Sarawak Expert Group Moots Third Jab — Pfizer — For Elderly, Vulnerable

By Boo Su-Lyn |

The Sarawak Covid-19 Vaccine Advisory Group (Scovag) recommends Pfizer as a third dose for the elderly and immunocompromised, as Scovag is concerned about Sinovac vaccine efficacy.

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KUALA LUMPUR, Sept 14 — The Sarawak Covid-19 Vaccine Advisory Group (Scovag) has recommended that the state government offer a third coronavirus vaccine dose — Pfizer-BioNTech — to double-vaccinated senior citizens and people with compromised immune systems.

Scovag chairman Prof Dr Andrew Kiyu expressed deep concern about the effectiveness of Sinovac — the predominant Covid-19 vaccine used for adults in Sarawak at 80 per cent of doses administered — as the Delta variant rips through the state of 2.8 million people.

Sarawak was among the first out of the gate in Malaysia with vaccination, having fully inoculated about 64 per cent of its total population with two vaccine doses, but coronavirus infections are now soaring in the state as hospital beds fill up rapidly. 

Covid-19 deaths similarly spiked from an average of one case daily on August 11 to seven a day one month later, although Sarawak reported the third lowest per capita Covid-19 mortality in Malaysia in the past fortnight.

Dr Kiyu said Sarawak has the highest proportion of Sinovac used in its population, compared to other states, because the state government initially believed that it would have to call for elections by October or November after the national state of emergency was scheduled to end by August. But the Yang di-Pertuan Agong has since extended Sarawak’s state of emergency until February 2 next year.

“That’s why we argued to the national level that we must complete our vaccination by the end of August. Unfortunately, at that time, the only vaccine available in the whole country was Sinovac and we had no choice but to use that as the vaccine.

“But there are fallouts from this,” Dr Kiyu told a webinar titled “Living with Covid-19 Endemic” last Thursday organised by the Society of Private Medical Practitioners Sarawak (SPMPS) that provided CodeBlue a video of the speakers’ presentations in the virtual meeting.

Slide shared by Sarawak Covid-19 Vaccine Advisory Group chairman Prof Dr Andrew Kiyu in a webinar “Living with Covid-19 Endemic”, organised by the Society of Private Medical Practitioners Sarawak on September 9, 2021.

Dr Kiyu, a consultant epidemiologist, cited a Hong Kong study published last July in The Lancet Microbe medical journal — comparing the immune responses generated between the Pfizer and Sinovac Covid-19 vaccines in health care workers in Hong Kong — that found the mean neutralising antibody titre level after the second dose was 269 for Pfizer, but 10-fold lower for Sinovac at 27. 

The study — which did not look at other potential indicators of vaccine protection like T cells or antibody-dependent cellular cytotoxicity antibody — concluded: “The difference in concentrations of neutralising antibodies identified in our study could translate into substantial differences in vaccine effectiveness.”

“This is making life very dangerous for us in Sarawak because when we vaccinate people with Sinovac, are they truly protected like using Pfizer?” said Dr Kiyu, who is also a former Sarawak state health director.

“If we want to decrease hospitalisation, severe [disease], death and so on, we have to give the third dose to immunocompromised and the elderly, and we have to use Pfizer.” 

Vaccine Breakthroughs In Deaths Rise, Majority Victims Elderly Or With Comorbidities

Slide shared by Sarawak state health department director Dr Mohamed Sapian Mohamed in a webinar “Living with Covid-19 Endemic”, organised by the Society of Private Medical Practitioners Sarawak on September 9, 2021.

Sarawak state health director Dr Mohamed Sapian Mohamed shared at the SPMPS webinar that of 87 Covid-19 deaths reported in Sarawak last month, about a quarter or 22 victims were fully vaccinated.

About 87 per cent of the 87 victims had underlying medical conditions, while 77 per cent were aged 61 years or older. 

