• Way back on Oct 10 on the eve of Malaysia lifting the interstate travel ban the following day, flamboyant Health Minister Khairy Jamaluddin made a wise remark in urging Malaysians to travel safe because he cannot rule out another Covid-19 wave.

   

• “I know everyone is going to be rushing to the borders tomorrow but in the back of my mind as the Health Minister, my biggest worry is another wave and that’s not something that is out of the realm of possibility,” he said back then.

   

• “If the system can’t handle the surge, ICU cases, ventilators, oxygenated beds and admissions into hospitals, then it will put a tremendous stress not only on the public healthcare infrastructure but also on our frontliners.

   

• “We can’t afford that anymore. With the Health Ministry, I have made early preparations to ensure we can deal with the surge if it happens, but we don’t want to deal with a surge.

   

• “Today of all days, on Doctors’ Day, we ask Malaysians to be responsible and if you really value and appreciate what the frontliners have been doing for the past one-and-a-half years, you will be responsible, you will be self-aware and take care of your own health and health status to ensure that a surge does not happen,” said Khairy during the Doctors’ Day celebration organised by the Malaysian Medical Association (MMA) on Oct 10.

Booster jab to prevent another lockdown!

By Jamari Mohtar

The Pfizer vaccine, based on clinical trials is touted to have a staggering 95% efficacy. But according to the Wall Street Journal, a recent unpublished data from Israel shows the Pfizer vaccine was only 40% effective at reducing the risk of symptomatic Covid-19.

On Nov 23, the National Security Council posted on its Telegram channel a study by the Real-World Evaluation of Covid-19 Vaccines Under the Malaysia National Covid-19 Immunisation Programme (RECoVaM) and the National Medical Research Register (NMRR) which showed by September, those who were vaccinated in April to June had a lower immunity compared to those who were vaccinated in July to August.

Using the methodology of negative binomial regression, the study discovered in the case of Pfizer, its effectiveness was reduced from 89% one to two months after vaccination, to 68% three to five months later.

In light of the above, the relevant question to ask is if the original trial shows high efficacy (95%), why did a large portion of people in the Israel and Malaysia studies get the virus?

To fathom this dichotomy of 95% efficacy versus 40% effectiveness (Israel) or 68% effectiveness (Malaysia) shown by the Pfizer vaccine, there is a need to understand the difference between efficacy and effectiveness.

According to experts, vaccine efficacy refers to how well a vaccine performs under ideal, tightly controlled conditions like clinical trials. During trials for Covid-19 for instance, vaccines were given to people on a tight schedule.

Efficacy also has to do with what the researchers were studying. In the case of the Covid vaccines, they were looking at how well vaccines prevented symptomatic infection in a limited number of people, and NOT on whether they prevented infection altogether or kept people from being contagious.

Bear in mind too, with Covid-19, it’s possible to be infected and not show symptoms, which means asymptomatic infection wasn’t covered by the researchers.

In the Pfizer study, the company tested about 44,000 people for symptomatic Covid19 and only 170 developed the disease with at least one symptom. And of those, just 8 have been vaccinated while 162 have got a placebo. This is what added up to that 95% efficacy rate.

This trial finding is to be read as follows: in a vaccinated population, 95% fewer people will contract the disease when they come in contact with the virus and NOT that each individual is 95% immune to the virus.

That efficacy rate was calculated then during a specific time and under a specific set of circumstances in which many people were staying at home, avoiding a large gathering, wearing mask and the virus hasn’t mutated as much.

Vaccine effectiveness on the other hand refers to how well a vaccine works in the real world, outside of clinical settings. The real world is kind of messy in that not everybody get their vaccines at the exact interval or that everybody has the same kind of immune system.

But as the vaccine was approaching the time for regulatory approval from the authorities, peoples’ behaviour started to change too where in many places, businesses are open and large gatherings are happening again – the reason why efficacy number in trials are often higher than the effectiveness we see in the real world.

And what makes it all complicated and unfathomable is the virus itself is still evolving. The delta variant has become dominant in many countries and more transmissible than earlier strains of the virus which means more people will come into contact with it.

And it became dominant months after the vaccines has been authorised and millions of doses have been distributed. That means our current shots were designed from earlier version of the coronavirus and don’t look that good against delta.  

