What to expect with Covid-19 vaccines for kids ages 5 to 11...

‘Here’s what the science reveals about the safety of the Pfizer shot for this age group, the doses involved, and the role it will play in protecting everyone from the disease...

‘A recent Swedish study confirmed the value of this ring of protection: Families where one member is immunized have up to a 61 percent lower risk that others in the home will get COVID-19, while three or four immunized members gives more than a 90 percent reduction.

‘Inoculating children in an effort to protect others already happens in the U.S., Levy says. “Some say it’s not ethical to vaccinate kids for a disease that doesn’t affect them as much,” he says, but children are currently immunized against rubella when the main risk is to pregnant mothers, he points out.’

Read here (National Geographic, Oct 30, 2021)

Skin patch coated in Covid-19 vaccine may work better than injections

‘Covid-19 vaccines in use today have to be stored at cold temperatures, but a patch covered in tiny plastic spikes coated in a vaccine could provide an alternative...

‘A skin patch for administering covid-19 vaccines gives greater immune protection than traditional injections, according to a study in mice. The patch can be stored at room temperature and be self-administered, making it suitable for use in places that lack cold storage facilities and medical staff.

‘Although covid-19 vaccines are now widely available in many countries, they have to be transported and stored at cold temperatures. “We wanted to come up with an alternative that would be stable long enough to go that last mile, especially in resource-limited settings,” says David Muller at the University of Queensland in Brisbane, Australia.’

Read here (New Scientist, Oct 29, 2021)

Pfizer announces positive results for Covid-19 vaccine for children

‘Pfizer and BioNTech on September 20 announced positive results from a Phase 2/3 trial of their SARS-CoV-2 vaccine in children aged 5 to 11 years. The researchers found that a 2-dose regimen of 10µg doses administered 21 days apart demonstrated a favorable safety profile and robust neutralizing antibody response. The findings—which are neither published nor peer-reviewed—are a crucial step toward a SARS-CoV-2 vaccine becoming available for younger children, and the companies expect to submit an application to the US FDA for the vaccine’s authorization for that age group by the end of September. US regulators have issued warnings to the general public to wait for authorization before seeking vaccination for younger children, as the full adult dose of 30µg may put children at a higher risk for adverse side effects, including myocarditis.

‘The trial included nearly 2,300 children, and two-thirds of them in the vaccine group. The vaccinated children also were compared with a separate cohort of 16-25-year-old individuals who received the full adult course of the vaccine (2 doses of 30µg). The trial found that the neutralizing antibody response was similar between both vaccinated groups, with the neutralizing antibody levels within 5% of each other. Both groups also experienced similar post-vaccination adverse events.’

Read here (Pfizer news release) and here (Stat News, Sept 20, 2021)

The countries that are vaccinating children against Covid-19: As at mid September 2021

‘While many high-income nations, including the United States and most members of the European Union, now offer Covid vaccines for children 12 and older, a handful of countries have now authorized the shot for younger people. Meanwhile, severe vaccine inequality persists on a global level, with many developing nations continuing to struggle to provide first and second doses to high-risk groups -- with the very idea of getting shots to children still a pipe dream. Here's a global snapshot of where things stand.’

Read here (CNN, Sept 17, 2021)

Delta variant: Everything you need to know -- Tomas Pueyo

‘Delta is a deadly variant. It spreads like wildfire and kills efficiently. We need to be careful.

If you’re an individual

‘If you’re vaccinated, you’re mostly safe, especially with mRNA vaccines. Keep your guard up for now, avoid events that might become super-spreaders, but you don’t need to worry much more than that. If you’re not vaccinated though, this is a much more dangerous time than March 2020. The transmission rate is higher than it used to be, and if you catch Delta, you’re much more likely to die—or get Long COVID. You should be extra careful, only hang out with other vaccinated people, and avoid dangerous events.’

