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It has been exactly a month since Malaysia offered its very first COVID-19 vaccine shot, which is received by the prime minister Muhyiddin Yassin. At the time of writing, more than 200,000 frontliners in Malaysia have received a shot; and more than 5 million people in Malaysia have registered for vaccination on MySejahtera. (Source: jkjavmy)

Indeed, these are all wonderful news, but they are not good enough. To achieve herd immunity, we aim to vaccinate at least 80 percent of the population, which translates to 25.6 million Malaysians by February 2022. That’s an ambitious task!

In this article, we answer the question: does the brand of the COVID-19 vaccines matter? The short answer is: No, the brand does not matter. Even our PM has said it here. But if this answer does not satisfy you, do read on. You will understand why Malaysia procures certain vaccines brands and why the brand of COVID-19 vaccine actually doesn’t matter as much as you think it is.

Which brands are we getting in Malaysia?

As of February 2021, Malaysia has secured 66.7 million doses of COVID-19 vaccines through the COVAX Facility and advance purchases from five vaccine manufacturers. The five manufacturers which Malaysia procures/will be procuring the COVID-19 vaccines from are:

Pfizer-BioNTech from United States (Brand name: Comirnaty^®)
AstraZeneca from United Kingdom (direct procurement + COVAX facility purchase)
Sinovac from China
CanSinoBIO from China
Sputnik V from Russia

Source: https://www.facebook.com/jkjavmy/photos/117574060334149

The overall number of doses allows Malaysia to vaccinate 109.65% of the population – more than enough for us to go about. Among these five brands, those who have granted conditional approval by our own National Pharmaceutical Regulatory Agency (NPRA) are Pfizer-BioNTech, AstraZeneca and Sinovac*. On the other hand, Malaysia government is still in talks with Johnson & Johnson to procure its COVID-19 vaccines. Johnson & Johnson’s COVID-19 vaccine (a.k.a Janssen) poses an attraction to the governments worldwide as it only requires 1 dose. But as of now, we are stuck with five COVID-19 vaccines, and you can’t choose which brand to receive.

Source: https://www.vaksincovid.gov.my/pdf/Program_Imunisasi_COVID-19_Kebangsaan_Versi_Bahasa_Inggeris.pdf

*The Sinovac vaccine will be completing its fill-and-finish process by Pharmaniaga LifeScience Bhd in Malaysia. NPRA is still evaluating Pharmaniaga’s fill-and-finish facility and has yet to give the company approval to undergo the process.

What does vaccine efficacy really mean?

Different brands of COVID-19 vaccines have varying efficacies. Sure, no vaccine in the world is 100% efficacious, but the higher the efficacy the better, right? Well, the truth is much more complicated than that.

‘Efficacy’ may mean different things

We need to understand what these companies were actually measuring to come up with their efficacy numbers. For example, Pfizer-BioNTech’s vaccine is 95% efficacious, meaning that for vaccinated people, it was 95% efficacious in protecting people from getting COVID-19 symptoms. It does not mean that 95% of people vaccinated won’t get COVID-19 and 5% will. On the other hand, a preprint study of a phase three trial shows that AstraZeneca's vaccine is 76% efficacious at preventing COVID-19 after one dose. See the difference here? Efficacies may mean slightly different things and they need to be understood in the context of how the companies measure them and factors that could lead to such differences.

Different technologies

Firstly, these vaccines work differently. Pfizer-BioNTech uses mRNA technology; AstraZeneca uses viral vector; Sinovac uses inactivated virus, a more matured and older technology in vaccines. Because the vaccines use different ways to alert the immune system, the differing technologies could lead to varying degrees of efficacy.

Extracted from: https://www.vaksincovid.gov.my/pdf/Program_Imunisasi_COVID-19_Kebangsaan_Versi_Bahasa_Inggeris.pdf, page 13

Different study design

Secondly, when the vaccines manufacturers were running these trials, they were recording COVID-19 symptoms at different times after vaccination to see how well their shots could prevent disease. For example, Pfizer-BioNTech started recording symptoms 7 days after people received the second shot of its vaccine or placebo; the Russia’s vaccine Sputnik V, on the other hand, started recording symptoms 21 days after receiving the first dose of its vaccine or placebo.

Have the mutant variants arrived yet?

