KUALA LUMPUR: Malaysia should take a risk-based approach in the implementation of the National Covid-19 Immunisation Programme as it ramps up its vaccination drive, according to public health expert Datuk Dr Lokman Hakim Sulaiman.
Dr Lokman, who is the professor of public health and pro-vice chancellor of International Medical University Kuala Lumpur, said that to maximise the impact of the nation’s current vaccine supply, vaccination of the elderly and people with comorbidities must be expedited.
He said the vaccination drive should also zoom in on densely populated urban areas with a high level of economic activities.
“Since Covid-19 transmissions are highly localised, people living and working in such areas face a higher risk of infection.
“We can begin (the vaccination programme) by targeting urban or suburban districts in the states with the highest number of Covid-19 cases and fatalities,” he told Bernama, stressing that the figures must not be based on absolute numbers only but also the incidence rate.
In this regard, he said Labuan should be given top priority for mass vaccinations as it had the highest incidence of Covid-19 cases per 100,000 population.
“Labuan is an important offshore economic centre but its healthcare infrastructure is modest and at the level of a district hospital only.
“As its population is only about 100,000, all those eligible can be immunised in just a day or two,” added Dr Lokman, who is also a member of the WHO Advisory Group for Pandemic Influenza Preparedness Programme.
Dr Lokman said the government should also focus its vaccination drive on the Klang Valley, comprising Selangor, Kuala Lumpur and Seremban, which contributes to more than 50% of new Covid-19 cases on a daily basis.
“If we can manage Covid-19 in the Klang Valley, we will be able to manage the pandemic for the whole of Malaysia.
“By controlling the rate of Covid-19 infections in the Klang Valley, we will also minimise the risk of the infection spreading to other states through cross-border movements,” he said.
Commenting on the efficacy of the vaccines against infections caused by the more aggressive Delta and Alpha strains, he said recently published data from a Public Health England study conducted in April and May 2021 showed that the Pfizer-BioNTech vaccine was 88% effective against symptomatic disease from the Delta variant two weeks after the second dose was given, compared to its 93% effectiveness against the Alpha variant.
(Public Health England is an executive agency of the department of health and social care in the United Kingdom.)
Dr Lokman said two doses of the AstraZeneca vaccine were 60% effective against symptomatic disease from the Delta variant, compared to its 66% effectiveness against the Alpha strain.
Both vaccines were found to be 33% effective against symptomatic disease from Delta three weeks after the first dose was given, compared to around 50% effectiveness against the Alpha variant, he elaborated.
“Currently, we only have preliminary published data for the AstraZeneca and Pfizer vaccines. We do not know (the data) for other vaccines,” Dr Lokman said, emphasising that although some vaccines might show lower efficacy, they were still generally effective as a public health intervention tool for protection against Covid-19.
Delta (B.1.617.2, India) is one of the four Covid-19 variants of concern (VOC) that are being monitored globally. The others are Alpha (B.1.1.7, UK), Beta (B.1.351, South Africa) and Gamma (P.1, Brazil).
The latest variant to be highlighted by WHO is Lambda (C.37) which first appeared in Peru in August last year.
Malaysia’s Health Ministry, in a tweet on July 5, said the Lambda strain had been detected in over 30 countries and “is deadlier than Delta”.
Commenting on the Delta variant, Dr Lokman said it had been linked to the ferocious wave of Covid-19 cases in India in April and May this year, when the country reported more than 400,000 new cases a day.
“It has also been associated with the resurgence of infections in the United Kingdom, Nepal and other South-East Asian countries.”
He said epidemiologically, it was difficult to ascertain for sure the role of this variant considering that there were other factors, such as mass gatherings and activities, for the resurgence of cases in those countries.
“The Delta variant is said to be 60% more transmissible than the Alpha variant that was first identified in the UK in late 2020,” he said.
He indicated that the biggest concern with the Delta variant was that it was the “fittest and fastest” among the variants that had emerged.
“It is more efficient when it comes to causing an infection if it attaches itself to a new host. So, the vulnerable can easily become sick and suffer from severe infections and may die from it,” he said.
Meanwhile, Universiti Teknologi Mara (UiTM) Medical Faculty Infectious Disease Unit head Dr Rosnida Mohd Noh said the government should double efforts to increase the rate of second dose vaccination as it was seen as the best measure to strengthen immunity against the disease.
“To flatten the current infection curve, the most effective ‘medicine’ is vaccine. For safety, one dose is not enough; we need to have two doses.
“However, we also cannot assume that individuals with two doses of vaccine will not be infected. They can still be infected, only that in 88% of the cases they have no symptoms and in 96% they do not need hospitalisation,” she said.
The move will reduce the load on hospitals which are now at critical level following near-full capacity in intensive care units. — Bernama