Archive for the ‘Health’ Category

NST Leader: Make it compulsory

Saturday, January 11th, 2020
Annual vaccination is the most important measure to prevent seasonal influenza infection, according to the Centers for Disease Control and Prevention website.

The World Health Organisation (WHO) has declared 2020 and beyond as the decade for disease elimination.

Meaning, the countdown has started to achieve disease elimination targets as outlined in the United Nations 2030 Agenda for Sustainable Development.

It includes quashing emerging diseases, such as AIDS, tuberculosis, leptospirosis and chikungunya, as public health threats and achieving universal health coverage by 2030.

Yet, incidences of emerging and infectious diseases are more frequent of late and new diseases have surfaced in several countries.

The pneumonia outbreak reported in Wuhan, China, for instance, is caused by a new strain of corona or flu virus.

Dozens have fallen ill and some are in critical condition, but no death yet reported. The symptoms include high fever, breathing difficulties and lung lesions, the Wuhan health commission said.

Malaysia has not been spared — some 120 cases of Influenza A, with one death, have been reported in Penang, Selangor, Pahang and Negri Sembilan since the start of 2020.

On Dec 8, Malaysia saw its first polio case in nearly three decades, this newspaper reported. And in 2017, the Health Ministry disclosed there were some 25,000 tuberculosis cases with more than 1,900 deaths.

Alarm bells should start ringing now. The World Economic Forum reported that emerging diseases are likely to cause major epidemics. WHO also acknowledges that another influenza pandemic is unavoidable, although the severity and time frame are unknown.

It has, however, identified eight diseases that are likely to cause severe epidemics, among them Ebola, SARS (severe acute respiratory syndrome), Nipah and chikungunya.

Historically, the worst flu pandemic was between 1918 and 1920, known as the Spanish flu caused by the H1N1 virus, which infected 500 million people and killed 40 million worldwide.

The outbreak in Wuhan certainly appears reminiscent of the SARS scare in the early 2000s. SARS, first discovered in China in 2003, had spread to two dozen countries and killed 774 people and infected more than 8,000.

Scientists have cited urban migration, population increase, more international air travel and climate change as among the reasons for outbreaks of new diseases. The fact is, national health has become an international challenge.

An outbreak at any place must be seen as a threat to all countries, especially those that serve as popular travel destinations.

For Malaysia this is pertinent, especially with Visit Malaysia Year 2020. With the visa waiver for India and Chinese tourists in force, some 30 million visitors are expected here.

Imagine the dire situation if a visitor is down with an infectious flu during his visit — how the virus can spread if health authorities fail to detect and contain it.

Health authorities, it must be noted, have taken measures to protect our shores against foreign viruses.

Thermal scanners have been installed at international airports and other entry points to ensure visitors undergo health screening. Quarantine sites have also been identified.

But more can be done. This includes a national health policy that calls for compulsory vaccination for infectious diseases including flu viruses, and making available the influenza vaccine at hospitals and clinics.

Annual vaccination is the most important measure to prevent seasonal influenza infection, according to the Centers for Disease Control and Prevention website, which also recommends that “all people aged six months and older be vaccinated” against the flu virus.

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Take it outside: Designated smoking areas not allowed within eateries

Sunday, January 5th, 2020

Photo by AZHAR MAHFOF/The Star

BATU GAJAH (Bernama): Eateries are not allowed to provide designated smoking areas within the business operations area, says the Health Ministry.

Deputy Health Minister Dr Lee Boon Chye said the smoking ban was within three metres of the premises.

“If an eatery provides a designated smoking area outside the premises, it does not fall under the authority of the Health Ministry (MOH) but the local authority.

“We have had discussions with local authorities. The Housing and Local Government Ministry may consider allowing eateries to provide ashtrays for cigarette butts,” he said at a press conference to announce a “Health and Blood Donation” campaign at the Batu Gajah parliamentary community service centre here on Sunday (Jan 5).

Dr Lee said eateries would have to comply with the restaurant operating licence issued by local authorities, and stern action would be taken if the rules were flouted.

In a separate development, Dr Lee said lack of awareness among the public on the importance of early cancer detection was among the causes for the rising number of new cases.

According to statistics, 95% of cancer can be treated if detected early.

“However, cancer can be difficult to treat once it has entered the fourth stage,” he said.

