The less-than-ideal uptake in Covid-19 vaccine registration so far is because of trust issues, say medical and public health experts.
They attribute the low numbers to the circulation of dubious information including hearsay, and have called on the government to utilise all its resources to clear any doubts and instil trust in the vaccines among the public.
Universiti Malaya professor of occupational and public health Prof Dr Victor Hoe said some people had the misconception that the vaccines were unsafe or that some were better than others.
“When I held community engagements with residents, I found there were still many people who did not trust the safety of the vaccines. They were worried about possible adverse effects of taking the vaccines.
“They told us that they received news through social media and friends about the vaccines’ safety and efficacy, ” he said.
Dr Hoe said the low uptake could also be due to many people not having a smartphone to register themselves for the inoculation and urged the government to make use of all its resources to bridge the gap between technology and trust.
“The move should not just involve the Health Ministry but all levels, from village heads and community leaders to state assemblymen and MPs. They should organise engagement sessions with people on the ground to help them register and also to clear doubts regarding the vaccines.
“However, all of them should have been inoculated against the coronavirus first to ensure people’s confidence in the vaccines, ” he said.
As for states with a low registration rate,Dr Hoe said if the campaigns to promote better understanding and uptake of the vaccine failed, they should be reassessed.
“The cause of concerns should be addressed adequately without blaming any party, ” he said.
Dr Hoe, however, is not in favour of making Covid-19 vaccination compulsory.
The Special Committee on Covid-19 Vaccine Supply Access Guarantee has said that as at April 10, only over 8.4 million of the targeted 26.7 million people had registered.
Health Minister Datuk Seri Dr Adham Baba recently said the government would identify the causes of the slow uptake while Science, Technology and Innovation Minister Khairy Jamaluddin said Malaysia might review its voluntary Covid-19 vaccination policy come July if the rate was still low.
Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar said a majority of Malaysians were still adopting a “wait and see” approach.
“They see it as not urgent and think there’s still time before the actual vaccination (involving the public) starts, ” he said.
Dr Zainal Ariffin said the Covid-19 Immunisation Task Force needed to understand community behaviour and the dynamics of vaccination programmes.
“The most important outcome is the actual vaccination coverage, ” he said.
Agreeing that some citizens do have problems accessing registration channels and need help with it, Dr Zainal Ariffin suggested the government consider mass walk-in vaccinations when more vaccines are available.
He, too, thinks it is not necessary to make Covid-19 immunisation compulsory.
Universiti Malaya professor of epidemiology and public health Prof Dr Sanjay Rampal said more health experts need to critically appraise the benefits of the vaccines without pre-formed biases.
“This will increase trust in the translation of science and how it benefits the community... our opinions tend to be polarised through social media.
“Maintaining trust and goodwill is key to increasing vaccine uptake by the community, ” he said.
To encourage communities to register Dr Sanjay proposed having roadshows in shopping complexes, workplaces and community centres including at PPR (People’s Housing Projects) flats and villages.
Task force: Confirm vaccination appointment
PUTRAJAYA: Vaccine recipients under phase two of the National Covid-19 Immunisation Programme are reminded to confirm their vaccination appointment within 48 hours of receiving their details, or risk having it cancelled and rescheduled to a later date.
The Covid-19 Immunisation Task Force said the slots for those who failed to respond to the appointment notification would then be given to others.
“If they (recipients) confirm to be present for the vaccination appointment, a reminder will be sent three days, as well as a day before, the (actual) date, ” it said, adding that the notification for the appointment and the reminders will be sent via both the MySejahtera app and the Short Message Service (SMS).
For those who have not registered through MySejahtera, the appointment details will be sent via SMS.
The second phase of the national immunisation programme is set to begin April 19, targeting at-risk groups such as the elderly, individuals with comorbidities and persons with disabilities.
Those with queries regarding their appointment may contact the toll-free hotline at 1800-888-828. —Bernama
Covid-19 vaccines: Addressing the worries of allergy sufferers
Anyone with a history of negative reactions to certain medications may want to seek advice from an allergy specialist before receiving a Covid-19 vaccine. — dpa
Covid-19 vaccines can cause strong allergic reactions in very rare cases.
However, rare or not, this is making many allergy sufferers around the world uneasy.
