In this review, the anxiety faced by students in primary vernacular Tamil schools in Malaysia when having to speak in the English language is the focus. The primary target for the study is students at the Tamil vernacular schools known as the Sekolah Jenis Kebangsaan Tamil (SJKT) in Malaysia. A decade-long window has been used to extract studies and draw conclusions from the results of the studies published between 2015 and 2025. The review analyses both quantitative and qualitative findings, allowing for a more comprehensive and detailed account of the language anxiety phenomenon. It is found that most studies have focused on the impact of language anxiety on the students’ willingness to communicate (WTC) in English. The review uncovered several factors that contribute to speaking anxiety, including psychological, social, and pedagogical factors, as well as fear of negative evaluation, peer judgement, and limited exposure to English outside the classroom. The review also examined strategies such as task-based learning, peer-assisted learning, and mindfulness techniques, which were found to be effective in reducing anxiety and increasing WTC. The review highlights the need for contextually grounded strategies that address the unique challenges faced by students, particularly those in vernacular schools. Several recommendations for future research emerged from the synthesis. These include the need for design-based studies in vernacular schools, longitudinal tracking of anxiety levels, and the validation of anxiety measurement tools for students in the Southeast Asian setting.