He said initial screening for cancer could be done at health clinics, in the form of mammograms, pap smear tests as well as blood stool screening for colorectal cancer.

On Friday (Jan 4), Health director-general Datuk Dr Noor Hisham Abdullah reported that there was an increase in the number of new cancer cases over five years from 2012 to 2016, with 115,238 cases detected compared to 103,507 cases for the same period from 2007 to 2011.

The rate for cancer cases is 86 cases per 100,000 male population and 102 cases per 100,000 female population.

According to the same report, the top ten types of cancer detected among Malaysians for the period 2012-2016 were breast, colorectal, lung, lymphoma, nasopharynx, leukemia, prostate gland, liver, uterus and ovary.

Subsequent analyses by gender found that the highest rates of cancer in men were colorectal cancer, lung cancer and prostate gland, while in women it was breast cancer followed by colorectal and cervical cancer.

by Bernama.

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Eight reports of children diagnosed with Influenza A H1N1 in Sabah since Dec 15

Sunday, December 29th, 2019

The state Health Department has received eight reports of children diagnosed with Influenza A (H1N1) from a private hospital here, said Health and People’s Wellbeing Minister Datuk Frankie Poon. – Bernama file photo

KOTA KINABALU: The state Health Department has received eight reports of children diagnosed with Influenza A (H1N1) from a private hospital here, said Health and People’s Wellbeing Minister Datuk Frankie Poon.

The cases involving children between the ages of one to 12 were reported from between December 15 to 28, he said in a statement on Saturday.

“Eight cases have been reported and preventive measures have been taken to prevent the influenza virus from spreading,” he said adding that all the patients are in stable condition.

Poon said the Health Department has taken steps to spread awareness and educate the public on the H1N1.

The statement was issued in response to a viral message on social media alleging that there were children infected with the H1N1 virus admitted at a private medical facility here. The message also said that a doctor at the private hospital had advised parents not to take their children a shopping mall here to avoid contracting the H1N1 virus.

The hospital, through its Facebook page explained that it had never issued any alert about the H1N1 virus outbreak nor said there were many children infected with H1N1 in any malls in Sabah.

Poon added that the influenza, which is a seasonal infection of the respiratory system, presents with symptoms of the flu, sore throat, loss of appetite, headache, muscle and joint pain, and lethargy.

As the airborne virus is highly infectious, Poon said that it is important for people to maintain good hygiene by washing their hands with soap or hand sanitiser, practicing appropriate coughing ethics, and living a healthy lifestyle.

“Those with symptoms of H1N1 to confine themselves at home, and to wear face masks while in public. Usually, influenza causes a mild flu, but it could also cause a severe infection to high risk groups such as children, the elderly, pregnant women and individuals with chronic diseases.

“It is preventable through annual influenza vaccines administered to children aged 6 months and above at private medical facilities,” he said.

Vaccination, though not compulsory, is highly advisable for those who are at risk as it can help reduce complications caused by the influenza such as pneumonia, bronchitis, asthma flare up, ear infections, heart infection or encephalitis.

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All foreign workers must undergo medical check-ups before working in Sabah

Friday, December 20th, 2019

KOTA KINABALU: To stop contagious diseases such as polio disease from spreading, all foreign workers must undergo strict medical check-ups before working in Sabah.

Sabah Minister of Health and People’s Wellbeing Datuk Frankie Poon said the medical check-up is mandatory to all foreign workers as to reduce the risk of infectious diseases spreading in the state.

He added that the government would only take foreign workers in Sabah when they are needed to work in certain industries.

“We do not take in foreign workers if not necessary and we only prioritize local people to work in particular sectors such as the oil palm industries.

“But many locals are not willing to work in the palm oil industries and it will all go to waste,” he said this when met by reporters at Shangri-La Tanjung Aru Resort and Spa yesterday.

“For now, we only need very specific kind of workers from abroad that cannot be found here,” he explained. Meanwhile, Frankie also noted that illegal immigrants in Sabah would need to go through medical check-ups before being sent back to their home country.

“The Malaysian government through the Ministry of Health has signed an agreement with the United Nations Children’s Fund (UNICEF) and the Philippines counterpart to conduct the medical check-up before sending them back.

“These medical check-ups are financed by the Philippines government and all illegal immigrants, be it children or adult, are subjected to these medical check-ups.”


