Vexing questions over when the vaccines will come

  • Corporate News
  • Saturday, 10 Oct 2020

THE progress in developing a vaccine for the Covid-19 virus will certainly pose a threat to the meteoric rise in the values of listed Malaysian glove makers.

While the extent of that threat is debatable, Science, Technology and Innovation Minister (Mosti) Khairy Jamaluddin (pic) has given more insights into the progress of the vaccines and how it would reach Malaysians.

Speaking to StarBizWeek in a Facebook live session, Khairy revealed some interesting facts. Malaysia is using a multi-pronged approach in the race to procure the vaccine; the government is in discussions with various pharmaceutical companies in Malaysia to manage the logistics for transporting vaccines safely; and is also speaking with foreign pharmaceutical companies developing vaccines to secure supply. Khairy also says that “we must ensure whoever wants to be vaccinated by the publicly available vaccine can do so free of charge.”

Here are excerpts of that interview:

STARBIZWEEK: How close is the world in getting a vaccine?

KHAIRY: According to the World Health Organisation (WHO), there are 193 vaccines being developed around the world. Forty-two are in clinical trial stages and 11 are in phase three, the last phase of clinical trials. We should be getting safety and efficacy data from the phase three trials by November or December. Once that data is available, then the regulatory approval process will start. Of course, the US Food and Drug Administration (FDA) has issued emergency approval guidelines recently and so has the WHO.

In Malaysia, the approval and regulatory agency is the National Pharmaceutical Regulatory Authority (NPRA) under the Health Ministry (MOH). They will do the regulatory approvals for the vaccines. Once we have the data and approvals, then we can start the procurement process for the vaccines and transport it to Malaysia.

That is going to be a logistical challenge because for transporting vaccines, you need a cold chain and other complexities. This is something we need to prepare for. If the data is good by December, approval will come after that. Then we will be looking at next year, which is in line with the news articles about the vaccine’s timing, which is that deployment (of the vaccine) if it is safe, effective and efficacious, will be next year.

Can you elaborate on the local approval process and the need to prepare for cold chain supply for the vaccine’s deployment?

We have been discussing with some pharmaceutical companies who will assist in the transport and delivery of the vaccines across the country. We want to ensure that once we have procured the vaccine, we can immunise our citizens across the country. There are local pharmaceutical companies and some government-linked companies that have the cold chain facilities to deliver right to the hospitals and points of care across the country.

On where Malaysia will get the vaccine, we are pursuing a multi-pronged approach. We are still talking to Covax, the international facility run by Gavi and WHO. We are also speaking bilaterally to pharmaceutical companies directly through MOH and to governments like China, where we are trying to finalise an MoU at a government-to-government level to secure the supply of vaccines if they are approved later.

You mentioned there are 42 vaccines at the clinical stage. Do we have any agreements with those producers?

We have non-disclosure agreements signed with various pharmaceutical companies under the MOH. There are different types of vaccines being developed, the inactivated vaccine that the Chinese are developing, the genetic type of vaccine such as the messenger RNA, or mRNA that Moderna is developing, the viral vector virus vaccine AstraZeneca is doing with Oxford University and the protein vaccine Novavax. So we are looking across the board.

You can go with the tried and tested inactivated vaccine or you can take a risk and try to look at the data from the mRNA vaccine which has never been developed before. The most important thing is to ensure it is safe and efficacious.

How long will it take for the approvals to be done in Malaysia before a vaccine can be procured?

We are discussing this internally. We are reviewing emergency use authorisation for the vaccine that is being done by WHO and the FDA. Also, the European Union and Australia have come up with new guidelines as well. We will have our own guidelines hopefully in the next couple of months.

In August, you mentioned you will recommend to the Cabinet for a Covid-19 vaccine (once it is available for procurement) to be provided for free to all Malaysians. Any updates?

At the moment, we do not know how much it is going to cost. For example, Astrazeneca has indicated a price of US$5 (RM20.70) per dose. The range goes all the way up to US$40 (RM165.70) per dose. Those are the numbers we are getting from some of the other vaccine manufacturers and thIs information is publicly available. We do not know where it will land.

Certain companies may price it higher because they give a higher threshold as far as indemnity and liabilities are concerned. The ones that are priced lower, perhaps have a lower threshold of liability and indemnity. So, we are operating on ballpark figures but definitely it is going to be in the billions of ringgit. That said, it is going to be worth spending the money because this is the biggest public health crisis we have confronted in our lifetime. We are duty-bound to provide this as a public good to the people of Malaysia.

