By Professor Dato Dr. Adeeba Kamarulzaman / Professor Tan Sri Dr. Jemilah Mahmood

Two years ago on January 12, 2020, Chinese scientists shared the genomic sequence of the virus that was causing a large outbreak of severe pneumonia in Wuhan. This enabled the development of diagnostic PCR kits and a race to develop a vaccine.

On the back of decades of research in mRNA vaccine technology (Messenger RNA vaccines teach our cells how to make a protein that will trigger an immune response inside our bodies), two vaccines, (Pfizer-BioNTech and Moderna) were successfully developed, underwent large clinical trials and received emergency use authorization by the United State Federal Drug Administration by December 2020.

Since then, several more vaccines have been developed. To date 9.37 billion doses of vaccine have been administered globally. Just under four billion people or half of the world’s population have been vaccinated since December 2020.

In Malaysia, 59.8 million doses have been given, covering 78.6 percent of the total population. Almost 98 percent of adult population have received two doses of the vaccine.

With a concerted effort currently being made to achieve an equally high coverage of the booster dose to protect us against a potential Omicron surge, 35.4 percent of adults have received a third dose since October 2021.

Malaysia currently ranks among the top 20 countries in the world for vaccine coverage, including the booster dose. We should thank the Malaysian government, specifically the National COVID-19 Immunization Program (PICK) and the Ministry of Health (MOH) and recognize this extraordinary achievement.

Over the last 12 months since the global vaccine rollout, through intense scientific research and the most comprehensive vaccine safety monitoring in history, several important facts have been learned about the effectiveness and safety of these vaccines.

Fact 1: Covid vaccines save lives.

Local studies show that an unvaccinated person has a 40 times¹ greater chance of dying compared to a vaccinated person who has had two doses and 62 times² greater chance of dying compared to someone who has received a booster dose.

A recent European study estimated that 470,000 lives of those aged 65 years and older have been saved since the roll out of the vaccine program in Europe³.

Fact 2: The primary effect of the vaccine is to prevent severe disease, hospitalization and death.

Analysis of local data during the period of the Delta surge in Malaysia between July and October 2021 shows that the a reduction in the number of admissions to ICU and the a reduction in the number of new daily cases were achieved once the vaccine coverage reached 55 percent and 60 percent of the population respectively⁴.

This enabled loosening of restrictions and cessation of the movement control orders over the ensuing months across the nation and Malaysia entering Phase 1 of the National Recovery Plan.

Fact 3: Covid vaccines reduce the risk of transmitting the Delta variant.

People who receive two COVID-19 vaccines and later contract the Delta variant are less likely to infect their close contacts than are unvaccinated people with Delta⁵.

The Omicron variant, however, is estimated to be three to six times more infectious than previous variants and spreads more rapidly.

Although the Omicron variant has demonstrated some evasiveness against double dose vaccines, all vaccines still seem to provide a significant degree of protection against serious illness from Omicron, which is the most crucial goal.

With two vaccine doses, protection against severe disease drops to approximately 70 percent after three months and to 50 percent after six months.

Three months following a booster dose, protection against hospitalization among those aged 65 and over remains at about 90 percent⁶.

Fact 4: The Omicron variant is associated with breakthrough infections despite vaccinations.

Breakthrough infections after vaccines occur because no vaccine is 100% effective.

Even the measles, mumps and rubella (MMR) vaccine – one of the most powerful disease prevention tools we have – is only 96 percent effective against measles after two doses, while the seasonal flu vaccine is only 45 percent effective.

Despite this, the flu vaccine is estimated to prevent 130,000 flu deaths in the US alone each year.

Fact 5: Omicron causes milder symptoms and lower death rates than previous variants.

More evidence is emerging that the Omicron variant affects the upper respiratory tract, causing milder symptoms⁷ than previous variants and resulting in lower death rates being reported even in countries with very large numbers of cases.

Although Omicron may be associated with a milder form of disease, because it is highly contagious, the number of cases can grow exponentially with the risk of overwhelming the health system and already exhausted health care workforce.

