IS vaccination against Covid-19 really necessary?

Some organisations and individuals have been arguing that mass vaccination is not urgently needed in our country right now because the case fatality ratio for Covid-19 in Malaysia is quite low, at about 0.37% of diagnosed cases as of March 17. They claim that the situation is not a health emergency and that the authorities are over-reacting. But what these sceptics do not take into account is the fact that at this point in Malaysia) about 14% of those who are diagnosed with Covid-19 develop an over-reaction from their own immune system—the “cytokine storm”. These patients have to be hospitalised because they need treatment, including oxygen therapy, otherwise they could die.

Without lockdowns, the basic reproduction number (R nought) for Covid-19 is about three. The number of new cases diagnosed each day will go up exponentially (for example, from 100 to 300, then 900, 2700, 8100, and 24300 within the space of just one month). Our health system can handle the 14% of cases that develop cytokine storm when the total number of new cases per day is 1000, not forgetting that these patients each need to be treated 2 to 3 weeks in the hospital. But if we allow the number of new cases to increase to 20,000 per day, our health care system will be overburdened, and this is when the death rates will go up. Adverse outcomes for Covid-19 cases as well as ill non-Covid-19 cases will also increase!

When we approach these kinds of situations, we will need more lockdowns to bring the R nought to below 1.0, because only then can we give the necessary treatment to the Covid-19 patients. But lockdowns have caused severe economic hardship to about 20% of the families in Malaysia who have had their household income reduced by 50% or more. They are really in a bad shape financially.

Therefore, a mass vaccination programme is not only necessary, but needs to be implemented urgently and speedily. Since 5th February, the R nought has been below 1.0, but this will increase without the various movement control orders that had been in place. With a mass vaccination programmeme, we will be able to create herd immunity so that the R nought will remain below 1.0 without too much curtailment of normal economic and social activity, while at the same time, protecting people from succumbing to severe disease.

Besides the issue of herd immunity, we also need vaccination rollout as soon as possible to prevent variants of the Covid-19 virus from developing in the population. Variants have been detected in several countries, such as the United Kingdom, South Africa, and Brazil, where the pandemic was not adequately controlled. Some of these variants could prove to be more infectious and deadly, and it is of the greatest urgency that we stop the spread of the virus as much as possible and as quickly as possible.

Are the vaccines effective?

The incidence of new cases had dropped markedly in the groups of people who have already received a vaccine in the United Kingdom and in Israel. Hospital admissions have already started to come down. So, the evidence is very clear that the vaccine markedly reduces the incidence of severe Covid-19 infections.

However, we are still not sure whether some of the persons who have received the vaccine can still pick up the virus and harbour it in their noses and throats for a few days. It appears likely that even if this happens, the amount of virus in their noses and throats will be quite low (hence they may be asymptomatic) and their ability to pass on the virus will be lower than in those not vaccinated. But we need more data before we can be sure. That is why it is important for people to still wear masks in certain public spaces even after being vaccinated. 

Are the vaccines safe?

As of March 15, over 381 million doses of Covid-19 vaccines have been administered globally, with 85.6 million fully vaccinated persons (1.1% of the world’s total population). A very small number of people have developed a severe allergic reaction called “anaphylaxis” where the blood pressure can drop markedly and they develop severe swelling within their throats that can obstruct their breathing passages. This has only happened in those who have had serious allergic reactions in the past.

Apart from anaphylaxis, no other serious immediate reaction to the vaccine has been noted. Soreness at the site of infection and fever for the first one or two days is common.

But haven’t there been many reports of adverse events that have occurred after vaccination?

Yes, there have been reports of strokes, facial nerve palsies, thrombocytopenia (drop in platelet counts), blood clots and even deaths. But there is no proof that these events are caused by the vaccinations. All of these types of events occur in the population throughout the year even without vaccinations. To show they are linked to the vaccine, we need to determine that the incidence of these adverse events has gone up markedly from the “baseline” rate in a particular population after vaccination. Precaution of course requires that such cases be investigated to establish if there is a link to the vaccine. So far these sorts of analyses have not shown any worrisome increase in incidence of these events in the people vaccinated. 

Obviously, we must have a proper monitoring system in place to record all serious adverse reactions as well as a team of epidemiologists and statisticians to see if there is any sign that adverse reactions are above the baseline rates. The approval of Covid-19 vaccines by the Malaysian National Pharmaceutical Regulatory Agency (NPRA) also comes with conditions for the manufacturers to provide new information as this becomes available.

What about long-term adverse effects?

To be honest, it is not possible at this stage to completely rule out long term side-effects arising from the vaccines. There are many hypothetical possibilities—for example, traces of the chemicals used to inactivate the virus might cause some problem in some people, while in some others, RNA technology that induces our own cells to produce the spike proteins might trigger auto-immune reactions.

It is not possible for any authority to give a 100% guarantee about the long-term safety of the vaccines. But the impact of the pandemic on our population’s health, economy, and livelihoods is clear for all to see. As a society, we need to take the small risk that certain people may develop an adverse reaction in the longer term in order to prevent the immediate and immense danger and threat. What is important is that we should guarantee that if longer-term adverse reactions were to happen, those individuals will receive our full support and get the best treatment available free of charge. – March 22, 2021.

* The People’s Health Forum Malaysia is coalition of civil society groups committed to the principle of healthcare as a human right. 

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.