Minister Khairy Jamaluddin on Malaysia’s vaccination programme and its vaccine supply

Minister Khairy Jamaluddin, the Minister in charge of Malaysia’s vaccination programme, spoke to us on 23 July. This is update on the state of Malaysia’s vaccination programme.

Malaysia Watch Could you tell us about Malaysia’s vaccination progress please?

KJ: We hope to have 40% of the population fully vaccinated by the end of August and we hope to be able to have given the full vaccination to all adults in Malaysia by October, November of this year.

Malaysia Watch So, it’s 40% by the end of August?

KJ: Yes, so we are up to 34% who have received at least one dose.

MW: Is it fair to say that you have been a bit slow on the up-take, I think you started in February?

KJ: We started in February because of the global supply in equity. There was very, very inequitable distribution of vaccines early on which has resulted in many countries in Asia Pacific, not just Malaysia, but countries like Japan, South Korea, Australia arguably first world countries in Asia Pacific only starting at the same time, which was February.

Now we have a daily vaccination rate per capita that his amongst highest in the world, probably top 3 in the world, so it’s really not about the function of capacity or planning, but the function of supply.

MW: Are you supplies now adequate to reach your targets?

KJ: The supplies come in on a weekly basis, unfortunately for some vaccine manufactures they only give us two weeks… we only have sight over our vaccine supply delivery of maybe the coming fortnight, as a result that has made things a bit difficult, but thankfully because we have a portfolio of vaccines, some from Pfizer, some from AstraZeneca, some from the Chinese manufactures; we are able to smoothen the delivery schedule that otherwise still offers a lack of clarity.

MW: How do the three stack up in terms of percentage?

KJ: We’ve bought enough Pfizer vaccine for 70% of our population; we’ve bought the Chinese Sinovac vaccine for 23% of our population, so most of our portfolio is Pfizer. But the issue with Pfizer right now of course is delivery. To give you some detail, we have taken delivery as of the 21st of July, 7 million doses of Pfizer and the balance would be about 38 million.

For the Chinese vaccine, we have taken delivery of 12.8 million and the balance is just 3 million so you can see there that in countries like Malaysia, we are forced to hedge ourselves to ensure that, if we are reliant on pharmaceutical companies from the West where we know for certain that delivery is still skewed towards the advanced economies, we have to make up for it at the front end with other vaccine manufacturers.

MW: Does that mean you’ll be spending your Chinese imports?

KJ: Well for now, if we assume that Pfizer is able to stick to their commitment of delivering 25 million doses in the 3rd quarter of this year, which is contractual, then there will be no need for us to expand our supplies from the Chinese manufacturer but should there be any disruption to that supply schedule – as I said, we only have oversight over 2 weeks, the coming 2 weeks, then we are in a position where we have to procure from other sources.

Countries like Malaysia, over the last one year, we have made arrangements with multiple manufacturers to ensure we mitigate against delivery risk. Yes, some people may question the efficacy or effectiveness of some of these vaccines, but for countries like us; any vaccine is better than none. Any vaccine will offer you good protection against severe outcomes of covid. So, while we wait for the Pfizer vaccines to arrive, while we wait for the AstraZeneca vaccines to arrive, we have to mitigate against any delay by having options available to us and that for us is some of the Chinese manufactured vaccines, which has been listed by the WHO anyway.

You are not considering or looking into the Russian vaccines?

KJ: We are looking at the Russian vaccine, in fact we have an order for 6.4 million doses for about 10% of our population of the Sputnik V, it has yet to receive regulatory approval from our pharmaceutical regulator because there are some key data points on the stability of the vaccine that has not been finished by the Russians. But we are also waiting for the WHO to list the Sputnik V vaccine in the emergency usage list, once that happens then obviously, we can expedite our approval of the Russian vaccine, so it is part of our portfolio.

MW: Do you have any idea when the Russian vaccine might come through?

KJ: It could possibly come through in the next month or so, we have a standing order with them and once the regulatory approval is achieved then the suppliers will be able to send our order of the Russian vaccines. Much has been said about the geopolitics of vaccines, but to me it’s really utility. At this stage, I don’t care where the vaccines come from, as long as I have vaccines to administer to Malaysians and people living in Malaysia right now and then of course we will look at real world data on the effectiveness of the vaccine, how long the protection will last for, and the possibility to offer people booster shots later if we find the effectiveness wanes after some time.

This is something many countries are looking at, but right now I want to make sure as many people are jabbed as possible. Yesterday we did a record, which was about half a million doses in a day so now at our peak, our daily vaccination rate per capita is higher than ven in the UK at the UK’s peak.

MW: In terms of adherence to MCOs, this is something people have talked about, basically many of the MCOs have been heavily flouted, not just by the people but also by politicians and other people of public note. Is that something that has given you concern, it accounts for what’s now happening with the virus spread.

Well, I would say that for the large part Malaysians do adhere to the MCO but of course there have been lapses, and of course glaring lapses some of the members of the political elite…

MW: Does that shock you?

