be administered to them. This is indeed a good news to all expectant and lactating mummies! Secondly, on KJ statement on herd immunity yesterday, I am still not convinced that we’ll be able to reach herd immunity by year end, if herd immunity is defined as 80% population being vaccinated and that the maximum capacity of daily vaccination rate is only 150,000 doses per day as I’ve explained here: https://www.facebook.com/150371651783435/posts/2014874865333095/. 

We need to ramp up vaccination rate to an average of 250,000 doses per day from 1 June 2021 onwards to make achieving herd immunity by year end a reality.

However, whether we can reach the textbook-definition of herd immunity by year end is not as important as to whether our vaccination rollout can break the chain of infection and reduce the number of positive cases. The million-dollar question is then, with the limited dosage we can administer per day, which pathway can help us best to reduce the number of positive cases? As UK has all their data on vaccination (first dose & second dose), positive cases, testing etc available online, I was able to do an analysis of their strategy of first and second dose distribution and here are the findings. [UK was able to reach average vaccination rate of about 150,000 doses per day in first month of their vaccination rollout, 400,000 doses in the second month and by mid of third month 500,000 doses per day on average (last image). As for our vaccination rollout program, due to limited supply, our vaccination rate did not take up until last week.] Anyway, assuming that we are now at the equivalent to UK first two months of vaccination rollout, let’s now look at their vaccine distribution plan (first image). They prioritized 1st dosage to as many people as possible with more than 90% of total dosage administered daily being 1st dosage until they entered into third month, when it dropped below 90%. The population that received first dose of vaccination grow linearly for the first 3 months then at slower growth from fourth month on (second image). Now let’s look at what is most important - the number of positive cases dropped 40%, 75% and 85% from the peak respectively as the percentage of population received first dose vaccination increased from 10% to 20% to 30%. The percentage of second dosage only start increasing from middle of third month and it helped to further reduced the rate of growth of new cases. All in all, prioritizing first dose in their first phase of vaccination distribution has worked for the UK in term of reducing their positive cases significantly. Compare it to our vaccination roll out, as of 24th May 2021, cumulatively we’ve administered 1,578,225 first dose and 905,271 second dose, which is about 64% and 36% of total vaccine administered respectively. As we ramp out our vaccination rate in June, the government should seriously rethink our vaccination distribution strategy and consider the feasibility of UK strategy in prioritizing first dose. With 150,000 dose per day, we can reach first dose of vaccination to 20% of population in just 1 month (taking into account the 1.58 million that already receive first dose) and that can potentially help to reduce our positive cases significantly. This is particularly important as our number of new cases is increasing exponentially and reached record high again yesterday. We desperately in need of quick action. Every week of delay in vaccinations will literally cost us hundreds of lives. Of course, as we consider this strategy, we need to take into account the type of vaccines being administered, manufacturers recommendations and most importantly, whether we can control the spread of new variants and the efficacy of first dose of the vaccines towards the new variants, therefore it cannot be an apple-to-apple comparison to the UK case and wholesale copy-and-paste strategy into Malaysia vaccination rollout. However, I do believe that the real-life data of the UK show merits to the strategy and suit our conditions (as our infection rate is skyrocketing and we have limited capacity in vaccination rate – even 150,000 doses daily is not high to be honest). It indeed requires serious consideration from the government as we ramp up our vaccination rollout. Again, because parliament is closed, I can only write what is supposed to my parliament speech on social media so that the public is informed of the policy option and for the option to be considered by the immunization minister and the Covid-19 Immunisation Taskforce (just like what they’ve done in the vaccination for pregnant ladies case) as they are planning the next phase of vaccine rollout. -End-

Image 1: UK Example - First and Second Dose

Image 2: UK Example - First and Second Doses by % Population vs Daily New Cases

Image 3: Number of Vaccination given, be report date

Putting Vaccination Rates Comparison into Perspectives

The question of how we are doing in term of vaccination can be a tricky one.  Who do we compare ourselves to and on what matrix? Of course, the government will tell you that it is unfair to compare Malaysia to developed countries and that vaccine shortage is a common issue among all developing countries.  While it is true and it’s important for the international community to continue to speak against the developed countries who are hoarding the vaccine supplies, perhaps there is more than just the actions of the developed countries that led to the current low vaccination rate in Malaysia. 

