Health Minister Gan Kim Yong shed more light on Singapore’s COVID-19 vaccination strategy in a ministerial statement on Monday (4 Jan), as Parliament sat for the first time in the new year.
Aside from answering questions on the supply and operation of the vaccines, Mr Gan also provided a closer look at the safety, efficacy and side effects of the Pfizer-BioNTech vaccine, which is the only COVID-19 vaccine that has been approved for use in the immediate term. Read Mr Gan’s speech in full here:
Mr Speaker, Sir, thank you for allowing me to give an update to members on the COVID-19 situation, and specifically on our plan to vaccinate our population. Minister Lawrence Wong and I will address Oral Questions 2 to 14 and Written Questions 15 to 18 from today’s Order Paper, as well as questions filed by MPs for future sittings.
Sir, it has been almost a year since we had our first case. We have come a long way. We strengthened our healthcare system, enhanced our contact tracing capability, expanded our testing capacity, and introduced safe distancing measures. All these efforts work together as a multi-layered defence system to keep us safe from COVID-19.
With the continued support and sacrifices of everyone in Singapore, we have brought the situation under control and kept community transmissions low. We have now moved into Phase Three and are making steady progress towards a new normal.
However, this is not the moment to be complacent. Globally, daily infection numbers and deaths continue to rise in many countries, constantly setting new records, including countries that had been successful in containing their outbreaks previously.
We have also seen the emergence of new variants that appear to be more transmissible, and have had to tighten some of our border restrictions as a precaution.
We must therefore be prepared that despite best efforts, new infections will still occur here from time to time. We face the continuing risk of new clusters and outbreaks, and the danger of a new wave of infections getting out of control.
This will be the new normal for a long time to come. That is why we still need to keep up our multi-layered defence. In fact, we must further strengthen it as we continue our journey through Phase Three, and vaccination is a new line of defence we must put in place.
Vaccination is a critical shield to protect us and our loved ones against COVID-19, even as the global situation remains volatile. It will also be a key enabler allowing us to return to normalcy.
The Expert Committee on COVID-19 Vaccination, comprising professionals in infectious diseases, immunology and other relevant fields, has studied the available data on the vaccine, reviewed the reports from the Health Sciences Authority (HSA), deliberated at length and considered carefully safety and efficacy aspects of the Pfizer-BioNTech vaccine.
The Committee has concluded that the vaccine meets the safety and efficacy requirements of the World Health Organization and other international regulatory authorities, as well as that of our own HSA.
It recommended that everyone who is medically eligible should be vaccinated so that Singapore can achieve as high a level of vaccination coverage as possible. Vaccinations should however be voluntary. The Government has accepted these recommendations in full.
A high level of vaccination coverage will maximise protection for the population, and minimise the proportion of persons still susceptible to COVID-19. This will in turn reduce the risk of large outbreaks, and continue to keep community cases low, and allow us to further re-open the economy and resume more normal social activities.
We received our first shipments of vaccines from Pfizer-BioNTech at the end of last year. Our first vaccinations were conducted at the National Centre for Infectious Diseases last week. This is an important milestone and we are beginning to see the light at the end of this very long tunnel.
Dr Lim Wee Kiak and Mr Louis Chua asked about the number of vaccines that we have secured. I am not at liberty to disclose the specific quantity ordered, due to commercial sensitivities and confidentiality undertakings in our advance purchase agreements with the vaccine manufacturers.
However, I can assure members that we have secured enough vaccines for all Singaporeans and long-term residents in Singapore. A team headed by the Head of Civil Service led the efforts and undertook this very urgent, complex and difficult task.
The vaccines will arrive in Singapore in batches, given high global demand especially from countries with high rates of infection. Pharmaceutical companies will also need time to scale up vaccine production and distribution.
Following the first shipment of the Pfizer-BioNTech vaccine at the end of last year, we are expecting more deliveries in the next few months, including from Moderna and Sinovac. If all goes according to schedule, we will have enough vaccines for everyone by the third quarter of this year.
