Multiple Immunisation Strategies – Key To Successful Implementation

By incorporating multiple immunisation strategies, the Malaysian government can implement a successful vaccination drive and build greater public confidence.

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Published by CodeBlue, Asia News Today, Business Today, Focus Malaysia & The Sun Daily, image from WHIO.com.

Although both online and offline vaccine registrations were introduced last week, low public registration for the National Covid-19 Immunisation Programme (NIP) raises concerns that Malaysia might not achieve herd immunity anytime soon.

According to vaccine minister Khairy Jamaluddin, only 6.1 per cent of the population (1,468,137 individuals) had registered for vaccination via the MySejahtera mobile application as of March 1. It is far from the country’s desired target – to inoculate more than 80 per cent of the population (nearly 27 million out of 32 million Malaysians) by March 2022.

Up to date, there are five methods for Malaysian citizens to register for vaccination. 

According to the NIP Handbook published by the Covid-19 Vaccine Supply Access Guarantee Special Committee (JKJAV), the public could either register their interest to be vaccinated online through MySejahtera mobile application or the website specifically on vaccination at www.vaksincovid.gov.my.

In terms of offline vaccine registration, there are three methods for the public to choose – contact a hotline set up for the purpose of registration from today (March 5) onwards; visit public or private health clinics; and through outreach programmes for residents in rural and remote areas.

The recent establishment of JKJAV and the Covid-19 Immunisation Task Force (CITF) is indeed a good start for Malaysia to kickstart mass immunisation. However, to ensure its successful implementation, a whole-of-government and whole-of-society approach is required, going beyond the auspices of the Ministry of Science, Technology and Innovation (MOSTI), Ministry of Health Malaysia (MOH) and the National Security Council (NSC).

This would involve a host of different stakeholders such as non-governmental bodies, schools, universities and health care providers

To ensure every resident is vaccinated, Village Community Development Councils (MPKK), Community Development Officers (PPM) and resident committees need to play proactive roles in monitoring the vaccine coverage in their respective communities.

Even though government bodies and media outlets curated some online infographics, individuals who have limited digital devices or data connectivity might not understand how immunisation works and the advantages of vaccination.

Therefore, to ensure effective outreach programmes for residents in rural and remote areas, government agencies and non-governmental bodies must prepare the steps and potential side effects of immunisation in the form of leaflets, in addition to information disseminated through newspapers and magazines. They could explain the importance of vaccination while distributing leaflets through house-to-house visits.

Although registration for dependents, including elderly parents or individuals without smartphones, is expected to be made available via the MySejahtera mobile application in the middle of this month, children who are not staying with their elderly parents might not be able to assist in vaccine registration.

Due to the enforcement of the inter-state travel ban, Sabahans or Sarawakians currently working or living in Peninsular Malaysia could not fly back to their hometowns. They must undergo swab tests and apply for travel permits before reuniting with their parents.

To ensure everyone is vaccinated, government agencies and non-governmental bodies should assist the elderly in registering for vaccination via the MySejahtera mobile application, while explaining the procedures and possible side effects of vaccinations during house-to-house visits. They also could help individuals who do not have internet access or digital gadgets to register for vaccination.

In addition, MOH could adopt the U.S. approach – mobilising a large number of vaccine corps to volunteer in the vaccination programme.

Besides medical, nursing and pharmacy students, vaccine corps could be formed by community grassroots, comprising retired or unemployed clinicians. They could deliver vaccine shots, monitoring individuals who had just been vaccinated or scheduling second doses for the vaccines to be fully effective.

Students in the vaccine corps could be trained to administer vaccines in low-cost housing flats and shelters for the homeless and victims of domestic violence. They should also be provided transportation to vaccination sites or take doses directly to homebound elders who might have difficulty to travel from one place to another.

By mobilising vaccine corps on a large scale, MOH could accelerate the nationwide rollout of Covid-19 vaccines, besides ensuring doses are distributed equitably to every Malaysian citizen.

To speed up the immunisation processes, the government could also consider Indonesia’s approach – collaborating with private companies such as Grab and setting up drive-through vaccination service centres across Malaysia.

Furthermore, it is time for both federal and state governments to work together in providing mobile clinics for the convenience of rural residents in getting vaccinated.

Although the NIP has outlined the usage of mobile vaccination clinics, the majority of sites are concentrated within urban areas along the west coast of Peninsular Malaysia, as mentioned by Ezzaty Hasbullah on “Malaysia’s National Covid-19 Immunisation Plan: The missing details” (Malay Mail, February 17, 2021).

