The Sidelines: Public engagement in a pandemic
With Sargunan Sockalingam, physician and academic, at the University of Malaya
The Sidelines is the supplementary issue to every main edition of The Starting Block. Here you will find the interview transcript and more information about the conversation of the week. The interview is edited for length and clarity, and all links provided come from me, and not the guest.
Listen to the audio version here.
TRANSCRIPT
TINA CARMILLIA: Hello, my name is Tina Carmillia and this is The Starting Block, a weekly conversation on science and society with an emphasis on disinformation, data and democracy.
Before we start, I’d like to let you know that the transcript and credits for this conversation are available on The Sidelines, the supplement to every main edition of The Starting Block.
Now, in the next lane: Professor Sargunan Sockalingam, physician and academic at the University of Malaya. Our topic this week: public engagement during this COVID-19 pandemic and its implications to the future of healthcare in Malaysia, and beyond.
Ready? Let’s go.
SARGUNAN SOCKALINGAM: OK.
TINA CARMILLIA: How’s life, are you back in the front lines?
SARGUNAN SOCKALINGAM: Yeah, I start tomorrow, for two weeks. It’s not a pretty sight, the load is much heavier than what we had before. We still can manage but I don’t think we can hold on for much longer. We started touching 4,500 cases per day, and I’ve not seen a single single-digit death per day for as long as I remember.
TINA CARMILLIA: But with the vaccine rollout that’s happening slowly but surely, do you see that that might help alleviate the situation or is the rate of infection much higher than the rate of vaccination?
SARGUNAN SOCKALINGAM: Yeah, we don’t even have to go there – the rate of vaccination is painfully slow, it’s too slow. I’m not ashamed to say this because we’re supposed to be a country that’s way ahead of everyone [in] Southeast Asia, one of the top countries, but no, it’s really incredibly slow. I think we need to find out why.
At this point, some are saying that the people are hesitant, but that’s not true, because [the government] rolled out the AstraZeneca vaccine through a lottery – first come, first serve. And unfortunately, within… well, fortunately, within three to four hours, it was all taken up. That’s a sign that people really want the vaccine. My biggest problem – pet peeve – on this is that we’re too slow on our vaccine, and I cannot understand why.
TINA CARMILLIA: Let’s take a few steps back and look into public engagement because you said that maybe it’s not so much about vaccine hesitancy, but rather the rollout of the vaccine. There are a lot of speculations about where the vaccines are going and how it is being distributed and who is being prioritised, and part of that is the communication that’s involved through the public health authorities.
As someone who’s familiar with the media industry and also being engaged in science communication in the media pre-pandemic, what is public engagement like in the old, pre-pandemic world, versus now, when we’re under lockdown, when we’re online 24/7, therefore we get our information online as well. And, at the same time, we’re communicating about a novel virus, at least in the early phase, where there’s limited knowledge about it, and so we’re extrapolating from knowledge about other similar situations to be able to do evidence-based science communication. What is that like, because it’s not just science communication, isn’t it? It’s also crisis communication.
SARGUNAN SOCKALINGAM: You’re right. Where the public is concerned, I think the public is well-informed. What I don’t see happening is how the public is addressing our knowledge of the treatment of COVID-19 cases. Having seen what is happening in India, people know that oxygen is precious, that air oxygen is different from the oxygen that you get in your oxygen tanks. The oxygen tank is concentrated, it reduced the work of the lungs, especially when the lungs are sick, it reduced the work, which makes oxygen transfer easily, avoids hypoxia so it keeps your tissue healthy… So they have that level of knowledge, but unfortunately, what I’m a little worried about is that the public doesn’t seem to want to engage on that point.
What I am happy about is how the public’s well aware of the importance of physical distancing, wearing the mask, washing your hands, but what I find woefully lacking is isolation. People think that isolation is no longer important and I can’t see that, I don’t understand. I’m isolated at home, even though I am vaccinated, I’m minimising the number of people I meet. I don’t understand why people don’t have this within… there’s a huge gap of knowledge there and I think the public can occasionally be a mob. I would love to use the word ‘herd’ in the setting of immunity, unfortunately, we have a herd mentality.
And I see that in every country in the world. We saw that with what happened during the Trump era. We saw what happened among people who refused to give up their rights of public appearance during the peak of the pandemic. We saw that happened in Europe. We are now seeing something like that here, where, especially when it comes to commerce, people are absolutely fine with jostling with one another, feeling their body heat, exchanging fluids… and I don’t understand that. There seems to be some amount of information that is just wasted away, we don’t know why. So I think we have to understand that that ship has sailed – where we tell people, hey, you need to isolate. Nope, that’s over.
