The Health | October , 2020

BY AMEEN KAMAL

higher-income countries have locked up about a billion doses of Covid-19 vaccines candidates in late-stage clinical trials .

With growing concern Malaysia would be left behind , Prime Minister Tan Sri Muhyiddin Yassin recently assured Malaysians would have access to Covid-19 vaccines . But access means both a secured supply and ability for vaccines to reach the people .

So far , no confirmed deals were announced . Of course , Malaysian authorities would first need to investigate data on safety and efficacy , costs , speed of availability and other technical requirements , before negotiating towards a purchase agreement .

While these internal investigations are being carried out , Sinovac Biotech – a private Chinese company - reached an agreement to supply Indonesia with at least 40 million doses by March 2021 . That could have covered 125 per cent of Malaysia ’ s population of 32 million .

By the principle of herd immunity and through strategic prioritisation of different segments of society , Malaysia could initially go for lower volumes . Malaysia could prioritise frontliners and vulnerable parts of the population . In addition to direct bilateral discussions , Malaysia must ensure it makes the best decision through other platforms such as Covax – a global Covid- 19 vaccine allocation plan co-led by the World Health Organization ( WHO ).

The Malaysian authorities require further information before making commitments , but with Sept 18 lapsed , Malaysia must ensure it does not lose out in a global platform . According to the Financial Times , redesigning of the Covax facility to get wealthier nations to sign up had pushed the deadline from Aug 31 to Sept 18 .

Concerning international dealings , Malaysia relies on ‘ science-diplomacy ’ for early and equitable vaccine access . Therefore it has always reciprocated with equality in preference of countries and has conducted these fair diplomatic negotiations early on .

Therefore , outward projection in the media should reflect this , and not paint a skewed preference of any parties .

Logistical issues pose a challenge

Of course , should any country or company show any discrimination in vaccine supply , Malaysia will have no choice but to look elsewhere .

A lot of resources go into vaccine development and production . These companies need to be incentivised financially and through regulatory protection .

But at least , for cases of worldwide pandemic or a national health crisis , the moral high-ground should prevail , and vaccine-makers should not be pushed hard between equitable access to vaccines and satisfying hardcore capitalist investors or shareholders .

Some exemplary companies have announced more altruistic pricing decisions such as “ no profit during the pandemic ”, while others range from a “ marginal profit ”, vague indications such as “ appropriate return ”, and aligning with the price of vaccines for similar expressions .

Despite uncertainties in pricing , Malaysia ’ s leadership made the right move to consider making vaccines free for all Malaysians . Although this has yet to be approved , the action should be applauded and supported .

But securing vaccines is only the first part of the problem . Logistical issues may pose a considerable challenge for a nationwide roll-out .

According to Minister of Science , Technology , and Innovation Khairy Jamaluddin , initial discussions with Pharmaniaga Holdings Bhd and Duopharma Biotech Bhd showed there would be “ minimal investment ” needed to set up fill-finish processing lines .

In the pharmaceutical industry , fillfinish is the process of filling vials or syringes with vaccine and finishing the process of packaging the medicine for distribution . Many vaccine manufacturers use third parties to fill and finish their vaccines .

Malaysian authorities don ’ t know yet when and which type of vaccine it would procure , and the wide-range of vaccine types means the equipment and processes to fill-finish may significantly differ . In any case , this requires close cooperation between industry and the government early on to familiarise with testing and approval of equipment for the finished vaccine .

Additionally , Malaysia has to ensure efforts to prevent materials shortage or fillfinish and to ready of distribution chains are conducted soonest to avoid unexpected hiccups in vaccine dissemination . With countries scrambling to secure vaccines in advance , except that the related supply chains may also be monopolised early on .

Public acceptance and awareness important

According to author Kyle Blankenship , there are vaccines candidates reportedly requiring temperatures of -70 degrees Celsius for longer-term storage ( colder than the average annual temperature in Antarctica ), and at refrigerated temperatures for up to two days .

Such operating parameters would limit vaccination to be conducted at sites with specialised equipment , by trained personnel and for a minimal duration per vaccination event . It may take a while to cover a significant portion of the population under such constraints .

According to researchers from the University of Texas , the fill-finish process , storage , distribution , and other operational costs can incur significant charges on top of the vaccine price . The cold-chain supply network requires close monitoring of temperature during the transport , storage , and to the point of vaccine use .

Thus , it is evident that purchasing very different types of vaccines could impose a significant logistical challenge .

Assuming the hurdles mentioned above were tackled , the final hurdle comes from the rise of anti-vaccination (“ anti-vaxxers ”) amongst the people .

According to some analysts , there have been increasing media reports on vaccine refusal . This is further substantiated by a recent global survey conducted by Ipsos from July 24 to Aug 7 whereby only 35 per cent of Malaysians strongly agree in getting vaccinated while a substantial15 per cent disagree .

This could translate into a significant unvaccinated population , threatening herd immunity and causing the virus to spread again .

Public awareness and acceptance are essential for nationwide vaccination . Hence , the authorities must engage the public to address the root-causes of the anti-vaxxers movement such as past public health crises , religious perspectives of prohibited substances , the influence of fake news and disinformation on vaccines through social media , concerns on effectiveness , and potential side effects .

Should awareness prove insufficient , mandatory Covid-19 vaccination could be considered under the premise of national security , with its enforcement in a balanced consideration of human rights . — 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 .