It is no secret that Malaysia’s healthcare system was on the verge of collapse a few times during the current Covid-19 pandemic.
The cumulative number of confirmed cases in Malaysia exceeded 2.6 million on Nov 24 (2021).
Meanwhile, our global ranking in the cumulative number of confirmed cases rose from 89th position on Nov 18, 2020, to 20th position on Sept 27 (2021).
The reported number of Covid-19 deaths in the country exceeded 30,000 on Nov 21 (2021).
The deaths per million population is the highest in Asean and is about 1.4 times that of the world average.
According to the Statistics Department, there were 44,307 and 65,584 deaths in the second and third quarters of 2021 respectively.
These were 10.1% and 60.5% more than the second and third quarters of 2020 respectively.
The highest number of deaths – 23,539 – occurred in the period of June to September this year (2021).
A number of factors contributed to this, including:
- Insufficient testing and contact-tracing
- Human resource issues involving healthcare professionals
- Inadequate collaboration with the private and academic sectors, and civil society
- Less focus on the non-communicable diseases that exacerbate the severity of Covid-19
- Inadequate addressing of the squalid living conditions of migrant workers
- Non-compliance with standard operating procedures by politicians, and
- Inconsistent risk communication.
The political instability our country has experienced over these past two years (2020 and 2021) played a significant role in this as well.
In addition, we have insufficient use of digital technology and insufficient genomic testing, with Malaysia’s genomic sequencing efforts being even lower than Cambodia’s.
Covid-19 impacted on many aspects of daily living, particularly health and healthcare.
For instance, the Dewan Rakyat was informed on Sept 14 (2021) by the Health Ministry that its backlog of surgeries was estimated to be as high as 200,000 cases due to the pandemic.
This will have long-term consequences for illness and death, with excess and premature deaths the likely outcome.
Global experiences from previous emergencies indicate that indirect illness and death will probably exceed that directly caused by Covid-19 itself when the numbers are finally totalled up.
Two positive measures that were successfully undertaken though are the national Covid-19 vaccine coverage and the formation of the Greater Klang Valley Special Task Force.
These steps brought the dire health situation then under some control within a period of about 10 weeks with aggressive coordinated public health and clinical measures.
While many, including the government, agree that our national healthcare system – which has been putting in great effort on a limited budget for years – needs to be further strengthened, the Health Ministry’s budget was only increased by 1.5% for 2022.
More to come
There have been several epidemics and outbreaks in the first two decades of the 21st century that had affected many countries.
Old diseases returned and new ones joined them.
The former include plague and poliomyelitis.
The latter include severe acute respiratory syndrome (SARS) in 2003, H1N1 influenza in 2009, Middle East respiratory syndrome (MERS) in 2012-2013, Ebola in 2014, Zika in 2015 and Covid-19 in 2020 to date.
These diseases have spread faster and further with wider impact.
Outbreaks that were previously localised can now become global very rapidly.
This was and is exemplified with Covid-19, which has killed more than five million people globally to date.
Although it is impossible to predict the nature of the disease(s) to come, its source or when it will start, the World Health Organization (WHO) has stated that “with a high degree of certainty, that when it comes, there will be (a) an initial delay in recognising it; (b) a serious impact on travel and trade; (c) a public reaction that includes anxiety, or even panic and confusion, and (d) this will be aided and abetted by media coverage”.
Many scientists and doctors have warned of future pandemics.
This was stated succinctly in the annual Richard Dimbleby Lecture shown on BBC One on Dec 5 (2021) by Prof Dame Dr Sarah Gilbert.
The professor of vaccinology at Oxford University and inventor of the AstraZeneca Covid-19 vaccine said: “This will not be the last time a virus threatens our lives and our livelihoods.
“The truth is, the next one could be worse.
“It could be more contagious, or more lethal, or both.
“We cannot allow a situation where we have gone through all we have gone through, and then find that the enormous economic losses we have sustained mean that there is still no funding for pandemic preparedness.
“Just as we invest in armed forces and intelligence and diplomacy to defend against wars, we must invest in people, research, manufacturing and institutions to defend against pandemics.”
Lessons to be learnt
The primary lesson we need to take from the pandemic is the massive impact inequality and structural disadvantage has had on its course and outcome.
The faultlines in Malaysia’s public healthcare system were laid bare by Covid-19.
The years of underfunding have had, and are having, their impact on the rakyat.
Related health and healthcare issues like long Covid, health inequity, healthcare workforce resilience, mental health, better ventilation in buildings, etc have to be addressed.
Vaccination and “living with Covid-19” cannot be seen as the end of this public health chapter in our nation’s story.
As such, there is a strong case for the establishment of a Royal Commission of Inquiry (RCI) to inquire into and report on the management of the Covid-19 pandemic to date, as well as to make recommendations on the strategies and solutions to strengthen the healthcare system so that it can be better prepared for the next inevitable public health emergency.
The RCI would have to determine what Covid-19 management measures worked and what did not.
The objective is to learn from the errors made and recommend solutions.
Such an RCI should be chaired by a senior retired judge.
Its membership needs to include stakeholders like civil society and professionals.
To ensure public trust and to obviate politicisation, no current or retired politicians should be appointed to the RCI.
When the current pandemic will become endemic cannot be predicted.
To postpone the RCI to a later date, e.g. when Covid-19 becomes endemic, would deprive the country of the opportunity to put in place measures for the next public health emergency.
Towards this end, a timeframe, e.g. six to nine months, has to be put in place for the RCI to submit its report to the nation and Parliament.
The next epidemic needs to see us ready and prepared to tackle it, well-armed with the hard-won lessons gained from the lives, blood, sweat and tears we have lost to Covid-19.
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 expressed 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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