So you could have an MCO, and it doesn’t help that the current MCO doesn’t feel like an MCO because there’s traffic jam everywhere, I still see crowds everywhere. I think the basis of that is the priority now is the economy over lives. I think that’s the guiding principles, and I’ve posted about that on Facebook and people seem to agree.
When it comes to vaccination, vaccine rollouts and its information, right now, it’s a complete mystery to me what’s happening on the procurement, and the storage, and the transfer – I don’t know what’s happening. But as a person who’s received the vaccine, I could see that at least the storage and the administration of the vaccine part, is fantastic. It’s very ordered, it’s very peaceful, it’s very knowledgeable, the way things are being done. There’s ample preparation for allergic responses, people are whisked to the emergency the moment they detect something wrong, and I’m pretty happy with that. I’ve not heard of any untoward incident. So that’s really very good.
But it just proves to us the point that the public is willing to help in the vaccine rollout and we do not have any problem there. There’s no blockage there. When it comes to delivering the vaccine, to the people administering the vaccine, watching what happens – fabulous, fantastic. It’s just that we don’t know how the vaccines are coming in, where they’re being stored at, why the delay, why aren’t we transferring them to places. So we really, really need to understand why is there a delay. And I understand that there are some very big excuses, good excuses coming in. You know, in Malaysian society, we are being told that we should be subservient to the government. I think as a taxpayer, and as a civil servant, I have the right to ask because all we want is for things to be easy. The faster we vaccinate everyone, I think half the battle is won, and we are going to see less cases, at least [the ones] falling very ill. But we are nowhere there. Our statistics show that we are very, very close to what India has experienced, and this is where it’s really getting worrying.
The media is well informed but we have to understand – you just had World Press Freedom Day, (laughs) I’m sorry, press freedom, I know, sounds… You’ve just got to be careful. My solution to this – if you don’t want me to talk, ‘I no talk,’ that’s it. We can all sit down, sing Kumbaya, everything’s fine…
The question now is why are we being told to toe the line. You do not want to generate panic. [The authorities do] not want a matter of national security to come out, which is understandable. But let me tell you, you don’t need us for that.
TINA CARMILLIA: But you are talking. And you’re talking quite critically of the whole situation. Obviously, you aren’t the only healthcare professional who is speaking out, and in the past few months, there’s been some reining in or gatekeeping of the flow of information especially from healthcare workers in the public sector, such as yourself.
I mean, speaking of press freedom and freedom of information, and so on, how do you respond to something like – especially with the availability of social media and the public having this direct interaction with people like you, asking questions… How do you react to that when you’re told to toe the line and follow the official script?
SARGUNAN SOCKALINGAM: The easiest way to react to that is to follow what is being told. It’s really the easiest way. But there are ways to go around that. For instance, one reason why I find it very difficult to do is because as a diagnostician, when we see a problem, we have to call it out. If a patient comes to you with abdominal pain, I need to know what’s causing the pain. If I say it’s acute appendicitis, when it is acute appendicitis, that’s the truth. Well, you can deal with that. But, when it is acute appendicitis, but I say, “Nah, it’s just gastritis,” because gastritis is easier to treat, cost is less, and you tell the person, “Look, it’s just gastritis,” and you walk off. That’s basically why we are very much against… because if there is a mistake in this whole “emperor’s new clothes” situation, lives could be lost, and it will mean double the work for people like me because now we have to deal with a more complicated situation instead of having dealt with it first.
The question now is why are we being told to toe the line. You do not want to generate panic. [The authorities do] not want a matter of national security to come out, which is understandable. But let me tell you, you don’t need us for that. The matter of national security is already in the social media messages that are coming out. We could just sit for 30 minutes, waiting. You will see something coming out that is absolutely worrying. Now, I didn’t generate that, but there it is. It has exposed the more powerful population, it has exposed the power of social media, and what we seem to call as ‘epidemic misinformation’. This is what we are actually dealing with right now, and I think this is where I find the answers as to why are we seeing another wave? Why are we seeing a very slow vaccination rate?
I always believed that what we need is a situation room, we need a task force made up of epidemiologists, scientists, infection disease physicians, biomedical statisticians; and we need this group of people, including our IT specialists, those who can run simulations. We need them to run the show, we need them to tell us what has to be done, and not emotional leaders. That’s what we need right now. I don’t see it happening anywhere in the world, I’m not just talking about Malaysia, I don’t see it happening anywhere in the world. It’s about that person who comes out on TV every day, and I think that’s a waste of time. What we need is information, delivered in a very succinct, very organised manner, and that’s it, and we need the science behind it.
