Light at the End of the Covid Tunnel

By Enzo Sim

October 2021 COVER STORY
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ON FEBRUARY 24, then-premier Tan Sri Muhyiddin Yassin became the first Malaysian to be inoculated with the Pfizer- BioNTech vaccine; this marked the start of the National Covid-19 Immunisation Programme. Public response was slow at first, but that changed over the months.

As of September 21, 80% of the country’s adult population are now fully vaccinated, surpassing the intended October target.1 October is also when Malaysia will transition out of the pandemic phase into an endemic one, when the population technically reaches “herd immunity” of 80% fully vaccinated.2

At the time of writing, seven vaccine types have been approved for use, three of which will be discussed here for their efficacy against Covid-19, as well as post-inoculation side effects.

Know Your Vaccine Type

  • AstraZeneca (known also as Vaxzevria) is a viral vector vaccine, with a reported efficacy rate of 62-90%.3 A modified group of viruses is injected into the body for their genetic code to be recognised, and for production of the spike protein to mount an immune response against the novel coronavirus. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is flagged as a harmful but rare side effect of AstraZeneca; this occurs when the individual has both blood clots and a low platelet count.4

  • Pfizer-BioNTech is a messenger RNA (mRNA) vaccine that uses synthetic components to prompt production of spike protein similar to those found on the surface of the coronavirus to fight the pathogen. This vaccine type is recommended for pregnant women and immunocompromised individuals, but it also increases the risk of myocarditis (inflammation of the heart muscle), especially in male adolescents and young adults.5

  • Sinovac is an inactivated vaccine, considered to be a safer option for those with weaker immune systems and comorbidities. According to various reports, this Chinese-manufactured vaccine has an efficacy rate of between 50.4-91.25%. Its usage however will discontinue once supply ends.

Questions and Answers

A causal link between a certain harmful post-inoculation side effect with the type of vaccine administered is difficult to establish, and many studies are still underway, says infectious disease specialist Dr. Cheng Joo Thye of Seberang Jaya Hospital.

“If, for instance, an adult male with either hypertension, diabetes or cardiovascular disease dies a week after getting vaccinated, to determine cause of death, health professionals must consider all possibilities, including the patient’s own comorbidity.”

Infectious disease specialist Dr. Cheng Joo Thye.

All the same, these concerns have led some to rethink their options. Twenty-eight-year-old Ramesh Pillai has a history of high blood pressure and grew worried about the possibility of VITT when he was notified of his AstraZeneca vaccination appointment. “In the end, I had no choice but to cancel it. I hope the health authorities are able to properly assess a person’s health condition before assigning them the type of vaccine. This shouldn’t be difficult to do since the MySejahtera app requests for any pre-existing medical conditions to be recorded,” says Ramesh.

Others have also considered combining vaccine types to provoke a much stronger immune response or to produce a wider range of responses. But Cheng cautions that again, more research is needed to verify these claims. “Current guidelines still recommend the same type of vaccine to be given.” At the other end of the spectrum is the assumption that the immune system will be weakened post-vaccination. “This isn’t true. Rather, the body is working to strengthen its immune response; it is in the process of producing antibodies against the virus.” To promote transparency and assuage worries, the Health Ministry has made available to the public data on adverse events following immunisation (AEFI).6

There are also those whose decision to delay vaccination has more to do with the safety of the vaccination venue than with the vaccine type. Ong Kim Yan, 82, decided against getting vaccinated at the Tapak Pesta Sungai Nibong when she learned the centre had received several Covid positive cases just days before her scheduled vaccination appointment. “I grew even more afraid when my neighbour told me her MySejahtera risk status turned red (to indicate close contact) after returning from the centre.” This was back in May; Ong requested to reschedule her appointment and two weeks later, received her vaccine at Gleneagles Hospital Penang.

Ong Kim Yan.

Vaccine Hiccups

When Chantelle Ooi Tze Xin, 32, registered for her vaccination through MySejahtera, she was prepared for a long wait. But weeks stretched into months and Chantelle, who worked as an insurance agent, decided to take matters into her own hands. “I meet with many people in my line of work so I couldn’t afford to wait any longer,” she says. When the O2 Clinic at Air Itam began operating as a vaccine administration centre, Chantelle made arrangements to purchase the Sinovac vaccine and has since completed the two doses.