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Reforming Malaysia’s medical education system

Wednesday, December 18th, 2019

The glut of doctors and the contract system has caused much grief in society and the medical profession.

In previous weeks, I’ve proposed a better set of targets for the doctor-to-population ratio.

I’ve also proposed a practical basket-of-solutions to reduce the number of medical schools and students, and to improve how we select medical students through a single admissions test.

To complete the picture, let’s look at ways to improve the quality of medical education in Malaysia.

We will focus only on the quality of undergraduate medical education in local schools, because it’s logistically and legally impossible to increase the quality of foreign schools.

I will propose a philosophy of reform and a basket-of-solutions that can easily incorporate ideas from other people.

The lifelong medical education for graduate doctors will be discussed in future articles.

As previously discussed, because the Malaysian government cannot easily regulate the quality of foreign schools, we can choose to regulate the quality of their graduates through new entrance (Medical School Admissions Test) and exit (Common Licensing Exam) barriers.

When reforming the medical education system, we must think of the current system as an intermediate step to a better system and not the end-state itself.

The system must continuously improve, for three reasons.

One, the necessary medical knowledge increases exponentially every year.

Two, the health system that these students graduate into will be different from that which existed when they started medical school.

Three, the mindset, psyche and resilience of medical students change every few years, e.g. the Millennial doctor is different from the Gen X doctor.

Reforming our system requires a short-term solution to the inconsistent quality of the current 32 local medical schools and a long-term strategy to future-proof them.

The bad news is, even immediately fixing the short-term problem will show the fullest benefits only in 2025, i.e. when the next batch of first-year students graduate in five years.

Let’s call these two objectives Doctor 2025 (short term) and Doctor 2035 (long term).

On to Doctor 2025

The first and most obvious short-term solution to improve the quality of local medical schools, is to close down failing schools.

This should not be controversial, as our laws already allow it.

The Malaysian Medical Council (MMC) has a 132-page guideline on how to accredit a Medical Degree programme, on top of Malaysian Qualifications Agency (MQA) guidelines.

The MMC guideline is remarkably detailed, e.g. minimum of one lecturer to four students, maximum of eight students per group for bedside teaching, a 70/30 breakdown between medical and non-medical academic staff, and a 60/40 breakdown between full-time and part-time staff (who must teach more than five hours per week).

The accreditation is valid for five years, with all schools having to be re-audited after that period.

Withdrawing the accreditation is possible, although no schools have ever been suspended or banned, despite Institute of Health Management Malaysia data from 2014 showing that some private schools have 11% of their students not meeting the minimum academic criteria.

In other words, some schools are breaking the law, and they are still operating!

This task is not difficult. MMC and MQA can audit all schools over a 12-18 month period. We can even prioritise “failing medical schools” using new criteria such as “highest percentage of HOs (house officers) being extended or dropping out due to non-workplace issues”.

A short grace period of six to 12 months can be given before closing schools.

The work of the auditors must be insulated from political pressure, to send a strong signal that the health of Malaysians is too important for politics.

For fairness, existing students can be transferred to another school and the failing school can be taken to court under existing civil law, for appropriate refunds of school fees.

The second solution is for the Health Ministry (MOH) to centrally pair medical schools with public hospitals for their clinical postings.

The problem is that some public hospitals are currently hosting more than one medical school, leading to over-crowding of students and reduced learning opportunities.

This happens because private schools negotiate directly with the hospitals or State Health Departments, instead of Putrajaya. They often prefer public hospitals in the west coast of Peninsular Malaysia, probably because their students want to be in urban settings.

Centralising this decision in Putrajaya is crucial to maximise teaching opportunities, allow more specialists to engage in education, and improve social cohesion when paired with the newer specialist hospitals in Sabah, Sarawak or Kelantan.

The third short-term solution is to clarify existing MOH policies on using MOH specialists as “adjunct lecturers”.

Currently, private medical schools remunerate MOH specialists to teach their students.

This should be allowed, but a balance is needed between three public service objectives for a specialist: patient care, training junior doctors and teaching medical students.

Specialist retention is also an important consideration, and remunerated teaching can help with retention.

Finally, the Hippocratic Oath requires that a doctor teaches other doctors and MOH should encourage it as an appropriate part of a specialist’s workload.

Further on to Doctor 2035

These short-term solutions must continue into the long term.

