MALAYSIA'S push for Covid-19 booster jabs has given rise to another wave of infodemic, hampering the government's efforts to contain the virus.
Various unsubstantiated claims and false information amid concerns over boosters have been making their way across social media and messaging platforms.
The New Sunday Times speaks with two prominent experts — epidemiologist Professor Datuk Dr Awang Bulgiba Awang Mahmud of Universiti Malaya, who is also the Science, Technology and Innovation Ministry's Covid-19 Epidemiological Analysis and Strategies Task Force chairman, and molecular virologist Dr Vinod Balasubramaniam of the Jeffrey Cheah School of Medicine and Health Sciences at Monash University Malaysia — to address some of these claims.
Claim: "The need for booster shots proves Covid-19 vaccines do not work."
Dr Awang Bulgiba: Covid-19 vaccines do work and they work especially well against severe disease, hospitalisation and death. There have been many publications that demonstrate this.
For people whose immune systems do not respond that well or are unlikely to have responded well to the first two doses, the third dose is important and they need to get it.
These include people who had organ transplants, just completed cancer treatment and the elderly, as the third dose boosts their antibody levels and provide additional protection.
Some scientists argue that perhaps the third dose has become necessary simply because the dosing interval of Covid-19 vaccines (as short as two to three weeks) does not allow optimal long-lasting immunity to build up, so a third dose would do just that. Such a short dosing interval was because of the necessity of getting optimal immunity quickly in people during a raging pandemic.
Claim: "People have died after receiving mixed vaccines."
Dr Vinod: Mix and match gained traction with the recently released data showing high efficacy and protection against various Covid strains.
Data suggest that two doses of vaccines give the fullest protection and teach the body to make antibodies and T cells (important component of our adaptive immunity) to block and kill the virus. The mRNA vaccines (Pfizer-BioNTech's Comirnaty is a messenger RNA vaccine) are really good at inducing antibody responses and the vector.
Mixing vaccines has also shown a better reactogenicity profile (physical manifestation of the inflammatory response to vaccination) when compared with giving the same brand of vaccines (fewer side effects). So far, there are no data to show from the (Health) ministry of mortality from mixing vaccines.
Claim: "Senior citizens are at risk of post-vaccination death, especially after getting their boosters." (This viral message has been linked to the Health Ministry's senior principal assistant director Dr Chai Koh Meow's death on Nov 17.)
Dr Vinod: Health director-general Tan Sri Dr Noor Hisham Abdullah, on Friday, dismissed the rumours. He said based on the post-mortem report, Dr Chai died from heart failure, namely hemopericardium due to coronary artery disease and myocardial infarction.
Health Minister Khairy Jamaluddin said there was no direct link between Covid-19 vaccines and deaths based on studies done by the ministry.
Claim: "People who received their booster jabs suffer from rashes, have unusual joint pain and other side effects."
Dr Awang Bulgiba: Evidence coming out of the United States Centers for Disease Control (and Prevention) suggests that the third dose of an mRNA vaccine causes the same kind of adverse events as the second dose and nothing unexpected has shown up so far.
Dr Vinod: All vaccines (not limited to Covid-19) will have after-effects. This ranges from mild to moderate fever, chills and rigor, body aches, swelling at injection site, loss of appetite and swelling of lymph nodes.
These are not long term, and a good sign that our body's immune system is put to work, producing antibodies against that particular antigen. Some of us have a more reactive immune system, where the after-effects are more prominent compared with others.
Sadly, this information is used by many irresponsible groups to introduce fear, confusion and misjudgment about vaccines, especially in Malaysia's elderly population.
Claim: "Pfizer's Comirnaty administration as the third dose causes myocarditis
(inflammation of the heart muscle)."
Dr Awang Bulgiba: The risk of myocarditis following any Pfizer dose is very low as can be seen from several scientific publications. Most of the myocarditis cases have been mild or moderate in severity. (Two studies from Israel quantify the risk of myocarditis following the Pfizer–BioNTech shot, with one suggesting that the chance of developing the condition is about one in 50,000.)
Claim: "Covid jabs lead to chronic diseases like paralysis, blindness, deafness, learning disabilities, cancer, brain injury and Alzheimer's."
Dr Awang Bulgiba: Mass Covid-19 vaccination has only been around for one year, so I do not know where this came from. There is insufficient data to suggest this.
Dr Vinod: There are no real-life evidence, medical report or findings to substantiate these claims.
Claim: "Why must people sign a waiver if the government is 100 per cent certain the vaccine is safe?" (A question that emerged following reports on the deaths of more than 500 people inoculated against the virus.)
Dr Awang Bulgiba: It is impossible to ensure 100 per cent protection against Covid-19 or against any disease.
Some people will always be more susceptible than others to severe diseases and develop breakthrough infections, and even deaths. This has been extensively studied.
Dr Vinod: This is a common procedure in any healthcare setting. It is the professional and legal responsibility of healthcare providers to obtain informed consent (permission either verbally or in writing) prior to immunisation. There is no evidence of a direct link between Covid-19 vaccines and the deaths of 535 people inoculated against the virus.
Claim: "There are inconsistent claims, lack of data and insufficient information from the government on the longevity of booster shots."
Dr Vinod: Booster doses should offer us protection for at least another six months to one year provided there are no newer strains capable of better evading antibodies produced from vaccines.
