Let's get the anti-vaxxers to change their minds


The living and the dead: Two Covid-19 patients cling on to life in Hospital Sungai Buloh’s intensive care unit in Selangor, while two more have already lost their battle. The Covid-19 vaccines aim to prevent such severe cases. — Bernama

The number of reported Covid-19 cases in Malaysia exceeded one million last Sunday.

This was the highest number of newly-confirmed cases per million population in the Asean region.

Malaysia’s position in the global ranking of reported cumulative positive cases went up to 30th, up from 39th position on May 31 and 85th on Nov 18.

Last Monday, the number of accumulated deaths due to Covid-19 in the country was 8,201.

It is evident that there is widespread community spread of the SARS-CoV-2 virus.

This means that everyone is at risk of getting infected.

Covid-19 vaccination is perhaps the last throw of the dice to get some measure of control over the pandemic.

Although vaccination efforts have been ramped up significantly, the problem of vaccine hesitancy still has to be addressed – and urgently.

Factors for hesitancy

The reluctance or refusal to accept vaccination despite the availability of a vaccine is termed vaccine hesitancy.

It was already a growing concern even before the Covid-19 pandemic, and was in fact, listed by the World Health Organization (WHO) as one of the 10 threats to global health in 2019.

The personal drivers of vaccine hesitancy are:

  • Confidence (or lack thereof)
  • Complacency
  • Convenience (or constraints)
  • Calculation of risk, and
  • Sense of collective responsibility.

Addressing this issue requires an understanding of the public’s willingness to be vaccinated, the reasons for their willingness or unwillingness, and their trusted sources of information in decision- making.

According to published data, vaccine acceptance is mainly due to interest in personal protection against Covid-19.

One of the most common reasons for hesitancy are concerns about the safety of the vaccines and their side effects, particularly their rapid pace of development.

In general, healthcare professionals are trusted sources of gui-dance about Covid-19 vaccines.

However, reported intentions to vaccinate may not always translate into actual uptake of the vaccine.

Trust is essential

The Organisation for Economic Cooperation and Development (OECD) in its report recognised that the gaining and maintenance of public trust in Covid-19 vaccines and vaccination is as essential as the effectiveness of the vaccines themselves.

They stated: “Trust in vaccination, and in the ability of governments to communicate and to successfully deliver a vaccination programme, is critically dependent on:

  • “the extent to which the government can instil and maintain public confidence in the effectiveness and safety of the vaccines;
  • “the competence and reliability of the institutions that deliver them;
  • “the principles and processes that guide government decisions and actions in vaccine procurement, distribution, prioritisation, and administration;
  • “the capacity and effectiveness of regulatory agencies in handling issues and communicating consistently as events arise, while retaining public confidence in their review processes; and
  • “the effectiveness of the public engagement and communications that accompany these.

“Successful vaccination campaigns also require governments to partner and support community organisations to conduct extensive and well-managed community engagement.

“A thorough understanding is needed of different populations’ specific concerns, prior experien- ces both with vaccination and the health system in general, religious and/or political affiliations, and socio-economic status.

“It is also important to ensure that government actions are open to public scrutiny, and that public institutions engage with the population, by:

  • “Proactively releasing timely in- formation on vaccination strategies, modalities and accomplishments in disaggregated, user-friendly and open-source formats;
  • “Enhancing transparent and coherent public communication to address misinformation and the ‘infodemic’; and
  • “Engaging the public when deve- loping vaccination strategies, and in the form and content of key communications.”

In Malaysia

The total number of Covid-19 cases in Malaysia breached the one million mark last Sunday, leaving no doubt the SARS-CoV-2 virus is widespread in our community. — Health MinistryThe total number of Covid-19 cases in Malaysia breached the one million mark last Sunday, leaving no doubt the SARS-CoV-2 virus is widespread in our community. — Health MinistryThe data on Covid-19 vaccine hesitancy in Malaysia is limited.

