Vaccination strategies to complement National Recovery Plan

Our actions in the next few months will shape Malaysia's trajectory towards recovery.

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Published in The Star, Business Today, CodeBlue, Foucs Malaysia, New Straits Times, & The Sun Daily, image by Business Today.

National Covid-19 Immunisation Programme Coordinating Minister Khairy Jamaluddin mentioned that the next three months will be crucial for the vaccination campaign. EMIR Research supports this view, and presents herein some strategies and success factors that must be given attention to complement the effort.

Khairy pointed that the vaccination rate is going well at the moment with average daily doses surpassing earlier targets. Slight dips in daily rates that are not prolonged should not be an issue as long it’s part of an overall increasing trend and that the overall average rate meets the target.

More importantly, the effectiveness of the various excellent initiatives to ramp up vaccination pace will largely rely on consistent vaccine supply, in which Khairy expects 12 million doses to arrive in the month of July.

As supply bottleneck is expected to be alleviated for the next few months, potential local hiccups must be ironed out. Authorities are getting ready to handle this surge in supply, but the people must also ready to support this by registering and showing up to vaccination appointments.

That said, we must realise that things may not go as planned and we have to be mentally and strategically prepared for this.
Upon observing experiences in other countries that have vaccinated a significant percentage of their population, we have to take note of the likelihood where vaccines may not be working as well as they should, or, as well as we would need it to. This may include shorter immunity retainment and/or lower effectiveness than expected.

This is compounded with the potential impact of virus variants bypassing vaccine-induced immunity. That is, mutation is faster and significant enough to circumvent immunity to parental or other strains, even if immunity is retained longer. Combining these potential factors with lax human behaviour (leading to higher intensity of careless human interactions) after only receiving one dose could generate the perfect recipe for a surge in new cases and a new, more uncontrollable wave. These factors may have contributed to some countries reinstating movement restrictions despite a relatively large vaccinated population.

Nevertheless, vaccines appear to be the only option for now and it’s important to widen all sources of vaccines to be procured. In view of new and emerging variants, it’s crucial that authorities insist that the purchase of new vaccine batches (perhaps even batches that have not arrived) to be an “updated” version, if possible.

In this regard, authorities must diligently take into account findings relating to vaccine types and virus variants in other countries to guide procurement decisions for Malaysia’s current and future vaccine pipeline. If there is the luxury of time and options, then of course, vaccines that work best against new and emerging variants, help reduce infection and transmission (not only disease severity and deaths), and provide high levels of protection even with one dose would be preferred.

Given that updating vaccines may take time and the abovementioned strategies may not work in the immediate term, perhaps mixing of different vaccines should also be studied (through primary and secondary data) for efficacy against variants of concern, such as the Delta variant. Thus, genetic sequencing has to be increased accordingly.

Although we expect an increase in vaccine supply, there could be hiccups and any number of doses is still valuable. In this regard, recent studies by researchers from the University of California supported the notion of the sufficiency to give only one dose to people that were infected by Covid-19 before. This could free up additional doses for others.

That said, such studies, as well as cases of reinfection amongst vaccinated individuals indicate the need for booster doses for all. The said study is also limited to mRNA vaccines and it remains to be verified if other vaccine types would illicit a similar response. Also, it is uncertain if the strategy is sufficient to protect against new variants.

Global experiences also appear to indicate that we can’t just assume everyone receiving vaccines will develop sufficient immunity and retain in for a very long time. The potential need for a booster shot (which could be within months of the second dose) indicate a response to declining immunity levels. Thus, pharmacovigilance post vaccination needs to account for monitoring and measurement of immunological status.

It is noted that the US Food and Drugs Administration (FDA) currently does not recommend testing immunity levels post vaccination, but the information could be stored by health authorities for its own internal use, instead of public self-management.

As more research on Covid-19 antibody tests emerge, combining this information with vaccine type, sequencing results (linking to virus variants) and other patient information can potentially help provide guidance for vaccine procurement decisions, development of other pandemic management strategies, and serve as a basis for vaccine passports implementation which can help open up borders and the economy.

Extrapolating the experience of other countries, it’s crucial to ensure people vaccinated with only one dose do not become careless and start to forego physical distancing rules, proper hygiene practices and other SOPs. This was reported as one of the main factors for Chile to experience a strict lockdown despite vaccinating nearly 60% of its people.

There have been reports of low single-dose effectiveness against the Delta variant, which is increasingly becoming the dominant variant globally. Officials at vaccination centres should practice reminding this issue to people coming in to get their jabs. It is worth reminding that even if we get vaccines (even updated ones), vaccinated people may still carry and transmit the virus. It may not have to be this way in the future, but that’s for a separate discussion.

The point is that the combination of more transmissible variants such as the Delta variant and waning immunity magnifies the impact of increased human interaction. It’s also important to keep in mind that no vaccines are 100% effective, and these unlucky individuals that are not successfully immunised can move about and infect others.

The recent rise in local cases and R-naught value could be attributed to a combination of human interaction and/or more transmissible viruses – something that a “total” lockdown could have prevented or minimised, saving us from the recently enforced enhanced movement control order. It would appear some people have the propensity to learn things the hard way, and only now are the authorities rejecting MITI’s permission letters.

Despite Bloomberg’s weightage on economic and border openness, we should not blindly rush into subsequent phases and easing restrictions. The excruciating pain of the economic sector is understood and empathised, but it would be unwise to open up fast and enjoy what could be a temporary economic relief or being temporarily higher up in some monthly ranking.
Such hasty moves may only be fuelling the next wave, and another total blanket lockdown will only result in more business closures, job losses, and mental health issues. We may not be able to economically afford another major nationwide restriction, but we certainly cannot bring back the dead either.

Therefore, in treading this delicate balance, it is only reasonable that vaccination campaigns should increase prioritisation of the economic sector in the coming months to safely complement the gradual reopening in Phase 2 of the NRP.

Aligned with EMIR Research’s recommendation to shift focus on the economic sector in its “Exit strategy building blocks for Malaysia” published in June 17, Khairy reported that the next few weeks of the vaccination programme shall start to focus on the manufacturing, transport, construction, and plantation sectors, involving the target of 300,000 workers to be vaccinated.

We would like to restate our call to shift focus to as many economic actors as possible in the following months, ensuring mid-tier companies, and micro, small and medium enterprises to be prioritised (not just limited to the essential sectors). These are the companies that are most affected, and therefore, most in need of protection.

Understandably, it will take time to vaccinate the economic sector, so it is crucial to ensure as many businesses stay afloat through improving and increasing safety nets, such as those recommended by EMIR Research’s post-review of Pemulih stimulus package.
Time will tell if current vaccines would perform as well as we need it to, or if virus variants would throw a wrench in the recovery plan. In the meantime, we focus on what we can control.

If we can learn from other countries, stay united as a society, make the vaccination programme successful and be disciplined in adhering to SOPs even when vaccinated, then we can safely (and sustainably) loosen internal restrictions, open up borders and the entire economy. Our actions in the next few months will shape Malaysia’s trajectory towards recovery.

Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

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