To address the issue of insufficient vaccination centres in some parts of East Malaysia, both the Sabah and Sarawak state governments should consider providing flying doctor services in the remote areas of both states. It would shorten the delivery times of vaccines and allow rural citizens in both states to be inoculated as soon as possible.

As suggested by R. Murali Rajaratenam on “Enhancing trust in the vaccine” (The Star, February 26, 2021), each state could establish a public oversight committee to review and report on Covid-19 vaccination systems. Thereby, target groups and underserved populations could receive vaccination from major medical and public health providers according to schedule.

By incorporating multiple immunisation strategies through public oversight, strong partnerships and community involvement in immunisation, the Malaysian government can implement a successful vaccination drive and build greater public confidence.

Amanda Yeo is Research Analyst at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

Bahasa Malaysi

Diterbitkan di Malaysia Now & Utusan Malaysia.

Walaupun pendaftaran vaksin secara dalam talian dan manual diperkenalkan lebih dua minggu lalu, pendaftaran awam yang rendah bagi Program Imunisasi Covid-19 Kebangsaan (PICK) menimbulkan kerisauan Malaysia tidak akan mencapai kekebalan kawanan (herd immunity) dalam masa terdekat.

Menurut Ketua Pengarah Kesihatan Dr Noor Hisham Abdullah, hanya 22.1 peratus penduduk (5,355,970 individu) telah mendaftar untuk vaksinasi melalui aplikasi MySejahtera pada 13 Mac. Ini adalah jauh dari matlamat yang diinginkan – menyuntik lebih 80% penduduk (hampir 27 juta daripada 32 juta rakyat Malaysia) dengan vaksin Covid-19 menjelang Mac 2022.

Sehingga kini, terdapat lima kaedah bagi warganegara Malaysia mendaftar untuk vaksinasi.

Menurut buku panduan PICK yang diterbitkan Jawatankuasa Khas Jaminan Akses Bekalan Vaksin Covid-19 (JKJAV), orang ramai boleh mendaftar untuk vaksinasi secara dalam talian melalui aplikasi MySejahtera atau laman web www.vaksincovid.gov.my.

Dari segi pendaftaran vaksin secara manual, terdapat tiga kaedah untuk dipilih orang ramai – hubungi talian hotline untuk tujuan pendaftaran mulai 5 Mac; lawati klinik dan hospital awam serta swasta; dan melalui program pendekatan penduduk yang tinggal di kawasan luar bandar dan pedalaman.

Penubuhan JKJAV dan Badan Bertindak Imunisasi Covid-19 (CITF) baru-baru ini memang merupakan permulaan yang baik bagi Malaysia untuk melancarkan program imunisasi. Namun begitu, bagi memastikan keberkesanan pelaksanaan, pendekatan seluruh jentera kerajaan dan masyarakat (the whole of government and the whole of society approach) yang jauh merangkumi kementerian sains, teknologi dan inovasi (Mosti), kementerian kesihatan Malaysia (KKM) dan Majlis Keselamatan Negara (MKN) amatlah diperlukan.

Ini melibatkan pelbagai pihak seperti pertubuhan bukan kerajaan, sekolah, universiti dan penyedia perkhidmatan kesihatan, dengan tujuan mempercepatkan proses imunisasi.

Bagi memastikan setiap penduduk menerima vaksin, Majlis Pengurusan Komuniti Kampung (MPKK), Pegawai Pembangunan Masyarakat (PPM) dan jawatankuasa penduduk perlu memainkan peranan proaktif ketika memantau liputan vaksin di komuniti masing-masing.

Walaupun pihak kerajaan dan media telah mengedarkan beberapa infografik secara dalam talian, individu yang mempunyai akses terhad dalam peranti digital atau data mungkin tidak akan memahami proses dan kebaikan imunisasi dengan sepenuhnya.

Demi memastikan program pendekatan penduduk yang berkesan di kawasan luar bandar dan pedalaman, agensi kerajaan dan pertubuhan bukan kerajaan mungkin dapat memainkan peranan berkesan dengan menyediakan maklumat mengenai kesan sampingan imunisasi dalam bentuk risalah selain menyebarkan informasi berkaitan melalui akhbar atau majalah. Ini dapat diagihkan melalui lawatan dari rumah ke rumah.

Walaupun pendaftaran bagi tanggungan, termasuk ibu bapa yang tua atau individu tanpa telefon pintar akan disediakan melalui aplikasi MySejahtera tidak lama lagi, anak-anak yang tidak tinggal bersama ibu bapa mereka mungkin tidak dapat membantu dalam hal ini.

