THE National Recovery Plan, which is essentially a roadmap to exit from dreaded Covid-19 lockdowns, announced by the prime minister, is hinged on three criteria: Number of positive cases; ICU utilisation; and percentage of population fully vaccinated.

Some have questioned why the government used the three criteria and not others. There are also those who feel that more than three benchmarks should be used.

It is no surprise that there have been so many varied reactions. After all, even medical doctors may at times prescribe different treatments for the same illness.

Medicine is not an exact science. Often, it requires experience to form opinions. Sometimes, it is by trial and experiment. For example, a hematologist may try different regimes of drugs in chemotherapy treatment, or use radiation or bone marrow transplant to treat a lymphoma patient.

This is the reality of medicine. It is the same with public healthcare management. Even more so when it comes to managing contagious diseases, especially a new virus like Covid-19, which mutates quickly and has devastating consequences on people’s lives and livelihoods.

No one can, in all honesty, say they know exactly what to do. A good example is Dr Anthony Fauci. He is steadfast and unwavering on many things in the fight against Covid-19, but he has also changed his opinion as the pandemic evolved.

Let us now look at the three benchmarks chosen and why. The number of daily positive cases (4,000, 2,000, 500). This absolute number may not be the best measure. Indeed the trends (7- or 14-day moving average) in the death rate and daily new cases are better. But it will not be easily understood by most people.

Similarly, the dynamics around ICU utilisation is complicated, in that the number of beds available for a particular use is not necessarily static — there is the question of length of use for each patient, and so on.

The government has chosen to use the percentage of population fully vaccinated as a benchmark, that is, two doses of the AstraZeneca, Pfizer-BioNTech and Sinovac vaccines now in use. Some other countries (such as the UK and Canada) have opted for a single dose as a criteria for their lockdown exit plan. Malaysia has, therefore, decided on a more stringent criteria.

In Malaysia, with an unknown number of unregistered migrant workers, there is also the question of accurately accounting for them in the vaccination programme.

There are many complex issues for decision-makers to consider in deciding on the exit roadmap. That the exit roadmap explicitly used three criteria does not mean that no other criteria will also be considered. For example, if there is a sudden new variant that is extremely contagious and fatal, surely even the best of plans will have to be recalibrated.

Also, there is the implicit assumption that these three criteria will likely capture many more of the other public healthcare considerations that are required as part and parcel of decisions to be made on moving from one phase of the lockdown to another. For example, the level of testing, positivity and R-naught will be considered in the context of the number of new cases.

Some have asked why the positivity rate is not included as a fourth criteria in the exit roadmap. Why not just set and disclose everything, every data, every possible consideration and criteria in the name of transparency?

Well, because it is not necessary. Before surgery, does a doctor go into full details with his patient of every step he will take? He doesn’t. But that doesn’t mean he is not thorough.

In other words, the fact that the criteria for testing, tracing and positivity rate are not made explicit as benchmarks in the exit roadmap does not mean they are not a consideration. We will be surprised if it is otherwise.

Why vaccination must be the heart of the exit roadmap

It is true vaccination does not make the virus go away. And it is impossible to vaccinate all people, while the virus will mutate. And even for a fully vaccinated person, it is impossible to be fully immune forever. No vaccine is 100% effective.

Even when 80% of the population have been fully vaccinated, there will still be cases of Covid-19. We will have to learn to live with some positive cases of Covid-19 being present for years to come.

It is much like the flu. Science expects Covid-19 to become endemic over time — it will be around but contained in a manageable state.

Vaccination is the key to manage the transition from the current pandemic to endemic state. And so far, it is succeeding as seen in the US, the UK, Canada and Singapore. In short, to allow our lives to get back to normal, businesses to reopen, schools to start, and families and friends to see each other in person again, the only path to take right now is to quickly vaccinate as many people as possible.

The step-by-step exit plan of the government shows how restrictions will be eased over the next several months if certain milestones are met. There is now a roadmap for us.

Yes, the government may have fumbled and stumbled in trying to deal with the pandemic. But which government hasn’t? And we, the people, are not faultless either. We have all breached the SOPs to some degree or another and this has contributed to the transmission of infections.

The vaccination programme has started to pick up speed. Those who have been vaccinated have only praise to give about how smooth it is. Those who have not will get theirs in the next few months. With more supplies secured and delivered, more vaccination centres have opened up, including private clinics and hospitals. Factories, which are a major source of transmission, are now given priority.

The anger and frustration among us, because we have struggled with our lives and livelihoods these past 16 months, is understandable. But right now, the country needs more positive vibes and energy.

Let us give ourselves a break from all the negativity and toxicity on social media. Let us do positive things by getting ourselves and our families, friends and colleagues vaccinated.