Speaker Series : Is getting vaccinated overhyped ?
Social/health questions
1) What are your opinions on the COVID-19 National Immunisation Program? Is it effective and how do you define effective? (i.e. question of speed, equity, community engagement etc.)
CH: Government’s NIP has every good intention to vaccinate at least 80% population, and actually procure enough for everyone. The limitations are always with the vaccine supply and timing of their arrival. Malaysia is unfortunately not known as a vaccine development and production country, though now 2 local companies Pharmaniaga and Duopharma have upgraded their facilities handling at least the fill and finish production of Sinovac and Gamaleya’s Sputnik V vaccines, respectively. We are still depending on the overseas supplies and inputs.
Granted, up to 18 May, we have only 3.9% of the population at least have received one dose, the distribution in every state may vary from 2.5% to 13.7%, it is normally large and populated states which are lagging behind in terms of percentage of vaccination coverage. BUT economically lagging states such as east coast states, northern states and Sabah have particular low registration rates for vaccination.
These should show the community engagement has to be buck up if not at a later stage when there are more new supplies coming in, there we face an issue of not finding enough arms to get the shots!
4) What are the ethical considerations of an immunity passport? What are some economic considerations? and how can the government balance these two - if at all possible?
CH: it may not be just ethical but also scientific considerations have to be contended with when adopting covid-19 vaccination record as for the basis of an immunity passport.
Let’s jump straight into the science first:
One needs to understand that, the current vaccines in the global market are all targeting the wildtype Wuhan SARS-CoV2 variant, and that the vaccine protection usually comprises of 3 levels: the most ideal is to totally protect you from infection, but at least should prevent severe disease and death due to COVID-19. Many of us here should be aware that there is a wide range of vaccine efficacy rate depending on the vaccine type and the clinical trial settings, that means even though vaccination could generally avert people from contracting the virus, but it is not always the case. Surely we also have heard that there are vaccinated persons being infected. Though the prevalent scientific evidence points towards the great reduction of disease transmission due to vaccination, the risk is not zero for passing on the virus.
And now we have emerging virus variants of concern such as those originated from the UK, South Africa, Brazil and India. There are also scientific indications that the current vaccination does not work as well and produces weaker responses against the South African variant in terms of neutralising antibody titres. Though the cell-mediated immunity induced by the current vaccination is still good enough to give people the necessary protection, we may not know in future what would happen if other more potent virus variants emerge. Studies also show that the current vaccination protection level is still sufficient after 6 months, but we do not yet know for how long more the vaccination could protect, 1 year or 2 years?. What if one needs a booster dose later? Then should the health authority use a rapid diagnostic test kit to find out about one’s specific antiviral antibody level to validate the so called immunity passport?
With all these in mind, I tend to agree with the WHO’s position for not recommending the immunity passport due to too many uncertainties surrounding the vaccines, at the same time the vaccine production and supplies are still limited, thus immunity passport is never fair or equitable even within the population. WHO also rightly said that vaccination record does not mean that the authority should forgo other pandemic control measures.
To me, one can treat COVID-19 vaccination as a piece of medical record evidence, nothing more than that. The authorities should not use it solely to discriminate against unvaccinated persons. It is not fair due to global supply issues and the long waiting queue for the vaccination programme, and some even deemed unfit for vaccination.
Economic/socio-economic questions:
1) Vaccine administration is challenging. Reaching marginalised groups--especially groups in the remote rural interiors of Malaysia--are a major impediment to herd immunity and a crucial consideration for vaccine equity. There are various anecdotes about digitally-illiterate older citizens or Malaysians in remote interior rural areas without adequate internet access or marginalised Malaysians who fall through the cracks due to a lack of knowledge, access to infrastructure, or transport/mobility.
How do we ensure equitable vaccine access to these marginalised or underserved populations? What has been done so far and what are some policy avenues that can help avoid underserved marginalised groups fall through the cracks? Are there avenues to partner with local health care institutions, community organizations, and other trusted sources to promote vaccine awareness and uptake within local communities?
CH: on registration and administration of vaccination, if those populations have barriers coming and walking into the government or community facilities to get the vaccines due to physical distance constraints or fear of authority, then the government should consider coming to them while collaborating with the community leaders or familiar local faces to urge people to come forward to receive the doses.