In Germany, allergy outpatient clinics are seeing an influx of people extremely worried about the vaccines, says Dr Ludger Klimek, president of the Medical Association of German Allergologists (AeDA).
”Many would like to be vaccinated and are looking forward to it, and then they read that a severe reaction is possible,” he remarks.
“This has raised a lot of uncertainty.”
So, how high exactly is the risk?
Since vaccinations started in England and the United States, there have been reports of some strong allergic reactions that occurred shortly after a vaccination and had to be treated.
Precise data on the frequency of such reactions after Covid-19 vaccinations aren’t currently available, however.
Based on existing preliminary data, Dr Klimek says, the new messenger ribonucleic acid (mRNA) vaccines by Pfizer/BioNTech and Moderna likely carry a somewhat higher risk than the other Covid-19 vaccines – around 2.5 to 4 times higher.
Nevertheless, he adds, the risk is still extremely low, namely “one case in every 100,000 vaccinations”.
Allergic reactions aren’t confined to Covid-19 vaccines, of course, but can occur after taking any medication.
No one becomes allergic to a substance by taking a Covid-19 vaccine, he says, explaining that an allergic reaction to an ingredient in the vaccine means you’ve already been previously sensitised to it.
As the injected dose of it is higher, the reaction can be stronger.
Also, not all allergy sufferers are affected equally.
“If you have hay fever, you’re not really at higher risk of side effects than someone without allergies,” says Dr Klimek.
But if you’ve ever had an allergic reaction to certain medications – a laxative or X-ray contrast agent, for example – you might also have one to the ingredients in the Covid-19 vaccines, he says, noting that known allergenic substances in medications include polyethylene glycol, polysorbate and ethylene oxide.
While completely eliminating a risk is hardly possible, Dr Klimek says, you’d do well to consult an allergist if you’ve had an allergic reaction to a medication.
If need be, the allergist can refer you to a specialised allergy centre that can make a specific recommendation based on your allergy and the ingredients in the various Covid-19 vaccines.
As for whether, say, the Pfizer/BioNTech vaccine would be a better choice than AstraZeneca/Oxford’s, or vice versa, he says: “(An assessment like) this is very complex and not affordable by every doctor’s surgery.”
In any event, health experts, such as those at Germany’s Federal Centre for Health Education (BZgA), have made it clear that if you know you’re allergic to an ingredient in a Covid-19 vaccine, you shouldn’t get that vaccine.
Before you’re vaccinated, it’s imperative that you accurately and thoroughly fill out your medical history questionnaire – and if in doubt, do so with the help of an allergist – so that personnel at the vaccination site know what to watch for and can further evaluate you if necessary.
After getting the jab, you have to remain on site for at least 15 minutes so that you can be monitored as a precaution.
The wait is 30 minutes if you’ve ever had an allergic reaction to a vaccine, the BZgA says.
The most serious kind of allergic reaction is anaphylaxis, in which your immune system releases a flood of chemicals that can cause you to go into shock.
“This is definitely life-threatening,” says Dr Klimek.
Less serious potential reactions include a skin rash, scratchy throat or itching.
According to the BZgA, vaccination sites and mobile vaccination teams are required to be equipped to treat any cases of anaphylaxis quickly. – By Tom Nebe/dpa
Information in this article was accurate at the time of its writing. Due to the fluid nature of the Covid-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.
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The danger of too many people refusing vaccines
Some vaccines are only completed when a child is older, leaving them vulnerable to getting the infectious disease in the meantime. — Positive Parenting
Last fortnight, we talked about anti-vaxxers and why they oppose getting vaccines. So many anti-vaxxers do not want to get vaccines for either themselves or their families. But it only hurts them and their families, right? It does not hurt the world.
Wrong. It hurts the community and the world in the long run, or even in the short term.
There are two main types of anti-vaxxers.
One is the type who just refuses to inoculate themselves and their loved ones.
The other – even more dangerous – is the type who not only refuses to inoculate themselves and their loved ones, but also go around telling all their friends and acquaintances on social media not to inoculate themselves, too.
They want to make sure everyone believes in their misconceptions too, and will shout out their beliefs to the world.
They are the most dangerous type, although the first type are dangerous, too.
What is the danger?
When there are large numbers of people refusing to vaccinate themselves against a certain disease, it leads to the reemergence of that disease in that community or area.
Take, for example, measles.
Back when I was a kid, I had measles. Every single one of my classmates had measles.