Maybe to some extent, something like this is happening in the UK because the NHS is a science-based organisation. We have a service-based organisation. India found out the hard way despite being a country that probably has the most number of professionals, scientists, epidemiologists, and so on, you know what, I just can’t control it.
TINA CARMILLIA: And they are also a vaccine-producing country.
SARGUNAN SOCKALINGAM: We can ask why isn’t Malaysia a vaccine-producing country. We have the technology. We actually have fantastic technology in Malaysia. Of course, half of them are outside of Malaysia, everyone is “Malaysian-born” and getting awards and so on, but there are great talents here and we haven’t even looked into that and I think the reason for that is our obsession with industrialisation.
This is nothing. This is absolutely nothing. And what can possibly happen is a series of virus that comes out at the same time – an encephalitic virus, a gastroenteric virus, a respiratory virus, haematological virus, all coming out at the same time. That is highly possible. We might as well have an asteroid come and strike us. That is more merciful.
TINA CARMILLIA: I remember our conversation before this whole thing blew up into a full-blown pandemic. This was over a year ago, we were having beers, watching a live jazz show, and you were talking about, basically a projection of what actually turned into reality. That’s something that you and your peers foresaw, and I’m sure that you rang the alarm bells; what happened? Why was there a leakage in the information flow?
SARGUNAN SOCKALINGAM: The answer to that is that we’re insignificant. Who wants doctors and nurses and physiotherapists, occupational therapists to come and give their opinion? Nobody cares, right? Until it’s too late. I think everything is about funding at the end of the day, it’s about the flow of money. But people don’t want to fund this kind of things. They do not want to fund an analysis of future projections of what’s going to happen.
Maybe it’s uncomfortable. Maybe we just prefer to see this in movies like World War Z or Contagion. I think Contagion came out in 2012, and we saw how everything was so accurately predicted. And despite that, we had some little epidemics coming up here and there, and we still didn’t learn. When you have people in charge who do not have science as background – are you able to be that person who, in Malay, we say, turun padang? Are you that person? You’re not. That’s why I’m supportive of [Khairy Jamaludin]… we have our minister who is in charge of vaccination. At least I hear some decent things coming out of him, and he is talking about science. He’s the only person who says this.
But then again, it’s, I think, too little too late. So when a society that is being fed with the gilded sword of economic growth, wealth accumulation as the ultimate aim, you do not have time for this. And finally, we’ll get caught up. We can thank climate change for this, when the permafrost melts more, there are more viruses coming out. This is nothing. This is absolutely nothing. And what can possibly happen is a series of virus that comes out at the same time – an encephalitic virus, a gastroenteric virus, a respiratory virus, haematological virus, all coming out at the same time. That is highly possible. We might as well have an asteroid come and strike us. That is more merciful. That’s where I see things going, right now. You tell me when you think it’s going to be over. Do you think it’s this year? No, forget it. We’ll be lucky if we see the end of this at the end of 2022.
TINA CARMILLIA: The mutations are going to catch up with us.
SARGUNAN SOCKALINGAM: There we go.
TINA CARMILLIA: But with a mutation that becomes more deadly, that would spell the end of the virus. As a virus, I think I would want to survive. I want a high infection rate, but I don’t want my host to die. Do you see this virus turning into something that’s like HIV, for instance, where you can live for a very long time, with the virus?
SARGUNAN SOCKALINGAM: So that’s the ultimate role of any virus, that is to co-exist with the host and we could say that the anti-HIV therapy or the highly active antiretroviral therapy is, in fact, a bigger picture of how the virus learns to co-exist with humans. So it could well be not the humans who are planning this, it could be the viral genome that’s planning, “Hey, one day, no problem we can all live happily, these people will figure out what to do.”
But in the path to that, there will be mutations that kill. And when that happens, it’s like a genetic code that’s gone rogue that’s beyond control, that’s just going to kill as many people until it dies out along with it. So you will see like a branch-out. So out of the ten, let’s say, that branch out, four are these deadly mutations that don’t care, they do a harakiri, kamikaze thing. The other six are going to go along the lines… I mean, a virologist will be in a better place to tell you, but I think, as a person who studies immunity and autoimmunity, I see that. And I’ve seen that even in non-infectious cases when we try to treat rheumatoid arthritis, for instance, with certain medications, the biologics like monoclonal antibodies, there seems to be a resistance developing because our bodies develop resistance against medications, right? So this idea of resisting is a two-way thing. Humans may eventually develop immunity towards COVID-19 that actually works, but it’s going to take a long time for that to happen. But viruses move faster because they’re more like a pack of wolves that are more mobile, whereas we humans, we’ve learned to root ourselves to one place, we’re not as mobile as the virus.