Penduduk Sabah atau Sarawak yang kini bekerja atau tinggal di Semenanjung Malaysia juga tidak dapat pulang ke kampung mereka dengan segera, seperti yang mereka kehendaki. Mereka perlulah menjalani ujian swab dan memohon izin perjalanan sebelum bertemu dengan ibu bapa mereka yang tua.

Demi memastikan semua rakyat diberi vaksin, agensi kerajaan dan pertubuhan bukan kerajaan mungkin perlu membantu warga tua dalam pendaftaran vaksinasi melalui aplikasi MySejahtera selain menjelaskan prosedur dan kemungkinan kesan sampingan vaksinasi semasa mengadakan lawatan dari rumah ke rumah. Mereka juga dapat membantu individu yang tidak memiliki akses Internet atau peralatan digital untuk mendaftar vaksinasi.

Di samping itu, KKM mungkin dapat merujuk pendekatan AS – mengerahkan sejumlah besar sukarelawan dalam program vaksinasi.

Selain pelajar perubatan, kejururawatan, farmasi dan fakulti kesihatan yang lain, sukarelawan vaksin itu juga dapat dibentuk di peringkat akar umbi dengan mengerahkan para pakar klinikal yang telah bersara atau tidak bekerja. Mereka boleh ditugaskan dalam penyuntikan vaksin, memantau individu yang baru menerima vaksin atau mengatur dos kedua agar vaksin berkesan sepenuhnya.

Pelajar yang menjadi sukarelawan vaksin dapat diberi latihan dalam pengurusan vaksin di kawasan perumahan kos rendah dan rumah-rumah perlindungan bagi gelandangan dan keganasan rumah tangga. Mereka juga haruslah diberikan pengangkutan ke tempat vaksinasi atau memberi perkhidmatan dos langsung kepada warga tua yang mengalami kesukaran keluar dari rumah.

Dengan mengerahkan sukarelawan vaksin secara besar-besaran, KKM dapat mempercepatkan pengagihan vaksin Covid-19 di seluruh negara selain memastikan dos diedarkan adalah secara adil dan saksama kepada setiap warganegara Malaysia.

Bagi mempercepatkan proses imunisasi, kerajaan juga dapat mempertimbangkan pendekatan Indonesia – bekerjasama dengan sektor swasta seperti Grab dan seterusnya melaksanakan vaksinasi secara pandu lalu di seluruh Malaysia.
Lebih-lebih lagi, sekarang adalah masa bagi kerajaan persekutuan dan negeri untuk berganding bahu dalam penyediaan klinik bergerak demi kemudahan penduduk di kawasan luar bandar dan pedalaman dalam penerimaan vaksin.

Walaupun PICK telah menggariskan penggunaan klinik vaksinasi bergerak, sebahagian besar lokasi tertumpu di kawasan bandar yang terletak di sepanjang pantai barat Semenanjung Malaysia.

Dalam menangani masalah pusat vaksinasi yang tidak mencukupi di Malaysia Timur, kedua-dua kerajaan negeri Sabah dan Sarawak mungkin boleh mewujudkan perkhidmatan doktor terbang (flying doctor) di kawasan pedalaman masing-masing. Hal ini dapat memendekkan masa penghantaran vaksin dan membolehkan penduduk luar bandar di kedua-dua negeri ini menerima suntikan vaksin dengan lebih awal lagi.

Setiap negeri Malaysia mungkin dapat menubuhkan sebuah jawatankuasa pengawasan awam untuk mengkaji dan melaporkan sistem vaksinasi Covid-19. Dengan demikian, kumpulan sasaran dan penduduk yang kurang diberi perhatian dapat menerima vaksinasi daripada penyedia perubatan dan kesihatan awam mengikut jadual.

Dengan menggabungkan pelbagai strategi imunisasi melalui pengawasan awam, kerjasama dan keterlibatan masyarakat yang kukuh dalam imunisasi, kerajaan Malaysia akan mampu melaksanakan kempen vaksinasi yang berjaya – membina keyakinan rakyat yang lebih tinggi terhadap vaksinasi.

Amanda Yeo merupakan Penganalisis Penyelidik di EMIR Research, sebuah organisasi pemikir bebas yang berfokuskan kepada pencernaan saranan-saranan dasar strategik berteraskan penyelidikan yang terperinci, konsisten dan menyeluruh.

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