It was a thing you went through in childhood.
But when the measles vaccine was introduced as part of the MMR (measles, mumps and rubella) vaccination for children, measles all but disappeared in the parts of the world that were vaccinated.
And before you dismiss measles as a minor disease that mostly gives you red bumps on the skin, do not forget that it has many complications, including encephalitis (infection of the brain), which can lead to death in children.
By 2002, measles was declared eradicated in the United States due to widespread vaccination.
But this infectious disease soon reemerged, and by 2014, there were over 600 reported new cases.
This was because of anti-vaxxers who refused to vaccinate their children, resulting in some of them catching the measles virus.
Not only has this happened to measles, but whooping cough (pertussis) has also seen a dramatic increase in cases due to anti-vaxxers.
Right. But if my child is vaccinated and he goes to school with a child who has not been vaccinated, my child should be safe, right?
Yes, for the most part. It depends on the vaccine.
Some vaccines have a very high efficacy rate, such as over 90%.
This means that the vaccine will protect nine out of every 10 vaccinated children.
Let us say that your vaccinated child is the one out of 10 who did not develop antibodies to the virus.
If he goes to school with an unvaccinated child who has fallen ill, then your vaccinated child will get sick too.
Vaccines are supposed to confer herd immunity when enough people are vaccinated.
So, if you do not vaccinate your child, others who might otherwise be safe will get infected too.
And the ones who are the most vulnerable and will get sick first are:
> Infants too young to get vaccinated
You may say, “Oh, my child will not come across an infant.”
But that is not true.
You go to a hospital and there are infants in the clinic. You go to a mall and there are mothers with infants.
There are also some children who are too young to be vaccinated against a certain disease. You expose them too.
Children can only get certain vaccines at certain points in their lives.
The MMR vaccine, for example, is only given when they are one year old, and the second dose is given at age four.
Will you be responsible for a three-year-old child dying of measles just because you refuse to get vaccinated?
> People with weak immune systems
These include those with cancer who are on chemotherapy.
Yes, they may have been vaccinated before, but they are too weak now to mount an effective immune response.
In 2018, there was a college student in Pittsburgh, US, who had measles.
He exposed more than 100 cancer patients to measles. Any of them could have died.
> Healthcare workers
They are always at the greatest risk, even if they have been vaccinated before as they are constantly exposed to all sorts of dangerous microorganisms.
So, because of anti-vaxxers’ actions, large numbers of people are exposed to infectious diseases they might otherwise have not gotten.
OK, so I got the flu vaccine, but I still got the flu! That is why I don’t fully believe in vaccines!
The flu vaccine is only 40% to 60% effective.
Sometimes, you may have already been infected by the flu virus before you got your vaccine.
It takes two weeks after receiving the flu shot for you to develop immunity.
The flu vaccine also cannot shield you against all types of flu viruses as the virus mutates very quickly.
But it still works in protecting many vaccinated people from getting the flu, or getting a severe version of it.
Two doses of the MMR vaccine, however, is 97% effective against measles, 88% effective against mumps, and 97% effective against rubella.
So you cannot use the flu vaccine to say that all vaccines do not work!
Please get better informed about the type of vaccine you are taking.
Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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Covid-19 vaccines: Facts about the myths
Employees carry a container of mixed raw materials for mRNA at the BioNTech SE laboratory in Marburg, Germany. This technology was developed over the past 20 years. — Bloomberg
Although the Covid-19 vaccines offer hope in controlling the pandemic, they have been the subject of myths and misinformation that have contributed to vaccine hesitancy.
This article clarifies the facts surrounding some of the common myths, which the writer has encountered in interactions with patients, colleagues and friends.
Myth 1: The vaccine developments were rushed, so the vaccines are not safe
Facts: The development of vaccines, like medicines, require compliance with global regulators’ safety protocols and adequate testing.
The Covid-19 vaccines were tested in rigorous clinical trials involving tens of thousands of volunteers in many countries to ensure that they complied with safety standards, and protected adults of different ages, gender and ethnicities.
There was no shortage of volunteers, which was facilitated by social media.
None of the usual steps in testing procedures were omitted, but instead, were conducted on overlapping schedules to enable faster data collection and analysis.
As Covid-19 was so widespread, it did not take long to determine if the vaccines worked for vaccinated volunteers.
