A similar pattern is emerging with pneumococcus. Serotype replacement is evident<\/a> in countries that have implemented pneumococcal national immunization programs, such as Canada and Australia.\u00a0<\/p>\n Their national pneumococcal surveillance datasets show an increasing trend in certain serotypes such as serotype 3, an initially untargeted serotype, because of serotype replacement following the introduction of these programmes.<\/p>\n Vaccine Immunogenicity: Better Value For Money<\/p>\n Consultant paediatrician Dr Musa Mohd Nordin explained that a vaccine \u201ctrains\u201d the immune system how to recognise and neutralise a pathogen (e.g. virus or bacteria) without causing the actual disease.<\/p>\n \u201cImmunogenicity is the measure of how well the vaccine \u2018trains\u2019 the body to produce an effective, robust and long lasting immune response.\u00a0<\/p>\n \u201cThis includes production of antibodies to neutralise the pathogen before it can cause an infection, activation of T-cells to search and destroy the infected cells to prevent replication, and generation of memory B and T cells to establish durable immune memory,\u201d Dr Musa told CodeBlue.<\/p>\n Thus, although vaccines may nominally provide protection against specific disease serotypes, it\u2019s important to also evaluate how much of an effective immune response it provokes. Evidence from Hong Kong provides a clear case study.\u00a0<\/p>\n Although Hong Kong selected a pneumococcal conjugate vaccine that nominally covers serotype 3, the latest report from Hong Kong\u2019s Centre for Health Protection<\/a> on invasive pneumococcal diseases indicate that serotype 3 was dominant (with a prevalence range of 59 per cent to 82 per cent) in the pre-pandemic period (2015-2022) and remained so after (2023 onwards) at 43 per cent prevalence.<\/p>\n Vaccines with lifelong or long-term protection were undoubtedly \u201cbetter value for money\u201d from a public health and economic perspective.<\/p>\n \u201cHealth economists use specific metrics e.g. cost savings, to measure a vaccine\u2019s \u2018value for money\u2019. The MMR<\/a> and DTaP vaccines<\/a> saved US$14 and US$27 for every US$1 invested respectively,\u201d said Dr Musa.<\/p>\n The paediatrician explained that two doses of the MMRV (measles, mumps, rubella, varicella) vaccine and five childhood doses of the DTaP (diphtheria, tetanus, pertussis) vaccine confer long-term protection with fewer doses, resulting in cost savings.<\/p>\n \u201cPublic health is also enhanced with improved population coverage due to better compliance and uptake,\u201d said Dr Musa.\u00a0<\/p>\n \u201cA higher population coverage would not only confer individual protection, but also community protection due to stronger herd immunity and fewer disease outbreaks. Persons who cannot be immunised due to various factors, e.g. too young, immunosuppressed, will be protected by this community immunity.\u201d<\/p>\n Life-Course Immunisation: A Lifelong Shield For All<\/p>\n Dr Zulkifli Ismail, a consultant paediatrician and paediatric cardiologist who runs the Immunise4Life programme, is a strong advocate of expanding the very concept of immunisation to cover an individual\u2019s entire lifespan, a strategy known as life-course immunisation.\u00a0<\/p>\n \u201cIt should protect the elderly especially since we will be an ageing population soon,\u201d he told CodeBlue.\u00a0<\/p>\n \u201cThe elderly should be allowed to age healthily and vaccination is one of the ways. The others are proper nutrition, healthy lifestyle and prevention of falls.\u201d<\/p>\n Prof Dr Tan Maw Pin \u2013 consultant geriatrician who is president of the Malaysian Society of Geriatric Medicine (MSGM) and member of Malaysian Influenza Working Group (MIWG) \u2013 pointed out that many vaccines are now extremely effective in preventing severe disease and hospitalisation in older persons.\u00a0<\/p>\n \u201cVaccination is now the best option to address congestion in our hospital systems and to combat antibiotic resistance, since if people don\u2019t get severe infection, they won\u2019t be given antibiotics and they won\u2019t be hospitalised. So yes, the government should consider a national immunisation programme for older adults,\u201d Dr Tan told CodeBlue.<\/p>\n \u201cHowever, it will take time to revise the system to make it possible to effectively fund as well as deliver vaccines to older adults. While we all recognise that change takes time, we must make sure that the system is going in the right direction towards the necessary change.\u201d<\/p>\n Dr Tan highlighted the government\u2019s extremely popular influenza vaccination programme for older adults with medical conditions, with only a small amount of vaccines left in public health clinics.<\/p>\n \u201cWe would like to urge any older persons with at least one medical condition to book their appointment through MySejahtera for the vaccine immediately before the stocks run out,\u201d she said.<\/p>\n A 2023 study by Nur Syazana Mad Tahir et al<\/a> estimated a total RM3.3 billion annual economic burden of influenza on older adults in Malaysia from direct health care costs, equivalent to 10.7 per cent of MOH\u2019s budget for 2020.\u00a0<\/p>\n
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