Covid-19 Vaccine Rollout: Who Should Get It First?

By Azrul Mohd Khalib | 06 December 2020

Three priority groups: People in essential services (including health care and law enforcement), people at increased risk of developing severe disease from Covid-19, and people in settings with increased risk of transmission like prisons, immigration detention facilities, and workers’ dorms.

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Malaysians will begin 2021 with the strong possibility of seeing light at the end of the Covid-19 tunnel.

Should it receive approval from the National Pharmaceutical Regulatory Agency (a body under the Ministry of Health) and the manufacturer able to fill Malaysia’s order, at least one working Covid-19 vaccine will be made available for rollout in the first quarter.

It is not too early to start talking, planning and communicating how any incoming vaccine will be rolled out to the Malaysian population.

We should not wait until the vaccines are approved and actually delivered. One crucial point which needs to be communicated to the public is who should get the vaccine first.

In the coming year, at least 20 percent of the population or 6.4 million Malaysians will have access to the Pfizer-BioNTech vaccine two-dose regimen vaccine, while another 10 percent can expect to benefit from a COVAX initiative vaccine.

The government needs to put together and make public a vaccine priority list of people who should be first in line to receive a safe and effective vaccine when it becomes available next year. Because the initial number of people who are going to be vaccinated is determined by the number of doses that we receive, it is important for us to have a clear understanding and reasoning for why they are prioritised.

Guided by data and proven vaccination strategies as well as an understanding of the Malaysian epidemic, the Galen Centre believes that those who should be prioritised, can be categorised into three priority groups (in order of priority):

  1. Persons working in essential or critical services such as health care, law enforcement, cleaning and sanitation, elderly care, and those in supply and distribution of goods and services such as water, food and electricity.
  2. Persons who have increased risk of developing severe complications or dying from Covid-19 such as those aged over 60, with certain pre-existing underlying serious medical conditions such as cancer, chronic kidney disease or heart disease.
  3. Persons in settings where there has been demonstrated an increased risk of transmission, such as prisons and immigration detention facilities, and factory dormitories.

However, the list should adapt to changes in understanding of which groups are disproportionately affected.

Besides the three categories of people, we will need to also prioritise according to the states hit hardest by Covid-19. This would mean that Sabah, Selangor and Kuala Lumpur should be prioritised, focusing on Groups 2 and 3. This approach should continue throughout the year.

This will be a major challenge as the number of vaccine doses that will be initially received will be far less than what we will need. Assuming that the Pfizer-BioNTech vaccine is the first one to be deployed next year in the first quarter of 2021, we will only initially have a million doses, which means that we can only vaccinate 500,000 people at the beginning.

Those who are not in the three categories will have to be placed at a lower priority level, and will receive the vaccine much later, possibly in the end of 2021, or even 2022.

This will include people below the age of higher risk, younger, generally healthy, and not working in a critical or essential function. They will need to continue to practice the SOPs which have been introduced this year.

There is significant global demand for a safe and effective Covid-19 vaccine. Due to this demand, large volumes of doses will not likely be immediately available but must be prioritised for certain groups when the batches arrive.

This is why we need to start planning how to prioritise which groups have access to the vaccine first, and why the vaccine will need to be given to people who are at higher risk.

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