A critical factor was the large amounts of financial resources available to the vaccine projects as governments and donor agencies invested in the research and/or paid for the vaccines in advance.
This is unlike the research and development of other vaccines, which is usually funded by the company’s own resources.
Regulators worldwide reviewed and continue to monitor the safety of the vaccines – no public health safety concerns have been found thus far.
Myth 2: The vaccines can lead to infection by the SARS-CoV-2 virus
Facts: All Covid-19 vaccines stimulate the body’s immune system to recognise and fight the SARS-CoV-2 virus if there is an infection.
Sometimes, the process can cause temporary symptoms like fever, but these symptoms are normal and a sign that the body is building protection against the virus.
The mRNA (messenger ribonucleic acid) vaccines do not contain the live SARS-CoV-2 virus.
Instead, they instruct the body’s cells to produce a protein that is a part of the virus.
This helps the body recognise and fight the virus if infected.
The protein does not cause any infection and is eliminated from the body in about 72 hours.
Another type of Covid-19 vaccine is the inactivated vaccine.
This traditional method of producing vaccines involves the use of killed or inactivated SARS-CoV-2 viral particles to stimulate the body’s immune system without causing serious disease.
It takes a few weeks for the body to develop an immune response following vaccination.
This means that it is possible that a person could get infected by the SARS-CoV-2 virus just before or just after vaccination, and still get sick.
This is because the vaccine has not had enough time to provide protection.
Myth 3: The mRNA vaccine will alter the body’s DNA
Facts: mRNA is not the same as DNA (deoxyribonucleic acid).
mRNA, which is found in all living cells, acts as a chemical intermediary (or messenger) between DNA in the cell nucleus and the cellular machinery that produces the proteins needed for bodily functions.
mRNA instructs this machinery to produce these proteins.
The mRNA vaccines do not alter or interact with DNA in any way.
It only enters the cell cytoplasm.
It does not enter the cell nucleus where the DNA is located.
This means that it cannot affect or interact with the body’s DNA.
The mRNA instructs the body’s cells to produce the viral protein that stimulates an immune response and is eliminated from the body after its work is done.
Myth 4: The mRNA technology is a brand new technology
Facts: The mRNA technology has been developed over the past two decades.
It has been used to produce certain cancer medicines, and studied in other infectious diseases like influenza, Zika, rabies and cytomegalovirus infection.
The use of this technology has facilitated large scale production of vaccines, which is needed in managing the pandemic as quickly as possible.
Myth 5: The side effects of the vaccines are dangerous and severe
Facts: The Covid-19 vaccines contain normal vaccine ingredients, e.g. fats that protect the mRNA, salts and a small amount of sugar.
They were not developed with foetal tissue, and do not contain any materials like implants, microchips or tracking devices.
Just like other vaccines, there are short-term mild or moderate side effects.
They usually resolve without complications or injury.
These side effects include discomfort at the injection site for a day or two; muscle ache; headache; and fatigue or fever after vaccination.
These are usual reactions to any vaccine and indicate the immune system is responding.
Most symptoms resolve within days.
There is no perfect vaccine, just as there is no perfect medicine, without any side effects.
When hundreds of millions of people have received the Covid-19 vaccines, it is inevitable that some adverse events will occur in the days and weeks after vaccination.
As such, careful investigation is necessary to determine if the vaccine was the cause or if it was coincidental, i.e. the adverse event was not related to the vaccine, but may be attributed to it erroneously as it occurred soon after vaccination.
When evaluating such reports, it is important to check the denominators and not just the numerators.
There has been media hype about blood clots in those who had the AstraZeneca/Oxford vaccine, which has prompted investigations and vaccination pauses in some countries.
The UK Medicines and Healthcare Products Regulatory Agency (MHRA) received 30 reports from 18.1 million doses administered as of March 24 (2021).
One case and five cases were reported among the more than 400,000 doses administered in Australia and Holland respectively.
The World Health Organization (WHO), UK MHRA and European Medicines Agency (EMA) reviewed the reports and concluded that the benefits continue to outweigh the risks.
The EMA added that unusual blood clots with low blood platelets should be listed as very rare side effects of the AstraZeneca/Oxford vaccine, following a review of 62 cases of cerebral vein thrombosis (blood clot in the cerebral vein, which drains blood from the brain) and 24 cases of splanchnic vein thrombosis (blood clot in the splanchnic venous circulation, which drains blood from the digestive system) in the European Union (EU) drug safety database as of March 22 (2021), from about 25 million doses administered.