It must be accompanied by all previously discussed solutions to reduce the number of medical schools and students, and to improve the selection of medical students. Given their synergistic nature, fixing one problem helps to fix another.

To get us to Doctor 2035, there are a few long-term solutions.

The first is to commission a report similar to the Flexner Report, a book-length report published in 1910 that shaped the American and Canadian medical education system into the one that we still recognise today.

This report should contain the over-arching strategies and philosophies for Malaysia’s medical education system for the next 50 years.

It should contain the usual elements like curricula and skills of a doctor, but also introduce new elements like self-correcting mechanisms, the mix of public/private education, the different cultures of different generations and the right mix of paternalism/autonomy.

Other long-term quality improvement solutions are responses to the tectonic changes within medicine, health systems and societies.

One, we must accept that it’s increasingly impossible to teach medical students everything there is to know about medicine in five years.

Instead, we must teach them to manage the knowledge overload by moving away from rote memorisation, and teaching critical appraisal and data processing skills.

Another good skill to have is “learning how to learn”.

Two, as doctors are more than just diagnosticians, we must teach them that there is a world outside scientific medicine.

Brief introductions to health systems, funding mechanisms and health economics are inherently beneficial, and will also teach humility and a sense of awe.

Finally, the doctors of 1995, 2035 and 2045 will have different generational zeitgeists, but will work together in the same clinic.

Our medical education system must embrace the cultural and age differences, and prepare for teamwork of a completely different kind.

Studying medicine is one of the higher callings in life, and the trust and respect given to doctors is testament to that.

There will be no magic solutions to the optimal number of doctors we need, to reduce the number of medical schools and students, to select better medical students or to improve the quality of medical schools.

What we have is a basket of solutions to get the correct number of doctors – all well-trained and well-selected – in order to get the health that we deserve

By Dr Khor Swee Kheng
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Health Ministry: Children under five in Sabah to get additional polio immunisation

Sunday, December 15th, 2019

KUALA LUMPUR (Bernama): All children aged five years and below in Sabah will be given an additional polio immunisation to stop the proliferation of the virus in the state.

”A methodical plan is being drawn up and the additional immunisation will be implemented as soon as possible, ” said Health director-general Datuk Dr Noor Hisham Abdullah (pic) in a statement here Sunday (Dec 15).

Currently, he said, immunisations for children who had missed the procedure in the area where a polio case was confirmed and its surroundings had been implemented to ensure the polio immunisation coverage was boosted.

Until Dec 14,2019,59 children aged from two months to 15 years in the areas which had been overlooked for immunisations, have been given the polio vaccine. All the children involved were non-citizens, he said.

On Dec 8, the media reported that a three-month-old baby from Tuaran, Sabah was infected by the polio virus – the first case in 27 years after Malaysia was declared free of the disease.

Dr Noor Hisham said infectious diseases like polio were borderless and the best way to prevent them is through immunisations.

”As such, parents are urged to ensure children who have missed immunisations are taken to the nearby health clinics.

“A rescheduling of immunisations for children who have been overlooked will be done depending on suitability, ” he said.

He said the Health Ministry (MOH) would also contact the World Health Organisation (WHO) directly to obtain the latest information on the global polio situation.

He said MOH was also refining co-operation with the United Nation Children’s Fund (Unicef) to obtain vaccine supplies at a low cost (subsidised by Unicef) for a programme to immunise non-citizens in Sabah.

The giving of the vaccine would be implemented through selected non-government organisations (NGO).

He said the activities to detect Acute Flaccid Paralysis (AFP) cases, which showed a symptom akin to poliomyelitis, (namely, a proxy to poliomyelitis) in the area of residence of the baby concerned, were now being widened to nearby and high risk areas.

A total 1,553 people had been inspected, and none with the AFP symptoms had been detected, he said, adding that samples of faeces from 20 close contacts of the baby had been taken for laboratory tests and were waiting for the results.

by Bernama.

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Sabah’s poliovirus strain from southern PI, says WHO

Wednesday, December 11th, 2019

KOTA KINABALU: The first case of polio that was detected in Malaysia for more than 27 years in Tuaran, Sabah is genetically linked to poliovirus currently circulating in the southern Philippines, says the World Health Organisation (WHO).

WHO said that the confirmation came after a testing at its Regional Polio Reference Laboratory in Melbourne, Australia on Dec 6.