TINA CARMILLIA: I was reading a report that was released this month by the European Federation of Academies of Sciences and Humanities that said that there’s a paradox: “Scientists are generally held in high esteem in many societies due to their extraordinary contributions to human health and welfare, and are also involved in addressing current societal challenges,” but, “at the same time, the progress of science is envied and its terminology appropriated,” I suppose by pseudoscientists, so, the “trust in science is paradoxically under attack.” Do you see yourself as someone who’s been thrust to the front lines, in more than one way, whether it’s in the clinical setting or social media? Do you see that as a double-edged sword?
SARGUNAN SOCKALINGAM: Oh, yeah. I totally agree with you. It’s definitely a double-edged sword because it’s the cost of information, really. Information is useful. Unfortunately, in today’s era, we find people talking about end-products that now are going to generate revenue, and that’s what’s it’s all about. Now, we don’t have to go so far. If you look at what this whole pandemic has done, it’s created a whole market for vaccines. So conspiracy theories will say at the end of the day, this whole big thing is to create a new market. But then if you talk about that, you can create a new market out for anything.
What’s the other side? The other side is the moment you get people engaged in actively searching for the right information, I think that’s 90 per cent of the battle won, and I see that happening. To me, I see it as more people are interested in finding out what’s right. If you read Dostoyevsky, he would say that the function of a lie is to ultimately reveal the truth. I mean, I’m paraphrasing. And I think this is how we’re going to learn. It’s going to be a hard, bumpy ride, but eventually, people are going to know, the way we know that hydroxychloroquine doesn’t work in COVID-19. So it was a hard and bumpy road, but you know what, some people profited from it, the company that made hydroxychloroquine made a lot of money. But that’s the way things are, there’s a kind of a mob and herd mentality in all of this.
So what to do about the double-edged sword? Choose a side. And I choose the side of – not for any good reasons but because I like it, I like to look at facts and find out how these facts can be transmitted to the public so that it makes things better for everybody. You may not earn money, but at least you can be comfortable.
TINA CARMILLIA: Well, you’re a very noble guy, so…
SARGUNAN SOCKALINGAM: Thank you, thank you.
TINA CARMILLIA: (laughs)
SARGUNAN SOCKALINGAM: No, no, that’s because the good news is I have a profession that gives me a regular income, so I’m lucky. I don’t have to think about food for the next month and so on, but our day-to-day life is physically and mentally draining. I would like to think that we are all noble, I would like to, but, yeah…
TINA CARMILLIA: Alright, so let’s just wrap up. In our final stretch of this conversation, what is your Finishing Line on the implication of this pandemic – that’s not over yet – to the future practices in healthcare, for instance, with public engagement, with how the medical community and the media can work together, with how public policy in public health is going to be shaped.
SARGUNAN SOCKALINGAM: Definitely this is going to change things a lot because it’s out in the open. We need the scientists to be out there making the decisions, that’s it. We need epidemiologists, IT experts who can help with simulation processes using big data, data analyses. We need that. We need to start projections. We have enough data to do that. And then we need to get the scientists and epidemiologist to design public healthcare policies. How important is public transport in the scheme of things right now? How are we going to design our public transport? How can we make sure that we move people and we move them safe? Because you’re vaccinated against COVID-19, but then the next virus is right on the horizon, just appearing. What are we going to do then?
And these are the things that we need to sit down and talk about. Now everything is with the World Health Organization, I mean, credit to them, what they’re up against, it’s really very difficult. They’re up against a lot of criticism, it’s not easy, but I really think that we really need a specialised task force, get the private sector involved if necessary. If the private sector can now send successful rockets to space and back – we see the success of Elon Musk’s and Jeff Bezos’ programmes, I think this is good. We need financing, otherwise, it’s going to be a disaster that’s already playing out now.
So it’ll change things, but how it’s going to change, we need to decide that now. What’s right? When is it safe to have a music concert? We need the right people to decide that, not politicians. I don’t blame them, I’m not saying they’re bad, but you’re not trained for the job. It’s like asking a doctor to now become a pilot. We are asking unqualified people to manage a healthcare emergency. Seriously, guys? So I really feel that the moment is now, we need the right people. I’m very lucky that we work with some very fantastic people in Universiti Malaya, you know who they are and I wish we could give them more opportunities and chance.
TINA CARMILLIA: It’s great catching up with you, I’m sure I’ll have you back on at some point again.
That’s Professor Sargunan Sockalingam, physician and academic at the University of Malaya on the subject of public engagement on The Starting Block.
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