I’ve prepared 4 graphs with the help of Our World in Data (https://ourworldindata.org/coronavirus) to give more meaningful assessment to the current Malaysia vaccination rate: 

i. comparison with the average across different continents 

ii. comparison with our SEA neighbors 

iii. comparison with countries that have similar GDP per capita compared to us; and

iv. comparison with countries that have lower GDP per capita than us. 

    

 

For iii & iv, it is according to rankings prepared by International Monetary Funds (IMF) and excludes countries with populations smaller than 5 million (as it is easier for them to achieve high vaccination rate due to small population and may distort the perspectives). These 2 graphs show clearly that we’ve fallen behind not only when compare with developed countries and developing countries that are richer than us but also those that are poorer than us! Therefore, the explanation of low vaccination rate due entirely on income level does not hold water. In fact, we are even falling short of the government's earlier estimation of vaccine supply! (I explained this in my earlier post.)

Now, in all fairness, can we still tap our shoulder and say, “no worries, we are doing well in vaccination and ignore the naysayers?” The first step into improving anything in life is to recognize that there are shortcomings, then find out why and learn from those who are doing better than us. We urgently need to find ways to catch up so that together we can see the end of the tunnel by end of the year as targeted by the government. 

No, although we are from opposite side of the political divides, I don't wish to see the government fail in this. In fact, the whole of Malaysian society should rally behind this cause to ensure the success of the National Covid-19 Immunisation Program.

- End - 

Is our vaccine supply now falling short of government earlier estimation? Are we on track of getting 4 million of additional vaccine supply in the month of May?

Media Statement by Yeo Bee Yin, Member of Parliament of Bakri on Friday 21 May 2021, in Bakri, Johor.  

Is our vaccine supply now falling short of government earlier estimation? Are we on track of getting 4 million of additional vaccine supply in the month of May? 

 

As Malaysians are enduring the movement control order (MCO 3.0) for more than a week now with the daily Covid-19 positive number shows no sign of improvement, we begin to wonder if MCO 3.0 will be extended and most importantly, when will we be seeing the end of the tunnel? Indeed, many things may not be within our control such as emerging variants. However, we can at least do other things such as increasing efficiency and speed in trace, test and isolate as well as managing the vaccination rollout better to lower the number of cases and severity of the positive cases. 

 

Vaccination rollout in the United Kingdom (UK) showed clearly that vaccination although not the silver bullet is a major solution to the crisis. Let me illustrate that in numbers. The UK started their vaccination roll-out in the beginning of 2021. At the start of the year, the first dose vaccination rate was less than 3% while full vaccination rate less than 1%. As of now, nearly 70% of the UK population has received at least first dose of vaccine and about 40% completed two doses of vaccine as of now. The number of their Covid-19 positive cases dropped from the range of 60,000 per day in January 2021 to the range of 2,000 positive cases per day in May 2021. Within just 5 months of efficient vaccine rollout, the UK saw a drop of more than 95% of positive cases! [1]

 

Malaysia National Covid-19 Immunisation Plan was launched on 24 February 2021. On 14 April 2021, the Immunisation Minister Khairy Jamaluddin shared on his social media an estimation of vaccine supply and demand curve by Special Committee on Ensuring Access to Covid-19 Vaccine (JKJAV) as below. 

 

Yesterday, it was reported that Malaysia has administered 2.07 million doses of Covid-19 vaccines as of yesterday according to JKJAV. Assuming 70% usage rate, we have received about 2.95 millions of vaccine supply so far. However, from the estimation graph, we should have received about 6 million vaccine supply by mid of May (red arrow). Is our vaccination supply now falling short of earlier estimation? 

