WITH the first batch of Covid-19 vaccines due to arrive in Malaysia today, health experts are urging the government to be more flexible about the target groups for immunisation in its three-phase national vaccination campaign.

People in high-risk categories should be considered for precedence aside from front-liners to avoid vaccine wastage.

Universiti Malaya Tropical Infectious Diseases Research and Education Centre director Dr Sazaly Abu Bakar said it would also be more efficient to line up the target groups for shots in order of priority, even among front-liners, so that the vaccine is given to those who need it most and as quickly as possible.

He recommended the first doses go to healthcare workers, who are most at risk of infection among the groups in the front-liner category.

“Are all front-liners at equal risk of infection or are certain personnel more at risk than others?” he told The Malaysian Insight.

“Those who are most vulnerable should receive the vaccine first.”

Sazaly said Malaysia can learn from the US and Europe, both of which had experienced wastage in their immunisation campaigns. Their doctors had reported that one vial of the Pfizer-BioNTech Covid-19 vaccine was good for five doses instead of the prescribed six due to leakages in the vaccination process.

In Japan, a shortage of syringes had limited the number of vaccinations that could be administered despite the availability of the shots.

Health Minister Dr Adham Baba has announced that the low dead volume (LDV) method would be employed here to prevent wastage.

Vaccination is voluntary in Malaysia, which has acquired more than enough doses to to inoculate its 32-million population.

National Covid-19 immunisation programme coordinator Khairy Jamaluddin has said that leftover shots from missed appointments will go to the volunteers on the vaccination campaign to avoid waste.

Sazaly said this has to be properly planned out. 

“The government should have a reserve list of volunteers and recipients ready (to take the shots) if the original recipients don’t turn up.”

Former deputy health minister Dr Lee Boon Chye said such planning is crucial as the Pfizer-BioNTech vaccine will lose effectiveness five days after it is thawed. The vaccine must be stored at extremely low temperatures.

“If 1,000 doses were thawed out and only 500 showed up to be vaccinated, the rest will go bad if not used within five days. We should explore the possibility of using the vaccines on those who are not in the target groups to avoid wastage,” Lee said.

On who should get inoculated first, Lee said the government made the right call to prioritise medical front-liners who are also likely to be more receptive to inoculation.

The second phase is focused on high-risk groups such as senior citizens and the third phase for people aged 18 and above.

Lee said the government should be more careful with the vaccine stock in the third phase which may not proceed as smoothly as the earlier phases.

He said if the government will only vaccinate targeted groups in the second phase, wastage may occur due to low turnout.

“We cannot be too specific about giving it only to the elderly and high-risk groups. Some wriggle room is needed in this aspect or wastage will occur.

“For example, (wastage could occur) if we start with wanting to vaccinate a certain number of individuals above a certain age but we do not reach the target. Or if we want to vaccinate those exposed to the virus and have prepared 100 vials but 30% of them don’t show up, then what do we do?.

“After the first phase, it is not possible to enforce too strict a timeline.”

Lee said public confidence in the vaccine was lacking and the government should rectify that with a campaign to share information

“For many people, the most important thing is safety, such as who can or cannot be vaccinated.”

Lee, a medical doctor, said the government also needs to clarify who cannot be vaccinated, such as pregnant women or women who are attempting to get pregnant. All these, he said, needs to be explained.

Health policies specialist Dr Khor Swee Kheng also said the government must have a transparent framework to prevent vaccine abuse as there will be groups lobbying to be vaccinated early such as teachers, media professions, restaurant workers, and etc.

“They are all important and should all be vaccinated as early as possible. However, scarce vaccine supplies will mean that resource allocation decisions must be made using a reliable, standard and transparent framework,” Khor said.

He added trade-offs are the only possible solution in such a situation but it is imperative that the government is transparent about the process it to prevent abuse. – February 21, 2021.