Vaccines and COVID-19: Who should get it first

Dr Tharani Loganathan was interviewed by Ainaa Ahmad of FMT news regarding the issue of prioritisation of COVID-19 vaccinations in Malaysia. This interview was first published by FMT news on December 2, 2020 and was subsequently published by several other local dailies.

The following are the full transcript of the interview:

1) Are there any concerns with the vaccination and its prioritisation in terms of who will get it first?

Most vaccination programmes aim to vaccinate entire populations, thus achieving herd immunity. When a sufficiently large proportion of a population is vaccinated, infectious disease transmission is blocked, as contact between those who are infectious and those who are susceptible is greatly reduced. Herd immunity confers protection against infection among the unvaccinated, including those ineligible for vaccination.

The world is racing to develop and produce a safe and effective COVID-19 vaccine. The vaccine will be a scarce commodity, with nations rushing to procure enough for their populations. Even with many candidate vaccines in the race, it is unlikely that all Malaysians will be vaccinated in 2021. Difficult decisions will have to be made to ensure fair distribution of the COVID-19 vaccine.

It is crucial for Malaysia that two high priority groups are vaccinated first. First are the front liners, who due to their employment are at high risk of COVID-19 exposure.  Second are those high-risk individuals with co-morbidities and the elderly,  who are at risk of experiencing more severe disease, which may be fatal.

The allocation of vaccines must be fair and transparent. The government must have clear eligibility criteria, to ensure the vaccines reach target groups without leakage or wastage. Thus definitions of who is a front liner and who is at risk of severe COVID-19 infection and eligible for the vaccine must be clearly spelt out.

2) Are there concerns with the possible cost to the public?

The COVID-19 vaccine should be part of the National Immunisation Programme, thus be freely available to all Malaysian citizens according to eligibility.

The COVID-19 vaccination programme will be an expensive investment but a necessary one. As we know, COVID-19 has had a devastating impact on our economy and our lives in many ways. Thus, any cost-effectiveness analysis would have to include the societal costs of the pandemic including job loss and loss of schooling, as well as costs to the health system including the increase in COVID related and unrelated mortality and morbidity.

3) Should the government aim to vaccinate migrants, undocumented or otherwise, or refugees to help curb the pandemic.

Malaysia has a sizable migrant worker population, with 3-6 million documented and undocumented workers estimated. There are approximately 180,000 refugees and asylum seekers in Malaysia. This population of non-citizens in Malaysia are vulnerable to COVID-19 infection due to poor living and working conditions. Barriers to healthcare access for non-citizens make them unlikely to seek treatment early, putting themselves and the community around them at risk.

Non-citizens should be vaccinated because they are at high risk for infection and if not vaccinated will remain as a reservoir of the virus in our country.

Given that the COVID-19 vaccine when available will be a precious commodity, the government should prioritise the identified target groups. The responsibility to vaccinate migrant workers should be given to employers. When the vaccine is available for purchase in the private sector, employers should be required to vaccinate all their migrant workers. Vaccination certificates should be mandatory before return to work.

4) What would the difficulty be in doing so? If the health sector is already inaccessible to them how can we expect them to get immunised?

The difficulty would be the undocumented migrants who do not have the legal right for employment or stay in the country.

The government should offer undocumented migrants an amnesty and refrain from criminalizing immigration offences during this pandemic. Also, the government should offer a pathway towards regularization of undocumented migrants, allowing them to obtain temporary work permits, visas and health insurance. Giving an option for non-citizens to purchase health insurance will enable them to contribute towards financing their vaccination.

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