Prioritisation of Population Subgroups
As recommended by the Expert Committee, we will prioritise vaccinations of groups that are most at-risk. This is also consistent with the World Health Organization’s guidance, and similar to what other countries are doing.
We will therefore begin with the healthcare workers and staff working in the healthcare sector as they work in direct care of patients or in supporting roles.
We will also prioritise COVID-19 frontline and other essential personnel, including swabbers hired by Health Promotion Board, staff working at the Government Quarantine Facilities, Community Care Facilities, and dedicated Stay-Home Notice facilities.
We plan to start vaccinating our elderly and those at greater risk of severe disease from COVID-19 infection starting from February 2021, beginning with seniors aged 70 and above.
We will also prioritise others who are in jobs or settings where risk of a super-spreading event is high, such as the construction, marine and process (CMP) sector, including migrant workers. Thereafter we will progressively broaden our vaccinations to include other Singaporeans and long-term residents who are medically eligible.
As more vaccines are approved for use, we will adjust our vaccination programme, depending on the vaccine supply as well as the disease epidemiology at that point in time.
The national effort to vaccinate the population will require considerable resources to implement. This is one of our key focus areas this year.
The last time we did a vaccination of this scale was in 1959, in response to an outbreak of smallpox, where slightly over 1 million people were vaccinated. The scale of the current effort is larger, but we are also much better prepared.
We started planning for this very early on. We have put in place end-to-end processes to meet the cold-chain logistics requirements – from delivery and receipt at the airport, through to storage and then transport to vaccination sites – so that the quality and efficacy of the vaccines are not compromised.
While our healthcare workers are receiving their vaccinations within their healthcare institutions, we are concurrently readying clinics and vaccination centres for others to be vaccinated when it is their turn.
Prior bookings will be necessary given the cold-chain requirements at the vaccination sites and multi-dose vials of the vaccines. It will also ensure operational efficiency and minimise individual wait times. More information on how to make the booking will be provided later.
We encourage everyone to come forward for your vaccination when your turn comes so that we can increase our coverage as soon as possible.
We should also bear in mind that some vaccines, such as Pfizer-BioNTech, will require two doses, 21 days apart, and it will take up to another 14 days after the second dose to achieve maximum protection against the virus.
At the same time, we will test our systems thoroughly before ramping up to ensure that vaccination operations proceed smoothly and patient safety is not compromised.
Safety and Efficacy of Vaccines
There were several questions from members, including Foo Mee Har and Sylvia Lim, on the safety and efficacy of the vaccines. These concerns are understandable, given the extraordinary speed at which the COVID-19 vaccines have been developed and brought to the market. The speed achieved is the result of a strong and concerted global response to a major pandemic, rather than a compromise of safety standards.
Let me assure you that the safety and well-being of Singaporeans is top priority in our vaccination efforts.
First of all, the vaccine must be approved by HSA. Under HSA’s Pandemic Special Access Route (PSAR), HSA’s scientific and clinical experts apply strict international standards to assess COVID-19 vaccines to ensure that they meet the stipulated high standards of quality, safety and efficacy.
These standards are the same as those used for full vaccine evaluations, except that long-term data from clinical trials will only be evaluated later, as the data becomes available.
The data that has been reviewed includes those from pre-clinical studies done in laboratories, clinical trials on human volunteers, manufacturing and quality controls, as well as the ongoing experience with the actual use of the vaccine.
The assessment and recommendations for the vaccines are also reviewed by HSA’s Medicines Advisory Committee and Panel of Infectious Diseases Experts.
HSA will only allow a COVID-19 vaccine to be used if it is assessed to be sufficiently efficacious and safe for use, and only if the benefits of the vaccine are assessed to outweigh the risks of any potential adverse effects from the vaccination.
HSA has put the Pfizer-BioNTech vaccine through this rigorous review process and has authorised its use. The Moderna and Sinovac vaccines are also currently undergoing the review process.
Following HSA’s approval, the independent Expert Committee appointed by MOH has also reviewed the clinical data on safety and efficacy of the Pfizer-BioNTech vaccine, and has been briefed by HSA on the full range of considerations in granting interim authorisation. The Expert Committee concurs with HSA – that the vaccine is suitable for use in Singapore, for persons aged 16 years and above, for the prevention of COVID-19.
