26-04-2025
Beyond Childhood: The Case For Lifelong Vaccination In Malaysia
By Dr Wong Chuan Loo
When most people think of vaccines, childhood immunisations — against measles, mumps or polio —often come to mind. However, in a rapidly aging Malaysia, where seniors are projected to outnumber children by 2050, immunisation must evolve into a lifelong public health strategy.
According to the United Nations Department of Economic and Social Affairs 2024, Malaysia is undergoing a significant demographic shift with profound implications for its healthcare system. This transition underscores the urgent need to strengthen preventative care measures, particularly through adult immunisation.
Malaysia's National Immunisation Programme (NIP), introduced in the 1950s as part of a maternal and child health initiative, currently offers free vaccines against 13 childhood diseases – more than double the original six recommended by the World Health Organization Expanded Programme on Immunisation. However, an additional seven recommended vaccines – covering illnesses such as chickenpox, dengue, COVID-19, hepatitis A, meningococcal disease, influenza and rotavirus – are only available at private healthcare facilities for a fee. This two-tiered system limits access for many adults, particularly the elderly.
Are Older Malaysians Being Left Behind?
While over 90% of Malaysian children are vaccinated against 13 diseases, adults and seniors remain vulnerable to various vaccine-preventable illnesses, such as influenza, pneumonia, and shingles. Influenza alone costs Malaysia RM3.3 billion annually in healthcare expenditures, primarily due to hospitalisations involving unvaccinated seniors. Meanwhile, cervical cancer remains the third-leading cause of cancer-related deaths among Malaysian women, despite the human papillomavirus (HPV) vaccine being free for teenage girls since 2010.
Demographic shifts pose additional challenges such as a shrinking workforce will struggle to support a growing elderly population, and a smaller tax base risks underfunding healthcare even as demand surges.
Globally, the COVID-19 pandemic exacerbated immunisation gaps. A joint report by GlaxoSmithKline plc (GSK) and IQVIA found that over 100 million adult vaccine doses were missed in 2021 and 2022 alone. Malaysia must urgently embrace a lifelong vaccination approach to bridge this gap and reduce future public health and economic burdens.
Why Lifelong Vaccination Matters
Vaccines are not only about preventing illness, but they also enable a better quality of life. In Malaysia, a modeling study found that implementing a national influenza immunisation programme for seniors could prevent over 66,000 influenza cases and more than 3,000 hospitalisations annually.
Among diabetics, flu shots reduce hospitalisation risk by 54%. Pneumococcal vaccines lower the risk of pneumonia by 41% in lung disease patients, and reduce mortality by 22% in adults with cardiovascular disease. Expanding HPV vaccination to include boys and men could accelerate progress toward eliminating cervical cancer altogether.
Despite the data, adult vaccination uptake remains low. A 2023 study found that while 47% of healthcare employees attributed sick leave to the flu, only 5% of seniors reported receiving the flu vaccine. The reasons are varied: Policy Gaps: Adult vaccines are not included under the NIP. HPV coverage for girls stands at 52%, compared to 96% in Indonesia. Access Barriers: Rural clinics face stockouts, while urban adults may delay vaccines due to mobility or time constraints. Vaccine Hesitancy: Myths surrounding vaccine safety, adverse effects, and halal compliance persist. Misinformation and Pseudoscience Belief: Social media amplifies harmful myths, including belief in 'homeopathic vaccines'. Healthcare Provider Gaps: Some healthcare practitioners lack training or willingness to advocate for adult vaccination, and may even perpetuate misinformation.
If unaddressed, these challenges could drive elderly healthcare costs in Malaysia to hit RM21 billion by 2040, with hospital admissions nearly double those of younger age groups.
Vaccines as a Lifelong Shield
To protect its aging population, Malaysia need a robust, cost-effective, and multi-pronged National Lifelong Vaccination Strategy that combines fiscal pragmatism with public trust. Key recommendations include: Universal Access: Expand the NIP to cover essential adult vaccines (influenza, pneumococcal, and HPV for all genders), leveraging 'sin taxes' on tobacco and sugary drinks or through public-private partnerships to subsidise vaccine dose costs. Transparency on Adverse Events: Launch a public-facing Adverse Events Following Immunisation (AEFI) dashboard to clarify facts and dispel myths. Electronic Immunisation Registry: Establish a centralised e-registry to track vaccination status and automate reminders for supplementary boosters. Public Awareness Campaigns: Train healthcare professionals to serve as vaccine advocates and collaborate with religious and community leaders to address halal concerns and misinformation. Corporate Accountability: Offer tax incentives for companies providing employee flu jabs as such programmes can save up to RM90.30 per worker annually in productivity gains.
As Malaysia approaches an aged population, vaccines must evolve from a childhood rite to a lifelong shield—an essential investment in national health, productivity, and resilience for every stage of life.
The author is a Lecturer at the School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University. Related
