Perspective: Malaysia Needs To Catch Up On Boosters

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UALA LUMPUR (Bernama) – It has been more than two years since pharmaceutical companies came out with COVID-19 vaccines, including Pfizer which became the primary vaccine that proved to be the most effective in reducing death risk, and yet less than 50 percent of Malaysians have received their booster shot.

Prime Minister Datuk Seri Anwar Ibrahim on Wednesday entreated Malaysians to get their booster shot as yet another wave of COVID-19 cases is about to hit the nation with the expected holiday travel from China, which recently ended its zero COVID policy, as well as from other countries which are battling various sub-variants.

Ministry of Health is prepared to tighten COVID-19 pandemic controls, including the standard operating procedures (SOP) at the border. Health Minister Dr Zaliha Mustafa said the measures will take effect when needed and apply to all travelers, not just those from China. --fotoBERNAMA (2022) COPYRIGHT RESERVED

He also said the government would monitor travellers to ensure Malaysians’ health and safety, and called for everyone to do their part to protect each other. Mask mandates will probably return.

Which is all very nice as I have always supported masking, especially indoors. At least Malaysia never fully abandoned masking requirements in certain areas, such as public transportation and healthcare settings.

But we did falter when it came to vaccinations and boosters. As a proponent of COVID-19 vaccination and getting all the vaccines when they are available, I felt the call for booster shots feels reductive and it may have come too late. And apparently, I am not alone in this.

Epidemiologist Datuk Dr Awang Bulgiba Awang Mahmud told Bernama via WhatsApp that Malaysia needed a long-term strategy to manage and deal with COVID-19 and the long-term consequences of the disease by focusing on a National Immunisation Programme for adults on top of getting bivalent boosters to protect people.

“Repeated boosting with the same type of vaccine is NOT a sustainable public health strategy,” he said.

After three years and multiple mutations, COVID-19 sadly remains a threat. On top of the influx of travellers from China, there is also the new variant XBB.1.5, touted to be the best at evading vaccines and at bonding with cells, on track to becoming dominant globally as it is doing so in the United States and the United Kingdom.

“We’ve been hearing this a lot. It is the most transmissible sub-variant yet,” said Dr Vinod Balasubramaniam, a virologist at Monash University Malaysia.

He stressed that while the sub-variant may be able to cause breakthrough infections among vaccinated people, there was no evidence it was as lethal as Delta or that it can evade the neutralising response or the protective effect of the vaccines.

The question is why were there no loud and more pushy efforts to get the booster last year – similar to when the vaccines first became available – when Omicron had its wave? Although journalists continued writing about vaccines and boosters, I will admit that the volume of stories and focus were not as much once the economy opened up.

As of yesterday, the first booster uptake was 49.9 percent and two percent for the second boosters in Malaysia. One doctor described the rate as “horrific”.

Dr. Vinod Balasubramaniam. -- Photo courtesy of Dr. Vinod Balasubramaniam

But why is the uptake so poor? 

Some health experts blame poor planning and poor messaging on boosters. 

“The MoH (Ministry of Health) tends to make its case for boosters as a knee-jerk reaction to events (like the emergence of the Omicron variant and China abandoning its zero COVID policy) rather than making out boosting as a long-term strategy. It thus results in poor messaging, poor planning and poor execution with consequent poor uptake,” said Dr Awang Bulgiba.

On the flip side, many Malaysians also preferred to believe that because people were not dying en masse with Omicron – which is the strain the new variant descended from – COVID-19 has turned into seasonal flu or a bad cold.

Several doctors told me that in general, Malaysians are very poor when it comes to health-seeking behaviour, saying many preferred to hope for the best instead.

“It’s one of the reasons why our screening rates are so low,” said Dr. Maninderpal Kaur, a radiologist and breast imaging specialist at Kuala Lumpur Hospital.

To be fair, it is not just Malaysians who think that; this hope that we were really past the pandemic is something others share, no more so than those in the United States who are now struggling with increasing cases, hospitalisations and deaths even though vaccines are plentiful and free.

 

VACCINATE NOW

The attitude of refusing tools to help protect one’s health is somewhat alien to me.

When pharmaceutical companies came out with the COVID-19 vaccine in late 2020, and all the hoopla with the nurses and live injections took place on live TV, I desperately wanted to get the shot.