In assessing the suitability of vaccine candidates for specific population groups, the Expert Committee took into consideration four key criteria – vaccine safety, vaccine efficacy, vaccine tolerability, and data adequacy of clinical trials.
The Expert Committee has assessed that the Pfizer-BioNTech vaccine demonstrated a high vaccine efficacy of 95% in reducing symptomatic COVID-19 disease among persons aged 16 and older, and its safety profile is consistent with that of other established and registered vaccines used in immunisation against other diseases.
Mr Melvin Yong asked whether there is any data to show that the current COVID-19 vaccines are effective against the new strains seen in the UK and Europe. Mutations occur in viruses naturally and different strains can emerge from time to time, especially in a long-drawn pandemic.
While this B.1.1.7 strain from UK, does appear to be more transmissible, there is currently no evidence that current COVID-19 vaccines are less effective against this strain. Experts have said that it is unlikely that these mutations would impact effectiveness of current vaccines.
Vaccine producers such as Pfizer-BioNTech and Moderna have also come forward to reassure that their vaccines should protect against the B.1.1.7 variant, and are undertaking studies to formally confirm this. MOH will evaluate the data as it emerges and review our vaccine strategy and border measures accordingly.
Miss Cheng Li Hui, Mr Lim Biow Chuan and others have asked about potential side effects. Both HSA and the Expert Committee have studied the data, from clinical trials as well as actual experience from vaccinations carried out in other countries. They have factored this into their evaluation before granting authorisation or making a recommendation on the use of COVID-19 vaccines.
Based on data available today, people who receive the Pfizer-BioNTech vaccine may experience side effects such as pain in the injection site, fatigue, fever, muscle aches, or headaches. These are similar to the side effects for other established vaccines and they usually resolve on their own in a few days.
As with all medications and established vaccines, there is a small risk of very rare but serious adverse events that may occur post-vaccination, including allergic reactions.
HSA and the Expert Committee have therefore recommended that those with known severe allergies should not be vaccinated. All vaccine recipients should also be observed on-site for 30 minutes post-vaccination, so that any severe allergic reactions such as anaphylaxis can be detected and treated promptly.
MOH will also introduce a vaccine injury financial assistance programme to provide support for persons who suffer a serious adverse event that is assessed to be related to COVID-19 vaccines administered in Singapore. While we expect few to need this, the programme will give peace of mind to those taking the vaccination. Further details on the programme will be provided in due course.
In addition, HSA requires vaccine manufacturers to submit new information continually for active review. HSA and the Expert Committee will continue to monitor and review the efficacy and safety of COVID-19 vaccines in the local population and internationally. This includes data on specific population subgroups such as those below age of 16, persons with immunosuppression, or pregnant women who were excluded from initial clinical trials.
HSA and the Expert Committee will also look at long-term safety data to detect rare and severe adverse events, and study the durability of protection provided by the vaccines. This on-going monitoring is the norm expected for any vaccines that first come into use.
Mr Dennis Tan asked whether there will be a need to separate blood collected from donors who have and have not received COVID-19 vaccinations. There is no need to do so. The COVID-19 vaccine does not cause infection.
While the COVID-19 vaccination will be voluntary, we strongly encourage everyone who is medically eligible to get vaccinated when the vaccine is offered to you. This will not only protect yourself, but also indirectly protect others who cannot be vaccinated due to medical reasons.
This collective protection will be more effective the more people are vaccinated. In case of a fresh outbreak, with more people vaccinated we can keep the number of cases low, minimise the stress on the healthcare system, ensure that those who are ill get the treatment they need, and allow us to return to normalcy sooner.
Some may feel that there is no urgency to get vaccinated given the current low number of community cases and the local situation is well under control. We must not be complacent or wait till an outbreak and then rush to be vaccinated.
We have seen a few community cases in the last few days, which shows clearly that there are hidden cases among us. We are also seeing new variants that are more contagious. Any of these cases has a risk of sparking a major outbreak as we have seen in other countries.
