Malaysia’s Preventable Coronavirus Disaster

On March 1, Malaysia’s recent political crisis moved to a resolution after nearly two weeks of drama. Muhyiddin Yassin, a member of Parliament, was sworn in as prime minister, ending a chaotic period during which his predecessor, Mahathir Mohamad, resigned; the ruling coalition disbanded; and numerous politicians switched sides and jockeyed for an audience with the king in the hopes of being appointed prime minister.

That very same day, on the outskirts of the capital, 16,000 members of an Islamic missionary movement called Tablighi Jama’at were wrapping up their four-day gathering at the Sri Petaling mosque complex.

The attendees would pack their bags and go home to communities across Malaysia, Brunei, Cambodia, Indonesia, Singapore, the Philippines, Thailand, and Vietnam. And they would take the coronavirus with them. According to Malaysia’s Ministry of Health, at least 943 of the country’s 1,518 confirmed coronavirus cases, as of Monday, have been linked to this single event, now dubbed the “Tabligh cluster.” Singapore, Thailand, Brunei, and Cambodia have traced mounting numbers of confirmed cases back to the Sri Petaling gathering, where about 1,500 of the attendees were foreigners. Eight of 14 coronavirus deaths recorded in Malaysia to date are also directly linked to the Tablighi gathering.

The Tablighi gathering took place at a moment when the pandemic’s global death toll had reached more than 3,000 and numerous nations had already started shutting down public events. But as the days and weeks ticked by, Malaysia dragged its feet. As the number of cases grew, mosques and churches stayed open, sporting events were played, and business continued as usual.

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Over the next nine days, as cases quietly spread within Malaysia—and global outbreaks meant that the virus was hardly an obscure phenomenon—members of the country’s new ruling coalition spent more time figuring out their own political status than they did on the pandemic. The National Alliance Party brings together several key members of the previous administration, including Muhyiddin himself, and former opposition parties like the United Malays National Organization. It’s an untested group, under a brand-new leader, working to assert authority after the resignation of Malaysia’s most senior statesman. In the end, this political upheaval may have proved a deadly distraction—one that lost the country crucial time in which to stem the spread of the coronavirus.

“Basically, the first few days were spent putting a cabinet together, with as many positions as possible. The obsession was to cement the coalition,” said James Chin, a Malaysian political scientist at the University of Tasmania. Muhyiddin ended up assembling an unusually large cabinet of 70 members of Parliament. “With regards to the virus, they were given advance warning, but I don’t think they were well prepared—partly due to political drama and partly because health care bureaucrats didn’t think it would spread so fast to Malaysia.”

Chin said health officials continued to work under the false pretext that COVID-19 was a foreign or imported threat and misapprehended the importance of community spread through domestic events like the Tablighi gathering.

“Malaysia’s ongoing political turmoil caused some setback to the fight against coronavirus,” said Swee Kheng Khor, a senior health policy fellow at the University of Malaya. “The nation spent 14 days without a health minister in the transition between governments.”

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Adham Baba, the 57-year-old member of Parliament from Johor who was finally appointed as health minister March 9, was trained as a general medical practitioner and served previously in the country’s Higher Education and Youth and Sports ministries.

“He’s a nice enough guy,” Chin said, “but some of his directives have been questionable at best. Public opinion of him is not very high right now, especially after his viral TV appearance.”

Adham went on a public program called Bicara Naratif last week and advised people to counteract the coronavirus by drinking warm water because it could flush the virus down until it gets eliminated with stomach acids—a baseless claim that came under swift criticism from the public and medical practitioners alike.

“One big miscalculation was that [Muhyiddin’s government] had a choice to hire the old health minister back—Dzulkefly bin Ahmad, who was quite capable and could have smoothed the transition—but the optics were bad because he was part of the previous administration,” Chin said.

On March 13, the government announced a ban against mass gatherings “literally three hours before Friday prayers last week,” said Karl Rafiq, an independent policy researcher who lives in Kuala Lumpur. “So of course those prayers happened, too, around the country. But that’s our leadership for you.” The following week, on March 18, Malaysia finally sealed its land border with Singapore and enacted a two-week “movement control order,” which bans Malaysians from leaving the country, mandates a 14-day quarantine for those returning from abroad, closes all nonessential businesses and schools, and prohibits all mass gatherings. But even that order was marred by poor planning and communication, leading to surging crowds at the border crossing, police stations, and grocery stores. On March 25, Muhiyiddin announced that the order will be extended until April 14.

A number of steps that are finally in place today in Malaysia likely could have been enacted sooner. 

A number of steps that are finally in place today in Malaysia likely could have been enacted sooner, including closing houses of worship, tracking Tablighi gathering participants more vigilantly and with more cultural sensitivity, and giving more notice for the movement control order. For some context, neighboring Singapore raised its domestic risk assessment to “orange” more than five weeks earlier, on Feb. 7, encouraging people to cancel or defer nonessential large-scale events to curb the spread of the coronavirus. The Ministry of Health did not respond to requests for comment.