It said the case of polio from Sabah is a rare strain of poliovirus called circulating vaccine-derived polio (cVDPV) Type 1 and that these polio viruses only occur if a population is seriously under-immunised.

The southern Philippines had declared an outbreak of polio on Sept 19, 2019.

The patient, a three-month-old male child, developed fever and paralysis on Oct 26.

“We are deeply concerned about the confirmed case of polio in Sabah,” Dr Ying-Ru Lo, WHO Representative in Malaysia, said in a statement Tuesday.

“WHO, alongside UNICEF, stands ready to support the Health Ministry in responding to this outbreak and ensuring that all children in Malaysia receive the full protection of polio vaccines.

“The only effective way to protect children from polio is vaccination,” said Unicef representative in Malaysia, Marianne Clark-Hattingh.

“We must make it a priority to stop its transmission so that every child, regardless of their economic status or origin, is protected against this terrible disease,” she added.

Polio spreads in populations with low immunisation coverage. The virus has the potential to cause paralysis or occasionally death.

WHO and Unicef have been providing technical advice on the outbreak response, on-the-ground monitoring and support for risk communication.

“Children are most at risk of polio. Parents and caregivers should ensure that all children under the age of 5 years are vaccinated.

“Polio vaccines are extremely safe and effective and have resulted in global cases decreasing by over 99%. Polio vaccines must be administered multiple times to stop outbreaks and protect children,” said WHO.

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Polio scare: ‘Many Pulau Gaya folks settled in Tuaran village’

Wednesday, December 11th, 2019

TUARAN: Neighbours at Kg Damat in Jalan Sungai Damit, here, who they suspect is where a three-month-old was confirmed to have the polio virus, claim that one of the parents is a Filipino migrant from Pulau Gaya who married a local and settled there in the 1990s

The neighbours, who did not wish to be identified, said there were many others from Pulau Gaya who also began to reside there since.

They said although they were not officially told if their village was the focus, their curiosity was aroused by visits of health officials lately. One resident said they saw health officials carrying out regular inspections at a particular house in the village the past two days.

“We read the statement issued on the Ministry’s website, about a victim diagnosed with the polio virus in Tuaran. However the exact location was not revealed, we don’t know if it happened here or not.

“However, the presence of health officials carrying out inspections and surveys here raised questions,” he said.

He said there are over 300 residents in the village, including outsiders who have stayed in the area since the 1990s.

“Some are married to locals and work here, some have even built their houses here,” he said.

He hoped a thorough check-up will be conducted to prevent the infection if indeed the virus was indeed from the village.

Villagers said several individuals carried out inspections at their homes through stool samples but did not comment further. “They (health officials) came to residents houses and the family members were asked to provide a sample of their stool.

According to the Ministry’s website, the victim is currently being treated at a hospital’s Intensive Care Unit after coming down with fever and fatigue.

The three-month-old boy had been diagnosed with vaccine-derived poliovirus type 1 (VDPV1). Better known as polio virus on Dec 6, believed to have a genetic link to the Acute Flaccid Paralysis (AFP) case in the Philippines.

This is the first case since Malaysia was declared free of polio virus infection for the past 27 years.

Meanwhile, the type of polio virus contracted by a three-month old boy has been confirmed by the World Health Organisation (WHO) and the United Nations Children’s Fund (Unicef) to be the same virus that broke out and is spreading in southern Philippines.

Malay Mail reported that the boy from Tuaran had contracted a rare strain called circulating vaccine-derived polio (cVDPV) Type 1.

“These polio viruses only occur if a population is seriously under-immunised,” they said in a the press statement.

“The virus has the potential to cause paralysis or occasionally death,” they added.

They said confirmation of the type of virus was based on testing conducted by the WHO’s Regional Polio Reference Laboratory in Melbourne, Australia on December 6-10 after the boy developed fever and paralysis.

The Philippines declared a polio outbreak on September 19, WHO and Unicef pointed out, noting that Malaysia’s last case was 27 years ago in 1992.

Earlier, Health Minister Datuk Seri Dr Dzulkefly Ahmad said it was suspected that the virus infecting the boy was brought into Sabah from the Philippines as the infant’s family members had not travelled overseas.

WHO and Unicef, meanwhile, said they have been assisting Malaysia with technical advice on the outbreak response, on-the-ground monitoring and support for risk communication.

