SEPTEMBER — We have heard recent calls for the fines under the Prevention and Control of Infectious Diseases Act (PCIDA) 1988 (Act 342), to be increased several fold from RM1,000 to a maximum of RM3,000 or even RM10,000. We should not support such proposals.
They would disproportionately affect the most vulnerable in society, likely increase the incidence of corruption, and result in criminalisation, stigma, and discrimination of those affected. Such measures would also work against the objective of improving public health outcomes, namely preventing the further spread of disease.
The popular rationale is that only through the threat of increased severity of penalties under the PCIDA, can compliance to the standard operating procedures (SOPs) of the recovery movement control order (RMCO), be improved and new clusters of infection be prevented or stubbed out. That the existing fine of RM1,000 is outdated and not sufficiently severe to be taken seriously.
However, there are problems with these arguments.
This proposed measure must meet the threshold of at least two questions. Firstly, has the existing enforcement and implementation of SOPs by law and health authorities failed?
The emergence of new clusters recently might make that conclusion seem reasonable. However, despite emerging complacency and the number of SOP violations being reported during the regular press conferences, general adherence and compliance among the public are actually high. Compare our situation to what is currently happening in some European countries and the United States.
An examination of the recent clusters and even the serious case of the Plantation Industries and Commodities Minister, lends strength to the argument that people do not understand why these SOPs are necessary, why they need to be adhered to.
Go to a family gathering or meeting, and it is likely that there will be no masks worn, no hand sanitisers used, and everyone is salaam-ing. It is not out of defiance of the SOPs or trying to beat the system, but more likely due to the problem of low health literacy.
Health literacy, an essential component of public health interventions, has not been taken seriously in this country, and historically suffered from neglect and low investments. Despite the protests of many public health experts, the previous government even dismantled the Malaysian Health Promotion Board (MySihat).
The National Health and Morbidity Survey 2019 findings clearly show a major problem. One in three Malaysians have low health literacy, and are not likely to understand disease prevention activities, health promotion and healthy lifestyle practices.
Punishing people for something that they do not fully understand is wrong, especially when we have not done enough to improve our health literacy before this outbreak started. Will the police and health authorities be looking into every meeting, family gathering or jamuan? Observing the SOPs should now be part of everyday life, and not whether law enforcement is nearby.
Increasing penalties as a quick way to obtain desired results, will have the unintended consequence of punishing the most vulnerable in society, especially those living in hardship, people of lower income, and marginalised individuals. They will be disproportionately affected.
Unfortunately, we have already seen how people are being treated differently when it comes to the enforcement of these SOPs. Imposing such punishing fines will risk sending many to prison due to their inability to pay them. Surely, that is not what we want to achieve.
The second question is whether there is any evidence or study to support that increasing penalties and fines will actually result in an improvement in the level of compliance and adherence to SOPs, leading to a decrease in the number of cases.
The insistence on an evidence-based approach from the beginning has led to the progress and achievements thus far.
It is tempting to use instruments of the state such as fines, imprisonment, or both, to enforce measures such as quarantines or compliance with SOPs. However, they have limitations and harsh legislation during public health emergencies often undermines public health by creating barriers to prevention, testing, care, and treatment. They end up doing more harm than good.
Studies show that the use of fear, intimidation, and threats of punitive penalties in a public health emergency creates stigma, discrimination, and victim-blaming. Former Covid-19 patients are already experiencing this.
Rather than come forward to seek treatment, people will likely hide their illness fearing repercussions.
Ensuring that people learn from their mistakes to protect themselves and others, should be the objective of the law, not to inflict cruelty, permanent harm, or injustice. But that could be what these proposals to increase penalties end up doing.
Laws can be blunt instruments which may not only be ineffective at stemming transmission of disease, they may even exacerbate the problem.
If you must punish, even a fine of RM250 and a night in police lockup are sufficient. It still hurts and the experience is sobering. As it is, RM1,000 is almost the minimum wage in this country.
It is hard to see new clusters emerging despite the efforts and measures put into place, but the reality is that until a viable and safe vaccine is available and widely taken, Covid-19 will be with us for a long time to come, and managing new unlinked cases will be the norm.
Proposals should not come from an angry or frustrated place, and must be evidence-based.
We must not be complacent, and constant vigilance will have to be our new mantra. But we need to focus on and increase our investment in informing and educating people. We know it can be done.
Government officials, politicians and community representatives need to set a good example by wearing face masks, practice social distancing and follow SOPs. How do we expect people to take compliance seriously when our leaders do not?
Hard earned lessons from previous pandemics have shown that good information, cooperation, empathy, and compassion reduces suffering, protects public health, and saves lives.
* Azrul Mohd Khalib is the head of Galen Centre for Health & Social Policy.
** This is the personal opinion of the writer(s) or organisation(s) and does not necessarily represent the views of Malay Mail.