KUALA LUMPUR, August 1 — As Malaysia moves into the “living with Covid-19” phase, government should consider registering updated Covid-19 vaccines on an annual basis, according to Prof Dr Andrew Kiyu Dawie, a consultant epidemiologist at Universiti Malaysia Sarawak (Unimas).
The former Sarawak state health director compared Covid to flu vaccination that is regularly updated every year to target emerging variants, with the vaccines registered by Malaysia’s health regulators and provided in private health care facilities.
“The approach to managing Covid-19 will become more akin to that of endemic diseases such as influenza. This phase emphasises the continued importance of non-pharmaceutical interventions, including the use of face masks and regular handwashing, to safeguard public health,” Dr Andrew said.
“Additionally, Covid-19 vaccines will remain a crucial tool, particularly for high-risk groups. To effectively address emerging variants, it is essential to consider annual updates to Covid-19 vaccines, similar to the yearly updates for flu vaccines.”
Dr Andrew highlighted the role of the National Pharmaceutical Regulatory Agency (NPRA) in regulating and monitoring Covid-19 vaccines, ensuring their safety and efficacy.
He suggested that the NPRA explore the possibility of registering updated Covid-19 vaccines annually to facilitate a more adaptive vaccination strategy and enhance the effectiveness of the country’s response to Covid-19.
He said that annual registration would allow the public to choose updated vaccines that match their health needs and risk factors.
“Furthermore, allowing the registration of these vaccines for private purchase would improve accessibility for individuals seeking protection without relying solely on public vaccination drives. This model has proven successful for flu vaccines, where individuals can choose to receive their vaccinations from private health care providers.”
While private access to updated Covid-19 vaccines is beneficial, Dr Andrew said it is equally important for the government to continue providing these vaccines in public health facilities.
To ensure comprehensive protection, he recommended that the Ministry of Health (MOH) include Covid-19 vaccinations in its plans to offer free annual influenza vaccinations for older adults under the National Immunisation Programme (NIP), starting in 2025.
In an advisory that announced the “living with Covid-19” phase, effective last July 15, MOH Malaysia lifted mandates on home surveillance orders and wearing face masks for individuals who test positive for Covid-19, treating Covid like any other respiratory infection. MOH did not provide any Covid vaccination advisory.
The only Covid-19 vaccines available in Malaysia are Sinovac for the ancestral strain of Covid-19 four years ago, even as other countries have already moved past the ancestral and bivalent vaccine phases, and registered XBB.1.5 vaccines for early this year, targeting yet another updated vaccine, JN.1, later this year.
According to the United Kingdom Health Security Agency’s (UK HSA) official blog in a post last May 13 (updated in July), a new group of Covid-19 variants, known collectively as FLiRT, has emerged.
“The unofficial nickname was inspired by the names of the mutations in the genetic code of the variants. They descend from JN.1, which had variant BA.2.86 as a parent,” wrote the UK HSA.
According to the Covid-19 Vaccine Tracker, as of July 2024, the Pfizer-BioNTech Comirnaty Bivalent Original/ Omicron BA.4/ BA.5 vaccine has been approved in 33 countries, while the Moderna Spikevax Bivalent Original/ Omicron BA.4/ BA.5 vaccine has been approved in a similar number of countries.
United States: KP.2 Strain of JN.1-Lineage, If Feasible
The US Food and Drug Administration (FDA) said that last June 6, it initially advised manufacturers of licensed and authorised Covid-19 vaccines that the 2024-2025 formula for use in the United States, beginning in fall 2024, should be monovalent JN.1 vaccines.
Based on the most current available data, along with a recent rise in Covid-19 cases in areas of the country, the FDA has further determined that the preferred JN.1-lineage for the Covid-19 vaccines (2024-2025 Formula) is the KP.2 strain, if feasible.
“This change is intended to ensure that the Covid-19 vaccines (2024-2025 Formula) more closely match circulating SARS-CoV-2 strains. FDA has communicated this change to the manufacturers of the licensed and authorised Covid-19 vaccines,” said the FDA in a statement last June 13.
In a June 27 statement, the US’ Centers for Disease Control and Prevention (CDC) recommended that everyone aged six months and older receive an updated 2024-2025 Covid-19 vaccine to protect against potentially serious outcomes of Covid-19 this fall and winter, whether or not they have ever previously been vaccinated with Covid-19 vaccine.
