Executive Summary

At the time of publication of this report, there have been over 7.6 million COVID-
19 cases and over 425,000 deaths from COVID-19 globally. In April and May
2020, these deaths were initially dominated by five countries in the West, notably
the United States, Italy, the United Kingdom, Spain, and France. At time of
publication, Brazil has entered the top five and displaced the United Kingdom.
This reality has challenged the idea that expertise, and indeed the robustness of
health systems, ‘is concentrated in, or at least (is) best channeled by, legacy
powers and historically rich states.’[1] Instead – countries in the East have shown
innovative and speedy pandemic responses that have kept infections and deaths
relatively low compared to the West.

One of these countries is Malaysia. An upper middle-income country with a

population of 32 million people, it has in recent years made a number of public
health achievements – the issuance of a government use license for access to
generic Hepatitis C drugs,[2] ranking highly on Bloomberg’s Healthcare Efficiency
Index,[3] and eliminating mother-to-child transmission of HIV and syphilis.[4]

This situation brief details Malaysia’s response in the first phase of infections,
beginning from December 2019 through to April 2020, and was informed by in-
depth interviews with a number of key stakeholders in the Malaysian response,
notably Datuk Dr Noor Hisham Abdullah (hereinafter Dr Noor Hisham), Director-
General of the Ministry of Health and member of the Board of Directors for DNDi;
Dr Hishamshah Ibrahim, Deputy Director-General for Research and Technical
Support at the Ministry of Health; Dr Suresh Kumar, infectious diseases physician
at Sungai Buloh Hospital, one of 40 hospitals nationwide designated as a COVID-
19 hospital; Dr Ravindran Thayalan, Head of Virology Unit, Institute for Medical
Research; Dr Melor Mansor, a COVID-19 frontliner and consultant
anesthesiologist at Kuala Lumpur General Hospital; Prof Datuk Dr Rahman
Jamal, head of taskforce for MOSTI-MOHE COVID-19 testing laboratories; Jean-
Michel Piedagnel, Director of DNDi South East Asia; and Mr Lambert, a 62-year
old patient who survived COVID-19.

These narratives as exemplified in these following pages illustrate the value of

coordination and early preparations in delivering a robust public health response,
that diagnostics capacity and efficiency was imperative, and, to quote Dr Mike
Ryan, Executive Director of the WHO Health Emergencies Programme, that
“Speed trumps perfection… the greatest error is not to move.”[5] Echoing this, Dr
Feroza Sulaiman, Special Officer to the Director General of Health Malaysia, “We
acted quickly, but we also used basic public health tools – social distancing,
advocating the wearing of face masks in public spaces, contact tracing, frequent
hand-washing. These were early key interventions while awaiting further
evidence-based recommendations.”

In summary, this situation brief finds:

1. Malaysia’s preparedness and planning began in December 2019, when
they first heard from Chinese authorities that there were cases of acute
respiratory illness;
2. Previous experience with MERS and the 2002-2003 severe acute
respiratory syndrome (SARS) epidemic, including experienced contact tracing
teams, was key in enabling a speedy response;
3. Malaysia drastically upgraded health facilities and diagnostics capacity in
February 2020, including an 86% increment in diagnostics laboratory capacity,
89% increment in critical care bed capacity, and an 49% increase in the number
of available ventilators (from 526 to 1034 units);
4. Malaysia hospitalised all individuals diagnosed as COVID-19 positive,
whether symptomatic and asymptomatic;
5. Learning from other countries, including China was essential in identifying
do’s and don’t’s in the COVID-19 response, including in terms of treatment;
6. While evidence on treatments was still murky, Malaysian physicians
prioritised monitoring for negative side-effects of treatments and adjusted
medication regimens