Vaccine breakthrough proportions of Covid-19 fatalities in Sarawak increased in the first week of September to 54.55 per cent compared to 25.29 per cent in the month of August, or 18 fully vaccinated people among 33 deaths recorded from September 1 to 7. 

About 91 per cent of the 33 Covid-19 victims recorded September 1-7 had comorbidities, while 76 per cent were aged 61 years and above.

“These people are elderly and have comorbids,” Dr Sapian told the webinar, adding that many brought-in-dead Covid-19 cases and fatalities sought medical treatment late.

“So now, we have to educate the public because no matter how many doses you give the vaccine, you can still have disease, but only that you limit or there’s lesser risk of getting severe disease, but you still get the disease.”

Sarawak Periodic Study Compares Protection From Pfizer, Sinovac, AstraZeneca

Slide shared by Sarawak Covid-19 Vaccine Advisory Group chairman Prof Dr Andrew Kiyu in a webinar “Living with Covid-19 Endemic”, organised by the Society of Private Medical Practitioners Sarawak on September 9, 2021.

Dr Kiyu said the Sarawak Infectious Disease Centre (SIDC) is currently undertaking a serology study to monitor neutralising antibody levels over time in people fully vaccinated against Covid-19 in the state. 

According to a slide that he shared in the SPMPS webinar, SIDC’s study is recruiting 150 fully vaccinated individuals per vaccine type administered (Pfizer, Sinovac, and AstraZeneca-Oxford). Study participants will be sampled six times over a period of 24 months — on the third, sixth, ninth, 12th, 18th, and 24th month after receiving their second jab. 

Dr Kiyu also said although Scovag has recommended administering third shots for individuals with weaker immune systems, as well as booster jabs for other people to curb waning vaccine effectiveness, the booster inoculation programme must first be approved by the federal government. Central health authorities have yet to announce policies related to mix-and-match vaccines or booster shots.

“They’re now very concerned with completing their first round of vaccination,” he said. “Only we are thinking about the third and booster dose. Of course they’re starting to think about that now, but we want it now already.”

Sarawak state housing and local government minister Dr Sim Kui Hian confirmed that Scovag has already made recommendations to the state disaster management committee (SDMC) on a Covid-19 booster vaccine rollout.

“Yes, to targeted groups,” Dr Sim told CodeBlue when contacted.

Slide shared by Sarawak Covid-19 Vaccine Advisory Group chairman Prof Dr Andrew Kiyu in a webinar “Living with Covid-19 Endemic”, organised by the Society of Private Medical Practitioners Sarawak on September 9, 2021.

Health Minister Khairy Jamaluddin said last Thursday that the federal Special Committee for Ensuring Access to Covid-19 Vaccine Supply (JKJAV) is expected to receive this week recommendations from its technical working group on booster jabs, amid Sarawak’s surging epidemic despite complete inoculation of 88 per cent of adult residents. Sarawak has already started giving the Pfizer vaccine to minors aged 16 and 17 years that number about 96,000 in the state.

Dr Kiyu said the extremely infectious Delta variant that carries high viral loads in the infected — to the point that people can contract the virus just from passing by an infected person on the street, such as in Australia and China — has spread from the southern zone in Sarawak to the middle and northern zones of the largest state in Malaysia. Almost all samples tested in Sarawak now show Delta.

“So we are really in danger,” the professor of public health at University Malaysia Sarawak (Unimas) said. “And also because 80 per cent of our vaccines are Sinovac vaccines.”

Dr Kiyu cited a United States’ Centers for Disease Control and Prevention (CDC) study that found an eight-fold reduction in Covid-19 disease incidence, as well as 25-fold reductions in both hospitalisation and death incidence, among fully vaccinated people compared to the unvaccinated. 

“Unfortunately, such figures for Sinovac as we have is not readily available,” he said, pointing out that America primarily uses mRNA vaccines, Pfizer and Moderna. Sinovac is an inactivated vaccine.

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