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LETTER | The unfolding Malaysian vaccine anxiety

LETTER | When the AstraZeneca (AZ) vaccination registration was announced to begin in early May, I was quite excited to finally get the opportunity to get vaccinated after months of uncertainty, whilst waiting for the National Covid-19 Immunisation Programme (NIP) to be rolled out to the general public. 

My partner, on the other hand, was not so lucky, as she had a medical condition that put her in the high-risk category for the AZ vaccine. Thus, while my wait was over, her anxiety over not getting vaccinated continued with no clear end in sight.

While I shared her frustration throughout, she was not unique in these circumstances. Looking at how fast the AZ appointments were scooped up, mere hours after opening, it was glaringly obvious how many more Malaysians continued to feel anxious, despondent and desperate over their inability and lack of agency in getting vaccinated. Worse still, if you are one of the millions coming from rural, poor or migrant communities.

The Covid-19 Immunisation Task Force (CITF) was formed in January, its sole purpose to develop a working strategy and policy to administer any and all available Covid-19 vaccines to Malaysians in the hopes of achieving herd immunity. This was the light at the end of the tunnel in what has been a long dreary year of living under the MCO and trying to remember what the different suffixes and prefixes mean. The resulting programme was NIP that began rolling out the vaccine in phases starting in February with a goal to vaccinate a large majority of adult Malaysians by 2022.

Since its formation, the CITF and its coordinating minister, Khairy Jamaluddin have been dogged by controversy after controversy. Starting with the lack of transparency over the acquisition cost of the vaccines, this task force has been constantly criticised and under fire for a litany of issues surrounding NIP including the slow rollout of vaccines, the incredibly oblique and rigid appointment system through the MySejahtera app and the bizarre parallel rollout of the AZ vaccine outside of NIP that was later subsumed under NIP.

What was most striking is that the CITF, together with the Ministry of Health, was waging a health campaign to counter anti-vaxxers and vaccine hesitancy amongst Malaysians. As the vaccines seemed to have emerged rather quickly, there are indeed some who are hesitant to take the vaccine and this left room for anti-vaxxers to sow their misinformation.

While that campaign was ongoing, the CITF had overlooked another group of Malaysians who felt frustrated and anxious over the slow and uncertain rollout of the vaccines; Malaysians with vaccine anxiety.

I see vaccine anxiety coming in two stages, often at varying stages of a country’s vaccine rollout. The first happens early during the initial vaccine rollout when individuals are eager to get vaccinated but are unable to find the means to do so or are feeling anxious over the procedures to acquire them. The second is when a large portion of the public has already been vaccinated, leaving the remaining few who are hesitant to be vaccinated due to numerous concerns of its effectiveness and their safety, in particular anti-vaxxers.

These forms of anxiety were first documented by Americans in early 2021 where healthcare professionals and academics employed various forms of health communication in the form of public engagement campaigns to address this issue and recommend ways to overcome vaccine anxiety. The main approach to assuage public anxiety was to explain the situation with the vaccine programmes, what were the causes for delay, reassure people that having this anxiety was normal and offer practical solutions to manage them.

Vaccine anxiety in Malaysia (and possibly many other developing countries) is still in the first stage with people feeling despondent, isolated, anxious and depressed due to the lack of certainty and clarity over the processes. The current NIP system provides limited information to registrants over when their appointments will be or where they are in the invisible queue.

The evidence of how widespread vaccine anxiety is evident through the overwhelming response to the AZ rollout which crashed the registration website all three times it was opened up due to high traffic and the appointments were scooped up in a matter of hours. In recent weeks, thousands throng vaccination centres throughout the country with slim hopes of getting a slot for whatever leftover shots are available. 

Public safety experts have highlighted that these long queues to “try their luck” with vaccine centres was due to the spread of rumours; these rumours are widespread because of the lack of information and transparency from the government and is a clear indication of the desperation that people feel they need to do whatever they can to secure a vaccine shot for themselves.

The healthcare system is currently at its breaking point and stories of Malaysians dying on arrival are a grim reminder of the lethality of Covid-19 that many Malaysians were spared through most of 2020. Malaysians living in urban centres, who have endured work from home (sometimes in cramped spaces), being furloughed from work (forcing them to seek alternative sources of income), or just praying for a return to the way things were.

The vaccine anxiety in Malaysia is palpable. Both the CITF and other supporting government agencies are not handling it effectively even as they try their best to work through the pandemic. The distribution of appointments through MySejahtera remains opaque as vaccine appointments often arrive without warning and despite being in Phase 3 of NIP, there are still frontliners (most notably the press) and vulnerable Malaysians who have yet to receive their first shots.

The government needs to recognise the uncertainties, fears, and anxieties that Malaysians are experiencing, which can be handled through more effective and continuous health communication campaigns. This can help comfort Malaysians and even offer them something tangible to look forward to. Understandably, the slow rollout is unavoidable due to the limited access to vaccines for developing nations like ours, but hope can be restored in many other ways. While it is laudable that Khairy gives daily updates on the progress of NIP, it is these current supporting systems that have the biggest room for improvement.

Aside from the poor execution of the AZ registrations, MySejahtera is a cumbersome app that can certainly aspire to be a more transparent and empathetic platform; provide more details about appointments or the current position of an applicant in the queue, make the vaccination centre walk-in system more formalised (so people can sign up for them rather than blindly wait outside), and refine the appointment system for those waiting in line and potentially exposing themselves.

While it’s unclear how much of the allocated RM70 million has been used up in developing MySejahtera and the vaccine registration websites, the remainder of those funds should and can be dedicated to enhancing the user experience (UX) of these apps, with the main goal to reduce vaccine anxiety amongst Malaysians. Part of the government’s responsibility to manage the distribution of the vaccine is in managing the expectations, emotional and mental wellbeing of Malaysians waiting to be vaccinated.

The mental health of the entire country is at stake due to this pandemic. The information campaigns must expand to include vaccine anxiety in addition to anti-vaxxers and vaccine hesitancy. Addressing the needs of those suffering from vaccine anxiety can be achieved by providing mental health guides and reassurances to the millions who are desperate to be vaccinated and have no clear means to get it.

BENJAMIN LOH YEW HOONG is a senior lecturer at the School of Media and Communication at Taylor’s University.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.

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