If you’re a community leader

‘If you’re in charge of a community, you have two goals:

1. ‘Vaccinate, vaccinate, vaccinate. The lives of your community depend on it. Any vaccine that works is better than none. If people are opting out, try to lure them in. Most are not anti-vaxxers, but rather they’re on the fence, or simply don’t see the benefit worth the cost. So change their calculation. Create lotteries. The Ohio one, among the first, probably didn’t work, but the cost is paltry compared to the cost of deaths and closing the economy this Fall.
2. ‘Keep Delta at bay as much as you can while vaccinations proceed. An elimination strategy will be best. Good border fences and test-trace-isolate programs are your best tools. Super-spreader events should still be avoided. Masks indoors and in crowds should be mandatory. Great ventilation is a must. 

‘However, if you have vaccinated everybody that wants to be vaccinated, and the rest simply doesn’t want to get vaccinated, then the calculation changes drastically. If your location values the freedom of its people to make the wrong decisions (as long as they don’t impact others), then you might consider opening up the economy. Delta will tear through those unvaccinated, but that’s their prerogative. Maybe the reality will hit better then.

‘But it really depends on each society. Opening up without full vaccination would infect some of those vaccinated, about 10% of them would get long COVID7, and about 0.3% of them would die8.

‘So here each society needs to decide. Say 40% don’t want to vaccinate. Is the freedom of 40% to not vaccinate worth the deaths and Long COVID of those vaccinated? Otherwise, are you willing to force people to vaccinate? Are you going to keep the country closed until there’s a booster vaccine? Will you be able to get your fences and test-trace-isolate programs to work?’

If you’re in charge of vaccine policy

‘An R0 of 8 is bad news for herd immunity. It puts its threshold at ~90% of people protected, which is impossible to reach if vaccines are only 65% protective of infection. Booster shots are necessary. Let’s accelerate their testing, approval, release, and deployment.

‘Also, support vaccine mix-and-match. In most countries, today, if you need a boost you are forced to take the same vaccine. But mixing types likely protects you better and is as safe as using the same type.’

If you’re in a developing country

‘We don’t pay enough attention to developing countries. Most of the science and media focuses where the money is, in developed economies. But Delta is very hard in developing countries, especially in dense urban areas where the poor are forced to work but live in close quarters with many others. India, Argentina, Tunisia, South Africa, and Indonesia are very sad examples of this. 

‘Unfortunately, there’s not many special tricks that poor countries can pull. They tend to have a younger population, which helps. The one thing they have going on for them is that they tend to be warmer and more humid, which helps against COVID. Also, thanks to a warmer weather, they can have more events outdoors. This is the one thing they can leverage: have as many of your gatherings outside, while you do everything you can to vaccinate your population, and delay as much as you can the arrival of Delta with strong fences. 

‘Let’s hope vaccine production keeps growing and people the world over can get vaccinated before the fall.’

Read here (Uncharted Waters, Aug 11, 2021)

Covid FAQ Summer 2021, Part 1: Tomas Pueyo

‘You shared the last article about the Delta Variant so much that nearly 400,000 people read it. Thanks for spreading the word on something so important. You also asked so many good questions that I have tried to answer as many as I could in this article. It’s so long that I split it in two pieces. This 1st piece covers these questions:

1. What’s the update on the Delta variant and cases worldwide?
2. Am I safe if I’m vaccinated? What activities can I go to? Why are there still cases in very vaccinated countries?
3. I’m vaxxed. Can I go to an indoor event if I get masked?
4. When will we leave this behind? when we’re all vaccinated?
5. Can vaccines stop the pandemic?
6. Do we know more about vaccine effectiveness?
7. Should vaccines be fractionalized?
8. Should I get a booster shot?
9. Should I mix-and-match?

Read here (Uncharted Territories, Aug 11, 2021)

Note: Part 2 is only premier, paid subscribers

Include migrant workers in Covid-19 vaccination or face disaster – P Gunasegaram

‘A decades-old problem studiously ignored by successive governments – despite so many articles written and questions raised in Parliament and elsewhere – is going to come back and bite us on our backsides as we desperately deal with increasing numbers of infections and deaths from the Covid-19 pandemic.

‘Unless and until the problem of migrants – specifically migrant workers, both documented and undocumented – is properly considered and included in any Covid-19 mitigation programme, things will continue to get worse even as more people are vaccinated. And there is no telling how long the problem will be around us.