Claim: "The government has previously said booster shots are not for everyone, but that is not the case now. How many boosters will we need to stay protected — four, five, 10? Will there soon be a need for annual boosters?"
Dr Awang Bulgiba: There are ongoing debates on this in academic circles and the jury is still out on whether annual booster doses will be required. Whether we still need a fourth or more booster jabs is still being studied in several countries. Levels of antibodies will naturally decline over time.
Two things are not quite clear at this point —firstly, does vaccination result in sufficient B- memory cells which retain the memory to boost antibody production to a sufficient level when someone is infected by the SARS-CoV2 virus again? If sufficient memory cells exist to enable immediate production of sufficient levels of antibodies if someone is exposed to the SARS-CoV2 virus, then annual booster jabs may not be required.
Secondly, what is the level of T-cells in a person who has been vaccinated or who has been infected? The Independent Covid-19 Vaccination Advisory Committee, headed by me, recommended to the government in December last year to establish a Voluntary Covid-19 Vaccination Registry to follow up on volunteers for two years. Monitoring should include testing for neutralising antibodies, as well as B-cells and T-cells (CD4+, CD8+). This kind of data will inform us whether the B- and T-cell immunity lasts longer after the third dose and whether annual boosters will be required.
Claim: "The government did not allow for heterologous vaccines under the Covid-19 National Immunisation Programme (NIP). Why is it permitted now?"
Dr Awang Bulgiba: We needed to consider the evidence coming out on the heterologous prime-boost and heterologous booster dose.
Sooner or later, I thought this might happen as the antibody levels after vaccination with Sinovac have been shown to decline rapidly over time.
Dr Vinod: Although heterologous vaccines were approved in many countries, during the NIP, the clinical trials done worldwide were not extensive, and were very limited and ongoing.
We needed to know the overall effect (reactogenicity profile and efficacy data) from the trials done. It is evident now that mix and matching proves to be one of the best avenues in getting a robust protection against the Delta strain. This is the main reason — timing. No malice over this.
Claim: "Malaysians are being used as trial subjects. Sinovac has been proven to be ineffective which is why the government is offering Pfizer as boosters."
Dr Awang Bulgiba: Research suggests that the Sinovac vaccine does work to some extent, but it is clear from a comparison between an inactivated virus vaccine and mRNA vaccine that the antibody levels induced by the mRNA vaccine are higher.
There is, thus, the case for the heterologous booster as it has been shown that someone who has received an inactivated virus vaccine, like Sinovac, has a much better boost in antibody levels following a booster using an mRNA vaccine. This has been shown in studies done elsewhere, so I am not surprised that the government has done just that.
Dr Vinod: This is not the case. In the early stages, we needed to get our hands on the best available vaccines in the fastest time, when the mortality rates were high. Sinovac was one of the fastest vaccines we were able to procure, followed by Pfizer.
The Sinovac vaccine, although not perfect, gave a very decent protection (more than 50 per cent efficacy).
However, with emerging variants such as Alpha, Beta and Delta, the whole equation changes. The majority of the vaccines' efficacy is reduced. These vaccines were made at a time when there were no variants.
And all of the Covid-19 vaccines are made within a year of the pandemic, the data we get are in real time, we had to adapt to changes as we go.
The latest data prove that a third booster dose increases our vaccine efficacy back to more than 90 per cent and this is vital to fight against Delta.
Claim: "Covid vaccines are nearing expiry, hence the government is pushing for booster shots. Malaysia is clearing its existing Pfizer stock and its efficacy is doubtful."
Dr Vinod: The United States Food and Drug Administration (FDA) is the world's strictest and most trusted regulatory body in relation to drugs/ pharmaceuticals, including vaccines, and it has approved an amendment for Pfizer-BioNTech extending the expiration dates of the Covid-19 vaccine from six to nine months.
No changes have been made to the vaccine itself to enable the extension of expiry dating. Again, these are one of many conspiracy theories by irresponsible groups to spread misinformation on vaccines.
Claim: "Covid-19 is man-made and the virus was released into the environment so that these pharmaceutical companies can sell their vaccines and make money. Vaccine producers and governments are raking in profits by generating unnecessary fear and pushing for booster shots."
Dr Vinod: It is inevitable that vaccine producers will make money out of vaccines, booster shots included. This is simply because of the technology that they have and we don't.
We also do not make decisions based on our needs alone. Booster shots for all age groups were endorsed by the FDA and the CDC. This is necessary with data showing waning vaccine efficacy and lower protection against symptomatic/hospitalisation against Covid-19, more severe in vulnerable groups.
The government has also clearly showed the total costs of vaccine procurement and there is again no malice around it.
To combat fake news and misinformation, as well as allay public fears and concerns, Dr Awang Bulgiba stressed that the government must be transparent with data and analyses, and engage the public properly.
"One of the biggest problems with the country's pandemic management has been the poor crisis communication. This was brought about by poor, confusing and contradictory messaging.
"There has not been much engagement with behavioural and communication experts, and the situation has been worsened by the application of double standards leading to a distrust of official messages."
Dr Vinod urged the authorities to impose stricter punishment, and jail sentences, on fearmongers/groups who spread unfounded claims and theories.
"The authorities must monitor social media, the Internet and communication (systems) for false or fake news regarding vaccines.
"The government also needs to release national data on adverse effects/complaints from vaccinations and the outcomes, as well as the full data on alleged mortality from vaccines."