Since the beginning of the vaccination drive, and especially now with the roll-out to the general population, there have been many who are concerned on whether they are suited to receive a Covid-19 vaccine and if so, which one to take?
Along with the general roll-out the government has now provided guidelines on a pre-vaccination assessment process. This instalment aims to provide more information on this issue.
The first question that comes to mind when talking about pre-assessment is to answer the question of why is it even needed? Much data and information has been shared on the safety and efficacy of the different vaccines in different populations; and so there may arise concerns on why there is suddenly now a move to assess individuals on their suitability to receive vaccines. The question people might have is: But I thought the vaccines were good for everyone to take?
Truth be told, the health community has always clarified that there will never be blanket use of any sort of medical intervention on the whole population, especially without clear data to back it up. It has always been clear that there will be individuals who need to be carefully screened in terms of their pre-existing conditions before being given vaccines.
In the Covid-19 context, this is not due to the fact that the vaccines have been thought to worsen the pre-existing disease or condition of these individuals; but rather on whether the vaccine would have been able to induce immunity in them. For example, in a person who is immunosuppressed due to specific medication or medical conditions, vaccines would not be able to induce their immune system to produce antibodies. Thus the vaccine would be ineffective. This is why the pre-vaccination assessment process will be helpful.
Another reason why pre-vaccination assessments will be important is because of the diversity of the vaccine portfolio that Malaysia has been fortunate enough to have. With multiple vaccines to choose from for different segments of the population, we can tailor the vaccination programme- to give the best vaccine each individual is suited to receive in order to get the optimum benefits (i.e. efficacy) at minimum risk (i.e. possible side-effects) ratio. For those who are ill, this risk/benefit assessment needs to be done individually with the patient and their treating physician. Hence the need for pre-vaccination assessment.
There is also an additional social component for why pre-vaccination assessments are necessary in the Malaysian context. Malaysian patients have a dynamic range of health literacy levels; ranging from those who understand well their own disease conditions and are able to self-manage their conditions right down to some individuals who have no idea of even what disease they have but know that they need to ‘take 2 white pills’ every day.
This heterogenous spectrum of patients are each unique and need individual assessment to ensure their suitability for receiving vaccines. For those who are unsure, the option then should always be to ask whether or not you need an assessment- this is conversation you as a patient need to have with your treating physician.
You will notice that we are careful to use the term treating physician because, once again, Malaysians have a tendency to seek for medical advice from anyone who is a medical or health professional. In many instances, these may even be individuals who have never treated you or do not know your condition(s) at all. While well-meaning, they would really have no way of accurately offering you recommendations on what vaccine you would need to receive.
As such, always go back to either your family doctor, or the specialist following you up most regularly. If you are going to see a physician for the first time after a long period, please make sure that you bring the most recent reports, updated laboratory results and other medications that you are on in order to ensure that they can perform an accurate pre-vaccination assessment (this is especially true of many of us who are just treating our conditions by buying medicines from pharmacies and have not been followed-up by a doctor for a long time).
Now, the good news is that not everyone with a chronic disease needs to get a pre-vaccination assessment. Only individuals from 3 groups as mentioned in the table below need to get assessed prior to receiving vaccination jabs. They are as described in the table below. Two important points to note are: i) If you do not belong within the described population below, you do not need a pre-vaccination assessment; and ii) if you are confused on whether you do belong within the 3 groups, please just consult a doctor and make sure before you go for your vaccine appointment, are turned down, and miss out.
YOUR QUESTIONS ON THE PRE-VACCINATION ASSESSMENT: ANSWERED
Question: I am on a blood thinner which I have been taking for a few years. Should I be pre-assessed as I am not on a regular follow-up?
YES. Any patient with a chronic disease and consuming regular blood-thinning medication should be on regular follow-up. You not doing so does not mean that you do not need a pre-vaccination assessment. Please do so.
Question: What happens during the pre-vaccination assessment process?
Your treating physician will assess to determine whether:
i) you are eligible to be vaccinated as per normal
ii) you can be vaccinated but it needs to be postponed due to your current condition; or
iii) you should not be vaccinated
Your treating physician will also identify which vaccine you are most suitable to receive; when would be good for you to be vaccinated; and where you are to receive the vaccine- it could even be at the hospital where you are being followed-up.
Question: My next follow-up is in 4 months. Should I wait for the follow-up date to get a pre-vaccination assessment?
NO. Each institution may have their own slightly differing protocol as to how and when pre-vaccination assessments are done but they are definitely not going to make you wait till your next appointment in 4 months time. Please call them and have a conversation on when to schedule this and immediately do so. More details will be provided by your individual follow-up centre.
If you would like to get caught up on previous topics covered under this series, they are available as per the link below:
| Infovax Instalment 1 | Efficacy of Covid-19 vaccines | INFOVAX: A dose of truth |
| Infovax Instalment 2 | Safety of Covid-19 vaccines | Understanding vaccine safety |
| Infovax Instalment 3 | Anaphylaxis and Covid-19 vaccines | INFOVAX: Anaphylaxis and Covid-19 vaccines |
| Infovax Instalment 4 | Are the elderly dying due to Covid-19 vaccinations? | INFOVAX: Are the elderly dying due to Covid-19 vaccinations? |
| Infovax Instalment 5 | The Vaccine that won’t alter my DNA | INFOVAX: The vaccine that won’t alter my DNA |
| Infovax Instalment 6 | Viral virus carriers | IINFOVAX: Viral virus carriers |
| Infovax Instalment 7 |
Take or not? Questions about the AstraZeneca vaccine |
INFOVAX: Take or not? Questions about the AstraZeneca vaccine
|
INFOVAX is a community education and awareness series on Covid-19 vaccines brought to you by the Malaysian Medical Association Public Health Society (MMA PHS). Feel free to ask questions and clear your doubts about Covid-19 vaccines by putting them to us at [email protected]. Your questions and answers will be collated and answered in the following sessions.