Dr Musa Mohd Nordin, Pediatrician
Asst Prof Mohammad Farhan Rusli, Public Health Physician
8 October 2021
It looks like the magic number of 90% touted by the Prime Minister and the Minister of Health, may soon be celebrated with inter-state crossings. This is the proportion of adults above 18 years old who have been fully immunized with COVID-19 vaccines.
This “adult herd immunity” concept is unique to Malaysia and we are surprised that none from among the infectious diseases and public health fraternity has challenged it validity. Will it confer indirect protection to the unvaccinated segment of the population? Most certainly not! [1]
In an earlier piece, we concurred with a pediatrician colleague, Dato’ Dr Amar Singh, that we should be instead be emphasizing and mainstreaming data on total population vaccination rates rather than adult vaccination rates. [2]
At best, 90% adult vaccination coverage translates to 65% vaccinated population which is insufficient to protect the unimmunized population of the country. It would have been possible to protect against the original Wuhan strain or maybe the Alpha Variant Of Concern (VOC).
In the face of the raging Delta Variant of Concern (VOC), which is highly transmissible with a Reproduction Number (Ro) of 5-7, we need to immunize at least 90% of our total population in order to confer indirect protection to the unimmunized 10% cohort. [3]
Only then we can consider transitioning from the pandemic to the endemic phase. We must learn from the experience of our southern neighbors who are now experiencing a surge of COVID-19 cases despite achieving a vaccination uptake of 83%.
235 (84%) of the 281 hospitalized patients in Singapore (6 Oct 2021) were more than 60 years old. They have begun to offer third doses of mRNA vaccines to their elders. We have yet to begin and even then, it is only an optional requirement. [4] This is of much concern because 41.6% of our population are recipients of the inactivated vaccine which has been shown to be associated with more admissions into the ICU and mortalities, and by extension, more breakthrough infections and hospitalizations [5,6].
The other population of concern are the children and adolescents below 18 years old. Up until 8 Oct 2021, we have vaccinated 68.5% of 12-17 year old adolescents with 1 dose and 4.7% with 2 doses. This needs to be ramped up further in our efforts to boost population immunity.
Even then this is inadequate. We need to begin to look at the new data on the safety and efficacy of mRNA vaccines in the younger age group. The FDA will be reviewing the mRNA vaccine for children aged 5-11 years old on 26 Oct 2021.
There has been an explosive increase in the number of children infected and dying from COVID-19 up until mid-September 2021 compared to the previous year.
The American Academy of Pediatrics have reported that 100 children have died from COVID-19 in the recent 5 weeks.
The Delta variant has caused a 6-8 fold increase in the Case Fatality Rate of children as shown in the table below.
Whilst in the transition phase there are 3 other indicators apart from vaccination coverage which must be carefully considered in our re-opening strategy.
We alluded to these indicators briefly in this newspaper report and will discuss them in more detail in a forthcoming essay. [7]
- https://www.thestar.com.my/news/nation/2021/09/06/khairy-sabah-to-start-vaccinating-adolescents-at-end-october-once-adult-herd-immunity-achieved
- https://www.malaysiakini.com/columns/590054
- https://drmusanordin.com/2021/09/06/80-community-immunity-is-not-enough-minister-part-i/
- https://www.thestar.com.my/news/nation/2021/10/07/covid-19-booster-shots-will-not-be-mandatory-says-kj
- https://covidnow.moh.gov.my/vaccinations
- https://codeblue.galencentre.org/2021/09/23/covid-19-vaccines-cut-icu-risk-by-83-deaths-by-88-in-malaysia/
- https://t.co/q3ofUxwN5e
