The development of vaccines on a global scale is a priority to end the COVID-19 pandemic. Recently, there have been dramatic shifts in vaccine confidence around the world, threatening the implementation of approved COVID-19 vaccines in order to achieve an optimal herd immunity in the community.

With the aim to educate and build confidence among UTAR staff and students as well as the members of the public on the benefits of vaccination in general and COVID-19 vaccination in specific, UTAR Centre for Research on Communicable Diseases in collaboration with the Department of Soft Skills Competency (DSSC) of Sungai Long Campus successfully organised a public webinar titled, “COVID-19 Vaccine: To Vaccinate or not to Vaccinate?” on 19 February 2021 via ZOOM.

Supported by UTAR Faculty of Medicine and Health Sciences (FMHS), the two-hour insightful webinar was delivered by FMHS lecturer Dr Kang Waye Hann.

In order to enlighten the participants about the vaccine and how it affects an individual’s immune system once he or she gets vaccinated, Dr Kang kick-started his talk by explaining how a human’s immune system works. He defined, “Human’s immune system is specially designed to identify and destroy foreign organisms or pathogens from the body or neutralise the toxins that some bacteria produce. Hence, whenever the human body is exposed to harmful pathogens, our body develops an immune response to get rid of the invaders.” He further explained, “Among the responses are fever to elevate the body temperature to stop pathogens from breeding; vomiting, diarrhoea, sneezing and coughing to eject the pathogens out of your body; and other undesirable symptoms due to the immune response to the infection such as body aches, fatigue, nausea, etc. However, your body will also encounter very nasty bugs, which they can’t win the war, especially bugs that may cause severe infections and complications.”

He then proceeded to elucidate the participants on how a vaccine works in the body of the recipient. He expounded, “The immune system is the body’s natural defence against viruses, bacteria and other nasty stuff. However, viruses are especially good at developing disguises that help them hide from the immune system and this is why we need vaccines to help our bodies see through the act. Most vaccines contain a weakened or dead version of the virus they are meant to protect against, though some vaccines carry only the proteins found on the virus’s surface. In either case, once these substances are injected into the body, our immune system grabs them up and learns how to identify them, kind of like a cheat sheet that helps you prepare for a big test. Eventually, when the body comes into contact with the real virus it knows how to protect against it and can set to work gobbling up the viruses before they can do too much damage.”

The webinar also touched on the concept of herd immunity. Dr Kang used the infectious disease Polio to explain how they still have to get shots for polio, even though no one they know has gotten it. He said, “Vaccines act as a firewall that prevents the spread of diseases to others. When enough people develop resistance to a disease by getting a vaccine, the chance that a virus can infect someone and then keep spreading drops to near zero. This is how polio went from a disease that was infecting thousands of people in the past to one that caused few cases reported worldwide now. Certainly, the protection only continues if people continue to give their bodies a cheat sheet or vaccines to beat polio.” He added, “Vaccines provide herd immunity indirect protection for individuals who could not be vaccinated due to other reasons. There are various types of vaccines, categorised by the antigen (bacterial or viral material) used. This will determine how the vaccines are used, how they are stored, and how they are administered.”

Dr Kang also introduced the types of vaccines available. Among them are live attenuated vaccines meaning alive but weakened bacteria/virus; inactivated vaccine meaning dead bacteria or virus; subunit vaccine meaning pieces or parts of a bacteria or virus and toxoids meaning modified toxins that are harmless. He put forward, “There is little pre-existing immunity to SARS-CoV-2, hence everyone is prone to be infected. There is no established treatment for SARS-CoV-2 yet, like influenza therefore COVID-19 causes more severe diseases than influenza, with long term complications. COVID-19 may increase the risk of long-term health problems. Body systems and organs of an infected person of COVID-19 can be affected. The virus could affect the heart and bring damage to heart muscles, damage to the brain and nervous system, mental health issues, musculoskeletal and et cetera. Months after infection with SARS-CoC-2, some people would still be battling with crushing fatigue, lung damage and other symptoms of ‘long COVID’.”

