Vaccination is one of the most cost-effective interventions that has saved millions of lives.
The administration of a vaccine stimulates the human body to produce an immune response that helps provide protection against infectious disease(s).
Vaccines are critical in the prevention and control of outbreaks of infectious disease(s).
When the Covid-19 pandemic occurred, there was a global effort at accelerating development of vaccine(s) to control the SARS-CoV-2 virus.
International cooperation
At the start of the pandemic, a multilateral alliance initiated an international effort to enable low-and middle-income countries to have equitable access to Covid-19 tests, vaccines and treatments.
This alliance, named Covax, was co-led by Gavi, The Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations (CEPI); the World Health Organization (WHO); and the United Nations Children’s Fund (Unicef).
The rationale for this effort stemmed from the fact that technologies for such developments were only available in a few high-income countries.
In a global emergency, it was to be expected that these countries would take care of their own populations first and that production could not cope with demand.
Unicef was the primary delivery partner as it was the single largest vaccine purchaser in the world and had the resources ready for logistics and delivery within countries.
By Oct 19, 2020, 184 countries had joined Covax, which was initiated that April.
The Malaysian Cabinet agreed on Oct 14, 2020, to participate in Covax, but only officially joined on Nov 13, 2020.
Not surprisingly, Covax was unable to deliver the vaccines required by the countries that had signed up.
As of August 2022, Malaysia had only received 1.387 million vaccine doses out of the 6.473 million agreed upon earlier.
Covax came to a close on Dec 31, 2023.
Local vaccination programmes
The Cabinet established a special committee to ensure access to Covid-19 vaccine supplies (JKJAV) on Oct 14, 2020.
This committee was co-chaired by the then Science, Technology and Innovation Minister Khairy Jamaluddin and the then Health Minister Adham Baba.
Covid-19 vaccines were developed by manufacturers at an unprecedented speed, and by December 2020, the first vaccines were approved and administered to humans.
Needless to say, the previous strict criteria for approval of vaccines were relaxed because of the global emergency.
The vaccines that Malaysia procured were from Chinese biopharmaceutical company Sinovac, American multinational biopharmaceutical company Pfizer and British multinational biopharmaceutical company AstraZeneca.
The majority of the vaccines were procured commercially, while the rest came from donors.
Malaysia’s National Covid-19 Immunisation Programme (PICK) was launched on Feb 24, 2021, with Khairy as the coordinating minister.
When the Government changed and the Cabinet was reshuffled in August 2021, Khairy became the Health Minister and the coordination of PICK was managed by the Health Ministry (MOH).
The PICK was implemented in phases.
The MySejahtera contact-tracing application, which was implemented prior to Khairy’s move to MOH, was utilised for vaccination purposes.
Covid-19 reached its peak numbers locally during the period of July to September 2021, with public hospitals in the Klang Valley on the verge of collapse.
As such, Operation Surge Capacity was launched in July 2021 in an effort to ensure every adult in Kuala Lumpur and Selangor had received at least one dose of vaccine by August 2021.
Various efforts were made to increase the vaccination uptake.
Several mega vaccination centres were set up in metropolitan areas for large scale vaccinations.
A public-private partnership Covid-19 industry immunisation programme (Pikas) was launched in June 2021 to accelerate vaccination uptake among the workforce.
Two other programmes were also initiated for specific sectors, i.e. the Agrofood Industry Vacci-nation Programme (Aivac) and the Retail Industry Vaccination Programme (Rivac).
In November 2021, a vaccination centre programme (PPV) was established, which replaced Pikas, Aivac and Rivac.
Under the PPV, companies and associations could request private hospitals and doctors to provide vaccinations for their staff and members.
The government bore the costs of the vaccines and reimbursement was made through ProtectHealth Corporation Sdn Bhd, which is owned by MOH.
By Jan 9, 2022, ProtectHealth reported that it had contributed 49.5% of the total vaccinations throughout Malaysia (i.e. 29.35 million doses), as well as 72.1% of the total booster dose vaccinations (i.e. 5.63 million doses).
The daily vaccine doses administered reached a peak of more than 500,000 in July 2021.
By June 2022, 71.2 million doses had been administered, with 27.3 million Malaysians and 84.2% of the population fully vaccinated.
The success of the vaccination programmes contributed to the reductions in the number of admissions to intensive care units (ICUs), ventilator usage and the number of new daily cases.
On July 26, 2022, the vaccines were projected to have prevented up to 17,000 deaths in Malaysia.
Unanswered questions
The vaccination campaign was regarded as one of the successes of the response to the Covid-19 pandemic in Malaysia.
Although vaccination started late compared to other countries, it caught up rapidly, despite the circulation in social media of misinformation and disinformation about vaccines that undermined public trust.
Khairy’s leadership steered the nationwide vaccination programme successfully.
However, there are some unanswered questions which include:
- What was the rationale for the time taken to join Covax?
- Could the nationwide vaccination programme have commenced earlier and at greater scale had Malaysia joined Covax, as well as procured the vaccines, earlier?
- Could the misinformation and disinformation about Covid-19, the diagnostics, treatments and vaccines have been countered more effectively?
- Why were 1.1 million vaccines allowed to get past their expiry dates – ranging from one to 212 days, according to the audit in April 2022?
Who was accountable?
Did anyone consider donating these vaccines to poor countries prior to their expiry dates?
Malaysia had a successful Covid-19 vaccination programme that saved many lives.
However, there were shortcomings that need to be addressed as current modelling suggests that there is about a 50% likelihood of another pandemic in the next 25 years!
In short, vaccination is the key to primary healthcare, an indisputable human right and one of the best health investments money can buy.
Vaccines underpin global health security and are a vital tool in disease outbreaks/pandemics and addressing antimicrobial resistance (AMR).
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. 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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