AS battling Covid-19 will likely extend well into 2022 due to immunological uncertainties and virus variants, we need tools that go beyond vaccination.

Specifically, Malaysia should consider early-stage prophylactic treatments such as antiviral medications to prevent disease progression for non-severe cases. For example, the United States, which has a population of 328.2 million, has reportedly allocated US$3 billion for antiviral treatments. Scaled to population size, Malaysia would correspondingly require RM1.26 billion.

Malaysia also needs to consider specialised treatments such as monoclonal antibodies (mAbs) for those with higher risk of getting severely ill.

For example, 30,000 doses of sotrovimab may cost approximately RM529 million, based on the US wholesale cost of US$2,100 per dose, according to online pharmaceutical portal Fierce Pharma. 

As a comparison, the Australian government announced on Aug 8 that it had secured 7,700 doses of sotrovimab with an estimate of eight to 15 per cent high-risk SARS-CoV-2 positive patients.

Of course, new treatments are constantly being developed and this allocation isn't only for antiviral medications or mAbs — it can be swapped for other emerging interventions the Health Ministry deems promising, safe and effective.

Relatedly, learning from what was a confusing set of changes in the 2021 healthcare budget, it is hoped that the 2022 Budget will be clear and transparent.

For example, next year's drugs budget may not need to be lumped together under the "medical supplies for medical facilities" under "Program Khusus".

Certain Covid-19-related drugs may be parked under respiratory medicine as it is primarily a respiratory disease.

Given that Covid-19 may result in secondary health complications, a new programme/activity for Covid-19 may be created instead of pooled in one general line item.

Another important allocation to be increased would be Skim Peduli Kesihatan for the B40 (PeKa B40). As a public healthcare programme for the lowest income group, there is a need to increase budget allocations to accommodate the increasing size of this income bracket.

It is estimated that the B40 could increase to B50 within 2021, therefore at least an additional RM20 million is needed. Given that more households are expected to drop into the B40 group by 2022, an additional RM40 million injection is proposed, bringing the allocation to RM120 million in 2022, compared with RM80 million in 2021.

For both non-communicable and transmissible diseases, there should be an expansion of budget allocations for both generic and innovative drugs.

Another that requires a budget revisit is psychiatry and mental health programmes. Surprisingly, it was reported that this specific programme experienced a nearly 10 per cent reduction in allocation in 2021 compared with 2020.

It was reported that the Malaysian Mental Health Association observed "more than a twofold increase" in stress-related help requests since the start of the pandemic. Depression, suicide and domestic violence have also increased.

Economic struggles and disruptions to education are expected to continue in 2022, prolonging the already exacerbated mental health issues among students, households and the economic workforce.

As such, a minimum 15 per cent increase from the 2020 allocation of RM344.8 million to RM396.5 million is proposed for 2022.

Head of Galen Centre for Health and Social Policy, Azrul Mohd Khalib, reportedly said that "we need people to be healthy, be responsible for their own health and invest in their own wellbeing to prevent the onset of non-communicable diseases and be better prepared for medical emergencies such as catastrophic injuries".

So it is time for the government and the health system (public and private players) to start promoting and incentivising healthy lifestyles.

A heftier sin tax should be created not only for cigarettes and alcoholic beverages, but also perhaps for many other ingredients and chemical substances to fund a special budget for lifestyle-related non-communicable diseases.

In promoting this, special incentives (beyond tax exemptions) for healthier lifestyle options such as healthy food, sports equipment, outdoor activities and gym memberships should be offered.

In addition to expanding the public healthcare budget, innovative funding mechanisms such a co-payment between public and private players should be considered in order to allow Malaysians better access to innovative drugs, treatments and health programmes.

The writer is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research

https://www.nst.com.my/opinion/columnists/2021/09/729820/expand-sin-tax-incentivise-healthy-lifestyle