Going deeper, Dr Kang also elucidated to the participants that in total there are three types of COVID-19 vaccines, namely mRNA, Viral Vector and Inactivated Virus. The three vaccines differed from each other by their main component and mechanism. He said, “The first vaccines mRNA stands for a messenger; RNA is a single-stranded RNA molecule that is complementary to one of the DNA strands of a gene. It forms viral proteins inside the host cells and stimulates an immune response. It is simple and easy to manufacture and no live component is involved. However, the mRNA vaccine requires strict storage requirements and unprecedented use. An example of an mRNA vaccine is Moderna Pfizer/BioNTech.”

“Meanwhile, Viral Vector vaccine is a harmless modified virus that contains viral genetic material. Its viral material stimulates human cells to produce proteins and stimulate an immune response. The vaccine is well-documented and it is more effective and adaptive to immune response. However, the vaccine requires a complex production process and needs to ensure the viral vector is 100% safe. Among the examples of Viral Vector vaccines are AstraZeneca — CanSino Biologics Johnson and Johnson's Sputnik V. On the other hand, Inactivated Virus vaccine consists of dead virus killed by heat, chemicals or radiation which will stimulate an immune response. It is also a type of vaccine which is well-documented, involve no live component, and suitable for patients with weaker immune systems. However, it is an expensive vaccine to produce and the one and only example is Sinovac.” 

Moving from the benefits that an individual could get from vaccination, Dr Kang also emphasised on the common side effects that one could get from vaccines. He said, “Just like any other medications, vaccines can cause side effects. These side effects can be caused by vaccine product-related such as antibiotics, stabilisers, preservatives, adjuvants and proteins; vaccine quality defect-related; immunisation error-related; immunisation anxiety-related; and coincidental event. Among the common and minor reactions include fever and malaise, which can be part of the immune response to the vaccine.” Dr Kang said that vaccines, just like other pharmaceutical products, undergo extensive testing and review for safety immunogenicity and efficacy in the laboratory, in animals and in three phases of clinical trials. Once they are proven to be effective, only then they will be submitted for approval to market. After vaccines are marketed, there will be post-licensure surveillance of vaccine safety to monitor adverse events associated with vaccine use.”

He added, “It takes almost 10 years and costs USD500million to produce an effective and safe vaccine. However, for COVID-19 the world can’t afford to wait. Hence, safety is ensured by investigating safety at every stage of vaccine development and post-trial monitoring. To date, no major side effects have been reported in phases One, Two, and Three of the clinical trials for vaccines such as Pfizer and Moderna. It is also proven that vaccines that use the mRNA platform are very effective but also reactogenic and likely to cause a noticeable immune response.”

In his talk, Dr Kang also explained how the COVID-19 vaccination will be implemented in Malaysia. He said, “The vaccination will be spearheaded by the Jawatankuasa Khas Jaminan Akses Bekalan Vaksin COVID-19. The project aims to vaccinate 109.65% of the population and free vaccination will be injected into volunteers. There are a total of three phases, Phase One (Feb-Apr 2021) for the first liners including public and private health care providers and essential service providers, Phase Two (Apr-Aug 2021) for remaining health care providers and essential service providers plus high-risk population such as elderlies above 65 years old and patients with chronic diseases and Phase Three (May 2021 - Feb 2022) for all volunteers above 18 years old, regardless of nationality; priority will be given to red zones followed by yellow and green zones.

As a conclusion, Dr Kang concluded, “Vaccination is essential in controlling the spread of infectious diseases. To date, COVID-19 vaccinations have shown to be safe and the enormous benefits of vaccination outweigh the small risks.”

The webinar ended with a successful live Q&A session. The insightful webinar attracted more than 269 participants on the ZOOM platform and more than 1,600 views on UTAR DSSC Facebook.

Dr Kang is currently a lecturer in the Department of Medicine, Faculty of Medicine and Health Sciences, UTAR. He graduated from UNIMAS in 2008 and obtained his MRCP in 2014. He had served in many places including Hospital Serdang, Hospital Kuala Lumpur and Hospital Kuala Pilah. He has just completed his training as a clinical endocrinologist in Hospital Universiti Kebangsaan Malaysia, and his research interests mainly include diabetes and testosterone. As a visiting consultant physician in Sungai Long Medical Center, he has managed several COVID-19 patients during his watch.