By Dr Khor Swee Kheng

Very often in the pandemic of 2020, we found ourselves in situations with no good choices. That's normal. This is a once-in-a-lifetime pandemic with no useful policy textbooks or manuals. Public health experts and scientists raced to understand COVID-19, and we continue to learn more. Political leaders and policymakers struggled to deploy old solutions for a vast new problem.

It's now 11 months since Malaysia's first COVID-19 case. As we enter 2021, I humbly offer three strategies for Malaysia's national health: to use time wisely; to stabilize our tolerance levels of risk; and to match our solutions to the size of the problem. This will help us in our second year with COVID-19.

Firstly, Malaysia must use time wisely. In other words, we must prepare for future problems today, instead of waiting for the problems to arrive. For example, we had four months between June-Sept 2020 when we had very few cases. That quiet period came after a national MCO sacrifice of two months. We may not have utilized that four quiet months effectively.

Some of the problems in the third wave are similar to the problems in the first two waves. Examples include the living conditions of foreign workers, the speed and scale of testing and isolating, effective contact tracing using apps, data sharing from the Health Ministry, and coordination between federal-state responses.

This is why Malaysia must use time wisely in 2021. Quiet periods or not, the government must use time to rebuild, strengthen infrastructure and implement long-term durable solutions. Two specific examples include building the vaccine infrastructure before the first stocks arrive in Feb 2021, and to deliver a clear management plan when we find positive COVID-19 cases during the mass testing of foreign workers starting in Jan 2021.

In the second year of the pandemic, we cannot fight the same problems as in the first year. We must get these old problems under control, and then solve new ones. That means we must use our time wisely, and not waste it.

The second strategy for national health in 2021 is to stabilize our tolerance levels for risk. After one year, it seems like we are willing to tolerate much higher levels of risk, compared to the early stages of the pandemic. This can be dangerous. We must have a stable tolerance level of risk, not increasingly tolerate more and more risk.

Here's an example. In March, we had approximately 100-300 daily new cases. In December, we had approximately 850-2300 daily new cases. Despite this dramatic increase, everyone has started taking COVID-19 lightly. Government entities are no longer marching to the same disciplined tune as in the beginning of the pandemic and appear to be more relaxed. Citizens are no longer consistently wearing masks or physically distancing.

There may be reasons why we take it lightly. We all have pandemic fatigue and want our old lives back. Malaysia may have 2000 daily cases in December, but we feel better when comparing it to Indonesia's 5000-8000 cases or the United Kingdom's 13,000-53,000 cases in the same month. These are understandable, but dangerous.

We cannot take COVID-19 lightly. We cannot endlessly tolerate increasing amounts of pandemic risk. I do not support a second MCO and will work to help avoid it. But I do not believe that we can endlessly tolerate more risk and assume that we will never need a second MCO.

What I do support is a stable level of risk tolerance. In other words, take COVID-19 consistently seriously until we are all safe. A pandemic continues to rage around us. To government agencies, take things seriously, communicate better, use time wisely and prepare for future problems. To citizens, wear your masks and stay home where possible. Don't let the increasing numbers numb us into thinking that we can endlessly tolerate more risk.

The third and final strategy for national health in 2021 is to match our solutions to the size of the pandemic. In other words, we need solutions that are proportional to the size of the problem. After one year of fighting COVID-19, we know that our pre-2020 solutions, tools and policies are inadequate. COVID-19 is simply too big for any old solutions.

In the early stages, all governments are forgiven if they don't know what to do. After one year of COVID-19, all governments lose that excuse. Given the scale of COVID-19, we need ambitious, imaginative and Very Big solutions to a Very Big problem. In other words, unprecedented problems need unprecedented solutions, not old, timid and ineffective solutions.

This means that our government must aim much higher in 2021. We need new ways to deliver history's most important vaccination program, as safely, effectively and quickly as possible. We must reimagine a new social contract for health, that protects citizens and non-citizens in fair, sustainable and politically acceptable ways. We can integrate our non-health and health infrastructure to enable better contact tracing, such as South Korea's use of credit card transactions and China's use of QR codes. We need a true whole-of-society response.

In the first year, governments can be forgiven for relying on what they are familiar with. In the second year, governments must respond to COVID-19 in much bigger ways. This once-in-a-lifetime problem requires once-in-a-lifetime solutions. Only then can we beat this pandemic.

The COVID-19 pandemic will define not just 2020, but the 2020s. The strategic choices we make in 2021 will define how effectively Malaysia manages COVID-19 and recovers from it. As we usher in the new year, let us make three resolutions as a country: to use our time wisely, to stabilize our tolerance of risk, and to bring ambitious giant solutions to a giant problem. Happy New Year, Malaysia.

(Dr Khor Swee Kheng is an independent consultant for the World Health Organization.)