‘The only way to overcome this major roadblock is to simply remove it and wholeheartedly include as many as six million migrant workers (which is about a third of the documented and undocumented workforce of an estimated 18 to 19 million) into the vaccination programme – the only workable solution right now to mitigate the pandemic and get back to some form of normalcy.’

Read here (The Vibes, July 29, 2021)

10 Covid-19 vaccine vexations to ponder on – P Gunasegaram

‘It’s a rather trying time for all of us, and many are the aspects of the pandemic in Malaysia that remain unanswered despite frequent questions from the public. Today, we will focus on 10 Covid-19 vaccination vexations. There are more, but the 10 main ones will do for now.

1. Why were we late to vaccinate people?
2. What will be the total cost of vaccination?
3. Is there a breakdown?
4. Are middlemen involved, and who are they?
5. Are mega vaccination centres necessary, how much do they cost, and are they sources of infection?
6. Are there alternative distribution channels, and why were they not used?
7. Are migrant workers being vaccinated?
8. What about undocumented workers?
9. Is there a black market for vaccines?
10. Why are people getting blank jabs?

Read here (The Vibes, July 22, 2021)

Should we vaccinate our children against Covid-19 in Malaysia? — Amar-Singh HSS

While we take every protective measure to prevent children from getting infected, we need to ask ourselves if we should consider vaccinating children against Covid-19. Some issues to consider the risk and the benefit are discussed below.

• How severe is Covid-19 in children? Will vaccines benefit children?
• Are Covid-19 vaccines safe to use in children?
• Are there benefits to the family and society?
• Remember that children cannot be a priority for vaccination until we first vaccinate all adults that are keen. This includes the elderly, those with chronic illness, younger adults who comprise our workforce and our migrant workers.
• What are other nations doing?

Summary

‘The pandemic impacts all of us, even those not infected. We will have to grapple with these issues as parents and a society as we decide about Covid-19 vaccination for children. How effectively we control the outbreak locally and the spread and impact of variants (mutations) will also determine our response and decision regarding this issue.

‘In Malaysia we have yet to make a serious impact on vaccination rates for those at high risk of severe illness and death (the elderly and those with chronic illnesses). No matter how much we want to support children, it is imperative that we push for those at highest risk to be vaccinated before we vaccinate children. In addition, it is vital to vaccinate young adults who are working and mobile as they are important drivers of the pandemic. However we should consider selectively vaccinating children with severe disabilities in residential care, especially if at high risk of exposure to Covid-19.

‘My personal preference would be not to subject our children to mass vaccination against Covid-19 however to control Covid-19 in the community we may have to vaccinate children aged 12-17 years. The recovery of our nation from Covid-19 means the recovery of our children from the severe mental strain that currently impacts them daily. Lives are currently being lived on a ‘pause button’ and vaccination is an important measure to return our society to a semblance of normality.’

Read here (The Malay Mail, June 6, 2021)

Wider vaccination, herd immunity vital to recovery — Moody's Analytics

‘A stronger push towards wider vaccination and herd immunity will be key to domestic recovery and should facilitate an economic rebound as emergence of new Covid-19 variants poses high risk, Moody's Analytics economist Sonia Zhu said. Malaysia's economy contracted by 0.5% year-on-year in the March quarter, following a 3.4% slump in the fourth quarter of 2020.

"Despite a gradual easing of gross domestic product (GDP) contractions, conditions will likely stay weak in the coming quarter due to the latest Movement Control Order (MCO)," she said in a statement today... "Hence, a stronger push towards wider vaccination is key," she said, adding that at present, only 3.4% of Malaysia's total population has received at least one dose of a vaccine.

‘The slow vaccination rate casts doubt on the ability to reach herd immunity target by the end of 2021, tilting the balance of risks to the downside for the subsequent quarter, opined Zhu.’

Read here (The Edge, May 14, 2021)

India's Covid-19 emergency: The Lancet proposes two strategies

‘India must now pursue a two-pronged strategy. First, the botched vaccination campaign must be rationalised and implemented with all due speed. There are two immediate bottlenecks to overcome: increasing vaccine supply (some of which should come from abroad) and setting up a distribution campaign that can cover not just urban but also rural and poorer citizens, who constitute more than 65% of the population (over 800 million people) but face a desperate scarcity of public health and primary care facilities. The government must work with local and primary health-care centres that know their communities and create an equitable distribution system for the vaccine.