I have told the MOF to set aside a few billion ringgit for the budget to procure the vaccine. People who want to get the approved vaccines from private hospitals are free to do so but we are here to ensure that those who want to be vaccinated by the publicly available vaccine can do so free of charge.

Should the government subsidise part of it and the public pay some amount for the vaccine?

It depends on the MOF. My recommendation as the minister is to treat this as a public good, hence it has to be free. But there is one caveat. We are not sure how long this vaccine is going to last. When I speak with pharmaceutical companies, they don’t necessarily know how long the efficacy of the vaccine will be. So, you may need another round of immunisation and we might have to start planning for that. Maybe, the initial doses will be free and we have to think about our financial capacity as far as additional doses are concerned.

Once the vaccine is procured, what would the priority be? Are we looking at it being given to frontliners first because it may depend on the amount that is available?

We will be coming up with a schedule soon and will communicate this to the public. Obviously, we will prioritise the most vulnerable groups first. We will be looking at frontliners, health workers, social workers, vulnerable groups, so some of the elderly population should be inoculated first. We will come up with clear communication on who will get vaccinated first, the schedule for it and how it will be coordinated.

People want to know how soon we can get the vaccines. Your take please?

It is difficult for me to give a commitment, this is subject to many things which are out of our control. Regulatory approvals, transportation, logistics, to name a few. The assurance I can give to the Malaysian public is that we are taking a multi-pronged approach in trying to procure the Covid-19 vaccine, continuing to discuss via Covax, continuing to talk to governments directly like China. I just had a one-hour discussion with the US ambassador about vaccines.

We are talking directly to pharmaceutical companies through the MOH, signing non disclosure agreements, even looking at using fill and finish facilities in Malaysia. I have been talking vaccine to vaccine people non-stop.

Last night, I even dreamt of being injected with a Covid-19 vaccine made by a particular company, I am not going to say which one. On a matter of clarity... some people are asking why is he (Khairy) speaking about the vaccine issue. Why isn’t it the MOH? We have a working group among MOH, Mosti as well as Wisma Putra.

I work closely with Health Minister Datuk Seri Dr Adham Baba and Foreign Affairs Minister Datuk Seri Hishammuddin Hussein, Health D-G Tan Sri Dr Noor Hisham Abdullah as well as Tan Sri Dr Jemilah Mahmood, who briefs the Prime Minister. I am coordinating this and we work closely.

Once there are vaccines to be procured, aside from the ones from Covax, what is the percentage of our population we hope to immunise for, say, the first round. Would it be around 20%?

Even if you look at Covax, at the countries joining Covax, for the first round they are only going to give the vaccine to 3% of the country’s population. So it doesn’t matter if you order for 10% of 50% of your population. For the first round, Covax said they will give for up to 3% of your population so that will address your frontliners and your most vulnerable groups.

Again, managing public expectations, don’t expect that once the vaccine is approved, once Malaysia buys it, that we are going to get 30 million doses on day one. It will come in stages. It is not just the production availability but also logistics.

Imagine transporting 30 million doses, the transport, the logistic preparations. As for herd immunity, it depends on how we react to the vaccine, it depends on the seroconversion, how long the vaccine will be effective for, people are saying 70%-80% of herd immunity. We can operate on that for now but then again, it is very early days, to come up with a number before we get herd immunity because once you get herd immunity, what if the antibody count starts dropping?

Then you’re back to square one so we really don’t know enough right now. Hopefully we will get more clarity on this as the data comes up.

Anything else to add?

Malaysia, like any other country, has people with alternative theories. We have pretty robust anti-vaccine groups in Malaysia and this is why communication, public health, risk communication around the vaccine is going to be very important. I have been discussing this with Tan Sri Jamilah on how we are going to craft the communication strategies around this because we don’t want a situation where anti-vaxxers come out and point to certain examples which are not apple-to-apple comparisons.

For example, they may point to what happened in the Philippines when they came up with the dengue vaccine which resulted in deaths of infants. So we are going to have to ensure we communicate the safety data, the efficacy data of these vaccines, clearly to the public.

What is being shared right now in terms of data, what’s being peer-reviewed, not many people can understand that. I can’t understand that but we have to distil that and communicate that so the people are confident when we do this mass immunisation, they will participate because obviously for us to defeat covid, apart from the long term effectiveness of the vaccine, is that everyone is immunised and we get to herd immunity.

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