KUALA LUMPUR – The government should not rush into giving third doses and booster shots to fully vaccinated individuals without local scientific data and justification, said health experts.
This is despite calls by some epidemiologists and consumer rights groups that are of the view that it is wise for the Health Ministry to administer boosters to high-risk groups and those with comorbidities.
Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud told The Vibes that the government must be guided by evidence from local data rather than rely on other countries’ findings.
He said it is imperative that the ministry has its own data set as there are several vaccine brands in Malaysia’s portfolio, and each has a different efficacy rate.
Dr Awang Bulgiba, who also heads the Independent Covid-19 Vaccination Advisory Committee, had recommended that the government establish a voluntary coronavirus vaccination registry last December.
“A total of 50,000 vaccinated individuals will need to be recruited as volunteers into this registry, and followed up on for two years.
“They will be followed up on to study and evaluate how long the immunity caused by different vaccines lasts, so testing for neutralising antibodies, as well as B-cells and T-cells, will need to be done.”
According to the National Human Genome Research Institute, B-cells and T-cells are lymphocytes. B-cells produce antibodies that are used to attack invading bacteria, viruses and toxins, while T-cells are a group of immune cells that can target and destroy virus-infected cells.
Dr Awang Bulgiba said there should also be a study on whether the heterologous prime-boost, or mix-and-match, approach will result in a better immune response than relying on a single vaccine type.
He said this is to enable MoH to determine who is more likely to benefit from such an approach.
“We need to remember that CanSino and Johnson & Johnson are single-dose vaccines, so the possibility of booster doses for such vaccines is quite real.
“If regular booster doses are required for the rest of the population, then the National Covid-19 Immunisation Programme will need to continue beyond its original time frame, and a permanent structure will need to be set up to manage this.”
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He added that the government announced the setting up of the sero-surveillance programme in July that he hopes will be able to provide the evidence required for policy decisions of this type.
Sero-surveillance provides estimates of antibody levels against infectious diseases, and is considered the gold standard for measuring population immunity due to past infection or vaccination.
It is an important component of disease surveillance, and complements notification, hospitalisation, mortality and immunisation coverage data. National sero-surveillance programmes are well established in many countries worldwide.
Dr Sanjay Rampal, a specialist on public health medicine and professor of epidemiology at UM’s Social and Preventive Medicine Department, echoed similar sentiments, saying there is still limited evidence on the need for booster shots following primary vaccination.
However, he said, it is postulated that the elderly population will gain the most from such a programme.
Procure ‘future-generation’ jabs
Dr Rampal said Putrajaya should procure a future generation of vaccines that are more effective against newer Covid-19 variants, rather than stockpiling first-generation jabs.
“With time, the market may get flooded with first-generation Covid-19 vaccines when new-generation vaccines become available. It would be wise to procure future-generation vaccines rather than stockpiling first-generation vaccines.”
On the other hand, Universiti Putra Malaysia epidemiologist and biostatistician Assoc Prof Dr Malina Osman is of the view that it is wise and appropriate for the government to administer Covid-19 booster shots to high-risk groups.
“MoH has probably studied in detail the situation in the field, particularly on what is happening in Sarawak. In Sarawak, despite its relatively high vaccination rate, the numbers of new cases and those needing admission to intensive care units remain high.
“The emergence of VOCs (variants of concern), particularly the Delta variant, may also contribute to the high transmission rate, causing breakthrough infections among fully vaccinated individuals.
“Based on what has been experienced in Israel, Singapore and some European countries, I think similar steps have also been explored by our government to justify the need for booster doses.”
She said the definition of “fully vaccinated” status could change with the administration of boosters.
“Epidemiologically, the status should be reviewed from time to time. This depends on the emergence of potential VOCs and outbreak patterns.”
She also foresees that booster shots will be needed on a regular basis, like the flu shot.
Yes to boosters if guided by science: Fomca
Datuk Paul Selvaraj, secretary-general of the Federation of Malaysian Consumers’ Associations (Fomca), said the group is in favour of the booster shot roll-out as long as the policy is guided by science.
“That is the fundamental principle. Booster shots are still very new in the country. We need our own medical research to ensure that the interest of the people is top priority.
“We realise that science has been changing a lot, and sometimes, even the World Health Organisation has conflicting reports.
“It is not about Fomca supporting this policy or not; we only support science.”
Last Sunday, Health Minister Khairy Jamaluddin said the government has not ruled out the possibility of Covid-19 booster shots for those who are healthy and under the age of 60.
Khairy said at this point, Putrajaya is prioritising high-risk groups and those with pre-existing health conditions for these doses.
He added that Sarawak will be one of the first states to kick-start the booster programme when the ministry finalises the clinical guidelines for the shot.
Sarawak was one of the first states to complete the national immunisation drive, and fully vaccinated individuals there are set to get a third jab this month. – The Vibes, October 1, 2021
