Malaysia's Bold Goal: Zero Dengue Deaths by 2030 with Renewed Vaccine Confidence

The public health impact of dengue has grown steadily more complex. Despite decades of vector control efforts, dengue incidence continues to fluctuate at high levels, straining health care services and periodically overwhelming hospitals during outbreaks. Climate change, urbanisation, population mobility, and insecticide resistance have all contributed to the persistence of dengue transmission. Malaysia’s aspiration to achieve zero dengue deaths by 2030 demands renewed confidence in safe, effective vaccination as part of a dengue integrated management strategy. The availability of the live-attenuated tetravalent dengue vaccine TAK-003 (QDENGA®) presents an important opportunity to recalibrate Malaysia’s dengue prevention approach, grounded in strong scientific evidence and lessons learned from the past. Learning From CYD-TDV: A Necessary Caution, Not A Permanent Barrier Malaysia’s cautious stance toward dengue vaccination has been shaped by the CYD-TDV (Dengvaxia®) experience. This first licensed dengue vaccine was a major advance, but it came with a serious problem: for people who had never had dengue before (seronegative), the vaccine could sometimes make a future infection worse. This is an immunological risk of the CYD-TDV vaccine known as antibody-dependent enhancement (ADE). Regulatory restraint and professional scepticism were not only justified—they were essential to protecting public trust. However, this should not be allowed to cast a permanent shadow over all dengue vaccines. Scientific progress depends on evidence, not legacy fear. Why TAK-003 Is Different Now, a new vaccine called TAK-003 has changed the game. It provides strong, long-lasting protection, cutting down drastically on hospitalisations and severe dengue illness in both seropositive and seronegative individuals. The most important breakthrough is that it does not have the previous safety problem. Unlike the first vaccine, TAK-003 does not make dengue worse for people who are new to the virus (seronegative). To date, there is no evidence of increased disease severity leading to hospitalisations and no deaths related to TAK-003 in the entire clinical development program. There have been no clinical signals of severe disease (proxy for ADE) following the two primary doses after more than four-and-a-half years of use. A more recent additional third dose also did not show any concerns. Booster-dose studies provide additional reassurance in the established safety profile of TAK-003 over the duration of seven years and no new safety risks were identified. TAK-003 directly addresses the central concern that has constrained dengue vaccine policy and practice in Malaysia. Unlike the increased hospitalisation risk (increased disease severity) seen at 22 months in the CYD-TDV study (Diagram I), no increased hospitalization risk has been seen at 54 months or at 90 months (Diagram III) or at any point during the TAK-003 clinical development program in DEN-30. Implications For Malaysian Public Health Policy Malaysia’s dengue burden is characterised not only by high case numbers, but by periodic surges in severe disease that disproportionately affect children, working-age adults, and urban populations. Preventing hospitalisation and death—rather than merely reducing infection—is therefore the most meaningful public health outcome. TAK-003’s demonstrated efficacy against severe dengue aligns well with this objective. Equally important, the vaccine can be deployed without needing complex and costly pre-screening tests. TAK-003 has been approved in 41 countries and more than 21 million doses have been distributed. Real world data from Brazil, demonstrated high vaccine (TAK-003) effectiveness in reducing dengue-related hospitalisations. Post-marketing safety data globally remain consistent with the established DEN-301 clinical study. There is also an on-going Malaysia’s Active Surveillance Study to reinforce the safety profile. For regulatory authorities, the accumulated evidence supports confidence in the vaccine’s strong safety record, and removes the biggest worry of the past. For clinicians, you can recommend TAK-003 to your patients confidently as a crucial shield against severe dengue disease. And for the public, TAK003 is a safe and effective option to protect yourself and your family. Rebuilding Trust Through Science And Transparency Public confidence in dengue vaccination in Malaysia must be earned through honest public engagement, post-marketing surveillance, and clear articulation of how TAK-003 differs from previous vaccines. Health care professionals, public health leaders, and policymakers share responsibility in conveying that caution has informed—not obstructed—progress. These measures will reinforce trust and ensure that vaccination complements, rather than replaces, vector control and early clinical care. For the general public, this second-generation dengue vaccine gives protection to the individuals and communities, and should be considered before another surge of cases and deaths due to dengue occurs. A Critical Tool For The 2030 Goal Zero dengue deaths by 2030 is an ambitious but achievable goal for Malaysia. Vector control alone has proven insufficient. Early diagnosis and clinical management save lives, but they do not prevent outbreaks. The addition of a safe and effective dengue vaccine that protects against severe disease changes the equation. TAK-003 is not a silver bullet—but it is a scientifically sound, evidence-based tool that Malaysia can no longer afford to ignore. With robust seven-year extended safety data, absence of evidence of increased disease severity (ADE), and a strong safety and efficacy profile, regulatory authorities and health care professionals should have confidence in its role within a comprehensive dengue control strategy. The question is no longer whether Malaysia should trust dengue vaccination again, but whether it can afford not to—when lives are at stake. Dr Musa Mohd Nordin is from the Malaysian Paediatric Association (MPA), Dr Zulkifli Ismail is from Asian Dengue Voice and Action (ADVA), and Dr Koh Kar Chai is from Dengue Prevention Advocacy Malaysia (DPAM).