This is the reason why we are hearing more about breakthrough cases. In fact health officials expected breakthrough cases were more likely among people who had gotten the vaccine earlier on, in Jan or Feb. This is partly because antibodies, which the body produces after the vaccines to protect itself against the virus naturally decrease over time.

That, along with the unknown about variants is the big reason why in the US, the Biden Administration announced new vaccine recommendation to stay ahead of the virus in the form of a booster shots programme for fully vaccinated adults 18 years and older.

What the booster shots programme is trying to achieve is to ensure that immunity is kept high enough, hence increasing the chances that the vaccine would prevent severe illness that could then lead to hospitalisation and deaths.

In the meantime while breakthrough cases continue to occur, experts say these are usually mild and don’t result in severe illness. And this is proven by both the Israeli and Malaysian data, which showed the vaccine has 91% effectiveness against hospitalisation and death.

While the Israel study is all about Pfizer, the Malaysia study also includes the vaccine Sinovac, which also exhibits the same pattern in terms of waning effectiveness through time, although in term of both efficacy and waning effectiveness, the Pfizer vaccine performs better.

All this points to the crucial need for booster jabs to forestall a new Covid wave and avoid a lockdown. In addition to vaccines, experts also recommend preventive measures like mask wearing and social distancing to keep the virus from spreading and mutating further.

It has since been proven by data worldwide that among Covid deaths, the majority comprises those who were not vaccinated at all and those with only one dose of vaccination, hence the endemic policy of relaxing restrictions only on those who were fully vaccinated.

With the number of severe Covid-19 cases among vaccinated people increasing in Malaysia, Health Minister Khairy Jamaluddin has called on all to take booster shots.

He said the effectiveness of vaccines would start to wane after a few months, with the Sinovac vaccine being the quickest to lose its effectiveness.

“While Sinovac is effective, there is evidence its effectiveness wanes sooner. That’s why we want you to take whatever booster is on offer,” Khairy tweeted on Nov 20.

He further explained the faster waning period is the reason why the interval for Sinovac booster shots is three months, compared with six months for Pfizer and AstraZeneca.

In his tweet, the Health Minister shared a graph showing data for Covid-19 admissions in Hospital Sungai Buloh in the state of Selangor, which revealed that most of Category 4 and 5 patients are Sinovac recipients.

The last epidemiology week (week 45) for instance, saw 165 Sinovac recipients admitted to Hospital Sungai Buloh as Category 4 and 5 patients. In comparison, 24 were Pfizer recipients while seven had taken the AstraZeneca vaccine.

When the immunity afforded by vaccines starts to wane, it also raises the real possibility of an increase in the transmission of the disease, which means the possibility of a new wave occurring is no longer remote.

In recent days we have seen the latest wave of Covid-19 cases hitting Europe with a vengeance. Some countries have responded by imposing partial lockdowns and placing more restrictions on unvaccinated people.

Germany, which has declared a state of emergency, shattered a new record on Nov 18, reporting more than 65,000 new cases. In the Netherlands, more than 20,000 new cases were reported on Nov 17, a new record for the third day in a row, and on the same day in France, where a fifth wave of the pandemic is underway, the number of new cases topped 20,000, a level not reached since Aug 25, Reuters reported.

So it’s not paranoia when the authorities in Malaysia here is warning about the emergence of a new wave, and the best thing we as responsible citizens of the country should do is to heed the advice to religiously observe the SOPs, and especially going for a booster shot when your appointment to do so is given on your MySejahtera app.

It is indeed very assuring when on Nov 21, Khairy announced the Health Ministry will introduce a heightened alert system to detect early signs of an increase in Covid-19 cases in the country.

Through the system, the MOH proposed that some sectors be tightened if there was an increase in cases, but it would not be a “total lockdown”. “If we can, we want to avoid lockdown because lockdown not only disrupts the economy, but has other effects on family well-being and mental health,” said Khairy.

He also reminded the public not to be too complacent when the states transitioned to Phase Four of the National Recovery Plan. “We are very worried because we have seen the early signs (of rise in cases). However, it has not reached the level of paralysing the health system, but the signs are very clear,” he added.

Last week Austria became the first European country to make Covid vaccination a legal requirement, with the law due to take effect in February. Politicians in neighbouring Germany are debating similar measures as intensive care units there fill up and case numbers hit fresh records.

Regards,

Jamari Mohtar
Editor, Let’s Talk!