A PRICKLY SUBJECT

The Government’s move to the 6-in-1 combination vaccine for children has put the topic of vaccinations in the spotlight. IMU Healthcare’s Consultant Paediatrician, Associate Prof Dr Erwin Khoo shares how he thinks this will benefit the community more than one way.

No one likes injections.

Whether your child is an all-out bawler with tears streaming down his or her face or a silent sufferer who puts on a brave front, children will undoubtedly feel some form of anxiety when faced with the prospect of an injection.

Yet that shiny needle is a must to administer vaccines that help to protect and save lives. The first two years of a child’s life are a time when they are exceptionally vulnerable, and it is during this time, doctors work hard to ensure that every child is immunised against the diseases that used to plague the world.

Malaysia recently announced that our public healthcare system was moving away from a 5-in-1 combination vaccine to a 6-in-1 combination which included Hepatitis B in the mix (which used to be given as a separate course). Previously the 5-in-1 combination covered diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenza type b

What this translates to, in practical terms, is that protecting your child against all six diseases will now require only five injections instead of seven.

“The 5-in-1 vaccine came in three doses plus a booster shot. Alongside it, children would also need to take the Hepatitis B vaccine in a series of three shots. That was a total of seven shots. However, the 6-in-1 is a series of five jabs that gets you covered for all the six diseases,” explains Dr Khoo.

This transition is not one that comes out of the blue. The Government’s National Immunisation Programme (NIP), which has been in place since the 1950s, has regularly gone through such changes to keep it updated and in line with the latest medical advancements. For example, the NIP was using a 3-in-1 vaccine, which then progressed to the 5-in-1 in 2008.

“Private healthcare has been using the 6-in-1 vaccine since 2013, and 49 countries have adopted it into their respective public healthcare systems,” Dr Khoo says. Dr Khoo also assures that as technology advances, so do the efficacy of the vaccines: “All vaccines go through rigorous clinical trials to ensure their efficacy.”

The change might not seem like a big deal to some. “The health benefits or coverage of taking two separate injections compared to a combined vaccine is essentially the same—one doesn’t give you a better health coverage than the other,” Dr Khoo says. “However, the positive implications of such combination vaccines are really what falls outside the health benefits,” he explains.

For many parents, a trip to the doctor requires taking time off from work and making extra travel arrangements that ultimately cost money. Those who are paid daily wages suffer the most when they must block off time to head to a clinic or hospital. Reducing the number of times children need to go in for a jab decreases the barriers that have tripped up many a struggling parent.

While the time and cost implications of this are apparent, the knock-on effect is even more substantial. Fewer trips mean less missed appointments, which means a lower fall out rate on vaccination schedules.

Diseases such as Hepatitis B can be fatal and is a dire condition to have. Still, it is a vaccine-preventable disease, and by making it easier to keep to the immunisation schedule, the gain in protection for children is manifold.

There have also been questions about the necessity of bombarding the body with so many vaccines at one time. An argument may be that separate injections, taken diligently, will still offer the same results. While this may be true, the benefit of combination vaccines is that, as Dr Khoo explains, the course of vaccinations is completed earlier. Therefore the child is protected from an earlier age. 

There are also far-reaching benefits on the flipside. Cutting down on the number of injections means that doctors and nurses can use the time to focus on other health developmental issues in children. As front liners, fewer injections also means a decreased risk of needle injuries and less hazardous waste.

“The transition is also an excellent opportunity for paediatricians to talk about vaccines—about its benefits as well as raise awareness of how science has changed medicine and healthcare,” Dr Khoo says.

Dr Erwin Khoo, Consultant Paediatrician, IMU Healthcare

This is especially useful to reach vaccine-hesitant parents.

“There are parents who are uninformed or misinformed, who may not be getting the right information or who rely on social media for information. Some are well-read who are not against vaccines but who are cautious and want to discuss the topic with their doctors,” he says.

In Malaysia, there is no law to mandate child immunisation. “There are countries that mandate vaccinations, but the question is not whether we should mandate vaccinations but how to impose such a law. How are we going to penalise parents? It’s not easy, and we do need to be cautious. Any such regulations should be practical and sustainable,” he says.

“Libertarians don’t oppose mandatory vaccinations, but they want to have a choice to make that decision. It’s their right, and that’s why education alongside verified information is so important,” he stresses.

It is a touchy subject but educating the public is something Dr Khoo is passionate about: “I strongly feel that it is not ethically right to judge or label any individual for his or her own beliefs. We see vaccine-hesitant parents and each person has the right to their own understanding, and it is often guided by their moral direction and information they receive.

“Parents want what’s best for their child. Most if not all want to know more and learn,” he adds, saying that the media plays a significant role in helping to disseminate the right information.

The 6-in-1 vaccine transition will be done gradually and will not affect those who are already receiving their jabs on the previous schedule. According to Dr Khoo, it will roll out according to the vaccine’s availability in the Government’s healthcare facilities.

Alongside this, the national pneumococcal conjugate vaccine (PCV) programme will be kicking off in December 2020. Those born from 1 Jan 2020 onwards will be entitled to the jabs at government hospitals and clinics.

This, Dr Khoo says, is all part of the Government’s initiative to ensure that children are given the best start in life. This child is the beneficiary of these vaccinations, who will be especially happy to have a couple of fewer jabs to endure.