Relatives and friends living in the US and UK got their shots while most of Malaysia had to wait until healthcare workers and the elderly got theirs. At the same time, anti-vaxxers and the vaccine hesitancy movement grew, thanks to social media. Many were regurgitating tripe from conspiracy theorists in the US and elsewhere.

I was impatient for mine and when the government offered AstraZeneca to the general public, I took it. When boosters became available via walk-in in December 2021, I was one of the first in my company to get it. When it was time for a second Pfizer booster in June 2022, I went to Paradigm Mall in Kelana Jaya, Selangor, which was a walk-in COVID-19 vaccination site for anyone seeking to protect themselves.

And when I got my chance to get the bivalent vaccine – which combines the vaccine for the original strain of COVID-19 and the updated vaccine for the Omicron strain – thanks to a trip to the United States two weeks ago to visit family, I was quick to grab it.

Getting my COVID-19 bivalent booster in California, US. --fotoBERNAMA (2022) COPYRIGHT RESERVED

CALIFORNIA PLAGUE

The pandemic experience in the US was slightly jarring. I was used to wearing a mask in Malaysia indoors more often than not, even in shopping malls. So I was wearing my mask the whole flight to the US. Arriving in San Francisco, I saw many wearing masks although not all did, which is still okay.

The shock came when I arrived in Lincoln where my in-laws live. Masks became few and far in between. Considering the town had a large number of seniors, it was odd to see so many people without a mask in indoor settings. If it weren’t for the incessant coughing around me, I would have thought it was pre-pandemic times or that COVID-19 was over.

Knowing that the US was undergoing a ‘tripledemic’ of COVID-19, flu and respiratory syncytial virus (RSV), it was especially shocking.

I suppose I shouldn’t be surprised. For three years I have read about Americans protesting mask mandates, giving stupid reasons like wearing masks causes carbon dioxide poisoning. The booster uptake there wasn’t much better either, although it was better in California than in other parts of the United States. 

Which is a shame considering how easy it was to get one, even if you are not an American or a resident of the country. The Centers for Disease Control (CDC) website stressed that the vaccine is available to all and that all they cared about was the age and last date of vaccination or infection.

To get the shot, all my husband and I had to do was make an online appointment with a nearby pharmacy and show up at the chosen date and time. Pharmacies dispense COVID-19 vaccines to everyone who needs them, with or without insurance. As I was not an American citizen or lived in the US or had medical insurance in the country, my vaccine was paid for by the US government.

US is currently providing COVID-19 vaccines to everyone who wants it, regardless of citizenship. --fotoBERNAMA (2022) COPYRIGHT RESERVED

I was a bit nervous at first – concerned the pharmacist might suddenly channel the worst of his xenophobic instincts and decided against his tax dollars paying for my booster – but he processed the paperwork and gave my husband and me our bivalent vaccine.

He then gave us our CDC card, stating which vaccine we got and when we got it. I never developed any side-effect other than a slight soreness at the injection site that went away in a few hours. It was, overall, a very painless experience.

Two weeks in, I am now protected against the Omicron strain, something I am grateful for since I have a few underlying health issues. 

 

WAITING GAME

 

I know I am lucky to have been able to go to the United States and get the updated vaccine while most of Malaysia has to wait. 

But with the renewed push for boosters, will Malaysians finally get boosted or should they prefer to wait for the bivalent vaccine?

Prof. Datuk Dr. Awang Bulgiba Awang Mahmud. --fotoBERNAMA (2021) ALL RIGHTS RESERVED

Doctors agree that the bivalent boosters give the best protection against COVID-19 currently, but disagreed on whether boosting with a monovalent (original) vaccine would be helpful.

“The best booster is whatever is in front of you. We should not wait for the bivalent vaccine, god knows when it’s going to come. Ideally, everyone should get boosted,” said Dr Vinod.

Dr Awang Bulgiba disagreed, saying rather than boosting with the same monovalent vaccines, the strategy should be maintaining non-pharmaceutical interventions such as indoor mask mandates and improving indoor circulation.

“I do not advocate monovalent boosters when bivalent ones are as safe and protect us better,” he said, adding that the focus should be on pan-coronavirus vaccines, intra-nasal vaccines and vaccines which are specifically designed to induce cellular immunity in the future.

 

-- BERNAMA

 

Tags: COVID-19; bivalent booster; vaccine; XBB.1.5; California

 


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