‘Second, India must reduce SARS-CoV-2 transmission as much as possible while the vaccine is rolled out. As cases continue to mount, the government must publish accurate data in a timely manner, and forthrightly explain to the public what is happening and what is needed to bend the epidemic curve, including the possibility of a new federal lockdown. Genome sequencing needs to be expanded to better track, understand, and control emerging and more transmissible SARS-CoV-2 variants. Local governments have begun taking disease-containment measures, but the federal government has an essential role in explaining to the public the necessity of masking, social distancing, halting mass gatherings, voluntary quarantine, and testing. Modi's actions in attempting to stifle criticism and open discussion during the crisis are inexcusable.’

Read here (The Lancet, May 8, 2021)

Is the first come first served vaccine rollout scientifically and ethically right? — Dr Musa Mohd Nordin

‘This narrative may not go down very well with the many young Malaysians who have successfully secured their AstraZeneca-University Oxford (AZ) doses. It was a frantic scrambling by the tech savvy for the 268,000 doses of the AZ vaccine. All vaccine doses were snapped within a space of four hours. Now that they have jumped the queue, some of them have even begun to rationalize the legitimacy of the first come first served vaccine roll out!...

‘The risk of being admitted to hospital and of dying from COVID in a 70 year old is 1786 and 906 times respectively, when compared to the risk of suffering from a blood clot.

‘Thus my suggestion to prioritize the AZ vaccine rollout in the high infection rate states, namely Sarawak, Kelantan, KL and Selangor, with the first right of refusal to the groups at the highest risk of severe COVID disease and deaths, i.e. those above 60 years old. Only when these high-risk elders have been protected, then the AZ vaccine can be offered to others. This makes medical sense and it is the ethically right response, within the context of limited vaccine supplies and the presently known risk benefit analysis.’

Read here (The Malay Mail, May 5, 2021)

Are we losing the fight against Covid-19? – P Gunasegaram

‘With neither vaccinations to provide herd immunity nor control measures to reduce the infectivity rate, it looks like the government has indeed lost control of the fight against Covid 19, and we, the people, may have to pay the price.

‘There is a terribly urgent need to increase the vaccination rate. While this is being done, controls must be reimposed. It is a time for tough decisions, and one can only hope that this backdoor government will put politicking on the back-burner, and prioritise the last big battle against Covid-19 and minimise the damage.

‘To simply wait for vaccination to take its course and stop the pandemic may result in far too many casualties.’

Read here (The Vibes, Apr 20, 2021)

10 questions for Khairy on Covid-19 vaccinations: Ong Kian Ming & Kelvin Yii (April 16). Khairy replies on April 18

‘In the lead-up to the start of phase two of the National Covid-19 Vaccination Programme, there are many questions which need to be asked and hopefully answered. We commend the job which Coordinating Minister of the Covid-19 National Immunisation Programme Khairy Jamaluddin has carried out thus far under challenging circumstances. We hope that he can respond to the following 10 questions as phase two starts on April 19.

Read here (Malaysiakini, Apr 16, 2021)

Read Khairy’s reply here (The Vibes, Apr 18, 2021)

‘Tough decision’ in September on mandatory vaccination - Khairy Jamaluddin

‘Drastic measures including mandatory Covid-19 vaccinations are on the cards once Malaysia’s vaccination campaign reaches a “critical point” in September, said the campaign’s coordinating minister Khairy Jamaluddin. He said Malaysia will begin receiving an influx of vaccine deliveries in June, particularly from Pfizer and Sinovac, and supply will outpace demand in June or July.

‘By September, it is expected that vaccine administration rates will begin to slow not because of lack of vaccine doses or staff to administer it, but the lack of people willing to receive the vaccines. “So I told the cabinet that I'm going to come back in September and advise cabinet whether or not we go for mandatory vaccinations in September. That is going to be a big call.’

