This article first appeared in The Edge Malaysia Weekly on December 27, 2021 - January 2, 2022

RECOGNISING that the Malaysian economy cannot afford another lockdown, and taking a cue from its vaccine rollout earlier this year, the government has been responding fast to combat the Omicron variant. It began offering booster shots in October to prevent another wave of Covid-19 infections.

In fact, following the World Health Organisation’s recent warning that the Omicron variant poses a “very high” global risk, the Ministry of Health (MoH) said it will accelerate the rollout of the booster shots to 150,000 per day from 120,000 previously. It will then be increased in stages to 200,000 doses per day.

MoH’s website shows that 4.88 million people in Malaysia have got their booster shots as at Dec 21.

For starters, priority is given to people aged 40 years and above, younger people with concomitant diseases, employees and residents of long-term care facilities, pregnant women, as well as those who need the booster vaccination for overseas travel. People who received the Sinovac vaccine will also be given the booster dose first as its efficacy is relatively lower than the mRNA vaccines. In fact, Health Minister Khairy Jamaluddin recently warned that those who received two doses of the Sinovac vaccine will lose their fully vaccinated status if they do not get their booster shots by February 2022.

Still, as the antibodies tend to decrease after each shot of a vaccine, will booster shots be the new normal going forward? “This is something that is hard to predict,” says Professor Datuk Dr Adeeba Kamarulzaman, professor of medicine and infectious diseases at the University of Malaya (UM).

“What is certain is that if the world doesn’t vaccinate as many people as possible as quickly as possible, the chance of us encountering other variants is going to be high, which then makes the likelihood of needing regular boosters even higher,” she tells The Edge.

Adeeba points to a recent study (to be published soon) she conducted with her colleagues at UM that showed the mortality rate for those who received the Sinovac vaccine was higher than those who received the Pfizer vaccine should they develop breakthrough infections and severe disease.

“Having said that, the mortality rate was 43 times higher for those who were unvaccinated compared to those who were. Antibody studies have also shown that the immune response to the Sinovac vaccine is generally lower than that to Pfizer and AstraZeneca,” she adds.

Taking lessons from the successful rollout of the National Covid-19 Immunisation Programme (PICK), Adeeba says the government should now build a system that will allow for the capturing and sharing of data to make informed public health decisions, not just at the central level but also at the state and district levels.

“We need to build our genomic capabilities — to diagnose, monitor and analyse the epidemiology of outbreaks. The South Africans [for instance] were the first to detect the Omicron variant because they have built a sophisticated surveillance system and genomic capabilities, thanks to the tuberculosis (TB) and human immunodeficiency virus (HIV) pandemic response,” she says.

Consultant paediatrician Datuk Dr Amar-Singh HSS concurs. “Our genome testing is very weak. We have yet to develop a robust and automated electronic and seamless case notification system that is linked to epidemiological investigation.”

He believes yearly booster shots or the use of new severe-variant-based boosters will be unpopular with the public. “Rather, we would be prepared to take a new pan-coronavirus vaccine that targets all types of coronaviruses, especially if it is a nasally delivered vaccine (better protection against infection). We must be prepared to improve other prevention measures — a vaccine plus policy,” he says.

“Our funding, manpower and infrastructure for our health services have seen very poor growth in the past 20 to 30 years.

“We should also work to keep our health manpower labour force. We are losing our staff to private [practice] and other countries because we do not support them. The lack of resolution of the contract doctors and pharmacists’ problems after so many years shows the lack of interest in building our health services,” Amar says.

Nevertheless, ProtectHealth Corp Sdn Bhd CEO Datuk Dr Anas Alam Faizli reminds Malaysians that health is a joint responsibility of each individual and the government.

Amar echoes that sentiment. “The public need to also exercise responsibility in the face of the continued Delta variant spread and the threat of Omicron.”

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