The two bodies advised parents and guardians to ensure their children, especially those under five years old who are at highest risk, to get the full number of vaccination shots for full protection.

They gave an assurance that polio vaccines are very safe and are the main reason for 99 per cent of the reduction of cases worldwide.

By: R Gonzales.

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Mass immunization campaign for polio

Tuesday, December 10th, 2019

Dr Christina Rundi

KOTA KINABALU: The state Health Department will be conducting a mass immunization campaign for polio and is seeking public cooperation for its efforts to ensure that people are vaccinated.

“We will be conducting a huge immunization campaign for polio and this is the step we are taking to boost immunization coverage in Sabah (and) in localities where we feel there is risk.

“What we want now is to increase the percentage of immunization and that is what the state Health Department is doing. We may not be able to determine accurately the origin of the virus but the fact remains that it is now present in the state and we must protect the population,” said Health Department director Dr Christina Rundi.

Dr Christina told a press conference that the districts where the campaign will initially be conducted are Tuaran, Kota Kinabalu, Penampang, Putatan, Sandakan, Lahad Datu, Kunak and Semporna.

The districts were selected because the department’s ‘acute flaccid paralysis’ (AFP) surveillance had reported some symptomatic case in the past, she said adding that the immunization program will involve children under seven years old.

“This is not because there are polio cases in the area. For instance the case of the baby in Tuaran who was diagnosed with polio, he was detected through the department’s AFP surveillance.

“They noticed the symptoms and did the necessary tests for confirmation. Otherwise the baby would have been treated for something else. The symptoms were suggestive that there might be some weakness (in the baby so) this means the surveillance works.

“And since there has been no polio cases since 1992,  we needed to get double, even triple confirmation before we reported it. That is why it took some time before we reported it,” said Dr Christina.

She added that other than the AFP surveillance, the department will also conduct an environmental one as the virus is secreted in faeces and enters our system orally.

“Maybe the virus is circulated in the sewage so we also take sample of the sewage to be tested. But at the moment all our environmental samples tested negative. This is part of the surveillance,” she said.

To a question on what constitutes as high risk areas, Dr Christina said these are areas where the immunization coverage is low.

“Although they know the importance of immunization, some are unable to get their children vaccinated due to several factors such as no access in terms of logistics, financial as well as resources available to them. This will result in low immunization coverage,” she said.

“Even if the coverage is high you still need to go in because there are some pocket areas where people are not immunized,” she added, adding that it is all hands on deck for the campaign and this includes assistance from local leaders.

When asked if the State Government will now be screening foreigners entering Sabah for polio also, Dr Christina said no as it is not the routine as many countries have attained the polio free status.

The disease has been eradicated as vaccine is now available, she said adding, “however there are a few countries that have reported cases of ‘wild polio’ and we know these are places which do not have proper health system such as a war zone etc.”

“It is all about immunization and the immunization program is easily available in both government health facilities and private practitioners in Sabah. A fee will be imposed on non-Malaysians. It is just whether they want access to it or not,” she said.

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Is our healthcare system in crisis?

Tuesday, December 10th, 2019

I’m a trained doctor. Ordinarily, we’re not excitable people prone to panic. However, two very recent news in Malaysia caused me concern that our health system could be fraying.

The first is the polio case in Sabah, which is Malaysia’s first in 33 years.

The second is the sudden and unexpected announcement that the Cabinet has approved the decision to stop regulating the consultation fees of private doctors and dentists.

No more polio-free

Crises and dangers often announce themselves quietly.

The three-month-old Sabahan boy currently in Hospital Tuaran has a diagnosis of polio, the first in Malaysia since 1986. The three cases in 1992 were imported ones and not of local origin.

This is a quiet announcement of a very real crisis for Malaysia, and we cannot ignore it.

We don’t have enough information now to accurately determine how this infant contracted the disease. We’re unsure about his vaccination status, his living conditions, access to healthcare services and so on.

These facts are important for this infant, but can be trivial compared to the solutions for an entire population of 32 million Malaysians.

What’s certain is that this strand of polio only happens when populations are under-immunised.

Unfortunately, Sabah is also the state with some of the worst health outcomes, as well as fewest medical professionals and facilities, in Malaysia. It also hosts many non-Malaysians and stateless people.

All these facts are more relevant for the entire population.

