Retooling for a different task: Navigating Covid-19 Vaccinations through the Cancer Information System in Malaysia

Covid-19 vaccinations began taking off in Malaysia from the second half of the year in 2021. One of the issues with provision of the national vaccination programme which was being provided free for all Malaysians was that it was centred around large vaccination centres called PPVs (acronym for Vaccine Provision Centres in Malay).

Challenges abounded for people living with cancer in terms of their access to these PPVs. The first challenge was in terms of their own risk for contracting Covid-19. Most of these PPVs had thousands of people visiting them each day, with long snaking queues and its attendant high risks of transmitting Covid-19 to waiting vaccinee-hopefuls. As people living with cancer were already at much higher risk of contracting Covid-19 with much poorer outcomes already documented in many contexts, the concern for many of them was whether they should even attend their vaccination appointments or not. The second challenge for many people living with cancer was the fact that many of them were not mobile, both in terms of their physical fitness and in many cases, the inability to travel due to a lack of transport. This was further exacerbated by risk-mitigation rules which were in place in Malaysia at the time, effectively a ‘lockdown’ that prohibited travel in many different cases and situations. Additionally, many people living with cancer also had economic challenges in terms of paying for the transport and assistance required to obtain their Covid-19 vaccines at these PPVs.

As soon as the National Cancer Society of Malaysia realised that many of the clients and individual we served had these issues which were a stumbling block towards them getting their vaccinations- we swung into action, pivoting on the CIS as the foundation for a delivery system to get people living with cancer vaccinations as soon as possible. A nationwide media and press campaign was rolled out to get people living with cancer (and caregivers) who faced problems in getting vaccination to call the CIS toll-free line for assistance in getting their vaccine. NCSM, working together with the Ministry of Health Malaysia and our extensive number of volunteers then proceeded to provide at-home vaccinations for these individuals free-of-cost via mobile vaccination teams.

CIS specialists who fielded the calls mapped the requests from the callers in terms of geographical location, their pre-morbid conditions and their current health status. A medical professional working with the CIS team for this purpose verified the suitability of vaccinees to receive vaccination based on the information obtained from the CIS.  In order to provide a more holistic service, CIS operators also took down the details of people living within the same household to register them for vaccination as well. For the mobile vaccination programme, it was decided that all household members and not merely the individual living with cancer would be vaccinated in order to reduce the entire risk of Covid-19 infection.

Two days before the mobile teams went out to a neighbourhood, the CIS specialists, augmented with additional volunteers recruited for this task, called each prospective vaccinee to determine their health status ( in terms of whether they were acutely ill or not); and whether the household itself was safe (in terms of Covid-19 infectivity and whether anyone at home was exhibiting symptoms). On the day before the visit of the mobile team, CIS specialists made a reminder call to confirm the time of the visit the next day and subsequently followed up with calls on 1 day after the vaccination and 3 days after the vaccination to check on whether the vaccinees had any form of adverse effects following immunisation (AEFI) and how to manage these AEFIs as they arose. CIS specialists also reported having many different conversations on the safety and efficacy of the vaccines with prospective vaccinees who were concerned about this. CIS specialists also acted to debunk many myths pertaining to vaccines and vaccination in their in-depth individual interactions with these community members.

At this time of need, the CIS specialists performed a very important role to act as ‘quarterbacks’ to guide mobile vaccination teams to the homes of people living with cancer so that they could be vaccinated in a timely, safe fashion. Building on the social capital and trust of years of providing information services to the cancer community, the CIS proved to be an invaluable tool in helping people living with cancer in Malaysia reduce their risk of exposure to Covid-19 and remain safe through Covid-19 vaccination.

By Malini Rama, Mandy Thoo, Murallitharan M.