Will PH govt uphold pneumococcal vaccination pledge?

Baby and family

It has been more than a decade since calls were made to introduce pneumococcal vaccination (PCV) into the National Immunisation Programme (NIP), yet nothing concrete has come out of it.

But good news beckons if what insiders say is true – that the Pakatan Harapan government will fulfill its pledge in its manifesto before the 14th general election in May last year.

Erina Asmawani Abu Bakar, who lost her baby to pneumococcal on May 2, 2013, has not given up – she is still hoping that the Pakatan Harapan government will introduce the vaccination to keep its word.

Erina’s son Aqil Hamzah was one year three months old when he succumbed to the disease.

The tragic tale has been shared repeatedly over the years but Erina and her husband, IT executive Amir Fozy, are bent on ensuring their child’s death will open the eyes of those in power over the dire need for PCV. The couple has two daughters aged five and two. Aqil would have turned seven this year.

rina, Amir and Aqil Hamzah
Erina and Amir join Aqil, who was seven months old, in this 2012 picture.

“Hope is what we have. The fact that Pakatan Harapan made the pledge shows that they have heard our cries. The previous administration bluntly told us they just didn’t have the money to do it,” said Erina, 35.

Streptococcus pneumoniae is a bacterium that causes a number of common diseases, ranging from serious ones such as meningitis, septicaemia and pneumonia to milder but commoner infections such as sinusitis and otitis media.

According to the World Health Organisation (WHO), pneumococcal is a common cause of morbidity and mortality worldwide, though rates of disease and death are higher in developing countries with the majority of deaths occurring in sub-Saharan Africa and Asia. An estimated one million children die of pneumococcal disease every year.

The Department of Statistics, Malaysia revealed that in 2017, deaths caused by Ischaemic heart diseases was 13.9 per cent followed by pneumonia (12.7 per cent) while the principal cause of death in rural areas was pneumonia (13.4 per cent).

WHO recommends the inclusion of PCV in childhood immunisation programmes worldwide.

“But in Malaysia, we still have nurses at government clinics who don’t know what pneumococcal is. The lack of knowledge among medical personnel and the public in general is evident.”

“As we stay in Lembah Beringin, I got my two daughters vaccinated at a Klinik Desa and the nurses there didn’t know anything about pneumococcal or PCV. They just said whatever that is listed in their immunisation card is good enough. But my brother has been getting his children vaccinated at a private hospital and they have been getting a whole lot of shots – from PCV to rotavirus.

“People will then question … are private practices all out to make money by giving out a whole lot of vaccinations or is the list in the NIP not good enough? Only through education and awareness, will parents be able to make informed decisions and will then know the benefits of getting vaccinated, including for pneumococcal prevention.”

According to WHO, the pneumococcal vaccine had been introduced in 145 countries by the end of 2018. However, money, or rather the lack of it, has been the root cause why PCV is not listed in the NIP.

Besides the obvious health benefits and lowering the number of deaths, the extended economic benefits by making PCV compulsory include reduced education interruption, increase in productivity and increase in economic growth.

But these economic spillovers are not as direct as acquiring highways or building more affordable homes. The lack of political will and coming up with populist decisions also play a role, as evident over the years.

Policy makers within the Health Ministry face an uphill battle trying to find alternatives to raise funds as the current tax-based healthcare system is not helping to address the growing needs of a ballooning population. Equally frustrating their cause are ‘anti-vaxxers’ who continue to spread misconceptions about immunisation.

Pharmaceutical companies have also joined the race to get PCV into the NIP. Much effort has been made in recent times to convince the decision makers to adopt PCV, and in return score huge sales.

“We’ve been talking to them repeatedly and their answer has always been ‘we don’t have money’,” said a sales representative from a pharmaceutical company.

“All eyes are on the upcoming budget as we hope the Health Ministry will be given an allocation for PCV to be introduced.”

Another industry player said: “If money is the problem and it clearly is, perhaps the ministry could buy the vaccine in batches, targeting the B40 group first. Or perhaps the government can, for starters, offer tax exemptions to parents who vaccinate their children or allow parents to withdraw from their Employees Provident Fund (EPF) to give their kids the required shots.”

However, it is learnt that the Pakatan Harapan government could finally fulfill its pledge. Health Minister Datuk Seri  Dr Dzulkefly Ahmad, had in October last year, said he had put in a special request for the upcoming 2020 Budget which will be tabled on Oct 11 for pneumococcal vaccine to the tune of RM180 million (for a cohort (batch) of about 500,000 per year).

If true, will the government then invest in PCV13- or PCV10-covered serotypes?

While there seems to be insufficient evidence of a difference in the net impact of PCV13 and PCV10, WHO had in a paper (Pneumococcal conjugate vaccines in infants and children under 5 years of age: WHO position paper) published in February, said “PCV13 may have an additional benefit in settings where disease attributable to serotype 19A or serotype 6C is significant.”

Researchers Hannah C. McNeil, BSc Stuart C. Clarke and FRCPath, had in their paper ‘Serotype prevalence of Streptococcus pneumoniae in Malaysia – the need for carriage studies pointed out the most common serotypes in Malaysia were 19F, 14, 6B, 1 and 19A.

According to the report ‘Pneumococcal Conjugate Vaccine for Children Below Five Years Old‘ by the Health Ministry’s Health Technology Assessment Section, “PCV13 was predicted to provide a higher impact on severe invasive pneumococcal diseases (IPD) and community acquired pneumonia (CAP)” and that “PCV13 may be the choice to prevent death due to pneumococcal diseases in order to achieve Millenium Development Goal 4 (MDG4)”.

WHO had noted that once a PCV vaccination programme has been initiated, “product switching is not recommended unless there are substantial changes in the epidemiological or programmatic factors that determined the original choice of product, e.g. an increasing burden of serotype 19A.”

Erina is mindful of the many factors involved in listing PCV in the NIP.

“We understand that it’s not easy to spend so much money on PCV but perhaps the government can start by giving it out to a select group … the B40. From there, it can gradually increase the coverage.

“We hope it happens during the upcoming budget. But emphasis must also be placed on educating the masses about pneumococcal and other diseases related to the young.

“Whatever the case, we will not give up our hope to see PCV introduced in the NIP. It’s a cause that we will continue to fight … for Aqil and for all the children in Malaysia,” added Erina.