Myth 6: As Covid-19 has a high survival rate, vaccination is unnecessary
Facts: The death rate of Covid-19 varies and is influenced by age, gender, co-morbidities (concurrent illnesses) and social deprivation.
Covid-19 is now recognised as a multi-organ disease with a broad spectrum of manifestations.
Data from the United Kingdom found that more than half of Covid-19 patients had long Covid symptoms three months after discharge from hospital, with worse outcomes among those younger than 50, women, and those with higher pre-Covid fitness levels.
Another study reported that discharged patients had higher risks of new respiratory disease (six times), major cardiovascular disease (three times), chronic liver disease (2.8 times), chronic kidney disease (1.9 times), and diabetes (1.5 times), than matched controls from the general population.
These risks were higher in those younger than 70 and in non-white individuals.
There were similar reports from other countries, but no published Malaysian data.
Take home message
Getting the Covid-19 vaccine is important to prevent infection and serious disease, which may have long-term consequences.
It may also prevent the spread of the SARS-CoV-2 virus to others.
Anyone who has any doubt about getting vaccinated would benefit from a discussion with their general practitioner (GP) or family doctor.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. Information in this article was accurate at the time of its writing. Due to the fluid nature of the Covid-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
PETALING JAYA: China’s Sinovac vaccine is safe to be administered to senior citizens under the second phase of the National Covid-19 Immunisation Programme.
Coordinating Minister Khairy Jamaluddin said the special committee evaluating the vaccines took into account the latest data and found the vaccine to be “safe, effective and stable” for senior citizens.
He said countries which have so far administered the Sinovac vaccine to those aged 60 and above were Turkey (11 million), Brazil (seven million) and Chile (three million).
“The committee has reviewed the data and we have decided to use Sinovac for senior citizens based on Brazil trials and trial papers under review.
“The secondary efficacy of Covid-19 for the Sinovac vaccine was 83.7% for moderate and 100% for severe cases. So, this vaccine is effective in preventing severe cases of Covid-19 and is precisely what we want to avoid for those in phase two and senior citizens.
“This is because 80% of mortality for Covid-19 involve those aged 60 and above. If we can give 100% protection against severe cases, which the Sinovac vaccine does provide, then it is something we need to use, ” he said yesterday.
The Sinovac vaccine came under scrutiny lately with its efficacy rate reported to be varied across different countries.
Khairy also clarified that both the Pfizer-BioNTech and Sinovac vaccines would be used in phase two of the Immunisation Programme which starts next Monday.
The Science, Technology and Innovation Minister also said 31,776 vaccination appointments were sent through the mySejahtera application and SMS under phase two.
Of these, he said 18,215 did not confirm their appointments while 343 declined, adding that the government was scheduled to send out 50,000 more appointments yesterday.
“I urge those who have received the appointment details to respond on whether they will be present as this will allow us to make plans at the Vaccine Dispensing Centres (PPV).
“If we do not know how many will turn up, we worry that this will result in wastage or that not enough or too many vaccines would be brought there, ” he said.
Khairy said those who declined the first appointment date would receive a second appointment later.
“If they still decline, then we will investigate to find out why they do not want the vaccination. We currently believe it is because the dates are not suitable to them, ” he said.
Besides senior citizens, phase two will also involve persons with disabilities and those with comorbidities.
The minister also assured there would be enough vaccines as the country would receive supplies on a weekly basis amounting to 712,530 doses from this month.
He said an additional 200,000 finished product Sinovac vaccine doses would also come directly from Sinovac’s factory in China.
“The increase in supply should be sufficient for us to finish phase one and start phase two of the immunisation programme, ” he said.
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Wong Chun Wai began his career as a journalist in Penang, and has served The Star for over 35 years in various capacities and roles. He is now group editorial and corporate affairs adviser to the group, after having served as group managing director/chief executive officer. On The Beat made its debut on Feb 23 1997 and Chun Wai has penned the column weekly without a break, except for the occasional press holiday when the paper was not published. In May 2011, a compilation of selected articles of On The Beat was published as a book and launched in conjunction with his 50th birthday. Chun Wai also comments on current issues in The Star.
