KUALA LUMPUR -- Malaysia is set to begin its second phase of COVID-19 vaccinations on Monday, expanding the program to 9.4 million seniors and individuals with chronic diseases.
But with the government's voluntary registration system receiving a lukewarm reception so far, officials are mulling a switch to mandatory shots if participation does not pick up soon.
Since registration opened in February, 8.8 million people have signed up to get the jab, roughly 36% of the eligible population of 24 million. This casts doubt on the prospects for hitting the government's target of inoculating 70% of the total population by the end of December, which it considers the threshold for reaching herd immunity.
"September will be the critical point where we see if we can get to 70% by year-end," Science Minister Khairy Jamaluddin said in a local radio interview earlier this month. Depending on the situation at that point, he said the cabinet would face "the tough call" of whether to make vaccinations mandatory.
As of Wednesday, about 1.08 million doses had been administered in the first phase for front-line workers, of which 425,000 were second shots.
The second stage of immunizations will cover health care support service providers, seniors 60 years old and up, and high-risk groups such as those with comorbidities and disabilities. This phase is expected to last until August, after which the largest chunk of citizens -- over 13.7 million people aged 18 and up -- are expected to be vaccinated.
Back in January, the government had said the free-of-charge shots would be voluntary, but the sluggish enrollment appears to be changing government officials' thinking.
Dr. Sanjay Rampal, a specialist in public health medicine at the University of Malaya, told Nikkei Asia that the idea of making vaccinations mandatory raises "a difficult ethical dilemma, as our knowledge of vaccine safety and efficacy continues to evolve."
Technically, Malaysia's current state of emergency until Aug. 1 gives the government broad powers without going through parliament, contingent on the king's consent. The authorities may already have the power to enforce vaccinations: A 1988 law on infectious diseases states that officials can direct residents of outbreak areas to subject themselves to treatment or immunization.
"It shall be lawful for an authorized officer to use such force, with or without assistance, as may be necessary and to employ such methods as may be sufficient to ensure compliance," the law states.
Sanjay sees a few possible factors behind the slow registrations: public hesitancy to get vaccinated, a wait-and-see attitude and limited digital literacy hindering online enrollment.
"Polarization of opinion" and "poor vaccine literacy" could be contributing to the reluctance, he told Nikkei. "Those with a wait-and-see attitude are likely late adopters and will register in a couple of months as more Malaysians get the vaccine."
Sanjay added that governments need to be transparent about the potential harms along with the benefits of the vaccines, as trust and goodwill are essential. Any new evidence needs to be critically appraised without bias, he argued.
"This transparency is likely to increase trust in the translation of the science behind the vaccines and how it may benefit the community," he said. "A deeper integration of vaccine literacy initiatives within the social fabric of the community, through a whole-of-society approach, may increase vaccine acceptance."
Assuming more residents volunteer to roll up their sleeves, another challenge is ensuring the country will have enough shots to go around when they are needed.
Minister Khairy recently said Malaysia is facing a shortage of vaccines as it embarks on the second phase. He blamed the unequal distribution of supplies, dominated by advanced economies.
"One of the biggest reasons for low vaccine supplies in Malaysia and other middle-income countries is that rich countries have cornered the COVID-19 vaccine market," he said. "Some rich countries have bought enough vaccines for their citizens three to five times over. Many pharmaceutical companies give preference to rich countries for obvious reasons."
He said that has pushed Malaysia to balance its vaccine portfolio to include Pfizer, AstraZeneca and China's Sinovac. The efficacy of the Chinese shot has been the subject of much international debate, though Turkey has deemed it "significantly effective."
Khairy himself was the first in Malaysia to receive the Sinovac shot last month, in a show of confidence. On Wednesday, the minister tweeted that vaccine availability would get better from "June onwards."
Sanjay said vaccine deliveries and efficient scaling up of vaccine administration would be among the major factors in determining whether Malaysia completes the second phase by August as planned.
Meanwhile, the country continues to fight COVID-19 infections. Malaysia's seven-day average of daily cases is about 1,600, bringing the total for the pandemic to around 366,000.