The world has been plagued by the Covid-19 pandemic since the beginning of last year. It has been described as the worst pandemic in the last 100 years of our history.
Todate we have not found any effective treatment for this scourge. Over the past year, there has been intense debate on the development and rollout of a vaccine as a possible way of retarding the continuous spread of the virus.
The global scientific community has responded with great speed in putting the puzzles together to come up with vaccine candidates in a short period of time. The speed is unprecedented in our history.
Many countries have started vaccinating their citizens over the last few weeks. As the vaccine becomes a reality many new questions arise, both among citizens and those in the medical profession alike.
Currently there are about 63 vaccines in human trials and about 85 pre-clinical vaccines in various early levels of studies, including animal studies. Hence, it is a fairly crowded area.
Although about half a dozen vaccines have been rolled out and given to people in many countries in the world, 2021 might see many new additions to the armamentarium.
The United States had in December given Emergency Usage Approval for two vaccines and started its vaccination programme.
Other countries like the United Kingdom, China, Russia and many others have given emergency approval for various vaccines using the powers of their public health laws.
Some of these vaccines have completed their Phase 3 trials and their results have been scrutinised by the regulatory and approval authorities in different countries before emergency usage approvals were given.
Two of the vaccines which have completed their Phase 3 trials and have been approved for use in the US, have remarkable effectiveness in protecting the person vaccinated against being infected with Covid-19 with an efficacy of 95%.
The trial design required those vaccinated to be followed up for nine weeks after the second dose and such information be included as being part of the trial.
Analysis of the data had shown that both the vaccines were relatively safe and had minimal side effects.
The trial of another vaccine was temporarily stopped due to a case of a vaccinated person having transverse myelitis (localised inflammation of the spinal cord), but subsequently restarted after some investigations and clarifications.
In short, the current vaccines are not only effective but have also been found to be safe by the regulatory authorities.
Rapid development
Among the questions which have been raised by some quarters is the rapidity with which these vaccines were developed. Concerns have been raised on whether safety precautions were fully adhered to in the development of the vaccines.
One major factor which facilitated such rapid deployment of the vaccines is the advances in vaccine development technology.
Over the years, many development platforms have emerged which had allowed scientists to develop vaccines using non-conventional platforms, making it possible to be done much faster and in greater scales in comparison to known conventional vaccine development technologies.
Upon their development, these vaccines undergo Phase 1 to 3 trials before being rolled out to the public for general usage.
Many vaccine candidates could drop off in any phase of this process, and only a few reach the Phase 3 stage.
Some of the trials started in June this year and continued until November. Participants have been vaccinated since then, implying that some of them are now in their sixth month after having received the first dose.
Any adverse reactions suffered by them would have been noted. Analysis of such data shows that they are safe.
Some are questioning if there could be late onset side effects that could manifest months or years later. I do not think anybody can answer that with absolute certainty.
We have to be guided by previous experiences and the science behind these vaccines.
The government announced recently that it had procured enough vaccines to vaccinate 30% of the population beginning the first quarter of 2021.
The US which started its vaccination recently hopes to vaccinate 70% of its population by June 2021.
Singapore started their programme last week and is targeting all Singaporeans by the end of 2021.
The information available so far suggests that our government intends to vaccinate about 82% of the population.
I understand from available reports that 40% of the required vaccine had been procured from different sources and another 42% is being sourced from multiple sources, including from China and Russia.
Transparent and effective
Although the government has not stipulated a specific dateline to vaccinate 80% of the population, I hope it is targeted to be done by December 2021.
The government has the responsibility to communicate the policies behind this Covid-19 vaccination programme in a transparent and effective manner.
Todate, the government has opted for an mRNA vaccine and a vaccine developed by viral vector technology. Social media is abuzz with conflicting information on these new technologies and its safety.
Both these technologies involve the introduction of genetic material either directly or through the support of a viral vector into the recipients’ cells to invoke the production of Covid-19 antigens and subsequent immune response.
It is important that these principles be explained to the public in a simple and effective manner.
There are some quarters who have raised questions on the potential long-term effects of introducing a foreign genetic material into a human cell.
On the other hand, top-level scientists who sit on various advisory and approval bodies throughout the world have reviewed the technology and data from the clinical trials and approved the usage of the vaccine on the general public.
I believe that if there were serious concerns on the long-term safety of these vaccines, they would have considered them and addressed them appropriately.
The availability of multiple vaccines using different technologies will provide choices to individuals to decide on their personal preferences.
To allay public anxiety, the government has to collate all this information and communicate this effectively to the public.
Storage requirement
On the issue of logistics, it has already been noted by many analysts that the storage, distribution and process of vaccination are going to be a nightmare.
The storage requirement of the Pfizer vaccine is so demanding that the government is going to find fulfilling these requirements a daunting task.
Rural Malaysia, particularly Sabah and Sarawak, are already facing serious logistic problems in terms of access, connectivity and communication. The government will have to do major investments to create the necessary infrastructure to overcome these issues.
Independent auditors should continuously evaluate the integrity of the cold chain to ensure it is never broken. Vaccine failures in certain geographical cohorts have been linked to cold chain failures in the past.
This is in relation to vaccines in our current immunisation programme which have far less demanding requirements than the Pfizer vaccine.
Therefore, those monitoring the cold chains should be scrupulously honest to recognise and rectify any transgressions. Failure to do so can lead to a major public health disaster.
To-date, the government has not clearly defined its implementation strategy.
It has to inform the public of the timeline of the vaccination programme, the order of groups that are going to be prioritised and the logistical solutions which have been developed so far.
I believe this is a voluntary vaccination programme.
Effective communication is the only route to ensure that a substantial proportion of the population can be vaccinated.
It is a battle between misinformation and the right information. In this battle, it is the government’s responsibility to ensure that the right information prevails and predominates.
The health ministry has been the custodian of the immunisation programme in Malaysia. Since independence, the health ministry has created the infrastructure and network to ensure seamless and effective immunisation.
The health ministry is the authority behind the evaluation of vaccines, their registration, procurement and utilisation.
There have been some great success stories, for example, our HPV vaccination programme has been applauded by many even at international forums.
We also made the right decision in not registering the dengue vaccine for the lack of data supporting its effectiveness and safety.
However, for some strange reason, a ministry with so much calibre and experience has chosen to be relatively quiet in articulating the rationale and strategy behind the Covid-19 vaccination programme.
I hope the health ministry will be more proactive and assertive.
Dr S Subramaniam is the former health minister.
The views expressed are those of the writer and do not necessarily reflect those of FMT.
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