Delay Second Dose Of Covid-19 Vaccines To Protect More People — Dr Musa Mohd Nordin

Like KL, Selangor, Sarawak and Kelantan, Penang is a high infection state and the immunisation rollout must be prioritised in these five states.

While the world is witnessing a flattening of the Covid-19 pandemic curve, with declines in cases and deaths in some regions, Malaysia is presently experiencing a worrying upsurge of cases and deaths.

There were 113,010 cases in 2020 and 366,411 cases in the first five months of 2021 (until May 18, 2021) which comprised 76 per cent of the total cases.

During the whole of 2020, there were 471 deaths. Contrast this with 1,523 deaths up until 18 May 2021. A whopping 76% deaths in the first 5 months alone in 2021.

Examining the cumulative cases per million population, it looks like Malaysia is the second  worst performing country in the region, and closing in on India.

The National Security Council, the Ministry of Health and other ministries and agencies have failed to contain and control the Covid-19 pandemic, despite more than a year of living with the coronavirus, 

The US, the UK and Israel, all of which were even more severely affected by the pandemic have been able to mitigate the deadly effects of the pandemic.

One of the pivotal components of their success stories is their ability and competency to distribute their Covid-19 vaccines speedily, widely and attaining near herd immunity coverage.

To begin with, our public health back-to-basics of pandemic management is well below par. This is further compounded by the failure of the Health Minister and Vaccine Minister, in charge of the National Covid-19 Immunisation Programme (PICK), to efficiently and effectively roll out the programme.

The former boasted that by the end of February this year, 126,000 doses will be administered daily. The latter touted 75,000 daily doses.  

The latest data on the immunisation rate in Malaysia charts an average of 33,992 doses per day in the past 14 days from May 4 to 17. This is only about 27 per cent and 45 per cent respectively of the daily doses claimed by the two ministers.

Malaysia has only immunised 3.6 per cent of its population with one dose of Covid-19 vaccine as of May 14, which is nine times slower than neighbouring Singapore at 32.5 per cent.

Despite these low vaccine rollout numbers, the federal government had the audacity to refuse the Penang state government permission to immunise two million of its population for free.

Like Kuala Lumpur, Selangor, Sarawak and Kelantan, Penang is a high infection state and the immunisation rollout must be prioritised in these five states, considering the current shortages in the vaccine supply chain.

The federal-centric focus of everything related to the Covid-19 vaccines has now been shown to be non-sustainable. The federal government must stick to its role as a policymaker and not play the role of an implementer, which it has failed at.

Besides, never before in the history of immunisation policies since the 1950s has the private sector been blocked from procuring vaccines. If anything, the private sector has been the initiator in the procuring of all the new vaccines (e.g. Hepatitis B vaccines in the 1980s, MMR and HiB vaccines in the late 1990s, and HPV and PCV vaccines in the early 2000s), before they were later implemented in the National Immunisation Programme. Why should the Covid-19 vaccines be any different?

The Ministry of Health (MOH) and the Covid-19 Vaccine Supply Access Guarantee Special Committee (JKJAV) have now “successfully” conducted Phase One, Phase One+ and Phase Two A of the PICK. The next goal now is to immunise as many Malaysians that is humanly possible. 

This can be achieved if the state governments, the Association of Private Hospitals of Malaysia (APHM), private hospitals, general practitioners and other stakeholders are empowered to procure and administer the vaccines to complement the public vaccine programme.

Is it not our shared ultimate goal to achieve population immunity? The experience in India has testified that the involvement of the private health care sector in their national immunisation programme has increased the number of vaccines administered by seven times.

Through the Emergency Ordinance, and circumventing parliamentary oversight, the Cabinet is dipping into the cookie jar, a.k.a. the National Trust Fund. The prime minister and finance minister have justified this unprecedented act by citing the nation’s dire health circumstances and the financial crisis.

If a segment of the population is able to pay for the vaccines, is this not something that the government should welcome to cushion the financial impact to the national economy?

A smart partnership between the public and private health care sectors is vital to ensure a warp speed vaccine rollout and scaled-up coverage of the population. 

During the early days of PICK, the opposition leader proposed the delaying of the second dose of the Covid-19 vaccine. His thoughts mirror the UK experience, in its bid to ramp up the first dose coverage, to move towards the herd immunity threshold.

With the constrained global vaccine supplies, Singapore decided yesterday to extend the dosage interval of the Pfizer-BioNTech and Moderna mRNA Covid-19 vaccines to between six to eight weeks, from the previous three to four-week gap. Singapore is shifting its vaccine strategy to administer more first shots to its citizens and to spread the vaccine protective net wider.

In the UK, this delayed second dose strategy has plunged the Covid-19 hospitalisation rate in Scotland by 90 per cent. 

Public Health England reports that during the period of December 2020 to March 2021, at the peak of the Covid-19 wave in the UK, 10,400 lives were saved by the delayed second dose strategy.

A recently published study on the elderly showed that the antibody response was increased threefold in those given a delayed second dose of the Pfizer mRNA vaccine.

Earlier studies by the team of researchers at the University of Oxford showed that the AstraZeneca vaccine given later at 12 weeks had higher rates of vaccine effectiveness and also lowered the transmission of the coronavirus.

It is high time that the MOH and JKJAV consider this delayed second dose vaccine strategy and administer more first doses to more people in order to faster attain population immunity and mitigate the risks of the development of variants of concern (VOC) in the community.

This policy can be reviewed once the vaccine supplies has been restored.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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