OCTOBER , 2021 | THE HEALTH

The states of Johor , Kedah , Kelantan , Perak , Sabah , and Terengganu have been identified as potential laggards and may only reach fully vaccinated adult population in December onwards . Under this scenario , Sabah ’ s rate may even spill into January next year .

Reportedly , these are the same states with vaccination rates of below 50 per cent as of Aug 28 , and Prime Minister Datuk Seri Ismail Sabri Yaakob has reportedly given the Health Ministry and the Ministry of Science , Technology and Innovation until the end of September to ensure that the vaccination rates within the adult population in these six states reach 50 per cent .

However , the “ 50 per cent target could be an underestimation due to immunological uncertainties . Potential reduction of vaccine effectiveness against Delta variant , waning immunity , uneven level of protection from different vaccine types and Delta ’ s high infectivity rate are some of the key factors that may require a much higher percentage of successfully immunised population for protective effects at the population level to be achieved .

To have a better picture of what is happening and to better guide the validity of vaccine certificates , genomic sequencing and immunological studies ( such as seroprevalence surveys ) has to be ramped up significantly .

Younger age-groups may need to be vaccinated

In any case , the “ minimum ” scenario for all states is the continuation of its rate of total vaccinated people achieved in August , at which all above-18s would be vaccinated before the end of 2021 . Accordingly , most states will only reach 100 per cent fully vaccinated above-18 population mid-October onwards . Only the states of Sarawak , Selangor , W . P Kuala Lumpur , Labuan , Putrajaya and Negeri Sembilan may reach 100 per cent vaccinated adult population before October .

Relatedly , this may only provide 1.5 months of school before year-end school holidays . It may not be worth the risk and it ’ s best to wait until school reopens in 2021 when we have more information on how variants affect children , and more information on vaccination safety for children .

Under the same minimum scenario projection , the states of Terengganu , Sabah , Kedah and Kelantan have been identified as potential persistent laggards , with Perak and Johor potentially being in this group if the rates as of August could not be maintained . These states must consider all options to ensure a higher level of protected population is achieved , perhaps even considering delaying vaccination for those recovering from Covid-19 for six months , to free up limited vaccine doses for others . The other states must not go lower than the rates achieved by August , at minimum .

It has to be noted that the total adult population covers roughly 72 per cent of the population . Even expanding vaccination to above-14s would only increase this to about 75.5 per cent of the population . Thus , assuming the traditional definition of herd immunity stands , younger age-groups may need to be vaccinated to reach the above-80 per cent population for herd immunity .

EMIR-SING

BY AMEEN KAMAL

There is evidence that the Delta variant may still be transmitted by fully-vaccinated people similar to non-vaccinated individuals , which challenges the traditional definition of herd immunity .”

Addressing anti-vaxxers must not be underestimated

A recent report published in The New England Journal of Medicine indicated a higher risk of developing myocarditis ( a type of heart inflammation ) by Covid-19 compared to vaccines , which may provide additional argument in favour of vaccination and is in line with a recent report by the Centers for Disease Control and Prevention ( CDC ). Even so , there are findings by other researchers suggesting potential under-reporting in vaccine adverse events .

This is rightfully an intensely-debated topic , and while this is being determined , the immediate objective is to reach 100 per cent fully-vaccinated adult population , pending further information on younger age groups . Vaccinating the significant undocumented foreign population and addressing anti-vaxxers must not be underestimated and should take precedence while assessing the issue on children vaccination .

Other immunological uncertainties complicate these scenario projections . There is evidence that the Delta variant may still be transmitted by fully-vaccinated people similar to non-vaccinated individuals , which challenges the traditional definition of herd immunity . Either way , the number of cases becomes relatively less important , and the percentage of the protected population takes priority in reducing the number of severe cases .

Thus , despite the closure of some vaccination centres ( PPVs ) in Klang Valley , we need to ensure a high level of vaccination readiness . Moving forward , in addition to PPVs and general practitioner clinics , school halls should also be considered as a vaccination and testing centre given its ubiquitous geographical spread in the community , complementing the decentralisation strategy . — 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 .