Fact 6: Myocarditis following mRNA vaccines is rare.

Myocarditis following the mRNA vaccines is rare and estimated at 1-10 cases per one million vaccinated persons in multiple studies.

In comparison, myocarditis due to COVID-19 has been reported to occur in approximately 40 per one million cases of COVID-19.

In other words, myocarditis due to COVID-19 infection is more severe, more fatal and leads to greater permanent myocardial injury and occurs approximately 40 times higher than following an mRNA vaccine.

Evidence-based risk/benefit assessment shows that getting vaccinated is safer than running the risk of exposure to COVID- 19 acquired myocarditis⁹.

COVID-19 vaccines are being monitored for safety with the most comprehensive and intense vaccine safety monitoring program in history.

Fact 7: Pfizer-BioNTech vaccine is over 90 percent effective for children aged 5 to 11 years.

For children aged 5 to 11 years, the Pfizer-BioNTech vaccine is over 90 percent effective at preventing COVID-19.

Unvaccinated young children are at risk for prolonged post-COVID-19 conditions, hospitalization, multisystem inflammatory syndrome (MIS-C), or death.

The risk of vaccine-induced myocarditis is rare. 11 verified reports have been received after administration of approximately eight million vaccine doses among children aged 5-11 years in the United States.

Two deaths after Pfizer-BioNTech COVID-19 vaccine were reported for children with multiple chronic medical conditions.

On initial review, no data were found that would suggest a causal association between death and vaccination⁸.

Vaccinating children aged five years and older can protect the entire family, keep them in school and help slow the spread of COVID-19 in the community.

In conclusion, the scientific community, pharmaceutical and biotech companies supported by governments and philanthropists have delivered a modern scientific miracle: not one but multiple vaccines against COVID-19 in record time that have helped save millions of lives and returned the global and local economy to some semblance of normality.

However, the history of the COVID pandemic and in particular the vaccines will also be remembered for the widespread misinformation and disinformation that are contributing to significant levels of vaccine hesitancy all around the world.

Sadly, in Malaysia some of the biggest perpetrators of this misinformation and disinformation, using pseudoscientific analysis, are a few members of our medical fraternity.

We urge the public to continue to seek information on COVID-19 vaccines and treatment from reputable sites and organizations and not to fall for misinformation from unreliable sources.

References:

¹ Abdul Taib NA, Baha Raja D, Teo AKJ, Kamarulzaman A, William T, Hs AS, Mokhtar SA, Ting CY, Yap WA, Kim MCY, Edwin Amir L. Characterization of COVID-19 deaths by vaccination types and status in Malaysia between February and September 2021. Lancet Reg Health West Pac. 2022 Jan;18:100354.

² Real-World Evaluation of COVID-19 Vaccines Under the Malaysia National COVID-19 Immunization Program (RECoVaM). Ministry of Health Malaysia.

³ WHO/ECDC: Nearly half a million lives saved by COVID-19 vaccination in less than a year

⁴ Unpublished data. International Public Preparedness Center. NRP COVID-19 Report. Malaysia.

⁵ Eyre, D. W. et al. Preprint medRxiv: The impact of SARS-CoV-2 vaccination on Alpha & Delta variant transmission

⁶ UKHSA: Boosters continue to provide high levels of protection against severe disease from Omicron in older adults

⁷ Diamond M et al. The SARS-COV2 B.1.1.529 Omicron virus causes attenuated disease in mice and hamsters. Preprint. Nature portfolio.

⁸ Hause AM, Baggs J, Marquez P, et al. COVID-19 Vaccine Safety in Children Aged 5–11 Years — United States, November 3–December 19, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1755–1760.

⁹ Dr Musa Mohd Nordin: mRNA Vaccine-Associated Myocarditis are Rare and Less Severe Than Following COVID-19

(Professor Dato Dr. Adeeba Kamarulzaman, Universiti Malaya; Professor Tan Sri Dr. Jemilah Mahmood, Sunway University Malaysia.)