DEAR Health Minister,

I have read the reports on Covid-19 vaccine booster shots by the World Health Organization (WHO), which is committed to integrity and excellence and entrusted with caring for global health. It adheres to values of integrity, professionalism and respect for diversity. The values of its workforce reflect the principles of human rights, universality, and equity. Actions and recommendations are independent, fair, transparent and timely to make people feel safe, respected, empowered, fairly treated and recognised.

In its December 22 interim statement on booster doses for Covid-19 vaccination, the WHO concluded that introducing booster doses should be firmly evidence-driven.  To date, the evidence indicates a minimal to modest reduction of vaccine protection against severe disease over the six months after the primary series. Duration of protection against the Omicron variant may be altered and is under active investigation. 

More data will be needed to understand the potential impact of booster vaccination on the duration of protection against severe disease, but also against mild disease, infection, and transmission, particularly in the context of emerging variants. 

In several jurisdictions, booster vaccination has been introduced. All studies to date show a strong anamnestic immunological response achieving or improving upon the peak antibody levels following the primary immunisation series, but with insufficient data and too little follow-up to assess the kinetics and duration of the response. Because no correlate of protection has yet been defined, it is not possible to predict with high confidence vaccine performance of these heterologous schedules based on the immune response. Evidence is accumulating to inform global recommendations, which may be refined as additional data become available. 

Additional data include:

1. Assessment of the need for booster doses
• Epidemiology of breakthrough cases, by disease severity, age, co-morbidity and risk groups, exposure, type of vaccine and time since vaccination, and in the context of variants of concern;
• Refined vaccine-specific data on efficacy, effectiveness, duration of protection of vaccination in the context of circulating variants of concern; and
• Supplementary evidence from immunological studies assessing binding and neutralising antibodies over time, as well as biomarkers of cellular and durable humoral immunity.

2. Performance of booster doses 
• Data on duration of protection of homologous and heterologous boosters;
• Safety and reactogenicity of booster vaccination, including heterologous boosting from larger-scale studies; and
• Impact of booster vaccination on transmission.

3. Additional considerations include:
• Optimal timing of booster doses, possibility for dose-sparing for booster doses (e.g. fractional doses), booster needs in previously infected individuals, programmatic feasibility and sustainability, community perception and demand as well as equity considerations; and
• Refined modelling studies to guide strategies to optimise the impact of vaccination.

In a January 19 meeting of the International Health Regulations (2005) Emergency Committee on the Covid-19 pandemic, among the actions it called for as critical for all countries are:

• Continued use of evidence-informed public health and social measures, therapeutics, diagnostics, and vaccines for Covid-19;
• Lift or ease international traffic bans as they do not provide added value and continue to contribute to the economic and social stress; and
• Address community engagement and communications gaps and challenges posed by infodemics. 
Given the rapidly evolving situation and to promote trust and adherence, states should explain clearly and transparently the rationale for the changes of policies and PHSM, with a view to balance risks and benefits of such changes. These communications need to be tailored to different population groups, including those considered as most vulnerable.

Meanwhile, the WHO says there’s no evidence healthy children and adolescents need boosters and warned that blanket booster programmes could prolong the pandemic and increase inequity. While there seems to be some waning of vaccine immunity over time against the rapidly spreading Omicron variant, more research needs to be done to ascertain who needs a booster.

YB Health Minister,

Malaysians have been threatened that life would be made very difficult for them if there were not vaccinated and that they would probably made to undergo regular tests for which they would have to pay. We were also told booster shots would be voluntary.

Recently, we were reminded all senior citizens aged 60 years and above as well as recipients aged 18 years and above who have had two doses of Sinovac vaccine would be required to a take booster shot before March 1 to keep their fully vaccination status.

But the WHO said that introducing booster should be firmly evidence-driven and protection against the Omicron variant may be altered and it is still under active investigation. There were recent studies but with insufficient data and too little follow-up.

Are we following the WHO values with fair, transparent and timely actions to make people feel safe, respected, empowered, fairly treated and duly recognised, with respect for diversity?

Further, in its weekly update, the WHO reported that globally, from January 31 to February 6, the number of new cases decreased 17% compared to the previous week. In Southeast Asia, new cases decreased by 32% but new cases in Malaysia increased by about 46%. In the four days from February 6-10, the figure has already shot up 27%. What has gone wrong? 

What say you… – February 11, 2022.

* Saleh Mohammed reads The Malaysian Insight.

* 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.