KUALA LUMPUR, Oct 20 — Malaysia should determine whether the additional protection offered by higher valency pneumococcal vaccines justifies their higher cost, a consultant paediatrician said.
Consultant paediatrician Dr Musa Mohd Nordin said vaccine selection should be based on the pneumococcal serotypes causing disease among Malaysian children, rather than the number of serotypes covered by a vaccine.
“If moving from PCV13 to PCV15 or PCV20 gives only a small extra benefit for a much higher price, keeping PCV13 could free up money for other important childhood vaccines in the national immunisation programme (NIP),” Dr Musa told CodeBlue when contacted.
He said Malaysia needed stronger laboratory surveillance to determine whether pneumococcal strains not covered by PCV13 were becoming common enough to justify paying more for broader vaccines.
“So Malaysia needs strong, ongoing lab tracking – from major hospitals and the Institute for Medical Research (IMR) – to see whether non-PCV13 strains are rising enough to justify paying more for PCV15 or PCV20,” Dr Musa said.
Pneumococcal conjugate vaccines (PCV) protect against different serotypes of Streptococcus pneumoniae, which can cause invasive pneumococcal disease (IPD), pneumonia, meningitis, and bloodstream infections.
PCV13 covers 13 serotypes, while PCV15 adds 22F and 33F. PCV20 covers another five serotypes – 8, 10A, 11A, 12F, and 15B – on top of those covered by PCV15.
Dr Musa said recent Malaysian studies involving 92 IPD cases with an identified serotype found 19A, 3, 19F, 6B, and 14 among the most common serotypes.
Based on these cases, PCV13 and PCV15 matched 81.5 per cent of the identified serotypes, while PCV20 increased this to 84.8 per cent. PCV10 matched 37 per cent.
He stressed that these figures represented serotype matching, not vaccine effectiveness, and only included cases where the infecting serotype was identified.
The relatively small difference between the serotype matching of PCV13 or PCV15 and PCV20 highlights the need to determine whether broader coverage would translate into meaningful additional protection against severe disease in Malaysia.
Malaysia Needs Better Pneumococcal Surveillance
Universiti Putra Malaysia clinical microbiologist Prof Dr Zamberi Sekawi similarly said vaccine choice should be guided by local disease patterns rather than valency alone.
He said national paediatric IPD data from 2014 to 2017 found serotypes 14, 6B, 19A, 6A, and 19F were predominant. PCV13 would have theoretically covered 88.2 per cent of the isolates, compared with 64.1 per cent for PCV10.
“The decision should be driven by local disease epidemiology rather than valency alone. Historical Malaysian data suggest that PCV13 could provide a meaningful improvement over PCV10 because 6A and 19A were important causes of childhood IPD,” Dr Zamberi said.
However, newer Malaysian carriage data from 2023 and 2024 found serotypes 15C, 23A, and 11A were common among young children, he said.
Dr Zamberi cautioned that carriage does not necessarily translate into invasive disease, making stronger surveillance necessary to determine whether newer serotypes warrant a switch to higher-valency vaccines.
“Importantly, carriage is not the same as invasive disease, so we still need national IPD surveillance before deciding which higher valency vaccine gives the greatest additional benefit,” he said.
Dr Zamberi said Malaysia should conduct systematic, age-stratified serotyping of invasive pneumococcal isolates before and after any vaccine switch.
“Otherwise, we risk making a long-term procurement decision using historical disease data and relatively small carriage studies rather than the serotypes currently responsible for severe disease,” he said.
The question of vaccine choice has become more relevant as several pneumococcal conjugate vaccines with different levels of serotypes are available in Malaysia, raising questions over how much additional clinical benefit broader coverage provides in the local setting.
Consultant paediatrician Prof Dr Zulkifli Ismail said Malaysia used PCV10 from 2020 to 2023 before PCV13 was used during a catch-up programme, and said PCV20 is now being used in the NIP.
He said current local serotype data showed PCV10 covered just below half of the serotypes causing IPD, compared with about 81 per cent for PCV13 and PCV15, and about 85 per cent for PCV20. The figures suggest substantially greater serotype matching with PCV13 and PCV15 compared with PCV10, with a smaller incremental increase from PCV13 or PCV15 to PCV20.
Serotypes 19A and 3 remain problematic among children, Dr Zulkifli said, although only a fraction of the more than 100 known pneumococcal serotypes cause invasive disease.
“Adults will get pneumococcal infection from their toddler children or grandchildren. It is important for adults, especially the elderly and those with comorbidities, to get a single shot of the conjugate vaccine,” Dr Zulkifli told CodeBlue.
Vaccine Choice Should Weigh Cost, Health Benefits
Universiti Kebangsaan Malaysia public health specialist and health economist Prof Dr Sharifa Ezat Wan Puteh said vaccine selection should consider clinical performance, safety, local disease burden, and cost-effectiveness rather than purchase price alone.
Cost-effectiveness could be assessed based on diseases, deaths, hospital admissions, and complications prevented, as well as quality-adjusted or disability-adjusted life years, she said.
Cost-effectiveness would therefore depend on whether the additional protection offered by a vaccine translates into sufficient reductions in disease and associated health care costs to justify the additional expenditure.
A more expensive vaccine could therefore still be cost-effective if it prevented substantially more disease and associated health care costs.
Dr Sharifa Ezat also said Malaysia should consider expanding pneumococcal vaccination to older and high-risk adults as the population ages.
“The next step for Malaysia itself, not only for the immunisation for children, but also to target the elderly group,” Dr Sharifa Ezat told CodeBlue.
She identified older adults, people in institutional care, and those with conditions such as obesity, diabetes, and pre-diabetes as groups that could benefit from greater protection.
Dr Sharifa Ezat also linked vaccine policy to health security, saying Malaysia should reduce its dependence on imported medical products amid geopolitical and supply-chain disruptions.
“We cannot be dependent on external products only. We have to be locally strong,” she said, calling for greater government support and investment in domestic manufacturing capability.
