The Academy of Medicine of Malaysia, its Colleges, Chapters as well as other medical organizations listed below congratulate the Ministry of Health (MOH), Ministry of Science, Technology and Innovation (MOSTI) and the government for a successful launch of the National COVID-19 Immunization Plan. We are encouraged to see our colleagues on the frontlines get vaccinated as they continue to protect and serve Malaysians

We also welcome the government's decision to include pregnant and breastfeeding mothers as well as immunocompromised people, namely cancer patients, in the immunization plan (as announced on 1 March 2021). Both pregnant women and those with immunosuppression—i.e. people who have weakened immune systems and reduced ability to fight off infection—are at high risk of severe illness from COVID-19.

The World Health Organization (WHO) stated that 1 in 4 babies born to women with COVID-19 were premature. Pregnant women are also more likely to end up in intensive care, if only as a precaution and for additional monitoring. Separately, a study in the United States found that the mortality rate among cancer patients with COVID-19 was 25.6%, compared to the overall case mortality rate of 1.8%. So, it is imperative that this vulnerable population obtain the vaccine alongside others with comorbidities.

We recognize that there is some hesitancy due to the limited research on the efficacy of the vaccine on pregnant women and those with immunosuppression. However, existing studies show that the COVID-19 vaccine can still offer protection to these populations. The WHO, UK Scientific Advisory Group of Experts on Immunization and US Center for Disease Control have all concluded that the known and potential benefits of vaccinating pregnant and immunosuppressed people outweigh the known and potential risks. In fact, both the US and UK have identified cancer patients, including those undergoing chemotherapy and treatment, as priority groups for the vaccine, subject to the advice of their treating physicians. The US has also prioritized vaccinating pregnant women alongside those with underlying medical conditions.

We support the government's decision to take a similarly inclusive approach here in Malaysia. As immunosuppressed people come in variable diagnoses and conditions, each individual's medical team should conduct risk-benefit assessments which include the best time and treatment plan that will empower them to get vaccinated. There must be adequate communication and coordination with community stakeholders, from medical specialists to community clinics and care homes, to ensure that all immunosuppressed groups can make informed decisions based on their situation.

Regarding people living with HIV, who are also an immunosuppressed group, we stand with UNAIDS, the Malaysian AIDS Council and Malaysian Society for HIV Medicine in urging the government to allow all PLHIV to get the COVID-19 vaccine, regardless of their CD4 count or viral load. The science states that all types of COVID-19 vaccines are safe for PLHIV and while it may not induce a full immune response, some protection is better than none. The exclusion of some PLHIV in the national immunization program also risks further stigmatizing an already vulnerable population.

Finally, we urge the government to clarify where these vulnerable groups fall on the priority list in the National COVID-19 Immunization Plan. The vaccine registration process in the MySejahtera app does little to inform pregnant women and immunosuppressed patients of their risk status. It also falls short of providing resources for educating those with comorbidities on the COVID-19 vaccine as it relates to their condition. We urge the government to provide necessary updates to the app that will allow patients to empower themselves with the information and resources to get vaccinated according to their risk group.

The consensus within the medical community is clear: The known benefits of vaccinating pregnant and immunosuppressed people dwarf potential risks. Malaysia's immunization strategy must be inclusive and empower high-risk, vulnerable groups with the information to make good decisions. The national immunization plan must fully embody its motto: Lindungi diri, lindungi semua as a pandemic somewhere is a pandemic everywhere.

We, the Undersigned:

Academy of Medicine of Malaysia

Chapter of Breast and Endocrine, CoS

Chapter of Oncology, CoR & Malaysian Oncological Society

College of Anaesthesiologists

College of Dental Specialists

College of Emergency Physicians

College of Obstetricians and Gynaecologists

College of Ophthalmologists

College of Paediatrics

College of Pathologists

College of Public Health Medicine

College of Radiology

College of Surgeons

Malaysian Association of Rehabilitation Physicians

Malaysian Society of Haematology

Malaysian Urological Foundation

University of Malaya Cancer Research Institute