The battle has begun

This means that Sabah could be the frontline of Malaysia’s latest communicable diseases outbreak.

We can win this fight, but it’s against the backdrop of some poverty and statelessness, and an under-resourced health system.

One part of that fight is a more aggressive stance against the anti-vaccination movement wherever they may be in Malaysia.

It may be necessary that emergency mandatory polio vaccinations be instituted in Sabah to get the population up to the herd immunity levels of more than 95% vaccinated.

We will have to win the social media war and build an unlikely coalition of health professionals, religious scholars, community leaders, parents, teachers, politicians, media celebrities, and even grandparents to fight this battle.

The anti-vaccination movement can no longer be treated with too much respect or distance.

Building clinics, enhancing access or education campaigns are all well and good, but we must take the fight to the anti-vaccination movement.

Beyond addressing this movement, we must also consider that the health rights of non-citizens of Malaysia are crucial, for humanistic, ethical, legal and public health reasons.

These difficult topics must be a part of our national discourse, because our health depends on it.

Too much deregulation too fast

The second decision that concerns me is the deregulation of consultation fees in the private sector.

The decision could be directionally correct, but is definitely too much, too fast and too sudden.

I have several problems with this decision.

One, this is a sudden decision that appears to have caught almost everyone off-guard and did not involve enough stakeholders.

Two, the Government appears to have chosen deregulation as an easy way out, rather than undertaking the hard work of amending Schedule 7 and 13 of the Private Healthcare Facilities and Services Act 1998 (which was the original perfectly reasonable request from the medical profession).

Three, this appears to be the latest reactive short-term tactical decision by the Health Ministry (MOH), because it doesn’t seem to be part of any coherent long-term strategy.

Four, the MOH continues to disengage from the private sector, leaving Malaysia’s health system without a coherent ideology for how the public and private sectors can co-exist.

How can this move reduce healthcare cost? What is the masterplan for integrating the public and private healthcare sectors? Is it “MOH for Malaysia”, or “MOH only for public sector”? What is the government’s ideology and position for the role of private sector healthcare in Malaysia?

These are questions for our Health Minister.

An imperfect market

There are two important facts hidden behind the reactions of doctors, consumer associations and the public.

Firstly, the implementation date is not announced, because it still requires a formal approval by Parliament.

Secondly, the procedure fees of private doctors and dentists remain regulated, making it the only remaining fee category to be regulated by the Government.

I’m pro-market, but healthcare is full of market failures requiring government intervention.

As two examples, if you’re sick, you’re at the mercy of the nearest hospital or clinic (“captive market”). And even if you have lots of time and can understand medical jargon, you’ll still defer to a trained doctor (“information asymmetry”) and pay anything to get healthy again.

These market failures exist not because doctors are unethical, but because of the way the world works. There is no enemy at all, so we can focus on fixing the problem.

Previously, I’ve shown how price controls alone aren’t enough to control rising healthcare costs, and proposed price transparency and a new health financing system to correct for the market failure of imperfect information for patients.

This sudden deregulation of consultation fees without a proper check-and-balance mechanism of price transparency is more likely to lead to increasing healthcare costs, rather than reduced costs through increased competition.

Here’s what’s most likely to happen, in a sequence of unintended consequences.

Pressure will build on the Government to deregulate the final category of doctors’ procedure fees. This is reasonable because the Government has already set a deregulatory precedent. In 12-24 months, all fee categories could be solely determined by market forces.

We imagine the consumers and insurers can fight against rising charges, but this New York Times article shows the different ways in which healthcare charges can rise, without being fair or logical. Without price transparency in Malaysia, consumers and insurers can’t check any rising costs.

What we need is a new health financing system that helps integrate public and private facilities, and a restructuring exercise in the public healthcare system.

What we also need is for MOH to be more predictable and to make policies for all of Malaysia.

Keeping alert

In Ernest Hemingway’s novel The Sun Also Rises, one of his characters was asked how he went bankrupt. His answer was: “Two ways. Gradually, then suddenly.”

Malaysia’s health system remains strong, but we must be alert to small signals of incoherence from the political leadership and be thoughtful of the unintended consequences of short-term reactive decisions.

We cannot be complacent about the anti-vaccination movement and the health of non-citizens in Malaysia, and we cannot let our children down.

By Dr Khor Swee Kheng
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