Dr Khor SK Profile picture
Sep 23, 2020 7 tweets 4 min read Read on X
This week, I'll share some fun vaccine facts because 🇲🇾 joined COVAX.

Fact 2: there are ~10,000 diseases but only ~1500 treatments & ~30 vaccines.

How many diseases have been 100% eradicated by vaccines? Only one: smallpox, declared in 1980. (1/6)
~10,000 diseases? It's a rough number because “disease” could mean different things.

One resource is the International Classification of Disease 10th edition (ICD-10), managed by @WHO. It has ~70K codes!

Some are hilarious, like this pic. These are not diseases, of course.
Diseases can be infectious (eg tuberculosis, malaria or HIV/AIDS) or non-infectious (eg diabetes, cancer or asthma). Another term is “communicable”. Vaccines work against communicable diseases.

3 of the top 10 global causes of death are infectious, so it's a big problem.
~1500 cures/treatments? (Cure = 100% health. Treatment = trying to achieve a cure).

Using the US FDA as a guide, it has approved 1453 “new molecular entities” in its entire existence.

NMEs are completely new drugs, i.e. many companies make paracetamol, but it’s one NME.
There are >300 infectious diseases, but only ~30 vaccines. Why?
1. Vaccines are complex & expensive.
2. Bacteria & viruses mutate.
3. Many infectious diseases are tropical, which lacks capital & research capacity.

The last reason is the most important & controversial.
Despite ~30 vaccines, we’ve only eradicated smallpox. Why?
1. Eradication is possible only if everyone gets a vaccine.
2. Some germs have non-human hosts, like horses, cows or bats, so they can return.
3. No money or political will.

There's lots to do, & science is hard at work!

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More from @DrKhorSK

Jun 21, 2021
Q: Should we mix-and-match Covid vaccines?

A: Possibly, and data is increasing to support this policy.

A "mix-and-match" vaccines policy has increasing science behind it. The scientific term is "heterologous prime boost" (thelancet.com/journals/lance……, from Oxford).

1/4
Another recent study from Spain shows good results: nature.com/articles/d4158….

Many other countries are considering it in real-world practice: reuters.com/world/middle-e…

The concept of "mix-and-match vaccines" is not new, going as far back as 1992: ncbi.nlm.nih.gov/pmc/articles/P…

2/4
This @malaysiakini article has excellent information: malaysiakini.com/news/579479

Why do we need mix-and-match? Because supplies are low + we can reduce risk of side effects + it can stimulate a stronger immune response.

3/4
Read 4 tweets
Jan 20, 2021
🔺SURAT RUJUKAN🔺
Semasa saya bertugas sbg doktor, alat yg paling berkuasa bagi saya ialah Surat Rujukan.

Sejarah pesakit, pemeriksaan fizikal, ujian darah, MRI, ubat-ubatan dll memang penting. Tapi dlm pandangan saya, Surat Rujukan adalah lebih berkuasa.

Kenapa ye?
1/
Dua sebab penting:
🔺Saya tak mungkin tahu segala-gala ilmu & sains. Jadi, saya bergantung pada rakan sekerja yg lebih arif dlm bidang-bidang lain.
🔺Saya mungkin silap, jadi saya ingin kurangkan risiko itu.

Maka, Surat Rujukan akan menjaga kebajikan pesakit dgn lebih rapi.

2/
Mungkin saya pernah menulis beratus-ratus Surat Rujukan, spt kpd:
🔺Pakar jantung di Kuala Lumpur & Pulau Pinang
🔺Surat rujukan/sokongan utk Jabatan Kebajikan & badan zakat
🔺Rumah Seri Kenangan supaya mereka tahu keadaan fizikal seseorang warga emas yang baru sampai.

3/
Read 9 tweets
Jan 4, 2021
🔺“Doc, I don’t trust the Covid-19 vaccine because it’s too rushed. Normally, vaccines take 7-10 years.”🔺

Here is a thread to reassure you that the Covid-19 vaccine is as safe as possible, with only one year of effective & accelerated research.

