AB085. Pandemic vulnerability among indigenous populations in Malaysia: a scoping review of structural inequities and public health response

Background: Indigenous populations in Malaysia, including the Orang Asli in Peninsular Malaysia and native communities in Sabah and Sarawak, have historically experienced systemic marginalisation and limited access to healthcare. Their vulnerability during pandemics is shaped not only by geography or poverty, but also by long-standing structural inequities and cultural invisibility within public health systems. Despite heightened risk, there is limited synthesis of evidence on how pandemics have affected these communities and whether national responses have been inclusive. This scoping review aims to map existing evidence on pandemic vulnerability among Indigenous populations in Malaysia, identify key drivers of vulnerability, and examine how national public health responses have addressed or overlooked their needs.

Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. Systematic searches were undertaken across MEDLINE, PubMed, Embase, Web of Science, Google Scholar, and grey literature sources, including government and non-governmental organisation (NGO) repositories. Eligible sources published between 2020 and 2025 reporting on pandemic impacts [e.g., coronavirus disease 2019 (COVID-19), influenza A virus subtype H1N1 (H1N1), severe acute respiratory syndrome (SARS)] among Indigenous populations in Malaysia were included. Data were extracted to capture vulnerability domains, community and institutional responses, and gaps in health system inclusivity.

Results: Using the PRISMA-ScR methodology, a limited number of relevant sources were identified and analysed. Findings indicate that Indigenous communities, particularly the Orang Asli, experience substantial socioeconomic and structural vulnerabilities that heighten pandemic impact, including: (I) persistent poverty and lower educational attainment; (II) limited access to basic infrastructure, healthcare, and telecommunications; and (III) geographical isolation and cultural marginalisation. Despite these challenges, Indigenous communities demonstrated notable resilience through self-initiated public health measures and culturally appropriate communication strategies.

Conclusions: This scoping review highlights the complex interplay between structural inequities, Indigenous resilience, and public health responses during pandemics in Malaysia. Persistent socioeconomic disadvantages limit the effectiveness and accessibility of mainstream public health interventions, underscoring critical gaps in equitable health provision. At the same time, the findings reveal the adaptive capacity of Indigenous communities, who mobilised culturally grounded strategies to protect community health. These insights emphasise the need for inclusive, culturally responsive public health planning that meaningfully engages Indigenous populations in future pandemic preparedness and response.

Keywords: Pandemic vulnerability; Indigenous populations; Orang Asli; Malaysia