Government should try to arrange mobile clinics and vaccination medical teams.
2) Commentators often highlight the trade-offs between infection containment (lockdowns) and economic activity. A key component of the ‘reopening prioritisation’ requires a cost/benefit evaluation of the level of transmission risk based on the nature of work, and we know that certain sectors of the economy carry higher economic benefits.
Could there be tweaks to the national vaccine strategy A.k.a. moving from prioritising age (and mortality) vs prioritising younger workers who are more likely to be active members of the workforce and more likely to have a higher amount of social interactions--or moving from spreading more first doses throughout the population--is this something that would be feasible or desirable for Malaysia? (overall socio-economic costs of pandemic vs solely focusing on death risk)
CH: The current phases of NIP are reasonable enough, because the main objective of getting people to vaccinate is to protect themselves from getting severe diseases, hospitalisations and death. Thus, the design of phases goes according to the risk profile.
However, in reality, those who are most risky and most severely affected by COVID-19 tend to be the most conservative and reluctant to get the jabs. The government says that they will wait for no one when speeding up to provide vaccination coverage for the population.
Hence, the clever design of the ‘opt-in’ programme for AstraZeneca vaccine is a thumping public-relation and publicity success, this could boost the public confidence in the vaccine which some people have reservations about. It is a win-win situation, coz the younger generation could also get the vaccine faster than originally planned.
That is the tweak of strategy like you suggested. Other than that, effective and responsive waiting list for people to come forward to get the vaccines is also important, the last thing the government wants is to have vaccine wastage due to absentees or refusal to take certain vaccine.
I would agree and support the government to include economic frontliners to get vaccinated first, especially those working in a more crowded condition or having many interactions with clients or customers.
3) Besides issues of domestic vaccine equity, perhaps a larger more immediate issue is the issue of global vaccine equity. Data shows that some developing countries have managed to fully vaccinate all their frontliners and are close to achieving herd immunity in the coming months--while developing and poorer nations have far higher numbers of infections and deaths, and very low vaccine coverage.
One estimate for low-income countries suggests that only 2 percent of the population in these countries are vaccinated. Meanwhile, research has shown that there are large negative economic externalities to vaccine distribution in poorer countries--low vaccination rates in lower-income and middle-income countries create negative economic impacts for higher-income countries through lower trade demand and increased chances of new virus variants (India example). Does Malaysia have a role to play in ensuring global vaccine equity? Is there a political-economy rationale for sending our vaccine stock to poorer nations?
CH: Yes, Malaysia has international obligation and interest to ensure global vaccine equity, especially in supporting the call for TRIPS-waiver on the COVID-19 related medical products. It is time to rake up worldwide production and not be bound by the intellectual property barriers. Malaysian governments should show global solidarity supporting the cause to achieve equity of access of COVID-19 products.
In Malaysia, we do have very competent pharmaceutical industry and medical products manufacturing sectors. Therefore we can be part of the global production line for many life-saving medical products, not limited to just vaccines.Once we have the technology transfer and know how, we could at least ensure self-sufficiency and if we have excesses, could contribute in closing the gaps of global shortage.
4) There have been anecdotal reports about private channels for companies for vaccine procurement--how some firms and organisations are able to procure vaccines for their employees that bypass or circumvent normal vaccine access channels in Malaysia (example: UN agencies, Genting, etc). Is there truth to these anecdotal reports, and is there an economic rationale for private channels (i.e. if the extra amount companies pay for priority access can be redirected to procure more vaccines for the general population)
CH: I do not think the access issue is about money or the ability to pay, but equity and social solidarity for the national programme given that the vaccine supply is the limit and constraint.
So, One thing is about the procurement, but you also need someone to administer the vaccine, right? Ok, one may go find private healthcare practitioners to help out, maybe would be competing with the current workforce deployed to help out the public national programme. Also, if they procure the vaccines from the same pool of supply, then again if they get them earlier than the government, it will be at the expense of other people in the queue.
I would be ok if the employers all apply for priority access to vaccines if they can justify. Most importantly, why not the private sector and the state governments invite other vaccine manufacturers to register their products here and procure the vaccines from them?
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