The best time to vaccinate is now. If people wait until an outbreak has happened to get themselves vaccinated, it will be too late, both to protect themselves and to prevent the outbreak in the first place.
As PM has said, we have every confidence in our experts and the process that has been put in place. PM and our Cabinet colleagues, including myself, will lead on this. We will be getting ourselves vaccinated as early as possible when our turn comes.
To ensure access to the vaccine, COVID-19 vaccination will be free for all Singaporeans, Permanent Residents and long-term residents in Singapore, which will include Employment Pass, S-Pass, Work Permit holders, Foreign Domestic Workers, and Dependant’s Pass, Long-Term Visit Pass and Student Pass holders, totalling about 5.7m people. This excludes Short-Term Visit Pass holders, such as tourists.
I understand Mr Yip Hon Weng would like to know whether those who are not vaccinated will have their job scopes reviewed, in order to reduce exposure to the virus. In most instances, redeployment of non-vaccinated employees will not be necessary, unless there is a resurgence of local cases.
But all workers will continue to take the necessary precautions such as mask-wearing, and where required, donning of Personal Protective Equipment (PPE) and undergoing Rostered Routine Testing (RRT).
That said, there may be specific cases such as researchers or laboratory staff working directly on the COVID virus or those who face very high risk of exposure to infected individuals. MOH and MOM are reviewing the issue of vaccination of workers in such workplace settings and will provide advice later.
Ms Foo Mee Har asked if individuals will be issued vaccination cards after receiving the COVID-19 vaccination. Every person who is vaccinated will receive a physical vaccination card, and this will remind them of their appointment to return for their second dose, indicate clearly which vaccine was administered, and provide brief post-vaccination advice.
In addition, any person who is vaccinated will have their record updated in the National Immunisation Registry, and individuals will be able to check their vaccination status digitally.
Choice of Vaccines
Mr Louis Chua asked if individuals will be given a choice of vaccines when more than one has been approved for use. The allocation of vaccines will largely be based on medical indications of the different vaccines and the suitability of the vaccine for the different population groups, as well as availability of the vaccines.
Any COVID-19 vaccine that is approved for use will have to meet the stringent safety and efficacy requirements. Allowing individuals to have choice of vaccines will unnecessarily complicate this already complex vaccination programme. Anyway, in the immediate term, only the Pfizer-BioNTech vaccine has been approved for use. So there is no choice.
Public Education and Outreach
Mr Alex Yam and Ms He Ting Ru asked about our public communications strategy. Government agencies have been using various channels to understand public sentiments on the COVID-19 vaccines, including ground outreach and surveys.
Our findings showed that more than half (close to 60%) say they would get vaccinated if a vaccine becomes available in Singapore. About a third were more cautious, saying they would prefer to wait for more data before deciding.
We will continue our efforts to reach out to our population to explain the importance of vaccination and to assure them of the safety and efficacy of the vaccines we are using. I hope parliamentary colleagues will help to share this information with your constituents.
I would also urge everyone to refer to official or credible sources of information, and not to forward unconfirmed or false information.
For example, there were claims that six people had died due to the Pfizer-BioNTech vaccine during clinical trials. However, the facts are that only two of the six individuals were given the vaccine and the other four were given the placebo. Investigations revealed that there was no causal relationship between the vaccine and the two individuals’ deaths.
Spreading such misinformation undermines our efforts to protect Singapore and Singaporeans against COVID-19.
Sir, let me conclude. We have come a long way in the past year. We have been through the Circuit Breaker. Many have missed their vacations for the whole year. We have had to learn to manage with safe distancing measures when we are out and about. It is only through everyone’s concerted efforts that local transmission is now low in Singapore. However, the global situation is still far from under control.
Vaccinations will be a key enabler for us to return to normalcy. We have secured enough vaccines for the whole population. Every vaccine approved for use will meet all our safety and efficacy requirements. I strongly encourage all Singaporeans and long-term residents to get vaccinated when the vaccine is offered to you, to protect yourselves and your loved ones.
This will be the key focus of the Multi-Ministry Taskforce over the next few months. Let’s all do our part, so that we can overcome and emerge stronger.
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