LETTER | What's going on with M'sia's Covid-19 booster shots?

LETTER | Health Minister Khairy Jamaluddin, I read that the World Health Organization (WHO) is committed to integrity and excellence and is trusted to care for the world's health.

They adhere to values of integrity, professionalism and respect for diversity. The values of their workforce reflect the principles of human rights, universality and equity established. Actions and recommendations are independent, fair, transparent and timely to make people feel safe, respected, empowered, fairly treated and duly recognised.

In its interim statement on Booster Doses for Covid-19 Vaccination on Dec 22, 2021, they concluded that introducing booster doses should be firmly evidence-driven. To date, the evidence indicates a minimal to modest reduction of vaccine protection against severe disease over the six months after the primary series. Duration of protection against the Omicron variant may be altered and is under active investigation.

More data will be needed to understand the potential impact of booster vaccination on the duration of protection against severe disease, but also against mild disease, infection, and transmission, particularly in the context of emerging variants.

In several jurisdictions, booster vaccination has been introduced. All studies to date show a strong anamnestic immunological response achieving or improving upon the peak antibody levels following the primary immunisation series, but with insufficient data and too little follow-up to assess the kinetics and duration of the response.

Because no correlate of protection has yet been defined, it is not possible to predict with high confidence vaccine performance of these heterologous schedules based on the immune response. Evidence is accumulating to inform global recommendations, which may be refined as additional data become available.

Additional data include:

1) Assessing the need for booster doses:

Epidemiology of breakthrough cases, by disease severity, age, co-morbidity and risk groups, exposure, type of vaccine and time since vaccination, and in the context of variants of concern.

2) Refined vaccine-specific data:

Efficacy, effectiveness, duration of protection of vaccination in the context of circulating variants of concern

Supplementary evidence from immunological studies assessing binding and neutralising antibodies over time, as well as biomarkers of cellular and durable humoral immunity

3) Assessing the performance of booster doses:

Data on duration of protection of homologous and heterologous boosters

Safety and reactogenicity of booster vaccination, including heterologous boosting from larger-scale studies

Impact of booster vaccination on transmission

4) Additional considerations include:

Optimal timing of booster doses, possibility for dose-sparing for booster doses (e.g. fractional doses), booster needs in previously infected individuals, programmatic feasibility and sustainability, community perception and demand as well as equity considerations.

Refined modelling studies to guide strategies to optimise the impact of vaccination.

A) In the tenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (Covid-19) pandemic on Jan 19, 2022, among the actions critical for all countries are:

B) Continue to use evidence-informed public health and social measures, therapeutics, diagnostics, and vaccines for Covid-19.

Lift or ease international traffic bans as they do not provide added value and continue to contribute to economic and social stress.

C) Address community engagement and communications gaps and challenges posed by infodemics. Given the rapidly evolving situation and to promote trust and adherence, state parties should explain clearly and transparently the rationale for the changes of policies and PHSM, with a view to balancing risks and benefits of such changes. These communications need to be tailored to different population groups, including those considered as most vulnerable.

Booster introduction should be evidence driven

Meanwhile, WHO says there's no evidence healthy children and adolescents need boosters and warned that blanket booster programmes could prolong the pandemic and increase inequity. While there seems to be some waning of vaccine immunity over time against the rapidly spreading Omicron variant of the coronavirus, more research needs to be done to ascertain who needs a booster.

Earlier Malaysians were threatened that life would be made very difficult if not vaccinated if one chose not to and probably made to do regular tests and pay for it. We were also told booster shots would be given on a voluntary basis.

Recently, we were reminded that all senior citizens aged 60 years and above as well as recipients aged 18 years and above of full dose of Sinovac vaccine need to take booster shots to maintain complete vaccination status before March 1 as Malaysia is hit by Omicron wave.

But WHO said that introducing the booster should be firmly evidence-driven and protection against the Omicron variant may be altered, and it is still under active investigation. There were recent studies but with insufficient data and too little follow-up.

Are we following the values of WHO with fair, transparent and timely actions to make people feel safe, respected, empowered, fairly treated and duly recognised and the respect for diversity?

Further, in its weekly update, WHO reported globally, during the week of Jan 31 to Feb 6, 2022, the number of new cases decreased by 17 percent as compared to the previous week. In Southeast Asia, new cases decreased by 32 percent but new cases in Malaysia increased by about 46 percent. For the four days to Feb 10 (with three days remaining), it has already shot up 27 percent. What has gone wrong?

What say you?