The Health December 2020 | Page 22

There are still many uncertainties surrounding the Covid-19 vaccine that need to be addressed


The Health | december , 2020

| Column |

Covid-19 vaccination budget must account for all possibilities

There are still many uncertainties surrounding the Covid-19 vaccine that need to be addressed

A lot of resources have been set aside in Budget 2021 to procure Covid-19 vaccines and fund related operations . In addition to the number of people targeted to be vaccinated , the number of doses per person and price per dose , are crucial elements is the effectiveness of these new vaccines .

In June , the United States Food and Drug Administration ( FDA ) lowered the efficacy bar to 50 per cent for Covid-19 vaccine candidates . Other regulatory agencies around the world have also followed suit .
The former director of immunisation at the US Department of Health , David Salisbury covered this topic well in The Guardian and pointed out that an efficacy of 50 per cent means only half of those receiving vaccines may be protected .
In this lowest-acceptable case scenario , we would have to acquire at least double the doses to administer to twice as many people to meet target protected population . As explained by Salisbury , whatever the effectiveness rate ends up being , no vaccine is 100 per cent effective .
Other factors to be considered include immunity retainment and rate of virus mutation – a combination that complicates vaccine development , vaccine purchase strategy and vaccination efforts toward achieving nationwide immunity .
We are still unsure how long the acquired immunity would be retained . WION News reported in July regarding a study in the UK that measured antibody levels of patients after contracting the virus . The research showed immunity levels are prone to decline in ‘ just a few months ’ after recovery .
If this proves to be the case , then the acquired protection is very temporary , followed by seasonal Covid-19 infection waves . Vaccine purchase accounting for potential supplementary doses have to be taken into consideration .
Chinese authorities reportedly require vaccines to provide a minimum of six months of immunity to be approved for use in China . Should immunity last only a few months or six months , vaccination efforts may not be so straightforward .
Virus mutation possibility
Assuming the initial vaccinated population is unable to retain its immunity for long , significant pressure for access to the next round of vaccines has to be forecasted . The
Covax vaccine allocation plan was reported to initially provide vaccines for only up to 10 per cent of Malaysia ’ s population , and we don ’ t know yet when we can get more .
Additionally , we have to account for the possibility , however unlikely , of the virus mutation rate being faster than expected and at a magnitude that may render the vaccines useless . That would mean purchasing an entirely different version for the next batch .
There are researchers that doubt such scenarios , but nobody can say for sure at the moment . Therefore , the assessment on purchase volumes and the corresponding budget estimates have to at least consider these possibilities .
There are reports indicating a mutational trajectory towards the seasonal common flu . Current available data appear to be inconclusive , but this may be in agreement with the research that WION News referred to , which also made a similar claim .
Operational estimates must account for supply chain and logistical issues , addressing anti-vaccination groups and population uniformity .
We may be dealing with novel types of vaccines and WION News reported that many vaccine developers have emphasised on the ‘ uncertainties ’, which could be interpreted as a warning that vaccines are not guaranteed to work .
Further adding to the risk is the fact that there have been no clinical trials conducted on the Malaysian population to provide any direct extrapolation on efficacy .
Of course , indemnity clauses , disclaimers , and all the legal jargons related to efficacy , safety , and other metrices would usually be present in purchase contracts and are likely to be reflected in pricing structures . Malaysian authorities must review these carefully and ensure the budget is spent wisely .
The authorities should consider studying a scenario of procuring more than one type of vaccine to cover for potential vaccine failure and deploy a multi-vaccine strategy to increase chances of successful vaccination . Understandably , potential inefficiencies and practicality have to be considered given that purchasing different types of vaccines would present significant logistical complications , not to mention the obvious impact on government expenses .
National herd immunity
As for ground operations , its best for the authorities to consider conducting trial roll-outs with smaller volumes at several test locations first , prior to conducting nationwide vaccination .
Some vaccines could be more temperature-sensitive and less resilient to physical agitation . Poorly established supply chains , cold storage and distribution chains may fail , and human errors may occur due to lack of training and familiarity . It ’ s necessary to consider purchasing a buffer supply to account for potential handling losses .
Lastly , achieving national herd immunity is dependent not only on a high enough percentage of the population being vaccinated and retaining immunity , but it also requires uniformity . This means having a sufficient number of protected people spreading evenly in the population to ‘ surround ’ and protect the unvaccinated ones . According to a global survey conducted by Ipsos from July 24 to Aug 7 , a substantial 15 per cent of Malaysians disagree to get vaccinated .
Assuming the 15 per cent ‘ antivaxxer ’ groups are mostly concentrated in rural areas , clusters of infection could still spread within these communities . In this case , we ’ ll get a concentration of immunised population in urban areas , surrounded by many smaller groups of non-protected population .
Minister of Science , Technology and Innovation Khairy Jamaluddin has shown considerable insights on the matter in a Facebook Live session to StarBizWeek , where he indicated the possibility of billions of ringgits allocated in Budget 2021 . In a separate article Khairy also assured the authorities will set up task forces to carry out the necessary early preparations prior to receiving vaccines .
Without the approval and successful implementation of a well-thought-of national budget , negative health and socio-economic impacts are expected to be prolonged and worsened . Lawmakers should internalise ‘ economics of empathy ’ and set aside political differences to focus on the rakyat ’ s pressing needs . — The Health
Ameen Kamal is the Head of Science & Technology at EMIR Research , an independent think tank focused on strategic policy recommendations based on rigorous research .