Third Covid-19 Jab Warranted For Health Workers, Frontliners — FPMPAM, MMA, MPCAM

A third dose and consequentially periodical booster doses must be considered for health care workers.

Most of the frontline health care workers in Malaysia started their vaccination in February 2021. As such, they would now have had the vaccine for more than six months, when antibody levels are expected to wane.

With the additional threat of the more transmissible Delta variant, we, the undersigned, hereby request the Special Committee on Covid-19 Vaccine Supply (JKJAV) and the Malaysian National Security Council (MKN) to consider a third dose and consequentially periodical booster doses for our health care workers.

Health care workers are more exposed to the coronavirus compared to any other professions, so their risk of contracting the virus is very high.

Last month, the Ministry of Health in Israel, a country that has one of the world’s highest vaccination rates, released raw data on vaccinations and infections from December 2020 to July 2021. They estimated that vaccine protection against both infection and disease had dropped from above 90 per cent in the early months of the programme to around 40 per cent by late June; a decline that could be due to the effects of the Delta variant.

Nearer to home, the Indonesian government has started administering a third Covid-19 shot to health care workers following the deaths of hundreds of frontliners in the past two months, many of whom had been fully vaccinated, due to the spread of the more contagious Delta variant.

Authorities kickstarted the programme at the end of August 2021, covering some 3,820 health care workers in Jakarta, with the aim of giving the booster shots to 1.5 million workers within the next two weeks.

Since the pandemic started last year, at least 1,636 health workers — mostly doctors and nurses — have lost their lives to the virus.

We admit that there are many unknowns on what the true “correlates of protection” are when it comes to immunity, and a lack of hard clinical data that vaccine effectiveness is truly waning.

Still, we have noted that physicians in countries like Germany, France, Israel and the United Kingdom have started administering booster doses, especially for the more vulnerable segments of the population, as well as for health care workers, even if they are not immunocompromised or if their antibody titers are low.

Dr Robert Schooley, an infectious diseases expert at the University of California San Diego, warns of regulators waiting too long to begin to revaccinate, and end up doing the population a disservice.

We too believe that our regulators should not be so cautious that they do not act fast enough to prevent hospitalisations and deaths, especially as additional doses look like an inevitability.

Third doses of vaccines developed by Moderna, Pfizer-BioNTech, AstraZeneca and Sinovac prompted a spike in levels of infection-blocking neutralising antibodies, when administered several months after the second dose.

An ongoing trial in the UK is testing various combinations of boosters, including using a different vaccine from the original inoculations. Preliminary studies of these mix-and-match strategies suggest that they could lead to more robust immune responses, characterised by high levels of both antibodies and T-cells, which kill infected cells and support other antiviral responses.

We are aware that many have not even got their first dose. The drive to immunise them must continue, but it would make sense to concomitantly protect the very people, like ICU doctors, infectious-disease physicians, general practitioners, nurses, and all who make these efforts possible by being at the frontline of the Covid-19 battle.

Dr Steven Chow is president of the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM), Prof Dr Subramaniam Muniandy is president of the Malaysian Medical Association (MMA), and Dr Raj Kumar Maharajah is president of the Medical Practitioners Coalition Association of Malaysia (MPCAM).

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