 

Even if we don’t look back and finding fault, the graph also shows that in the month of May, we’ll receive 4 million additional vaccine supply. Looking at how urgent it is for faster vaccination rollout, two third of the month of May has gone, we would like to seek clarification from the government if the estimation of 4 million doses of additional vaccine supply this month will be achieved? And is the government going to find ways to compensate for the shortfall of vaccine supply from estimation? 

 

 

The government cannot put the entire blame of the shortage of vaccine supply to the behavior of the developed countries. We should find ways to do more efficiently of what we can control. For example, Pharmaniaga received 200 litres of Sinovac vaccine in bulk for fill-and-finish on 27 February 2021, however the first batch of locally filled-and-finished Sinovac vaccines (290,480 doses) was only ready to be distributed last week - more than 10 weeks after receiving the bulk supply. The government should review the process and if possible, find ways shorten bulk-to-vials process (without compromising the safety). 

 

We once again call upon the government to use whole-of-government and all-of-society approach so that we as a nation can achieve the vaccination target set earlier – i.e supply equivalent to 80% population by October and 80% population fully vaccinated by February 2022. The opposition (parties and states) as well as the private sectors are not the enemies to the government in this, there are still rooms for more collaborations that the government can leverage on so that we can together, ensure the National Covid-19 Immunization Program a success. 

- End -

 

 

[1] UK Covid-19 statistics such as vaccination rate, testing rate, number of positive cases etc can be found on website: https://coronavirus.data.gov.uk/details/cases

Where is the 150,000 testing capacity targeted by the government in January?

Media Statement by MP for Bakri, Yeo Bee Yin on Saturday 15 May 2021 in Bakri, Johor. (scroll down for BM and Mandarin)

Where is the 150,000 testing capacity targeted by the government in January?

Malaysians started the third movement control order (MCO 3.0) recently and many families are struggling to get by in terms of finance, jobs, education, business, physical and mental health etc. Beside the confusing standard operating procedures (SOPs) that draw a lot of angers and criticisms, the important question now is, what is the government doing differently this time around compared to MCO 1.0 and MCO 2.0?

The government cannot expect rakyat to be disciplined and suffer the financial impact of MCO while they themselves are not bucking up. One of the most important but straight forward actions to contain virus spreading is through test and isolate with a simple logic that the faster we find out Covid-19 positive people in the community and isolate them, the less likely for them to spread the virus in the community.

There have been calls from many groups, including the opposition lawmakers, to ramp up testing capacity of the country. In fact, back in January, the government itself said it targeted to increase RT-PCR (reverse transcription polymerase chain reaction) testing capacity of the country from about 70,000 to 100,000 with the aim to reach 150,000 testing capacity [1].

Four months have now passed, our testing figures still revolve around 70,000 per day, where is the promised 150,000? Covid-19 virus waits for no one, 4 months is a long time in battling once-in-a-century global pandemic!

In addition, the government makes no attempt to run other large-scale screening initiatives to identify positive cases in the community. It completely ignored the calls from many groups to include rapid antigen testing (RTK-Ag) in nationwide screening processes. While RTK-Ag may be less accurate, but it makes up for speed and capacity (as it is widely available and not restricted by lab capacity). It surely has a place to play as a stopgap measure as we struggle in increasing RT-PCR capacity.

Indeed, tackling Covid-19 crisis is not an easy one, but if after a year, the government can’t even get basic things like test and isolate right, what hope do Malaysians have? How many more MCO can we afford to bring the country out of Covid-19 crisis? The government is insane if their plan is to do the same thing over and over again but expecting a different result.

-End-

[1] https://www.theedgemarkets.com/article/malaysia-aims-more-double-covid19-testing-capacity-150000-da

The government should pay serious considerations on the relevant issues with regards to pregnant women in National Covid-19 Immunisation Program (PICK)

Media Statement by Yeo Bee Yin, Member of Parliament for Bakri on Wednesday 12 May 2021 in Bakri, Johor.

