by Citizens’ Health Initiative
With the exception of the People’s Republic of China and a few other countries like New Zealand, Vietnam, Cuba, Senegal, and Kerala state in India, which seem to have largely brought Covid-19 under control without the help of vaccines, most countries are struggling with succeeding waves of the pandemic and a likely global spread of a more contagious mutant of SARS-CoV-2.
The collateral damage to economic and social well-being worldwide has been unprecedented, and it underscores the urgently felt need for vaccines and a return to some semblance of normalcy2.
Despite a major lapse with a religious gathering of 16,000+ which erupted into several clusters locally and in the region (March 2020), Malaysia had performed creditably earlier.
Simmering Protracted Covid-19 with Periodic Outbreaks?
Unfortunately, since October 2020, a resurgence of clusters emerged from non-compliant returnees from abroad, and porous Sabah state border controls, exacerbated by lax enforcement of SOPs during the September 2020 Sabah state elections.
Immigration and health authorities were not sufficiently pro-active to prevent its further spread in the peninsula, resulting in numerous outbreaks, especially among workers in congested accommodations and workplaces, and in prisons and detention centres.
Unlike Singapore’s experience with outbreaks in migrant dormitory complexes, we in Malaysia are additionally reaping the consequences of decades of corrupt mismanagement of labor migration, viz. a persistently large pool of undocumented migrant workers (currently estimated at 1.23-1.46 million)3 who have strong incentives to avoid contact with government agencies.
Senior Minister Ismail Sabri’s disastrous U-turn in going after undocumented migrants (after initially promising them sanctuary and no arrests and deportation during the pandemic) greatly complicated pandemic control efforts, in particular the crucially important contact tracing.
Often younger and daily paid as workers, undocumented migrants are now even more inclined to ride out the milder symptoms of a Covid-19 infection, rather than risk arrest, detention and deportation if they surfaced to cooperate with testing, isolation, and contact tracing.
We thus face the prospect of protracted and repeated seeding of the general population by the asymptomatic or mildly symptomatic, especially undocumented workers reluctant to seek treatment unless severely ill. (We should also note that active avoidance of contact tracing and testing involves others disinclined to divulge network contacts or contact history, e.g. underworld elements, drug and sexual encounters, etc).
As in many other countries, most Malaysians support efforts to secure vaccines to enhance pandemic control efforts.
Procuring Vaccines for Malaysia
The Minister for Science, Technology, and Innovation Khairy Jamaluddin has announced commitments to purchase a basket of Covid-19 vaccines, and options for further orders4.
Khairy Jamaluddin needs to be transparent about the technical rationales, criteria, and pricing for his ministry’s purchasing decisions. In particular, he needs to respond to very pertinent points raised by the Covid Research Centre (KL)5, chest specialist Dr Jeyakumar Devaraj6, and others, which include the following:
- there is currently little information on longer-term safety beyond 2 months or on durability of protection, for all candidate or approved vaccines (any late-manifesting adverse effects will only be detected by conscientious follow-up surveillance, monitoring, and reporting systems). This is especially pertinent for novel mRNA vaccines, in comparison with the more familiar inactivated whole-virus vaccines with which we have decades of experience
- the decision by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) to grant immunity to Pfizer from legal liability for late-manifesting adverse effects, and the Pfizer CEO declining to be among the early vaccinees (professing selflessness in prioritising those more vulnerable, in contrast to some vaccine researchers who courageously vaccinated themselves even before phase 1 human trials) perhaps reflects the true risk perception and calculus of the pharmaceutical corporations (not forgetting the generous subsidies for their vaccine research and development from governments bent on ‘vaccine nationalist’ priorities)
- stringent logistic requirements (deep-freeze or ultra-low temperature facilities) for the mass deployment of mRNA vaccines to under-served remote areas
- one additional advantage of the inactivated whole-virus vaccine is that the host immune response is mounted against a spectrum of antigens from the whole virus, rather than against a much more limited array of antigenic sub-components of say, the spike protein. This could provide some insurance against mutations, say in the coding sequences for the spike protein, which might render vaccines directed solely against the spike protein wholly or partially ineffective.
Beyond the immediate urgency of securing access to adequate quantities of safe, efficacious and affordable vaccines, the larger question of our continuing dependency on foreign vaccine developers, producers and suppliers remains unaddressed7.
National Capabilities in Production of Medicines and Vaccines
Consider Cuba, a nation of 12 million citizens hamstrung by a 60-year economic blockade by the US, which has nonetheless invested in human and material resources to become a biotech power-house: interferon (IFN)-α2b, recombinant hepatitis B vaccines, synthetic polysaccharide vaccine against Haemophilus influenzae type B8, CIMAvax vaccine against lung cancer9, and innovative treatment of diabetic foot ulcers.
Cuba’s repeated offers of scientific collaboration in R&D, and joint ventures to position Malaysia as a regional production and distribution platform for Southeast Asia10, have elicited only a lukewarm response. Tan Sri Dr Abu Bakar Suleiman, the retired Director General of Health, and Johan Indot, have shown greater foresight and entrepreneurial verve as chairman and founding deputy chair of Bioven11, a Malaysian initiative which is shepherding CIMAvax through US-FDA and UK phase 3 clinical trials12.
It is not too late to make the necessary strategic decisions for a promising growth area (pharmaceuticals and vaccines) in the national and regional economies of the newly launched RCEP
For more information/clarifications, please contact:
- Agora Society
- Childline Foundation
- Citizens’ Health Initiative
- Health Equity Initiatives (HEI)
- Kuala Lumpur & Selangor Chinese Assembly Hall (KLSCAH)
- Malaysian Physicians for Social Responsibility (MPSR)
- North South Initiative
- Parti Sosialis Malaysia (PSM)
- Pengguna Pahang
- Pergerakan Tenaga Akademik Malaysia (GERAK)
- Persatuan Sahabat Wanita Selangor
- Reproductive Rights Advocacy Alliance Malaysia
- Suara Rakyat Malaysia (SUARAM)
- Third World Network (TWN)