Well, it doesn’t really shock me because I think these flouting of the rules by political elites have been happening all over the world, it’s not just in Malaysia really, it’s many other countries where politicians have found themselves in hot soup  by violating their own rules.

MW: Doesn’t excuse it though.

KJ: Absolutely not, two wrongs don’t make a right, just because it happens elsewhere in the world doesn’t mean it excuses us here in Malaysia. So, as I mentioned before, we have fallen short and that was most unfortunate. But I think, going beyond that, to right now, what is happening today as I said by and large Malaysians do observe the SOPs, but you have to remember that we have been under some form of movement control or another for the better part of the year and when fatigue sets in, lockdown fatigue sets in, a lot of people will lower their guard. 

Now we have to accept that the virus is spreading in the community, it’s not just in work-place clusters anymore, it’s just everywhere. So even just going down to the corner shop or whatever, you are at risk of getting the virus so that’s the reality we are dealing with right now.

How effective and how significant do you think the imposition of a state of emergency, in January last year, was in curtailing and is in curtailing the virus. People have said it was a political gesture rather than a real functional move with the virus in mind.

There were a few emergency ordinances that were imposed which allowed us to make a  decision more quickly and gave us flexibility to implement the vaccination program much quicker which is not to say that we couldn’t have done the same where the state of emergency did not exist. As far as I am concerned the vaccination program could have run just as effectively had we not had a state of emergency but perhaps for other parts of the pandemic management especially regarding movement control I think some of my other colleagues can speak to that but as far as I am concerned; has it helped the vaccination program?

Maybe in some instances of securing public venues to turn them into vaccination centres, again, that could have happened without the state of emergency, but it meant this time around it was much quicker. But I think we are set to let the state of emergency end on the 1st of August… [Indeed Malaysia’s state of emergency did end before 1 August, albeit shrouded in much controversy and rancour]

MW: That is definite?

That’s the thinking right now, the quote I would be happy with is that’s the thinking right now and that we will resume the normal order of business for parliament.

MW: It has been said (by the King) that you should get on with running the virus and the vaccines and the epidemic management rather than the internal bickering, and I wonder if that was a pointed message to the Prime Minister?

There is a realisation in government right now that we are prepared and the thinking in government is that the emergency will end on the first of August without an extension.

There have been comments, the Prime Minister given his own state of health and perhaps some might say the record up to now managing the virus, he might not be the best person taking it forward, is that something you would…

Well, the Prime Minister is in good health, I just came off a meeting that he chaired about 2 and half hours and he was very sharp and incisive in his comments and observations so I think as far as we are concerned there are no issues as far as his fitness to continue as Prime Minister… the reason we find ourselves  in the condition we are in right now is also partly due to factors beyond our control for instance the Delta variant and I think this is  similar to many, many other countries around the world. Just any given country in the Asia Pacific or around the world for that matter, is seeing an increase of cases because of this highly transmissible variant.

Asia does appear to have had a good start to the pandemic, but why do you think it has now let the virus loose as it seems?

KJ: I think the origins of these variants are very difficult to spot initially  just by nature of fact that this virus mutates on its own and we don’t know it becomes a variant until there is enough of a body of cases for the WHO to declare it as such so the action to close borders to where we think the variant of concern originates from, that is really a judgement call that has to be made early on when we don’t know much about what’s going on. That’s one.

Secondly, even if you close borders to for instance, the Delta variant in India, that’s where it started… it’s such a global world, foreign travel is still going on and they don’t have to come from India, they could have taken a plane from Dubai. In our case we found out that one of the entry points for the Delta variant into Malaysia was an oil and gas worker that originally flew in from India, I think he transited somewhere, he came into the Island of Labuan which is where our oil and gas centre for east Malaysia is. It was a hand-off, as someone who works off shore but coming into Labuan he infected a few people on the plane and that’s how the variant came into Labuan.

Because the delta has now been circulating for a quite some time, are you seeing a different pattern? How is hospitalisation and ICU availability? I read it was 80% and rising, recently.

So, what we’ve seen is, for instance, in a Kuala Lumpur and Selangor the hospitalisation numbers for the elderly have come down because they are fully vaccinated so we’re seeing a lot more younger people coming in for hospitalisation. We are also seeing an increase in the dead-on-arrival cases into the hospitals because the symptoms manifest themselves quite rapidly and there’s rapid deterioration once you reach category 4 or 5, so we are trying to decamp the hospitals as quickly as possible, of non- covid patients to private hospitals and to other care centres so that our public hospitals can manage the category 4 and 5 covid cases.

Right now, what we’re doing to ensure capacity is available in addition to adding more beds in ICU facilities is to recamp non-covid patients to private hospitals.

MW: Why are you seeing more dead-on-arrival cases, because people can’t get into the hospital?

KJ: No, we suspect it is much more rapid for people who have not been vaccinated. They isolate at home with mild symptoms, and they rapidly develop severe symptoms with death following quickly and this is what we’re observing right now.

So, the key point is they haven’t had any vaccination, is any of them young people?

This is also young people…the prevalence of serious cases under 18 is very low, and we have continued to observe that young people do not suffer the worse outcome of covid 19 and that is consistent with other parts of the world We are talking here 40s and 50s.