“Updated Covid-19 vaccines will be available from Moderna, Novavax, and Pfizer later this year. This recommendation will take effect as soon as the new vaccines are available.”
European Union: JN.1
The European Medicines Agency (EMA) recently recommended updating the antigenic composition of authorised Covid-19 vaccines for the 2024-2025 vaccination campaign, focusing on targeting the JN.1 family of Omicron subvariants, which are currently dominant.
The World Health Organization (WHO) expects the virus to continue to evolve from the JN.1 lineage based on genetic sequences of publicly available data.
An adapted Comirnaty vaccine for JN.1 was recommended, with other vaccines like Spikevax, Nuvaxovid, and Bimervax under evaluation by the Committee for Medicinal Products for Human Use (CHMP). The CHMP is the EMA’s committee responsible for human medicines.
United Kingdom: XBB.1.5
In a February 2024 advisory, the UK’s Joint Committee on Vaccination and Immunisation (JCVI) recommended mRNA Omicron XBB.1.5 vaccines by Pfizer or Moderna for spring 2024.
The JCVI recommended Covid-19 vaccination for adults aged 75 years and older; residents in a care home for older adults; and individuals aged six months and over who are immunosuppressed.
The UK HSA said in its May blog post, updated in July, that the UK’s spring Covid-19 vaccination offer, which was made available to eligible groups, closed last June 30. Information about a Covid-19 vaccination programme for autumn/ winter 2024-25 will be published later in the year.
Singapore: XBB.1.5
The Novavax/ Nuvaxovid XBB.1.5 vaccine has been included in Singapore’s National Vaccination Programme (NVP) and is available for free to eligible individuals aged 12 years and above. This updated vaccine targets the XBB.1.5 variant and is recommended for those unable to receive mRNA vaccines.
Sinovac-CoronaVac remains part of the NVP until September 30, 2024, pending full registration. If not registered by this date, it will still be available at private clinics through the Special Access Route (SAR). The updated Pfizer-BioNTech and Moderna vaccines are also available under the NVP.
An additional dose is recommended approximately one year after the last vaccine dose, with a minimum interval of five months. This is particularly advised for individuals at higher risk of severe disease, including those aged 60 and above, and medically vulnerable populations.
It is also encouraged for all individuals aged six months and above, particularly, health care workers, as well as household members and caregivers of medically vulnerable individuals.
South Korea: XBB Variants
South Korea continued its Covid-19 vaccination programme in 2024, with a focus on administering updated vaccines to high-risk groups.
The Korea Disease Control and Prevention Agency (KDCA) advised high-risk groups, such as those who reside in facilities vulnerable to the infection, to get Novavax’s updated vaccine, which generates an immune response against XBB sublineage of the Omicron variant, the same ones targeted by mRNA vaccines.
Vaccination is also highly recommended for those who are often in close contact with school-aged children and infants.
The updated vaccine is available for people aged 12 and older, including high-risk groups. Starting from December 18, 2023, eligible individuals can receive free vaccination with Novavax’s latest vaccine at vaccination walk-in sites without an appointment.
Australia: Booster Jabs
The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that adults aged 65 and over, or those aged 18 to 64 who are severely immunocompromised, receive a booster dose every 6 to 12 months. All other adults are eligible for a booster every 12 months, as well as severely immunocompromised children aged 5 to 17.
Healthy children and teenagers do not require a booster due to the low incidence of severe illness and high level of hybrid immunity in this group.
Japan: Routine Covid Vaccination
Japan’s free Covid-19 vaccination programme ended on April 1. However, the Japanese government has classified Covid-19 vaccines as “routine inoculations” for people aged 65 and above, as well as those aged between 60 and 64 with certain underlying medical conditions such as heart, kidney, or respiratory diseases.
The Covid-19 routine vaccination is to be administered once every autumn and winter, with a portion of the cost covered by a government subsidy. Others may receive the vaccination voluntarily as an optional vaccination at their own expense.
Japan offers the Pfizer/ BionTech and Moderna mRNA shots, along with its own Daiichi Sankyo vaccine.
