LETTER | The Academy of Medicine Malaysia is saddened by the case of the 3-month-old infant suffering from polio in Tuaran, Sabah, as announced by the Ministry of Health in a statement on Dec 8, 2019.

We applaud the transparency and rapid response of the Ministry of Health and the Sabah State Health Department, and thank all the health personnel involved in clinical, epidemiological and public health efforts.

This is the first case of polio in Malaysia since 1992, which raises our concerns about the state of immunization in Malaysia. In May 2012, the World Health Assembly declared ending polio as a “programmatic emergency for global public health”. The Polio Eradication & Endgame Strategic Plan 2013-2018 aims to completely eradicate all forms of polio, so that no child ever again becomes paralyzed from polio.

To protect our children from polio, the World Health Organization’s Polio Vaccines position paper in March 2016 recommends vaccination to all children. The polio vaccines (both oral and inactivated forms) have extensive and long-term evidence of safety and effectiveness. The inactivated polio vaccine (IPV) is recommended, but not mandated, in Malaysia’s National Immunization Schedule.

Malaysia’s strategies for vaccinating our citizens include high levels of routine vaccinations through our public health system, providing vaccines free of charge, making them accessible in all Klinik Kesihatan, some Klinik Desa and through mobile and Flying Doctor clinics, and public education campaigns. This has been supported by religious scholars from many religions, including Islam, medical associations and civil societies. These efforts have generally been very successful in ensuring our herd immunity is above 95 percent.

In recent years however, vaccine hesitancy has become increasingly apparent and vocal. The Academy is concerned that the wilful misinformation and irresponsible behaviour of groups that are against childhood vaccinations affect not only their own children, but also other young Malaysians.

We believe that more assertive measures are needed to ensure adequate vaccination rates in Malaysia, including a stronger counter-misinformation campaign against anti-vaccination campaigners and consideration for mandatory vaccination programmes.

The Academy is also concerned about the public health implications of not extending reasonable health services to non-citizens within the borders of Malaysia, such as undocumented migrants, refugees and stateless people.

While we recognize the complexity of the situation in terms of our laws, borders, sovereignty and challenges of financing, we equally believe in the principle of health for all for ethical, humanistic and public health reasons.

The principle of health for all is stated by the World Health Organization, the Sustainable Development Goals (specifically Goal 3.8), and the Universal Declaration of Human Rights. In his remarks during the 72nd World Health Assembly in May 2019, our Health Minister Dr Dzulkefly Ahmad stated his aims to achieve universal health coverage for Malaysia. We applaud these aims.

Therefore, the Academy of Medicine Malaysia:

1. Urges all parents to vaccinate their children according to the National Immunization Schedule. Please speak with your doctor to obtain more

information.

2. Urges the Ministry of Health to increase efforts to more assertively counter misinformation on social media. We also urge all citizens to exercise good judgment when sharing any health information on social media. The accuracy of the information and the intentions of the author are not guaranteed. Please speak with a health professional for advice. We equally urge all stakeholders not to use xenophobia as an easy solution for a complex problem.

3. Urges the Ministry of Health to consider the case for mandatory vaccinations, with sanctions for unreasonable non-compliance. We also urge the Ministry of Health to consider providing free vaccines to all children of non-citizens without criminalizing them in a system that encourages completing the course of vaccines.

4. Urges the Ministries of Home Affairs (including Police and Immigration), Law, Defence and Foreign Affairs to develop durable solutions to the presence of non-citizens in Malaysia. These durable solutions must consider the rights and duties of the non-citizens, and Malaysia’s rights and duties under international laws and norms. These durable solutions can begin with health and vaccine-preventable diseases.

5. Urges the entire health profession in both the public and private sectors to do their utmost in advocating for vaccinations at every possible opportunity.

These principles form part of the ethos of the World Health Organization. The Academy of Medicine Malaysia stands in solidarity with the entire health profession to protect the health of our most vulnerable.

Prof Dr ROSMAWATI MOHAMED is a Master of the Academy of Medicine Malaysia, representing 11 Colleges.