KUALA LUMPUR, April 28 — Ensuring migrants have equal access to the Covid-19 vaccine is crucial to gain control of the coronavirus, despite calls to have non-citizens pay for them or sideline them altogether, experts say.
Datuk Dr Ahmad Faizal Mohd Perdaus, president of MERCY Malaysia, said scientific evidence, and not public sentiment, should dictate public health measures.
“Public health wisdom dictates we have to ensure as many people as possible … get immunised, get vaccinated so that we can have herd immunity, which will then hopefully come into effect and break the chain of transmission once and for all.
“That is the public health wisdom, and that is the logic and the science,” he said, adding that no one group has natural immunity to the sometimes-deadly virus.
In February, Malaysia announced that foreigners, including undocumented workers and refugees, would be eligible for the Covid-19 vaccine free of charge in order to encourage them to get their shot, achieve herd immunity and, in turn, reduce healthcare costs.
The government also assured Malaysians that they would be prioritised for the vaccine over non-citizens, with undocumented migrants, refugees and the stateless possibly receiving their shots towards the end of the mass vaccination drive.
Officially, there are three phases of the National Immunisation Plan (NIP), with the first two phases targeting frontliners, the elderly and those with co-morbidities. The third phase is for the rest of the adult population, scheduled to run till the end of this year.
As of April 26, 2021, the total number of people vaccinated in Malaysia is 822,201.
Public sentiment vs public health
The International Office for Migration (IOM) and the United Nations reported an uptick in anti-migrant rhetoric in countries since the pandemic began. It is no different in Malaysia.
Social media posts on the government’s decision to vaccinate non-citizens for free have carried mixed reaction. A few voiced support for the move, but some disagreed. Many did not want their tax dollars to be used to pay for the vaccine for non-citizens, while others feared there would not be enough vaccine for Malaysians.
“Foreign workers are in all sectors and get a salary so why give them the vaccine for free? Let them pay for it themselves or have their employers pay,” wrote Sandra Naranasamy on Facebook.
However, Science, Technology and Innovation Minister Khairy Jamaluddin, who is also the coordinating minister for the National Covid-19 Immunisation Programme, said the vaccine would be free so as to remove a possible stumbling block for employers and foreign workers.
“Let’s say we ask them to pay or their employers to pay — that’s already an obstacle for them. They might choose not to vaccinate since it’s not compulsory,” he told a press conference in January.
Business and labour organisations have lauded the government’s initiative.
The reaction by some members of the public when it comes to Covid-19 and foreigners comes as no surprise to public health officials and experts, who have had to battle such sentiments since early last year.
Now, the public health officials warn such anti-migrant views could backfire on Malaysians — if migrants felt threatened enough to not get their shots or if the government gave in to public pressure and decided not to vaccinate migrants as planned, thus endangering the country’s herd immunity goals.
Equality to maximise immunity
Herd immunity, where enough people in the population have antibodies against a disease that it becomes harder to spread and sicken people, is the best way to end the pandemic, according to the World Health Organisation (WHO) and other health organisations.
The most humane way to get this level of protection is via vaccination.
“If we’re really serious about herd immunity — we’re talking about minimum 70 per cent (of the whole population) — then we need to get as many adults vaccinated as possible,” said infectious disease expert and member of the Selangor Covid-19 Task Force Datuk Dr Christopher Lee.
But not everyone can be inoculated against Covid-19.
In Malaysia, Covid-19 vaccines are currently approved for adults only, leaving children under 18, who comprise more than eight million out of 32.7 million, out in the cold.
In addition, some people with severe allergies and other health conditions may be exempt.
Dr Lee said the threshold for vaccinating the adult population in Malaysia has to be much higher as a result.
“The difficulty here will be the undocumented workers. I think (these) people will be fearful that if they register themselves and after the vaccination, they might be harassed or picked up to be deported and things like that. It’s completely understandable,” he said.
Of the 24.2 million adult population in Malaysia, about three million are non-citizens, according to the Department of Statistics Malaysia. The IOM believes there is an additional two to four million undocumented foreigners in 2019.
As of January 31, 2021, there were 178,710 refugees and asylum-seekers registered with the United Nations High Commissioner for Refugees (UNHCR) in Malaysia.
Some have suggested that the country could still achieve herd immunity without vaccinating migrants, which public health experts regard as not feasible.
“There is no science, no wisdom saying that you should only vaccinate a portion of a population and leave another (eligible) portion out, and hope to achieve (herd) immunity,” said Dr Ahmad Faizal.
Dr Duncan Robertson, a fellow in Management Studies at St Catherine’s College, University of Oxford, created a model, which he posted on Twitter, to demonstrate what would happen if a population sidelined a community in their mass vaccination plans.
In one graph, one infectious person in the middle of an unvaccinated community spread it to others until it got close to the few unvaccinated people, such as children, within the highly vaccinated population.
“It shows why we need to not leave hard-to-reach parts of the population unvaccinated,” he tweeted.
According to the Organisation for Economic Cooperation and Development (OECD), migrants are at least twice more likely to become infected with Covid-19 and to spread it.
With few roots, they can also be remarkably hard to pin down, which makes it difficult to conduct tracing if an outbreak occurs.
They have been in the middle of several super-spreading events and huge clusters. The Teratai cluster alone, associated with foreign workers at Top Glove factories, recorded 7,205 infections and lasted five months.
Dr Lee said vaccinating the migrant community would solve the issue and provide security for the public.
“If you want to protect the country, everyone should be vaccinated. That’s ideal,” he said.
However, he pointed out that including migrants in the vaccination plan does not necessarily mean they will come forward to get their shots.
“Even if you offer them free vaccine, they will not come because they are fearful of being deported and things like that,” he said, adding that the government would need to strategise on how best to meet this challenge.
To encourage migrants to come out and get their jabs, the government has promised safe passage.
They also said they plan to work with non-governmental organisations (NGOs), international organisations, embassies and community leaders to reach migrant communities, although the details have yet to be announced.
Dr Lee said outreach efforts should begin soon to win the trust of migrant communities, as well as to educate and assure them of the importance of getting immunised along with everyone else in Malaysia.
“We all share the space. The virus doesn’t know whether you’re a migrant, whether you have a passport, whether you’re living in Taman Tun or whatever. If there is an opportunity to spread, it will spread,” he said.