The government should pay serious considerations on the relevant issues with regards to pregnant women in National Covid-19 Immunisation Program (PICK)

Last Sunday afternoon, I had my first dose of vaccine in Dewan Maharani, Muar, according to government’s plan for members of parliament to get vaccinated in the first phase of National Covid-19 Immunisation Program (PICK). I would like to thank the professionalism of the officers that were responsible for vaccination program in Dewan Maharani. The process was smooth and efficient. As of today, except with arm sore, I have had no other side effects.

I am currently 17 weeks plus pregnant. While vaccination is proven safe and encouraged for the general population, World Health Organization (WHO) recommended the following on Covid-19 vaccination for pregnant women,

“Should pregnant women be vaccinated? While pregnancy puts women at higher risk of severe COVID-19, very little data are available to assess vaccine safety in pregnancy. Pregnant women may receive the vaccine if the benefit of vaccinating a pregnant woman outweighs the potential vaccine risks.”

The decision to vaccinate was based on the advice by my gynecologist due to the nature of my work with high risk of exposure to Covid-19. It was also made after reading multiple studies that reported that i. pregnant women are more likely than non-pregnant women of the same reproductive age to develop severe complications including require ICU admission and mechanical ventilation, if they are infected with Covid-19; ii. pregnant women with Covid-19 are also more likely than pregnant women without Covid-19 to deliver preterm, and to have babies needing neonatal ICU and iii. pre-existing comorbidities such as diabetes and hypertension, advanced maternal age (> 35 years), and high body mass index (> 30) are risk factors for severe Covid-19 pregnancy.

Even though there is lack of long-term safety data, I am not only facing high risk of exposure to Covid-19 but also high risk of complications if infected Covid-19 due to advanced maternal age and medical condition of gestational diabetes, so based on the WHO recommendation of “the benefits of vaccination outweigh potential vaccine risks”, I decided that I should be vaccinated. (Having said that, the decision to vaccinate should be on voluntary basis by each pregnant woman in consultation with her healthcare provider.)

In the process of vaccination, I found that there are some issues to consider and rooms for improvements for vaccination of pregnant women under PICK.

First, for pregnant women, not every type of vaccine is created equal because unlike the large-scale clinical trials of vaccine on general population with standard requirement of sample sizes, as of now, the availability of the safety data for pregnant women differs from one vaccine to another.

In Malaysia, most of pregnant women are in Phase 3 of vaccination program (younger population) but the type of vaccines being administered to them is still unknown. Malaysia government should gather the clinical data for pregnant women from different brands of vaccines under the country’s procurement plan, scrutinize them and make sure that the vaccines being administered to the pregnant women population are safe for pregnancy. The decision must be made based on SUFFICIENT data on pregnant women. Not only that, the government should also decide at which stage of pregnancy the pregnant women should be vaccinated, if she decides to be vaccinated. As of now, most of them will be scheduled to be vaccinated according to the age group with no consideration of the timing and stage of pregnancy.

Although pregnant women are at increased risk of severe illness from Covid-19, in PICK List of Priority Groups for Vaccination, only pregnant women who are working in healthcare sector are considered those with high risk of exposure, and for me, I was scheduled to be in Phase 1 of vaccination roll out as other members of parliament, but what about pregnant women working in other sectors, both public and private, that have equal risk of exposure?

All in all, I call upon the government to pay serious considerations on the relevant issues with regards to pregnant women in its vaccine rollout plan.

Lastly, the decisions and recommendations by the government for pregnant women must be communicated effectively to all pregnant women, such as making it compulsory for all obstetricians and gynaecologists to explain to their patients in a standardized easy-to-understand brochure that is available in different languages.

Such initiative by government will be greatly appreciated by the pregnant women population as they give peace of mind to them, many of whom are already going through morning sickness or other difficult pregnancy symptoms, mood-swings and anxiety of getting infected with Covid-19 due to the risk of complications.

- End -