Syaf, 28, encountered a similar problem. Every time she checked her MySejahtera app, it still read as “Registered”. She eventually wrote an enquiry email to the Multimedia University vaccination centre in Cyberjaya to request for an appointment date, on the advice of friends who did the same. She managed to book a slot, though Syaf only received the notification at 1pm on the day itself for her 6pm vaccination, and in the middle of a working day to boot. At SETIA Spice, Syaf enquired if she was able to get her vaccine there instead, but was denied. “I was given a new date one week later, but the whole experience has made me question how the vaccination registrations and appointments are handled.”

Herd Immunity versus Conspiracy Theories

One of the many Covid-19 vaccination centres in Malaysia. Photo by: @thamkc/1234RF.COM

Against Covid-19, the exact percentage for herd immunity is as yet unknown, but the general consensus has settled on 80%, with population size, demographic priority and vaccine type as determinants.7 But Cheng warns against letting our guard down. Vaccination does not guarantee 100% protection against Covid.

The government has made mask-wearing mandatory, but there is still no legal mandate for vaccinations. A new policy will soon be implemented however, for those who for nonmedical reasons are choosing not to get vaccinated; this will require them to adhere to a certain schedule or regimen of testing.8

Ivan Tan understands that the pandemic is real but has refused vaccination, “because Covid was caused by major pharmaceutical companies through lab leaks in order to reap huge profits from the worldwide sale of their vaccines,” he says. Meanwhile, Kumar Sivaraj alleges that “financial tycoons such as Bill Gates are trying to track down unfavourable populations to get rid of them, through injecting tiny microchips disguised as vaccines.” Fearing this “sinister plot”, Kumar has also refused to be inoculated.

Healthcare workers providing consultation before vaccination. Photo by: @thamkc/1234RF.COM

There are others who feel that getting vaccinated is a personal choice. Vaccinations for adolescents between the ages of 12-17 are currently being rolled out, beginning with those with pre-existing medical conditions. Myocarditis from the Pfizer vaccine especially, has sparked concerns among parents that studies of the effects of vaccines on the young lacked thorough research. “Historically, myocarditis has been reported as a rare adverse event in smallpox, influenza and hepatitis B vaccinations,” says Dr. Angeline Ang Swee Kim, consultant paediatrician at Pantai Hospital Penang.

Although most myocarditis cases linked to mRNA vaccination have required hospitalisation, most have responded well to standard treatment with a mild and self-limiting course. Published case reports show that, in addition to supportive care, non-steroidal anti-inflammatory drugs, steroids and colchicine have been used for some of these patients.

“Chest pain, shortness of breath and the sensation of a fast-beating, fluttering or pounding heart are symptoms to watch out for. These usually occur within a week from the vaccination date, and often after the second dose,” says Ang, adding that until data on efficacy and safety is made available, vaccinations should not be given to children below the age of 12 years.

In Penang last month, a court action was filed by parents of 18 minors against the government to stop the vaccination of children under 18, pending the results of clinical trials on the controversial drug Ivermectin.9 Ang gives the reassurance that “except for people with a history of severe allergic reactions to the components of the vaccines, they are recommended for and can be administered to most adolescents with underlying medical conditions.”

A physical vaccination certificate card with vaccination records. Photo by: @thamkc/1234RF.COM

Penang Tackles the Surge

As of September 24, 59.8% of Penang’s population are fully vaccinated, with 73.8% having received their first dose.10 Under Phee Boon Poh, executive committee chairman on environment and welfare, a Covid-19 emergency response team has been assembled to address the surge in cases; these are largely attributed to workplace clusters in the industrial sector. A total of 24,825 infections were reported until September 2, along with 31 Delta cases on August 16-29.

Strategies include close collaborations with the State Health Department to enhance operations at the Covid-19 assessment centres (CAC) and its call units, as well as handling logistical arrangements for patients travelling to treatment centres. Chief Minister Chow Kon Yeow says, “The team will also mobilise manpower, including volunteers under the PgCareAlliance platform to manage and identify patients’ needs; and to improve the needs of the treatment centres to ensure that the state’s medical system is not incapacitated entirely.”11

Enzo Sim

is a Mass Communications graduate who has an unwavering passion towards international relations, history and regional affairs of Southeast Asia. His passion has brought him to different Southeast Asian capitals to explore the diverse cultural intricacies within the region.