Editor’s Note:  This article first appeared in The MalayMail Online on 25th October 2016

Think tanks: Dengue Vaccine can save half of Malaysia’s RM735m dengue cost

PETALING JAYA, Oct 25 ― Two think tanks argue that Malaysia can half the estimated US$175.7 million (RM735.3 million) economic burden of dengue if it approves a vaccine.

Philip Stevens, director of UK-based public policy research organisation Geneva Network, pointed out that dengue cases have been rising in Malaysia, which shows that fogging and larvicide are not working.

“The vaccine could reduce the economic burden,” Stevens told Malay Mail Online in an interview here.

He added that although he estimated at least 50 per cent savings if the dengue vaccine is used in Malaysia, he could not give exact figures because it’s unknown how much the vaccine would be priced here.

Stevens cited a 2015 study by Universiti Malaya, the Health Ministry and US-based Brandeis University that estimated the cost of dengue in Malaysia at US$175.7 million a year, comprising the cost of illness (medical costs and productivity loss from illness and death) and the cost of prevention activities, mostly fogging.

The study had found that Malaysia spent US$73.5 million, or 0.03 per cent of the country’s GDP, on its national dengue vector control programme in 2010, and cited a previous research which put the annual cost of dengue illness in Malaysia at US$102.2 million in 2009, totalling an estimated US$175.7 million.

Earlier this month, Singapore approved ― for people aged between 12 and 45 ― the use of Dengvaxia, the world’s first licensed dengue vaccine developed by Sanofi Pasteur that provides immunisation against all four virus strains.

It is also approved for use in nine other countries including Thailand, Indonesia, the Philippines, Brazil and Mexico, according to Singapore’s Channel News Asia.

Singapore’s Health Sciences Authority said that Dengvaxia had an efficacy rate of 60 per cent against dengue and 84 per cent against severe dengue, according to a review of 24 clinical studies run by French pharmaceutical company Sanofi, including two major trials in Asia and Latin America comprising over 35,000 participants.

However, Malaysia has yet to approve the dengue vaccine, purportedly for safety reasons, despite the rise of cases and deaths from the Aedes mosquito-borne disease.

Stevens cited Health Ministry statistics that showed an increase of dengue cases from 43,346 in 2013 to 120,836 last year, with deaths rising from 92 to 336 in the same period.

A total of 71,590 dengue cases were reported from January 1 to August 20 this year, Health Ministry director-general Datuk Dr Noor Hisham Abdullah reportedly said.

Stevens argued that vaccines are the most cost-effective public health intervention and said Putrajaya’s reluctance to approve the dengue vaccine was sending mixed signals to the business community.

“It sends a signal that innovative products are not welcome here,” he said.

Azrul Mohd Khalib, senior manager of external relations with IDEAS, says the government can concentrate the use of the vaccine in hotspots, Kuala Lumpur, October 22, 2016. ― Picture by Choo Choy May

Azrul Mohd Khalib, senior manager of external relations with IDEAS, says the government can concentrate the use of the vaccine in hotspots, Kuala Lumpur, October 22, 2016. ― Picture by Choo Choy May

Dengue vaccine can be concentrated in Klang Valley

Azrul Mohd Khalib, senior manager of external relations with local libertarian think tank, Institute for Democracy and Economic Affairs (IDEAS), said Malaysians have the right to make their own decisions to get immunised.

“The government is posing a barrier to people’s right to protect themselves,” Azrul said at the joint interview with Stevens, who is also an IDEAS Senior Fellow.

He said the dengue vaccine in the Philippines is priced at RM300 per person for all three doses.

Azrul added that Malaysians and private companies could pay to vaccinate themselves and their employees if the government could not afford to subsidise the vaccine.

“Also, the government can concentrate their efforts on concentrated epidemic areas, such as the Klang Valley where 60 per cent of cases are located. No need for a national vaccination programme to start with,” he said.

He also pointed out that Malaysia was involved two years ago in clinical trials for Dengvaxia and that the government had said it wanted Malaysia to be the first country to adopt the vaccine.

“Today, it’s very strange why Malaysia is attacking the results of the trial it participated in,” said Azrul. “We want the Ministry of Health to be more transparent.”

He also warned the government that it would be harder for Malaysia to negotiate a good deal for the vaccine with each year of delay.

“There is a worry that Malaysia is waiting for the perfect vaccine. Experts will tell you it’s very rare for 100 per cent efficacy,” said Azrul. “I don’t think we can afford to wait.”

Health Ministry has Malaysia dengue vaccine safety concerns

Health DG Dr Noor Hisham said the ministry still has concerns about Dengvaxia and is in the process of reviewing the vaccine, but did not give a timeline for the review process.

“It’s not the issue of perfect, but the issue of safety. Safety and perfect [are] not equal,” Dr Noor Hisham told Malay Mail Online.

He cited a September 2016 study by Johns Hopkins University, Imperial College London and the University of Florida that found that while the vaccine could reduce illness and hospitalisation by 20 to 30 per cent in dengue hotspots, they could be significantly increased if the vaccine is used in locations with lower transmission of the virus.

The study noted that Dengvaxia manufacturers have acknowledged that the vaccine doesn’t work well on those who haven’t been previously infected with dengue before vaccination.

The World Health Organization (WHO) has recommended that countries consider introducing the vaccine only in areas with a “high burden of disease.”

“Dengue vaccine introduction should be a part of a comprehensive dengue control strategy, including well-executed and sustained vector control, evidence-based best practices for clinical care for all patients with dengue illness, and strong dengue surveillance,” said WHO in its position paper.