In the early 1990s, Malaysia faced a quiet crisis. Hidden among the fevers and coughs of our youngest children lay a bacterial killer — Haemophilus influenzae type b (Hib) — responsible for half of all bacterial meningitis cases in our paediatric wards.
Few have spoken of it. Fewer measured it. But a small group of clinicians, inspired by research shared from halfway across the world, decided to act.
That quiet determination was on full display recently when some of the world’s most distinguished vaccine scientists — who happened to be paediatricians — gathered to form a panel of vaccine experts.
It was a dream assembly: Dr Ranna Hajjeh, who bridged the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to tackle Hib research and supply chain gaps, Dr Thomas Cherian, present at the birth of GAVI in 2000, and Prof David Goldblatt, whose work on correlates of protection (CoP) enabled pneumococcal conjugate vaccines (PCV) to move from efficacy trials for PCV7 licensure in 2000, to licensure based on CoP for PCV10, PCV13, US$2 Pneumosil in 2019, and more recently PCV 15, PCV 20, and PCV 21.
But two stories stood out: one global, one deeply Malaysian.
First, Prof Mathuram Santosham, now 82, who conducted the earliest Hib vaccine trials among the Navajo population. In 2002, he travelled to India, only to find authorities unmoved.
His breakthrough came not in a boardroom but on a pitch: playing cricket with Indian players, he turned them into champions for Hib vaccination. Sometimes, the most powerful advocacy is personal.
Then came Dr Musa Mohd Nordin, recounting Malaysia’s own Hib journey. “Santosham’s provocations intimidated us,” he admitted, “but they worked.”
Inspired by Mathu’s shared research, Malaysian paediatricians studied local Hib burden under the then head of paediatric services, Dr Hussain Imam, writing in the Pediatric Journal of Infectious Diseases that Hib caused 50 per cent of paediatric meningitis.
Despite Asian scepticism about Hib’s prevalence and relevance, our cost-effectiveness analysis proved favourable. A proposal was submitted to the Ministry of Health.
Then the 1997 economic depression hit. Many programmes stalled. But Dr Narimah Awin, the then director of family health, famously declared: “We don’t need a twin tower. One tower is enough. The money from the other tower can fund our Hib vaccination programme.”
That was the turning point. In 2002, Malaysia became the first Asian nation to introduce Hib vaccine into its National Immunisation Programme (NIP) as part of the pentavalent combination, dramatically accelerating uptake.
Today, Hib disease is virtually eliminated in Malaysia. Nearly two decades on, the evidence is clear: that single declaration — sacrificing a symbolic tower for a child’s life — saved thousands.
The lessons for our future? First, nostalgia isn’t just sentiment, but a strategic archive. The Hib success shows that local data, cost-effectiveness analysis, and a champion with moral clarity can overcome even economic collapse.
Second, innovation doesn’t always mean a new molecule. Prof Shabir Madhi, the youngest on the panel, who introduced PCV to South Africa, reminded us of critical enablers: strong national surveillance, local data, an active immunisation advisory committee, and smart marketing to politicians.
These same levers can accelerate new vaccines, against rotavirus, Human Papilloma Virus (HPV), or future threats.
Third, collaboration works. Prof Kim Mulholland demonstrated Hib and then pneumococcal vaccine efficacy in the Gambia with 43,000 participants, showing for the first time that a vaccine (PCV) could reduce all-cause under-five mortality. That evidence helped nations add new vaccines to their NIPs.
As Malaysia rebuilds in this post-pandemic era, we face another quiet crisis: routine immunisation coverage has dipped, and new vaccines await inclusion.
The nostalgic moments from our Hib fight — the cricket match, the twin tower stand, the relentless local research — are not mere history. They are a roadmap.
One tower was enough then. Today, we need not less ambition, but the same clarity: put children first, gather local evidence, and champion the cause with courage.
The past did not eliminate Hib, people did. And they can do it again.
Dr Musa Mohd Nordin and Dr Zulkifli Ismail are paediatricians from Damansara Specialist Hospital (DSH).
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