Whilst the world is witnessing a flattening of the COVID-19 pandemic curve, with declines in cases and deaths in some regions, Malaysia is presently experiencing a worrying upsurge of cases and deaths.
There were 113,010 cases in 2020 and 366,411 cases in the first 5 months of 2021 (until 18 May 2021) which comprises 76% of the total cases.
During the whole of 2020, there were 471 deaths. Contrast this with 1,523 deaths up until 18 May 2021. A whopping 76% deaths in the first 5 months alone in 2021.
Examining the cumulative cases per million population, it looks like Malaysia is the second-worst performing country in the region, closing in on the Indian trajectory.
The National Security Council, Ministry of Health and other Ministries and Agencies have failed to contain and control the COVID-19 pandemic, despite more than 1 year of living with the coronavirus,
The United States, the United Kingdom and Israel which were even more severely affected by the pandemic have been able to mitigate the deadly effects of the COVID-19 pandemic.
One of the pivotal components of their success stories is their ability and competency to distribute their COVID-19 vaccines speedily, widely and attaining near herd immunity coverage.
To begin with, our public health back to basics of pandemic management is well below par. This is further compounded by the failure of the duo of Ministers, Health and Vaccines, in charge of the Program Imunisasi COVID-19 Kebangsaaan (PICK), to efficiently and effectively roll out the National COVID-19 Immunisation Program.
The former boasted that by the end of February 2021, 126,000 doses will be administered daily. The latter, the Vaccines Minister, touted 75,000 daily doses.
The latest data on the immunisation rate in Malaysia charts an average of 21,311 doses per day. This is only 17% and 28% respectively of the daily doses claimed by the 2 ministers.
Malaysia has only immunised 3.6% of our population with one dose of COVID-19 vaccines which is 9 times slower than our southern neighbour Singapore at 32.5%.
Despite these lousy vaccine rollout numbers, the Federal government has the audacity to refuse the Penang state government permission to immunise 2 million of its local population for free.
Like KL, Selangor, Sarawak and Kelantan, Penang is a high infection state and the immunization rollout must be prioritized in these 5 states, considering the current shortages in the vaccine supply chain.
The Federal-centric negotiations of everything related to the COVID-19 vaccines has now been shown to be non-sustainable. The Federal government must stick to its role as a policymaker and not play the role of an implementor, which it has now miserably failed.
Besides, never before in the history of immunisation policies since the 1950s has the private sector been blocked from procuring vaccines. If anything the private sector has been the initiator in the procuring of all the new vaccines (eg Hepatitis B vaccines in the 1980s, MMR and HiB vaccines in the late1990s, HPV and PCV vaccines in early 2000s) before they were later implemented in the National Immunisation Program (NIP). Why should the COVID-19 vaccines be any different?
The MOH and JKJAV has now “successfully” conducted Phase I, Phase I+ and Phase 2A of the PICK. The next goal now is to immunize as many Malaysians that is humanly possible.
This can be achieved if the state governments, APHM, private hospitals, GP, and other stakeholders are empowered to procure and administer the vaccines to complement the public vaccine program.
Is it not our shared ultimate goal to achieve population immunity? The experience in India has testified that the involvement of the private healthcare sector in their national immunisation program has increased the number of vaccines administered by 7 times.
Through the Emergency Ordinance, and circumventing parliamentary oversight, the cabinet is sticking its paws into the cookie jar aka National Trust Fund. The PM and Finance Minister has justified this unprecedented act with the nations’ ailing health circumstances and the financial crisis.
If a segment of the population is able to pay for the vaccines, is this not something that the government should welcome to cushion the financial impact to the national economy?
Smart partnership between the public and private healthcare sector is vital to ensure a warp speed vaccine rollout and scale-up coverage of the population.
During the early days of PICK, the Opposition Leader has proposed the delaying of the second dose of the COVID-19 vaccine. His thoughts mirrors the UK experience, in its bid to ramp up the first dose coverage, to inch towards the herd immunity threshold.
With the constrained global vaccine supplies, the Singapore MOH is studying this vaccine strategy to administer more first shots to its citizen and spread the vaccine protective net wider.
In the UK this delayed second dose strategy has plunged the COVID-19 hospitalisation rate in Scotland by 90%.
Public Health England reports that during the period Dec 2020 – Mar 2021, at the peak of the COVID-19 wave in the UK, 10,400 lives were saved by the delayed second dose strategy. [1,2]
A recently published study in the elderly population shows that the antibody response is increased threefold in those given a delayed second dose of the Pfizer mRNA vaccine. [3]
Earlier studies by the team of researchers at the University of Oxford showed that the AstraZeneca vaccine given later at 12 weeks had higher rates of vaccine effectiveness and also lowered the transmission of the coronavirus. [4]
It is high time that the MOH and JKJAV consider this delayed second dose vaccine strategy and administer more first doses to more people in order to faster attain population immunity and mitigate the risks of the development of variants of concern (VOC) in the community. [5,6]. This policy can be reviewed once the vaccine supplies has been restored.
References:
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00677-2/fulltext
- https://gov.uk/government/news/covid-19-vaccines-have- prevented-10-400-deaths-in-older-adults
- https://www.nature.com/articles/d41586-021-01299-y
- https://www.cnbc.com/2021/02/03/delaying-second-astrazeneca-vaccine-dose-does-work-study-shows.html
- https://www.bmj.com/content/373/bmj.n1087
- https://www.nejm.org/doi/full/10.1056/NEJMclde2101987
Dr Musa Mohd Nordin
19 May 2021