1/15
Firstly, 7-10 years is not automatically safe. Most of it is spent waiting, not researching.

Scientists wait for money, for approvals by committees who meet twice a year, or for paperwork.

They also wait for patients to join their trials; this is a major wait.

2/15
Many things can change in those 7-10 years.

Scientists move to new jobs or they lose interest. Drug companies change leaders, who then change research agendas or marketing strategies.

You see, science has real-life problems like other companies too.

3/15
Read 16 tweets
Jan 3, 2021
A short story:
🔺A Funeral, Durians, SMEs & the Covid-19 Vaccines🔺

Had to organise a funeral (cause of death: lung cancer). Noticed dry ice being used.

Spoke with the undertaker, who told me that each dry ice brick is ~RM20, is -70 Celcius and lasts ~1-2 days.

1/5
Asked him about vaccine storage. He gave two ideas:
1. Ice-cream distributors have cold rooms reaching -20C.
2. Durian exporters to China use a freezing process reaching -80C.

Great ideas from a practical hands-on man!

2/5
This gentleman doesn’t have a degree, but he has decades of work experience & lots of common sense.

I told him that one Covid-19 vaccine requires -70C storage. He educated me that Siberia’s temperatures are “only” -60C, so human beings need to work hard to achieve -70C.

3/5
Read 6 tweets
Dec 27, 2020
BEBENANG: Mengapa 🇲🇾 tak boleh umumkan harga vaksin?

Situasi ini amat kompleks. Kita mesti mempertimbangkan hujah & realiti utk kedua-dua belah situasi ini.
🔺Bab 1: di LUAR kawalan kerajaan (Tweet 3-9)
🔺Bab 2. di DALAM kawalan kerajaan (10-16)
🔺Bab 3: ringkasan (17-18)

1/18
Pertama sekali, sedikit pengumuman:
1. Saya seorang perunding bebas.
2. Saya tak memiliki stok apa-apa sykt di mana-mana.
3. Saya bekerja di Pharma 8 tahun (2Y sbg Medical Manager di 🇸🇬 + 6Y sbg Ethics & Compliance Director di Dubai, Shanghai & Paris, utk EEMEA & China).

2/18
BAB 1: DI LUAR KAWALAN KERAJAAN

Sykt farmaseutikal (atau pharma) mempunyai 3 pelanggan utama:
1. Kerajaan (kementerian, hospital atau insurans kerajaan)
2. Entiti swasta (hospital swasta, pengedar atau ejen)
3. Organisasi global (@UNICEF membeli 2 bilion dos vaksin/tahun).

3/18
Read 19 tweets
Dec 26, 2020
BEBENANG: 6 SEBAB mengapa 🇲🇾 perlukan portfolio vaksin drpd pelbagai syarikat, bukan drpd satu sykt sahaja:

1. Tiada sykt yg mampu bekalkan segala keperluan vaksin 🇲🇾. Kalaupun wujud, mesti setiap negara akan bersaing, & kita masih tak mampu bersaing dgn negara kaya.

1/12
2. Bahaya kalau kita bergantung pada satu sykt saja.

Mungkin ada kluster Covid-19 di kilang mereka. Mungkin ribut taufan melanda kilang mereka.

Mungkin mereka naikkan harga sbb ada kuasa monopoli. Atau mungkin vaksin mereka tak diluluskan NPRA.

2/12
3. Virus Covid mungkin ada mutasi. Ini disebut "antigenic drift".

Jika 🇲🇾 ada satu vaksin saja, & vaksin tu tak berkesan terhadap mutasi tersebut, maka seluruh bekalan vaksin itu dah tak boleh digunakan.

Portfolio vaksin mengurangkan pendedahan kita kpd risiko mutasi.

3/12
Read 13 tweets

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