Send vaccines to people who want it, not the hesitant

 

From Concerned Citizens

Many argue that even though there is a vaccine roll-out, we aren’t seeing any improvement. This scientific-based write up will shed some light on the subject.

We must first understand that a vaccinated person can still contract Covid-19 and that vaccines simply reduce the severity of Covid-19 cases and deaths.

So when comparing the efficacy of vaccination, let’s focus on the number of deaths.

Also, we have to understand that a vaccine administered will require at least two weeks for some amount of immunity to kick in. The reason we hear of some people being severely infected three to seven days after immunisation is that they were infected before immunity kicked in.

We must also ask how many deaths is significant enough? Are five deaths a lot? The best way to do this is to compare the number of deaths to the number of cases. This is known as the case fatality rate.

National statistics

We cannot view statistics nationally until we achieve a proper herd/near herd immunity. This is because our vaccine distribution across the land is not equal.

Thus when we look at the data nationally we see this:

The blue line represents the number of Malaysians vaccinated with the first shot in a day from a 100,000 population. However, since immunity takes 14 days to kick in, those who were vaccinated on May 1 will have some amount of immunity only on May 14.

Due to the complexity of the graph above, the researchers decided to zero down the numbers – meaning May 1 vaccinations will be reflected on May 14 – so that we can directly compare if the fatalities are directly linked with the decrease in immunisation. With that in mind, the graph below was plotted (including the zeroed-down vaccination per 100,000)

We can see that every time there is a dip in the seven-day average vaccination rate, we see a rise in both daily case fatality rate (National CFR%) and the seven-day average case fatality rate.

But every time there is a dip in the vaccination rate, we see a rise in the seven-day average death cases and even after a ramp-up later, we see that the average baseline of deaths, though constant, keeps finding a new higher baseline. In view of this, we have to focus on states to see if this trend is indeed true.

State comparison

We decided to select a few states for comparison and decided to share the perspective of the size of the state (by population) and the CFR seen. We selected four states:

• Perak (a state that has been said to have a good vaccination roll-out programme)
• Selangor (a state that wants vaccines but can’t obtain them yet)
• Negeri Sembilan (a state that has been seeing a CFR increase)
• Kelantan (a state that has seen vaccine hesitancy)

Perak

We have read that Perak has been doing a fantastic job in the vaccine roll-out. But how does that reflect on the pandemic and numbers? We see a dip in the vaccination rate early in May, we see a daily spike in CFR and an increase in the seven-day CFR. When the vaccination strategy was ramped up, the seven-day CFR responded by lowering to a new level. However, every time there is a surge in vaccination and a dip, we find mortalities going up (especially the seven-day average) and hovering over a new baseline which is slightly higher than the previous one. So far, 18.96% of the registered population in Perak has been vaccinated and 35.32% of the population has registered to be vaccinated.

Conclusion: The lesson learned is that a ramping up of vaccination can reduce the CFR but if erratic, we will see a shift in the baseline of the deaths. This perhaps is due to the rampant spread during the low vaccination days, especially among the population that has yet to be vaccinated. We need to ramp up testing and keep them constant so that the baseline CFR doesn’t move up and claim more lives.

Selangor

We see that when there is a dip in the number of vaccinated people, the CFR and seven-day average react spontaneously to it. This is because the state of Selangor is highly dense. Any reduction in vaccination, especially on a day-to-day basis, will be highly reactive on the death total. Even a slight plateauing of the vaccination numbers sees a rise in the average CFR and with even a sudden surge in the vaccination at the end of May, we see that the seven-day CFR remains.

This shows that the only way we can keep the CFR low and constant with a hope of a dip is to constantly vaccinate at a high rate.

Conclusion: With great healthcare facilities setup and rampant testing, much can be done but it will still need the support of vaccination to suppress the number of deaths that we are witnessing. We need a constant supply of vaccines, especially in the highly populated areas. Vaccinations given erratically might take time to respond, especially on the CFR baseline. There are many people willing to be vaccinated, but the roll-out has been limited. This will eventually cause a problem in trying to achieve herd immunity, especially since the density of the state is high.

Negeri Sembilan

This is a state of concern. We can see that from day one, the roll-out of vaccines in the state has been rather poor. However, as it ramped up over time, the cases of fatality plateaued. After the dip towards the end of the month, the rise in CFR was prominent, especially the baseline shift. So far 16.19% of the registered population has been vaccinated.

Conclusion: Ramping up vaccination in smaller states is just as vital, as spread can be fast due to the limited area of stay (places of stay might be clumped in areas due to geographical reasons). But with the ramping up of vaccination, we see that the fatality rate can be controlled. However, constant vaccine delivery is needed.

Kelantan

From the graph below, we can see that the dip in vaccination rate sees a gradual increase in the CFR. But what is strange is that although towards the end there was a pick-up in vaccinations with a few dips, the CFR baseline seems to be shifting upwards. This could be due to the fact that there was a very low uptake of vaccinations in the state.

So far 23.63% of those registered have been vaccinated but only 23.49% of Kelantan’s population has registered. This shows that though we may ramp up vaccination, if there is inadequate uptake, we may still end up with many deaths as we cannot achieve the intended herd immunity.

Conclusion: It is pointless having many vaccines within the state if there is very poor uptake – the result will be similar as to not having vaccines. The distribution of vaccines must then be re-strategised to areas where people want to be vaccinated so that herd immunity can be achieved faster in these vaccine acceptance areas. Though it sounds selfish, it is the only way to ensure that areas willing to have the vaccine administered are given an equal fighting chance to exit the pandemic as soon as possible.

Final conclusion:

The situation and exit from this pandemic and MCO rely heavily on how fast we can mass vaccinate the community. From the plotting of the above graphs according to states with different predicaments, we see that vaccination is a potentially successful way out, but it has to be done carefully, with great caution and at a constant but high pace.

One of the ways to mitigate the vaccine administration is to provide vaccines to areas with a high number of registrations followed by lower areas (since our system is an opt-in instead of an opt-out).

This will reduce logistic issues and wastage in transporting vaccines to areas with a poor uptake. The idea is to focus on areas that want the vaccines as soon as possible. This includes the areas in our workforce such as factories and other areas of high spread.

One of the better ideas we have heard is to mass test during this MCO 3.0 and vaccinate if the person is negative. We achieve ring immunity faster that way. Until we achieve good immunity within our community, our testing and active case detection must not stop.

Though vaccination is deemed a silver bullet, we must realise that we must continue to practice all preventive measures so that we avoid another pandemic in the near future.

We sincerely believe that the vaccination rate can serve as a good predictive analysis for what is to come in the near future, especially with regard to the mitigation of Covid-19.

As we know that immunity kicks in within two weeks, we can prepare our healthcare facilities should the vaccination rate drop before herd immunity is achieved (due to some reason or another).

It is best that we avoid this by ensuring a constant rate of ramped-up testing. - FMT

*Results accurate up to June 3

The writers are FMT readers

The views expressed are those of the writers and do not necessarily reflect those of MMKtT.