LET’S start with what is probably the most misattributed quote of all time: "The definition of insanity is doing the same thing over and over and expecting different results.” No, it wasn’t said by Albert Einstein, the most eminent scientific genius of the 20th century whose theories contributed greatly to knowledge and understanding of the universe.
The axiom is relatively new. It first appeared in 1981 in a guidebook published in the United States by Narcotics Anonymous (NA) to persuade addicts to kick their habit. The NA warned: "Insanity is repeating the same mistakes and expecting different results.”
Today, it is increasingly being applied to the ongoing fight against Covid-19.
At the start of the pandemic 18 months ago, most countries around the world pinned their hopes on masks, lockdowns and the rapid roll out of vaccines to achieve “herd immunity”. But this combination of a “silver bullet” solution no longer holds as much water as it used to.
Top scientists are now of the view that it would be delusional to keep doing the same things today, with the emergence of more contagious mutations of Covid-19, such as the Delta variant. Many of them now hold the view that herd immunity should no longer be the main consideration to overcome the scourge.
Prof Sir Andrew Pollard, director of the Oxford Vaccine Group, for example, has described herd immunity as "mythical” and "not a possibility”. Warning that vaccinations should not be based around herd immunity, he predicted the advent of "a variant which is perhaps even better at transmitting in vaccinated populations”.
Yet in Malaysia, in spite of former coordinating minister for immunisation Khairy Jamaluddin’s decision to stop using the term, the focus still appears to be on getting 80% of the population inoculated by February 2022.
While it is generally accepted that vaccines are the first line of defence against Covid-19, hopes that the shots would stop the spread of Covid-19 have faded. In many countries, including in highly vaccinated Israel, the rise of infections has led to more lockdowns and extensive testing. In several other nations, plans to make inoculation compulsory and require “vaccine passports” have led to violent mass protests.
Israel – where 60% of the total population is fully vaccinated, covering 80% of adults – has now decided on third booster shots, along with Germany, France and Spain. Experts have also confirmed that vaccines would not work for everyone and even against the original SARS-CoV-2 virus, 5% of the jabs were useless.
Let’s not forget that in every country, there are considerable numbers of people with conditions lessening vaccine efficacy, such as those with serious allergies, cancer patients, patients on immunosuppressant drugs, in addition to a significant number of people who do not want to be vaccinated because of mistrust.
As our Health Ministry is well aware, Malaysia too has its share of the vaccine hesitant. Given the ever-growing number of infections and deaths, even among the vaccinated, can they be blamed?
Based on what is being shared on social media, anger is rising among them for being regarded as convenient scapegoats for the spread of Covid-19, when the data shows that the fastest spread is from workplaces, especially factories – the latest announced on Monday (Aug 16, 2021) being 600 workers of a plant making personal protective equipment in Tangga Batu, Melaka.
The government has warned that the vaccine hesitant could face action. Current caretaker Prime Minister Tan Sri Muhyiddin Yassin, who announced this last Thursday, again cited achieving herd immunity as the reason.
"We will study and conduct some research about this (anti-vaccine) group. We need to know the background – whether most of them are so sick that they are afraid to take the vaccines or they don't want to take the vaccine because they don't believe in it,” he said.
If mistrust is the reason, why has the government, like others around the globe, failed to effectively communicate with them? Is the lack of informed consent among the reasons?
These questions should be seen in the context of what the vaccines really are – drugs under the US Food and Drug Administration’s “Emergency Use Authorisation” – a mechanism to facilitate the “availability and use of medical countermeasures during public health emergencies to allow the use of unapproved medical products, or unapproved uses of approved medical products to diagnose, treat, or prevent serious or life-threatening diseases or conditions when there are no adequate, approved and available alternatives”.
Among other things, the Ethical Code of the Malaysian Medical Association states that good communication between doctor and patient is essential for consent. Patients should be given adequate information in a way they can understand to enable them to make decisions about their medical care. It is a general rule that doctors should examine and treat patients only with their consent.
Consent is invalid if it is obtained through coercion, threat or force, or when the person giving consent is not aware of the full implications of consent. In cases where the patient is incompetent and cannot do so, consent should be sought from the next of kin. In situations where consent could not be obtained it should be at the discretion of the doctor concerned, as the protector of the life and health of the patient.
Instead of banking solely on vaccination targets, Malaysia should listen to the experts and adopt a multilayered strategy featuring a host of actions – vaccines, prophylactics, new antiviral drugs, and public health measures.
The Health Ministry should also explore the potential of newly developed innovations to check the spread of the virus indoors, such as China’s ultraviolet disinfection machine which helped 777 members of the country’s Olympic delegation stay safe from Covid-19 and India’s Shycocan virus weakening device which uses electrons to neutralise the positive charge of the virus and disable it from infecting people in places like schools, hospitals and work places.
Media consultant M. Veera Pandiyan likes this quote by Hippocrates, the father of Western medicine: ‘Natural forces within us are the true healers of disease.’
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