By Ameen Kamal,
About a billion doses of Covid-19 vaccines candidates in late-stage clinical trials have been locked up by advanced purchase deals by higher-income countries.
With growing concern Malaysia would be left behind, Prime Minister Tan Sri Muhyiddin Yassin has recently ensured Malaysians would have access to Covid-19 vaccines. But access means both a secured supply, and ability for vaccines to reach the people.
So far, no confirmed deals have been announced. Of course, Malaysian authorities would firstly need to investigate data on safety and efficacy, costs, speed of availability and other technical requirements, before negotiating towards a purchase agreement.
While these internal investigations are being carried out, Sinovac Biotech – a private Chinese company – reached an agreement to supply Indonesia with at least 40 million doses by March 2021. That could have covered 125% of Malaysia’s population of 32 million.
By the principle of herd immunity and through strategic prioritisation of different segments of society, Malaysia could initially go for lower volumes. Malaysia could prioritise front-liners and vulnerable segments of the population.
In addition to direct bilateral discussions, Malaysia must ensure it makes the best decision through other platforms such as Covax – a global Covid-19 vaccine allocation plan co-led by the World Health Organization (WHO).
Further information is required by the Malaysian authorities before making commitments, but with today’s (September 18) deadline, Malaysia must ensure it does not lose out in a global platform. According to the Financial Times, redesigning of the Covax facility to get wealthier nations to sign up has pushed the deadline from August 31 to today.
In relation to international dealings, Malaysia relies on ‘science-diplomacy’ for early and equitable vaccine access, therefore it has always reciprocated with equality in preference of countries, and have conducted these fair diplomatic negotiations early on. Therefore, outward projection in the media should reflect this, and not paint a skewed preference to any parties.
Of course, should any countries or companies show any discrimination in vaccine supply, Malaysia will have no choice but to look elsewhere.
A lot of resources go into vaccine development and production. These companies need to be incentivised financially and through regulatory protection. But at least, for cases of worldwide pandemic or a national health crisis, the moral high-ground should prevail and vaccine makers should not be pushed hard between equitable access to vaccines and satisfying hardcore capitalist investors or shareholders.
Some exemplary companies have announced more altruistic pricing decisions such as “no profit during the pandemic”, while others range from a “marginal profit”, vague indications such as “appropriate return”, and aligning with the price of vaccines for similar indications.
Despite uncertainties in pricing, Malaysia’s leadership made the right move to consider making vaccines free for all Malaysians. Although this has yet to be approved, the move should be applauded and supported.
But securing vaccines is only the first part of the problem. Logistical issues may pose a considerable challenge for a nation-wide roll-out.
According to Minister of Science, Technology, and Innovation (Mosti) Khairy Jamaluddin, initial discussions with Pharmaniaga and Duopharma showed there will be “minimal investment” needed to set up fill-finish processing lines.
In the pharmaceutical industry, fill-finish is the process of filling vials or syringes with vaccine and finishing the process of packaging the medicine for distribution. Many vaccine manufacturers use third parties to fill and finish their vaccines.
Malaysian authorities don’t know yet when and which type of vaccine it would procure and the wide-range of vaccine types means the equipment and processes to fill-finish may significantly differ.
In any case, this requires a close cooperation between industry and the government early on to familiarise with testing and approval of equipment for the finished vaccine.
Additionally, Malaysia has to ensure efforts to prevent materials shortage for fill-finish and readying of distribution chains are conducted soonest to avoid unexpected hiccups in vaccine dissemination. With countries scrambling to secure vaccines in advanced, expect the related supply chains may also be monopolised early on.
According to author Kyle Blankenship, there are vaccines candidates reportedly requiring temperatures of -70 degrees Celsius for longer-term storage (colder than average annual temperature in Antartica), and at refrigerated temperatures for up to two days.
Such operating parameters would limit vaccination to be conducted at sites with specialised equipment, by trained personnel and for a very limited duration per vaccination event. It may take a while to cover a significant portion of the population under such constraints.
According to researchers from the University of Texas, the fill-finish process, storage, distribution and other operational costs can incur significant costs on top of the vaccine price. The cold-chain supply network requires close monitoring of temperature during the transport, storage, and to the point of vaccine use.
Thus, it is evident that purchasing very different types of vaccines could impose a significant logistical challenge.
Assuming the above-mentioned hurdles were tackled, the final hurdle comes from the rise of anti-vaccination (“anti-vaxxers”) amongst the people.
According to some analysts, there has been an increasing media reports on vaccine refusal. This is further substantiated by a recent global survey conducted by Ipsos from July 24 to August 7 whereby only 35 per cent of Malaysians strongly agree in getting vaccinated while a substantial 15 per cent disagrees.
This could translate into a significant unvaccinated population, threatening herd immunity and causing the virus spread again.
Public awareness and acceptance are important for nationwide vaccination. Hence, authorities must engage the public to address the root-causes of anti-vaxxers movement such as past public health crises, religious perspectives of prohibited substances, influence of fake news and disinformation on vaccines through social media, concerns on effectiveness, and potential side effects.
Should awareness prove insufficient, mandatory Covid-19 vaccination could be considered under the premise of national security, with its enforcement in balanced consideration of human rights.
Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.