OPINION: KUALA LUMPUR- Don’t hesitate to get vaccinated

IT is without doubt that Covid-19 has dominated our life in 2020. Countries have been struggling to strike a balance between life and livelihood. Relaxing the lockdowns and movement control order to boost the economy would be followed by waves of sudden surges in Covid-19 cases.

But now there is light at the end of the tunnel with the encouraging development of Covid-19 vaccines. This unprecedented pandemic was matched by an unparalleled search for a Covid-19 vaccine.

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Vaccines typically require years of research and testing before reaching the clinic, but in 2020, scientists embarked on a race to produce safe and effective coronavirus vaccines in record time.

According to The New York Times, researchers are testing 63 vaccines in clinical trials on humans, and 18 have reached the final stages of testing, i.e. phase three efficacy trials.

Approval by the relevant authorities like the Food and Drug Administration (FDA) and European Medicines Agency (EMA) is the next stage, after reviewing and being satisfied with the trial data, before rolling out for public administration.

The United Kingdom was the first country to endorse the emergency use of Pfizer’s mRNA vaccine to combat the pandemic.

The US has authorised the emergency use of both Pfizer’s and Moderna’s vaccines. Countries like Indonesia, UAE and Saudi Arabia also plan to use the available vaccines to control the outbreak in their respective countries. More countries are expected to follow suit.

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On Nov 24, our government, through the Ministry of Health (MoH), signed a preliminary purchasing agreement with pharmaceutical company Pfizer to obtain 12.8 million doses of Covid-19 vaccines to meet the immunisation needs of 20%, or 6.4 million Malaysians.

Two days before that, an agreement with the COVAX facility was also signed to meet the immunisation needs of another 10% of Malaysians.

On Dec 13, it was reported the government had plans to increase its purchase of the Covid-19 vaccine to cover the immunisation needs of about 60-70% of Malaysians.

The purchase of the vaccines will be under the supervision of the MoH and Ministry of Science, Technology and Innovation.

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Vaccines have been proven to be safe and effective in preventing and containing contagious diseases, including the Covid-19 infection.

The next hurdle is to overcome the issue of vaccine hesitancy as Covid-19 vaccination would be a voluntary programme.

Vaccine hesitancy could be in the form of reluctance or refusal. Generally, individuals need two doses, with the second dose being administered 3-4 weeks later, to get full protection from the vaccine.

Judging from the speed of vaccine development and its Emergency Use Authorisation (EUA) in the UK and US, public scepticism against the vaccine should not be underestimated.

Therefore, concerted efforts are needed to encourage Malaysians to get vaccinated when it is made available.

Covid-19 vaccines are recommended for individuals aged 18 and above as there is no safety data on children.

Vaccine hesitancy might deny the herd immunity we are looking for to contain the pandemic.

The uptake of our country’s compulsory National Immunisation Programme (NIP) among children is high, but the same optimism cannot be applied to the adult population.

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From the press release, it is understood the government will make the vaccine free to the rakyat. Hence this will largely eliminate the issue of out-of-pocket to fund the vaccine. Of course nobody would stop any individuals getting the vaccines from the private medical service.

But it is understandable that the priority of the first batch of vaccines should be allocated to frontliners and elderly.

Stock availability, particularly for developing countries at least at the beginning, will be an issue as most countries have started the race to acquire as much dosages as they can for their population.

In order to convince Malaysian adults to consider vaccination, transparency in providing useful yet simple facts is important. Potential side effects need to be addressed and disclosed fully.

But the public need to be aware that scientific data for the long-term complications of the Covid-19 vaccine – despite being a novel intervention –are largely unknown at this stage.

As vaccine recipients increase, rare and uncommon adverse effects might emerge. This does not mean the vaccine is not safe, the benefit outweighs the risk.

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Safety issues aside, the effectiveness of any vaccine needs to be taken into account before mass vaccination.

From the available data released by Pfizer Inc, Moderna and Astrazeneca, producers at the forefront of Covid-19 vaccines, the effectiveness is reported at between 80% and 95%, which is good to contain further spread of the virus.

The duration of the immune protection, either acquired via natural infection or vaccine administration, is largely unknown.

Most Covid-19 vaccines in the pipeline require two jabs to confer artificial immunity against the infection. In this respect long-term follow up of vaccine recipients is required.

There is a possibility that the public might need to endure annual Covid-19 vaccination after the initial two doses as the virus is prone to mutation rendering the prior immunity ineffective.

Next is the logistic issue – storage, packaging and distribution before reaching the health facilities for administration. We do know that individual Covid-19 vaccines have their own cold chain requirement.

Pfizer Inc’s Covid-19 vaccine requires -70 degree Celsius storage, Moderna’s at -20 degree Celsius and Astrazeneca’s at 2 to 8 degree Celsius.

As Pfizer’s vaccine must be stored at -70 degree Celsius, meaning warehouse, trucks and planes, and point of care would all need ultra-cold freezers.

Clinics and hospitals in Malaysia, both public and private, are not used to keeping vaccines or medicines at those super-cold environments.

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However, it was made known that Pfizer Inc would make the necessary arrangement to handle the storage aspect of the vaccines. The vaccine cold chain must be meticulously maintained to ensure its effectiveness.

Medical personnel are advised to provide more information on-site of Covid-19 vaccination. Any concerns should be addressed and allayed appropriately.

Vaccination cards should be issued to clearly state the date of the immunisation, the brand of the vaccine, site of the vaccination and the second dose appointment due date.

Vaccinees are encouraged to report any adverse effects following immunisation to the relevant health facility.

It is reported that Covid-19 vaccines would be vetted and approved by the Malaysian Islamic Development Department (Jakim) after approval by the National Pharmaceutical Regulatory Authority (NPRA) to address the halal issue of the vaccine concerned.

MoH should set up its own immunisation registry to record the number of vaccine recipients, demographic data, monitor reported untoward effects and randomly check recipients antibody levels, if applicable.

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The database will then be used for things like accessing patterns of vaccination, tracking the required second doses and highlighting under-vaccinated populations. Data collected of course must be kept private and confidential.

Covid-19 vaccines given to high profile individuals will build trust and certainty among the public that the vaccines are safe. The Indonesian president and the US president-elect’s plan to receive the vaccines is a good example of instilling trust and confidence in the vaccine ahead of its widespread distribution.

Immunity passport or risk-free certificates could be an extra bonus for frequent travellers as more airlines operators request passengers to get vaccinated against Covid-19 before boarding.

Covid-19’s complex and evolving vaccine landscape – multiple doses required, lack of vaccine interchangeability, varying disease presentation, different efficacy and adverse effect profiles – may cause confusion. Clinicians should habitually share easily understandable and correct information with patients and the general community to maximise vaccine uptake.

The coronavirus pandemic has highlighted the challenges of not only developing a vaccine, but also making sure everyone who should be getting it, gets it.

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High hopes have been placed on the rapid development of a Covid-19 vaccine, but to be successful it must overcome many hurdles – limited availability, public mistrust, dosage frequency and storage requirements can all jeopardise vaccine coverage.

The existing scientific data suggests that 60-70% of a country’s population needs to be vaccinated against Covid-19 to provide the required herd immunity to stop the chain of transmission.

Ultimately, developing a safe and effective vaccine will only be the beginning, participation from the community is required for it to be a success.

Still, a vaccine is not a magic wand, it wouldn’t make the virus disappear. The process of vaccinating the targeted population is a tedious and time consuming process.

This means following safety guidelines, such as physical distancing and mask wearing, for some time to come.

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