Five suggestions to strengthen our booster strategy


Public education and communication should be continued to improve public confidence in the Covid-19 vaccines, including the need for booster shots. — FAIHAN GHANI/The Star

As we transition into an endemic Covid-19 stage, booster vaccine doses are inevitable.

For example, on Sept 22 (2021), the US Food and Drug Administration (FDA) approved a single Pfizer/BioNTech vaccine booster dose for three groups of people six months after they complete their primary vaccination series.

They are: those aged 65 years and above, those who are at high risk of severe Covid-19, and those with frequent exposure to Covid-19.

Following this, Health Minister Khairy Jamaluddin announced the rollout of booster doses in Malaysia from this month (October 2021) onwards for selected targeted groups.

However, the world continues to face shortages of Covid-19 vaccines.

Although vaccine shortages are worse in low-income countries, middle-income countries like Malaysia are not spared.

We have enough vaccines for approximately 110% of our population, but that number may be under-counting our actual population and boosters may deplete our supplies.

Therefore, it is crucial for Malaysia to implement an effective, nuanced and targeted booster strategy.

Here, we propose five ways to strengthen Malaysia’s booster strategy and support public health outcomes.

Strengthen primary vaccination

Firstly, we need to strengthen our ongoing primary vaccination series.

The primary goal of vaccination is to confer immunity on the entire population.

Malaysia’s own Real-World Evaluation of Covid-19 Vaccines under the Malaysia National Covid-19 Immunisation Program (Recovam) study has shown strong protection from the three main vaccines used (AstraZeneca/Oxford, Pfizer/BioNTech and Sinovac) against infection, symptomatic disease and ICU (intensive care unit) admission.

This shows that two doses of the Covid-19 vaccine are highly effective and protective against the SARS-CoV-2 virus, and likely sufficient for the general population.

Therefore, while we roll out booster doses to protect those who remain at risk, an equal focus should remain on our primary vaccination series, especially in states with low vaccination rates.

For example, on Oct 11 (2021), only 65% of the adult population of Sabah had been fully vaccinated, although the national average is now 90%.

Islanders at Pulau Mantanani, Sabah, wait to receive the CanSino Covid-19 vaccine. An equal focus on primary vaccination is necessary, especially in states that still have a lower proportion of fully-vaccinated adults. — FilepicIslanders at Pulau Mantanani, Sabah, wait to receive the CanSino Covid-19 vaccine. An equal focus on primary vaccination is necessary, especially in states that still have a lower proportion of fully-vaccinated adults. — Filepic

Collect booster shot data

Secondly, we need to gather and publicize data on the need for boosters in high-risk groups.

Currently, there is limited data globally on Covid-19 vaccine booster doses, like who should receive them, when, how often and the safety profile.

Therefore, to increase public confidence in our ongoing primary vaccination series, we urge the Health Ministry to gather and publicise local data and evidence on the definition of high-risk groups and their indications for booster doses.

This data will hopefully increase public understanding on issues such as the increasing infection rates in states with high vaccination rates, like Sarawak.

Following this, the promised targeted booster strategy should be publicised.

Some points to cover include transparent data on vaccine supply across states and regions, detailed definitions on high-risk groups, logistics of the administration of booster doses, and whether these booster doses are necessary or may be opted out of by targeted groups who have previously received two doses.

Continue public communication

Thirdly, we must educate and reassure the public that vaccines remain important and useful, even if we need a booster shot.

As in many aspects of health, adequate patient or public education will create understanding and motivation, while reducing fake news.

In this education process, the differences between a third Covid-19 vaccine dose and booster doses should be clarified, as these two terms are currently used interchangeably.

Although this may now be a minute detail, it may generate public distrust in the two-dose Covid-19 vaccine regime or other vaccination initiatives.

Proper education on the differences between these two terms will increase public understanding of the reasons for booster or third Covid-19 vaccine doses, which will increase public confidence in our booster strategy.

Communication with the public needs to be simple and targeted to our unique Malaysian demographic, which includes using multiple languages, formats and media.

Selangor state public health, unity, women and family development committee chairman Dr Siti Mariah Mahmud shows a graph on Covid-19 patient admissions to hospitals in the state for the period of Sept 1-21. Data on booster shots should be similarly gathered and publicised to help increase public understanding on the issue. — BernamaSelangor state public health, unity, women and family development committee chairman Dr Siti Mariah Mahmud shows a graph on Covid-19 patient admissions to hospitals in the state for the period of Sept 1-21. Data on booster shots should be similarly gathered and publicised to help increase public understanding on the issue. — Bernama

Making it routine

Fourthly, a booster strategy must be long-term and short-term at the same time.

We urge the government to begin laying down a sustainable foundation for an endemic Covid-19 strategy.

“Zero-Covid” strategies are slowly being abandoned worldwide because the inherent properties of the SARS-CoV-2 virus – such as high transmissibility and its capacity to evolve into new variants – make it impossible to be completely eradicated.

Instead, the world is now moving towards an endemic Covid-19 strategy, which will only be possible with widespread immunity achieved through vaccination.

Current data indicates decreased efficacy of Covid-19 vaccines over time, suggesting the need for repeated booster doses, and perhaps even a Covid-19 vaccine every 12-18 months for selected high-risk groups.

Therefore, our long-term strategy should include the embedding of regular booster doses into the National Immunisation Programme (NIP), unlike the current situation where boosters are being administered through the National Covid-19 Immunisation Programme (PICK).

In other words, we need to shift the Covid-19 vaccination campaigns from “campaign mode” to “routine mode”.

Developing our own vaccines

Finally, we should utilise this opportunity to accelerate the development of a National Vaccine Development Strategy.

The procurement of Covid-19 vaccines for Malaysia has not been an easy feat.

Furthermore, repeated purchases can be costly.

Malaysia has long produced international award-winning scientists, suggesting that our country has the intellectual capacity to come up with our own vaccines.

We must now build the regulatory and manufacturing capacity to match our intellectual capacity.

This can be made possible by appropriately building and investing in the country’s manufacturing facilities, by aligning with health policy areas of the 12th Malaysia Plan (MP12).

In addition to ensuring efficient and wise resource allocation of vaccine production, any advancement in manufacturing facilities will further strengthen Malaysia’s public health and pandemic preparedness in facing future health crises.

However, the government must create the conditions for private sector investment in manufacturing, rather than act as the sole or biggest investor.

This will ensure a clear separation between government and business, increase the chances that capital will be allocated efficiently and reduce the risk of corruption.

One part of the whole

Although currently controversial, Covid-19 booster doses are being increasingly accepted as a necessity.

Nonetheless, there are still ways for us to strengthen the booster shot programme, as we have described in this column.

Above all else, we urge everyone to remember that boosters and vaccination programmes are crucial, but they are only one part of the entire universe of our public health and pandemic responses.

Dr Ivanna Sim just graduated with her medical degree, Dr Sean Thum is a psychiatry trainee, and Dr Khor Swee Kheng is a physician specialising in health policies and global health, who tweets as @DrKhorSK. The views expressed here are entirely their own. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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