The results of an online survey of Covid-19 vaccine acceptance and concern among 1,411 Malaysians aged above 18 was reported in June in the journal BMC Public Health.

The survey included demographic groups such as young adults (40.7%), females (62.8%), Malays (63.8%), Muslims (72.3%), married persons (52.9%), those with tertiary education (86.8%) and those without medical illness (85%).

The respondents’ primary source of Covid-19 information was social media (97.4%).

Overall vaccine acceptance was 83.3%, with the lowest rates in those aged 60 years and above (63.4%) and pensioners (64.6%).

The reasons for vaccine hesitancy were:

  • Concerns about side effects (95.8%)
  • Safety (84.7%)
  • Lack of information (80.9%)
  • Effectiveness (63.6%)
  • Religious factors (20.8%), and
  • Cultural factors (6.8%).

Those who were more vaccine- hesitant had diabetes (16.1%) and hypercholesterolaemia (15.8%) respectively.

The Health Ministry reported that in a survey of 15,639 respondents carried out between April 3-16, 85% were willing to be vaccinated, compared to 67% in a similar survey in December.

Ten percent were uncertain about vaccination, while 5% disagreed with vaccination.

There was no information provided on the profiles of the respondents and their reasons for vaccine hesitance.

Recent adverse publicity about the National Covid-19 Immunisation Programme will impact on vaccine acceptance and hesitancy.

Reports of Covid-19 cases among staff in a mega-vaccination centre in Shah Alam, Selangor; allegations of delays in informing other staff about such cases; and the alleged use of empty syringes during vaccination have all contributed to unnecessary questions and doubts among the vaccinated and those awaiting vaccination.

Offers to revaccinate if it can be proven that an empty syringe was used and explanations that fatigue was the cause are not good enough.

Vaccination should be carried out safely without any risk to the recipient, except for the miniscule risk from the vaccine itself, with zero tolerance for any deviation.

The recent adverse publicity has provided fodder for the anti-vaxxers, almost all of whom have not seen the devastating effects of Covid-19.

Perhaps visits to Covid-19 wards could be arranged for these people.

Although the vast majority of healthcare workers have been tirelessly doing an excellent job vaccinating Malaysians against Covid-19, including reaching out to rural communities through mobile vaccination clinics such as this one in Kampung Bukit Perah, Kuala Langat, Selangor, public trust has been negatively affected by allegations of empty syringes being used for such efforts. — BloombergAlthough the vast majority of healthcare workers have been tirelessly doing an excellent job vaccinating Malaysians against Covid-19, including reaching out to rural communities through mobile vaccination clinics such as this one in Kampung Bukit Perah, Kuala Langat, Selangor, public trust has been negatively affected by allegations of empty syringes being used for such efforts. — Bloomberg

A complex balance

The reasons for Covid-19 vaccine acceptance and hesitancy are complex.

The emergence of SARS-CoV-2 viral variants and new Covid-19 vaccines on the market add to the complexity.

In the public information provided by the authorities, it is vital to maintain a fine balance in disclo- sing what is known and acknowledging the uncertainties.

The authorities have to be transparent about their Covid-19 res-ponse policies and strategies, as well as vaccine availability and administration.

Disclosure about how key decisions are made are critical for gaining and maintaining public trust.

The reporting of adverse events after vaccination is a vital component of monitoring the national vaccination programme.

However, prominent headlines and intensive media coverage may discourage vaccination.

As such, the media’s duty is to report responsibly and in a transparent, clear and unbiased manner.

Likewise, social media users have to be responsible and avoid spreading falsehoods that could contribute to vaccine hesitancy.

More expeditious efforts by the authorities are needed to address vaccine hesitancy in order to in- crease confidence in, and uptake of, the available vaccines.

With the dire straits the healthcare system is in, half-hearted measures or failure to do so is not an option.

The authorities need to act, and act now.


Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views express-ed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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