“You should not change governments in the middle of a health crisis—that’s just not good for the country,” echoed Lainie Yeoh, an art director based in Kuala Lumpur. “Everything they’ve done in response to the pandemic has been a series of very questionable decisions.”

Such frustration is understandable. More than two weeks elapsed between the Tablighi Jama’at event and the movement control order, giving the coronavirus plenty of time to spread. At the event, worshippers slept in packed tents, held hands with each other, and ate from shared plates, one Cambodian attendee told the South China Morning Post.

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Malaysian authorities have been trying to track down the participants but have still not found about 4,000 of them. Hundreds of the attendees were Rohingya refugees, further complicating matters. Tablighi Jama’at is a Muslim evangelical movement that focuses on missionary outreach to marginalized populations, including the poor, refugees, migrant workers, and drug addicts. But the Rohingya are considered illegal immigrants by the Malaysian government and have been reluctant to come forward for testing.

“I’ve been requesting people to go for tests for days, but many are guilty and ashamed to do that, even if they have symptoms,” said one member of the Malaysian Rohingya community, who did not want to reveal his name for safety reasons. “Plus, the Rohingya community here is not one solid block, so many people are isolated and can’t access tests anyway.”

Though he did not attend the gathering himself, he said Tablighi missionaries have frequently visited Bangladesh and Myanmar in recent years, which is why the movement is popular with the persecuted minority.

“The society of Malaysia is very angry with the Rohingya right now,” he noted. “But refugees will suffer more from COVID-19. We already have been struggling from a lack of support and protections, and many of us have been forced to take difficult jobs with low pay and risk of exploitation, which continues during the lockdown.”

The way some of the debate has been taking place is unfair, said Lilianne Fan, chairwoman of the Asia Pacific Refugee Rights Network’s Rohingya Working Group, who lives in Kuala Lumpur.

“There really shouldn’t be stigma for attendees, because no one stopped them at the time,” Fan said. “Malaysian media has been using quite a lot of blame-oriented language.”

Fan said it has been complicated to apply the new government’s policies to the migrant and refugee communities most affected by the outbreak. Many of the public health notices coming from the government are only in the Malay language and must be translated ad hoc into such languages as Arabic, Burmese, and Rohingya—which is mainly spoken, not written.

“People were also really fearful of being arrested, until the government finally made a very clear statement on Monday that no arrests would be made for undocumented people or refugees who come forward for testing,” Fan said. That statement only came 22 days after the Tablighi gathering dispersed.

Religious gatherings large and small have been significant in the spread of the coronavirus this year. In South Korea, a single “super-spreader” dramatically increased the virus’s reach: An infected member of the Shincheonji Church of Jesus came into contact with hundreds of others, likely through the community’s massive religious services, and precipitated an outbreak in the city of Daegu. In Indonesia, another Tablighi gathering was set to take place last week on the island of Sulawesi and was not canceled by the movement. Despite the provincial government’s entreaties, it was not cancelled until Thursday—by which time 8,500 worshippers from across Asia and the Middle East had already converged in the small town where the rally was to be held. Fan noted that several smaller Tablighi gatherings took place in Malaysia in early March after the Sri Petaling event.

But now that Malaysia finally has a new government, and one that seems to have woken up to the threat, the country is relatively well positioned to take on the virus. Malaysia is a middle-income country, richer than many of its neighbors, and has dealt with epidemics before.

“The main lesson learned during SARS was to organize entry screening for travelers and direct patients to designated screening sites,” said Christopher Lee, former deputy director-general of Malaysia’s health ministry. “Another major learning point was to engage private general practitioners and private hospitals … to complement Ministry of Health efforts. Other lessons include the need for isolation facilities and negative pressure rooms [that prevent cross-contamination], clinical staff protection and monitoring of staff health, and building the surge capacity of the labs in a short period of time.”

Even though the health ministry was leaderless for far too long, this institutional knowledge held over from past epidemics and ground-level technocracy helped provide a modicum of coverage through the transition of power, said Khor, the University of Malaya fellow. Meaning, the fallout could have been even worse.

Khor and Fan both praised Noor Hisham Abdullah, the long-serving director-general of health, for steering the ship during the leadership crisis. Abdullah is chief bureaucrat at the ministry and in charge of day-to-day affairs but reports to the public-facing minister of health.

“To me, I think it’s most impressive that the health ministry has worked throughout the political transition,” Fan said. “Of course, certain things like the movement control order must come from the top. And if the political crisis had come even a week later, it could have been an absolute disaster. But they have managed to pull through. In a way, it shows that this country can function without a government.”