So, people who haven’t been vaccinated, isolate and the thing takes over and before they can…

Yes, most of these cases are non-vaccinated people…

MW: Some are?

KJ: Partially, yes. Just to clarify, the delta came in in April, that’s the data that you wanted. I just want to share with you, some data of the effectiveness of our vaccine, as of the 16th of July, 3,106 health care workers from a total of 245,932, that’s 1.26% were infected after receiving both does of the Pfizer vaccine, but there were only 3 of the 3,106 who went into category 3 and only 0.1% who went into category 4 in terms of severity of the disease. So, in terms of the protection that the Pfizer vaccine has given, and we give all our health care workers the Pfizer vaccine, the protection has been superb.

MW: Are you preferring the Pfizer over the AstraZeneca and the Chinese?

No, no, we have no preference here in Malaysia, I took a Sinovac and so-far-so good.

MW: Looking forward, do you see any changes in how you manage the epidemic going forward?

KJ: Yes, I think for many countries, including the UK and Singapore, not with-standing the fact that they’ve rolled back a bit on opening up, I think many countries have started to accept that we have to so-called quote-on-quote “live with the virus”. And I think we are in full-blow mitigation right now there is no more talking about containing the virus, it’s out in the community and we can forget about 0 cases and it’s all about how you mitigate the cases, one big part of that strategy will be vaccinations. We have seen from other parts of the world, once you reach about 40% of your adult population being fully vaccinated then… case numbers may not drop with the delta variant, but you certainly will see a drop in hospitalisations and as well as in the death rates.

Again, the big caveat here is we don’t know what’s going to happen with delta and I’m watching the UK very closely because of ‘Freedom Day’ and with hospitalisations going up again, perhaps what I’ve just said here may not be applicable anymore.

I think we are preparing to understand that covid is somewhat endemic and vaccinations are key, perhaps booster vaccinations will be necessary and at some point we will have to stop looking at the daily cases and just have to focus on hospital capacity, ICU capacity, death rates and manage the virus that way.

And just on the economic aspect, there has been a lot of attention paid to the lack of economic support in Malaysia, for small businesses and individual businesses, do you feel more needs to be done? To recover an economy that has been affected by…

I think we’ve done well. We’ve put in fiscal stimulus that has been able to help many people. I think…

MW: Enough fiscal stimulus?

KJ: Well, we have to be aware that there are a couple things, one is of course the fact that we have a statutory limit for government debt which we’re coming very close to. So, in terms of fiscal rule available to us, to borrow more, we are coming to the upper limit of that. Even if we changed the law to enable Malaysia to borrow more, we are looking at very high debt levels, something like every ringgit that the government earns, about 12 cents or more will have to be paid to service our debt and that’s not the kind of situation that we want to be in for the medium to long term.

So as far as we are concerned, we are trying our best to provide assistance, not just fiscal assistance, but other assistances allowing people to withdraw from their provident fund and also allowing for the banks to offer moratoriums on loans. These are not direct fiscal stimulus or fiscal inputs, but these are also measures that have been designed to assist people. But we are also, extremely and painfully aware, that the fiscal space that we have right now is quite limited, so we feel that… I mean the vaccination program that I run is entirely an economic policy, as far as I’m concerned apart from it being a public health tool because the quicker I can vaccinate, the quicker we can recover, and so we really need to open the economy as quickly as possible.

So, you’d be appreciative, and you’d be valuing and look with favour upon the so-called liberation day approach by Boris Johnson.

KJ: Well, no. I would have done it in stages and far more carefully… I think having one Freedom Day where you throw caution in the wind is not something I would recommend as somebody looking at the data and the science of this and running the vaccination program. I would certainly insist that stringent guidelines and SOPs remain in place. Public mandate the wearing of masks everywhere, especially indoors; maintaining crowd control in indoor environments will be crucial. I think just lifting restrictions in total is quite dangerous, and flies in the face of the expert views, especially public health experts.

And finally, Minister, I understand as a reader of social media, there is a huge amount of anger with the government of Malaysia over the management of the virus, whether it’s disappointment, whether it’s criticism, reasonable and otherwise, is that something that concerns you? Given that you obviously have the interest of the people at heart.

Well as a politician, of course, we are concerned when the people are angry, and upset and disappointed. But we also have to remain focused on the work at hand. While I completely accept and analyse reasonable and valid criticism I have to have my eyes on the ball, so to speak.

The vaccination program is not a simple program to run. It requires a thousand and one moving parts on any given day. If we become bogged down by the criticism then we are not going to get the job done, but of course we keep our ears close to the ground and we need to listen to the people even if there is a lot of angry noise right now. We must always continue to listen even if it’s not palatable, only then will we understand where the pain points are and improve what we are doing.

MW: Is there just one point of criticism that you would accept as justified?

KJ: I always tell people I can’t speak for my entire government but just take for instance the job I’m doing as immunisation minister. No one has done this job before me, and I hope no one will have to do it after me. Any criticism … I take it whole heartedly as valid and try to explain and improve as I go along. There is no manual here for me to do my job.

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