Read here (Malaysiakini, April 9, 2021)

The Covid-19 vaccine: Lessons and challenges

‘The rapid deployment of vaccines is key in accelerating the return to normalcy... As policymakers vaccinate their populations against an ever-changing COVID-19, they’re discovering numerous challenges along the way. In this episode of The McKinsey Podcast, McKinsey partners Lieven Van der Veken and Tania Zulu Holt share insights on progress and lessons learned so far, and how to help get the vaccine distributed as quickly and safely as possible. An edited transcript of their conversation follows.’

Listen here (McKinsey & Co, Apr 9, 2021)

Europe is lashing out like a wounded animal but its injuries are self-inflicted

‘As if banning the shipment of 250,000 AstraZeneca doses to Australia earlier this month didn’t set a bad enough precedent, the EU went even further on Wednesday by threatening to take over AstraZeneca’s factories and strip the company of its intellectual property rights unless the pharmaceutical giant delivered more doses over the coming months.

‘European Commission president Ursula von der Leyen has grounds to be upset: while Pfizer and Moderna have delivered on their first quarter commitments and pledged to deliver a combined 235 million doses in the second, AstraZeneca is dragging the chain. The firm will give the bloc only 100 million doses over the first six months of 2021 when the EU was expecting 270 million...

‘AstraZeneca certainly bears no blame for the week’s other baffling decision by some EU members to suspend the jab over unfounded safety fears.’

Read here (Sydney Morning Herald, Mar 19, 2021)

Covid-19: Only 0.11% of 300,000 vaccine recipients so far are govt officials, elected reps, says Khairy

‘Only 0.11% of the 300,000 Covid-19 vaccine recipients in Malaysia so far are government officials and elected representatives, says Khairy Jamaluddin. The coordinating minister of the National Covid-19 Immunisation Programme said the 0.11% constituted 302 people, while the rest are mostly healthcare workers.

“Based on the breakdown of the 292,104 people who have been vaccinated as of March 13, they comprise 23.86% nurses, 22.23% doctors and 23.4% other healthcare workers such as medical assistants, X-ray specialists and ambulance drivers. Another 21.33% are frontline workers from the armed forces, police, civil defence force, Rela (people’s volunteer corps) and Customs officers, among others. Another 5.62% are dentists while 3.45% are pharmacists.”

Read here (The Star, Mar 15, 2021)

Khairy: No charges for Covid-19 vaccination at private facilities

‘Individuals who get an appointment for Covid-19 vaccine injection at private hospitals or clinics involved in the National Covid-19 Immunisation Programme will not have to pay any charges, said National Covid-19 Immunisation Programme Coordinating Minister Khairy Jamaluddin. 

“The charges are borne by the government,” he told a press conference on developments involving the progamme here today. 

‘Elaborating, Khairy, who is Minister of Science, Technology and Innovation, said Covid-19 vaccination centres (PPV) are set based on the address registered by the individual through the MySejahtera application. 

“If the vaccination centre near the address given is a private hospital, then they will go to that private hospital. Everything is based on location because we want to facilitate this immunisation programme,” he said.

Read here (Malay Mail, Mar 15, 2021)

Home Ground: Ethical issues in Covid-19 vaccine roll-outs

‘A principled and pragmatic approach to securing and allocating Covid-19 vaccines works best... ‘Every vaccination programme carries with it ethical concerns over, among other things, safety, efficacy and how to distribute and allocate the vaccine when there are limited supplies...

‘A vaccine programme in the middle of a global pandemic is even trickier. On the one hand, speedy access to the vaccine can make the difference between life and death. On the other hand, the vaccines for Covid-19 are new and relatively untested: The world is learning of side effects as millions more get jabbed; and while we know the short-term efficacy, no one knows how long the protection lasts.

‘As Prof Lim said at the webinar, rolling out vaccination in the middle of a public health emergency is like chasing after a moving target. This requires constant monitoring and updating of rules and plans.’

This account also discusses, in the Singapore context: (1) The race to get hold of supplies (2) Who gets jabbed first and why (3) Why giving a choice of vaccine is not a good idea.

Read here (Straits Times, Mar 12, 2021)