KUALA LUMPUR, Aug 23 —While Malaysia and the world racing to vaccinate their way towards herd immunity and restoring normalcy, infectious disease and epidemiology experts said that society should brace for life with Covid-19 at least for the medium term.

Malaysia has accelerated the National Covid-19 Immunisation Programme to vaccinate the entire adult population by October, but experts cautioned that this alone would not herald the end of the world-stopping pandemic given current circumstances.

They see existing safeguards like regular sanitisation, face masks, and physical distancing to remain for the foreseeable future, along with possible additions such as frequent testing and vaccine boosters even after so-called “herd immunity” is achieved.

Despite agreeing Malaysia was on the track to achieve herd immunity by the end of 2021 with the current vaccination rate, the experts predicted that 2022 would not yet resemble pre-pandemic times as Covid-19 and its variants would still not have been eradicated.

“The problem with herd immunity and Covid-19 is that, over time, many new [variants] have been detected, and the current vaccines are not 100 per cent efficacious in preventing transmission.

“The primary benefit of the immunisation programme will likely be to greatly reduce risk of hospitalisation and mortality,” Dr Sanjay Rampal, professor of epidemiology and public health medicine specialist at Universiti Malaya, told Malay Mail.

This view has been supported by recent Health Ministry data, which showed that over one in five new Covid-19 cases involved those with a history of vaccination.

As such, immunopathology specialist Prof Sibrandes Poppema said the prevalent view within the health community was that Covid-19 could become endemic, with outbreaks and epidemics occurring globally.

When asked if this meant Covid-19 might become like influenza, Poppema, who is also president of Sunway University, said it would eventually.

“However, in the first years there would still be many people with insufficient immunity and thus larger outbreaks than generally seen with influenza can be expected.

“In time, Covid-19 may also become like the other two endemic coronaviruses and be part of the yearly mix of viral colds,” he explained.

With breakthrough infections still a distinct possibility, Dr Sanjay said it was unrealistic to expect Covid-19 to be eliminated until there was both a low global incidence rate that was accompanied by effective and widespread vaccination.

However, Universiti Sains Malaysia (USM) virologist Professor Dr Yahya Mat Arip stressed that this did not diminish the importance of vaccination, saying that the success of such programmes was necessary to minimise the chances of Covid-19 mutations through new infections.

Each new infection gave SARS-CoV-2, the coronavirus that causes Covid-19, an opportunity to mutate into a new variant, which Dr Yahya said vaccination could reduce even if it could not eliminate.

Minimising the risk of new variants was also important to ensure that the vaccines currently available and being developed would continue to be effective against the coronavirus, he said.

“Eventually, the genome would stabilise and there would be a dominant variant,” he explained.

Over time, Covid-19 could become an endemic disease much like mumps, measles, and hepatitis that, while not completely eradicated, could be contained effectively through vaccination.

“As a virologist, I strongly believe that we can achieve herd immunity but, we have to remember we cannot prevent infections and the virus will always be present in our world. But, we can reduce significantly, if not completely, prevent the effect of the infection which is the disease,” he said.

Living with Covid-19

According to Prof Poh Chit Laa, head of Sunway University’s Centre for Virus and Vaccine Research, Malaysia and other countries must brace for sporadic and severe outbreaks of Covid-19 even after this pandemic ends, and compared it to influenza.

While not typical in Malaysia, influenza historically causes between three and five million cases annually, of which between 300,000 and 650,000 on average are fatal.

“Governments believe that as long as their countries have achieved 80 per cent herd immunity, it should be treated like flu with a few hundred thousand infections and few thousand deaths per year,” she said.

Other changes observed, said Poh and other experts, include how nations have already begun aligning their policies towards treating Covid-19 as an endemic.

The experts said preparations were already being made for possible booster vaccine doses, as well as semi-regular vaccination for high-risk groups such as the immunocompromised.

Poh said the supplementary doses would be especially critical for countries that rely heavily on tourism for revenue, noting that incoming tourists represented a heightened risk of importing a new variant of Covid-19.

Policy changes

Going forward, Dr Sanjay said future regulations should draw from the experience gained during these two years in order to ensure compliance with the preventive standard operating procedures.

He said these should be developed based on scientific evidence and focused on community empowerment, noting that the repeated interventions from the government so far have led to “pandemic fatigue”.

“Pandemic management that is authoritative and top-down will not get the necessary buy-in from the community for the long term; emphasis on policing, enforcement, and high unreasonable penalties rather than compassionate health-promoting approaches reinforce this disconnect with the community,” he said.

For Dr Yahya, it was also vital that health authorities keep reinforcing the pandemic management measures even after the country vaccinates 80 per cent of the total population, which was the target for “herd immunity”.

Systems for contact tracing, testing, quarantine must not be abandoned as it would leave the country exposed to renewed infection waves or new variants, he explained.

Dr Yahya said continuous monitoring of new cases must also be done to establish adequate epidemiological data.

“This epidemiological data is beneficial in terms of disease prevalence, so that early intervention is possible before the situation gets out of hand,” he said.

Poppema warned against complacency once herd immunity is reached, saying the consequences of doing so could already be seen in countries that were ahead of Malaysia in the vaccination race.

“Once we have reached herd immunity, we should remain careful, but as seen in Europe, human nature dictates that we will return pretty quickly to our previous behaviour. This is especially true for younger people,” he warned.

He added that continuous sequencing of new cases should also be prioritised to keep track and follow developments of new variants.

Additionally, Dr Yahya suggested that if financially feasible, a study to monitor levels of protective antibodies among the vaccinated population should be conducted as it would offer vital information towards achieving herd immunity.

“Despite all these things, we could still have a teh tarik season at a mamak in 2022,” he quipped.