Thirdly, the vaccines were all tested at different times. That’s important because some companies had already completed initial testing of their vaccines before the emergence of the genetic variants of the virus—some of which are more infectious than the original. Pfizer-BioNTech** tested their vaccines through most of 2020, when SARS-CoV-2 had not mutated as much, so most of the study participants who were infected, were infected by the same viral strain. On February 7, South Africa halted its use of the AstraZeneca-Oxford vaccine after preliminary laboratory studies showed it does not provide good protection against the virus variant that is dominant in that country.

For all these reasons, comparing the vaccines is like comparing apples to oranges. We need to be careful not to get too hung up with the efficacy numbers. All COVID-19 vaccines have passed a certain standard of efficacy posed by the drug authorities in various countries and can provide protection against getting severely-ill or dying from COVID-19, which, ultimately, is what we’d want any vaccine to do.

**Lab study finds that Pfizer-BioNTech’s vaccine is effective against Mutations Found in U.K and South Africa Variants.

Safety profile of different brands

Comparing the efficacies between different brands of COVID-19 vaccine is just as difficult as comparing their side effects. Our very own National Pharmaceutical Regulatory Agency’s (NPRA) is constantly monitoring the safety profile of all COVID-19 vaccines administered in Malaysia. Prior to its use, every COVID-19 vaccine brand in Malaysia goes through a rigorous testing by NPRA to ensure it is safe and effective, before a conditional approval can be granted to the vaccine.

Recently, eight countries in Europe have suspended use of AstraZeneca’s vaccine as a precautionary measure while a full investigation is ongoing into reports of blood clots in people who received the vaccine, including one case in Denmark where a person died. It is important to note it has yet to be confirmed that such adverse events are caused by the vaccine itself.

How Malaysia procures COVID-19 vaccines?

Have you ever wondered why Malaysia establishes a portfolio of five COVID-19 vaccines, instead of just buying one brand? If you have an investment portfolio of your own, you would understand the rationale behind it. Such diversification of vaccine procurement options allows us to be less dependent on a single source of vaccine supply. For instance, if Pfizer-BioNTech delays their shipments due to logistical reasons, instead of halting our immunisation campaign, we can continue administering Sinovac’s vaccines while waiting for Pfizer-BioNTech’s vaccines to arrive. Time is key in fighting a global pandemic.

Also, since the virus is likely to mutate over time, having multiple brands better prepare us for genetic variants. If we only rely on a single brand, and that brand doesn’t work against the mutants, we are doomed. Having different brands of COVID-19 vaccines also protects Malaysia from being held hostage by one company or to geopolitical rivalry. (Source: Dr Khor SK’s twitter)

Negotiations with COVID-19 vaccine manufacturers looked at not only the technical aspects such as durability, development, methods, stability, contraindications, population target, safety, effectiveness, dosage, registration and access, but also the commercial aspects of the vaccine such as pricing, refunds, delivery schedule, advance payment as well as logistics.

Buying vaccines for a country is not an easy job. We have the Special Committee for Ensuring Access to COVID-19 Vaccine Supply (JKJAV) to thank for that.

Herd immunity is the goal

We can get into the nitty-gritty of every single COVID-19 vaccine brand all we want, but ultimately, we need to be reminded that the goal of any vaccination effort is to achieve herd immunity. Herd immunity against COVID-19 not only protects the population, most importantly it protects vulnerable individuals who cannot receive COVID-19 vaccines. Read more about herd immunity here.

If we focus on this goal, we would realize that the brand of COVID-19 vaccine really doesn’t matter at all, because any brand of the COVID-19 vaccines will help us to achieve herd immunity, but only if 80% of the Malaysian’s population decide to receive it.

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A word from Doc2Us

If you have any enquiries related to COVID-19 and its vaccines, you can consult our COVID-19 Task Force, which consists of professional doctors and healthcare professionals, for FREE!

You can access to free COVID-19 virtual health advisory by downloading the Doc2Us app on http://onelink.to/doc2us or use our web chat https://web.doc2us.com/

For more information about Covid-19 vaccination programme in Malaysia, visit https://www.vaksincovid.gov.my/

Disclaimer: COVID-19 is a novel disease. The information and scientific evidence of its development and vaccines are changing as we speak. Some content of this article may be outdated in the future. We encourage you to always speak with a healthcare professional you trust for the latest updates on COVID-19 and its vaccines.

References

Cover image credit: Hakan Nural on Unsplash

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Which brands are we getting in Malaysia?