By Dr Lam Sai Kit

KUALA LUMPUR, Malaysia--It has been more than two years since the COVID-19 pandemic started in Wuhan, China, and the world is getting tired of the various restrictions imposed, affecting personal liberty and livelihood.

It is therefore not surprising that people are demanding that restrictions should be lifted so that life can return to normalcy and allowing economy recovery.

Faced with such growing demands, many countries have lifted almost all restrictions, with Denmark and England taking the lead, and several European countries likely to follow suit. Malaysia, too, is contemplating a similar move to declaring an endemic phase, although more cautiously, as announced by Health Minister, Khairy Jamaluddin (The Star, 4 February 2022).

Are we ready to make such a declaration? Let us examine the facts and the criteria which we should reach before moving to an endemic state.

In the statement issued on 19 th January 2022 by the WHO Director-General following the 10 th Meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic, he made several important points which should be taken into consideration prior to ending the pandemic.

1. There is still an urgent need for member countries to work together to end the acute phase of the COVID-19 pandemic.

2. The status of COVID-19 vaccines and vaccination targets have not been met at the global level, with inequality of vaccine access being the major problem.

3. New variants like the Delta and Omicron and their respective lineages are still cause for concern and potential future scenarios may involve variants that are more or less severe.

4. Challenges to maintain continued community buy-in for public health and social measures after two years.

Malaysia has indeed done well in vaccinating its adult population, but we still have many who have yet to be vaccinated because of health or personal reasons.

The government has just started the vaccination of children between 5 and 11 years of age, and it is hoped that the take up rate will be good, with the hope that 50 percent of those eligible will be vaccinated by the end of the month.

“If sufficient children get vaccinated, it will reduce the educational clusters that are being reported of late.”

Besides vaccination, the country should continue to practice public health and social measures (PHSM) until the government is ready to declare the move to an endemic stage.

“It is important not to rush into declaring an endemic status under pressure. We must ensure we have the country’s situation under control, which will include case reduction, adequate contact tracing, sample testing and genome sequencing, reducing hospitalization rates, severe disease, and excess mortality.

The capability of the country to handle any disease surge will once again be tested with the mass movement of people during Chinese New Year and the forthcoming JB election.”

There are certain novel technological improvements which give hope that the world can bring the pandemic to an end.

Better vaccines are on the horizon, with even a universal COVID-19 vaccine being developed by the US Army that will confer broader immunity and be effective against existing and future variants.

The rapid development of alternate vaccine formulations, including intranasal vaccines, will increase the ease of delivery in low resource and/or hard to reach areas.

It is hoped that this will lead to cheaper and more effective vaccines to meet vaccine inequality. Better SARS-CoV-2 diagnostic tests against new variants are becoming available and high-quality rapid antigen tests should be made available to all countries for an effective global response to the pandemic.

The emergency approval of new therapeutics by FDA against COVID-19 is indeed a significant development, and Paxlovid by Pfizer has just been approved for adult use in Singapore.

“It is hoped that local production and technology transfer to developing countries will contribute to global equitable access to therapeutics and vaccines. Sadly, there are countries whose vaccination rates are still below 10 percent of their population, and this is one of the key drivers of variant emergence and may pose the danger of new variants arising and spreading globally because of high COVID-19 incidence. It will be a challenge to achieve the WHO target of having 70 percent of vaccination in any country by June 2022.”

“So, for now, we must still treat COVID-19 as a Public Health Emergency of International Concern (PHEIC) and should still abide by and adhere to the public health and social measures which are already in place. We must face the challenges of maintaining continued observance of PHSM and to get as many people as possible (adult and children) vaccinated and boosted. I believe Malaysia is heading in the right direction, and as long as we do not let our guard down, there is a good chance that we will be in a good position to get out of the pandemic phase and to enter the endemic phase before long.”

*Dr Lam Sai Kit is a senior fellow with the Academy of Science Malaysia and research consultant with Universiti Malaya.*