Under Budget 2020, RM60 million has been set aside to provide children free pneumococcal vaccination, with Deputy Health Minister Dr Lee Boon Chye saying the exercise will start in June.
While the allocation fulfils a promise by Pakatan Harapan in its 2018 election manifesto, will the people get the best that is out there or will the government decide based on cost, given the current global economic climate?
This question arises because besides the two known products in the market – PCV10 and PCV13 – there is a new kid on the block which is said to be cheaper but largely untested.
What was thought to be direct competition between Pfizer’s PCV13 and GlaxoSmithKline’s PCV10 has now turned into a three-way race through Pneumosil, a 10-valent pneumococcal conjugate vaccine.
Whispers along the corridors of the Health Ministry in Putrajaya are that certain individuals are smitten over Pneumosil. It fits the bill and the vaccination exercise can be easily ticked off the government’s to-do list.
According to the World Health Organisation (WHO), PCV10 and PCV13 are licensed for immunisation of infants and children from six weeks to five years of age against invasive disease, pneumonia and acute otitis media caused by the respective vaccine serotypes of S. pneumoniae.
PCV13 is additionally licensed for the prevention of pneumococcal disease in adults aged above 50.
The duopoly has been around for close to 20 years and there has always been a debate among researchers on which product is better.
In the Malaysian context, PCV13 seems the best choice based on a report – ‘Pneumococcal Conjugate Vaccine for Children Below Five Years Old‘ by the Health Ministry’s Health Technology Assessment Section.
The report says: “PCV13 is 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)”.
Coming back to Pneumosil, a product of the Serum Institute of India, a senior Indian official was last month quoted by The Indian Express, ahead of the approaching Union Budget, as saying: “There is currently an Indian manufacturer in the market but they are yet to get approvals for India. When that happens and how they price it will to a large extent decide the course of the PCV rollout.”
The outbreak of the novel coronavirus, known as Covid-19, may buy Malaysian decision makers some time as the priority is to contain the spread of the virus and treat patients.
But tenders need to be called soon or the Health Ministry could suffer the same fate as its counterparts in the Education Ministry who were eager to get rid of YTL Communication’s 1BestariNet last year.
Despite assuring teachers and students that new telco players will be absorbed into the system before the 2020 school session begins, no tenders have been called to date.
The clock is ticking and the June deadline to give out free pneumococcal shots is fast approaching.
Pneumosil received WHO’s prequalification December last year, but efforts to get it registered with the Drug Control Authority in Malaysia may not be a walk in the park.
“The documentation needs to be in place and it’s always easier if the product has been tested or used elsewhere. Here we are dealing with a whole new product,” said an insider.
“In the past, there were attempts to get Dengvaxia registered and when told that we could very well be the first nation to do so, the remark was ‘so what, why can’t Malaysia be the first country to use it’. Look what happened to Dengvaxia,” the source added.
The Philippines in 2016 became the first nation to use Dengvaxia but controversy arose after Sanofi disclosed a year later that it could worsen symptoms for people not previously infected by the dengue virus.
The disclosure sparked nationwide panic, with some parents alleging the vaccine killed their children and triggered a vaccine scare that the government said was a factor behind a measles outbreak that killed over 200 people last year.
The Department of Health (DOH) in the Philippines, meanwhile, will be investigated by the House of Representatives after the former had reportedly decided to suspend the bidding for the purchase of PCV13 and opted to invite suppliers to offer bids for PCV10.
It must be reminded that the pneumococcal vaccination was included in Malaysia’s National Immunisation Programme to protect the biggest stakeholders – children.
Cost should not be an issue as young Malaysians – regardless of creed, colour, background and family’s financial status – deserve the best. Vaccines are not a luxury. They are a necessity.
As such, it is best that the decision makers in Putrajaya call the right shots.
