COVID-19 (Temporary Measures) (Amendment) Bill

Order for Second Reading read.

1.24 pm

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Minister of State for Health): Mr Speaker, on behalf of the Minister for Health, I beg to move that "The Bill be now read a Second time."

This Bill proposes a single amendment, to extend the validity of Part 7 of the COVID-19 (Temporary Measures) Act 2020 (CTMA) for an additional year. There will be no other changes to Part 7 of the CTMA, which will continue to enable targeted public health measures to be implemented and adjusted for the purpose of controlling the incidence and transmission of COVID-19, based on the evolving COVID-19 situation.

In the past few months, we have taken a three-pronged approach in our response to the COVID-19 pandemic. First, we have put in place the National Vaccination Programme to ensure that the population is well protected from disease through vaccination.

Second, we enhanced our healthcare capacity to handle the surges in cases and adjusted our healthcare protocols to right-site care. For example, lower-risk individuals with mild symptoms can be managed by their primary care doctors, while those at higher risk are assessed for management or monitoring at a care facility or hospital.

Third, we have continued to implement safe management measures (SMMs), such as limits on group and event sizes, safe distancing and work-from-home arrangements, to ensure community cases do not rise out of control and overwhelm our healthcare capacity.

In recent days, we have seen the number of COVID-19 cases peaking. There are indications that the wave is starting to subside and we are optimistic that with everyone's cooperation in adhering to public health measures, our healthcare system will continue to be able to tend to persons needing care. However, we must bear in mind that the pandemic is not over yet. New variants and new waves remain a possibility – it is quite a natural thing that viruses continue to evolve and mutate over time, as we have seen with previous variants. When such cases and events happen and whether they affect disease transmission and severity, cannot be predicted ahead of time. New variants can break through borders and we have seen this even in countries with strict zero COVID-19 strategies, resulting in forceful measures having to be implemented, painful ones, like lockdowns.

If Singapore’s re-opening is not carefully managed, infections may rise uncontrollably and potentially overstrain or even cause the collapse of our entire healthcare system. Even now, our healthcare workers have been labouring, since the pandemic started, for the past two years. SMMs are still needed for now and we will take a gradual and calibrated approach even as we move towards a greater degree of normalcy in our communities, businesses, workplaces and travels. While we have moved away from lockdowns, which are harmful to the well-being of our people and the economy, we must keep a position where we are nimble and ready to take appropriate measures should the situation worsen or change.

Part 7 of the CTMA ("Part 7"), which allows the Minister for Health to make regulations for the purpose of prevention and control of COVID-19 incidence or transmission, therefore remains relevant. As the key legal lever behind various SMMs, Part 7 has served us well by allowing for a multi-faceted public health response to COVID-19. It allowed us to weather the Delta and Omicron waves by slowing transmission.

The Multi-Ministry Taskforce (MTF) had previously announced plans to simplify and rationalise our COVID-19 SMMs to focus on the five most important and effective measures: mask-wearing; group sizes; capacity limits; safe distancing and workplace arrangements. Group size and safe distancing, for instance, limit the number of interactions persons would have at any point in time, especially in higher risk settings. This reduces the overall number of interactions a day and therefore limits disease spread. Capacity limits are important to prevent overcrowding which can lead to superspreading events.

In time to come, as case numbers display a sustained and consistent falling trend and the COVID-19 situation abates, we will ease measures along these five key SMMs by adjusting the relevant regulations.

Sir, a one-year extension of Part 7 of the CTMA will allow us to remain nimble and adaptable to the evolving pandemic situation and face any possible new variants. If COVID-19 ceases to be a threat before the end of this one year, the regulations can be repealed and Part 7 can be allowed to lapse. However, if more variants and infection waves take hold, the regulations under Part 7 will continue to be important for the protection of public health. Mr Speaker, Sir, I beg to move.

Question proposed.

Mr Speaker: Mr Yip Hon Weng.

1.46 pm

Mr Yip Hon Weng (Yio Chu Kang): Mr Speaker, Sir, I am glad to hear the Health Minister mention during the COS debate a few days ago that the current Omicron wave has peaked. I will share three perspectives on this Bill.

First, I would like to propose a more specific modality of extension. The Bill, along with Safe Management Measures (SMMs) and Vaccination-differentiated Safe Management Measures (VDS) have allowed us to react as quickly as we did towards the more infectious Omicron variants, without the need to resort to lockdowns.

This is so that businesses, schools and life in general can go on with minimal disruptions. While we should remain vigilant against possible new variants, I ask whether there is a need to extend the Bill for another full year. What happens next year, if the virus continues to exist and mutate? Do we extend this indefinitely?

From my conversations with my Yio Chu Kang residents, many dread the thought of continued restrictions on social gatherings, economic activities and events. They ask how is this endemic living if we continue to live with these nationwide restrictions that impact social well-being and businesses? I am not suggesting that we do away with the measures. But I hope the Ministry can and will introduce more certainty. Rather than this be given carte blanche, can MOH extend the clauses for a certain period of time only if we hit a certain trigger point, for example, if the R number or the number of deaths go up to a certain rate.

Second, Mr Speaker, Sir , I would like to ask whether the current SMM and VDS measures can be further streamlined. Several Members have spoken about this. I am glad to hear from the Senior Minister of State that MOH is intending to do this although the implementation was delayed, given the current Omicron situation. But we can certainly do more.

An example is the new SMM and VDS measures for coffee shops and canteens. The vendors may have more options now, but I have received feedback from the ground about how confusing the new measures are. Even some young patrons have trouble making sense of them, let alone seniors. Operators, too, have reported hesitancy to adopt the new measures, given that the added hassle and manpower to ensure compliance. I believe the abuse that some hawkers received from angry and confused patrons when VDS was first introduced last year remains fresh in their minds.

I have filed a Parliamentary Question on this matter and I look forward to the Ministry's response. I also believe that entry into markets and sitting arrangements in hawker centres can be standardised to reduce confusion.

Lastly, Mr Speaker, Sir, we should do more to nudge the unvaccinated people to get their shots. There is a general consensus among healthcare professionals and researchers that unvaccinated persons are in danger of severe symptoms and death, which increase the workload for the healthcare system.

Unvaccinated people also increase the risk of emergence of new variants. This is why VDS remains relevant. However, they cannot continue indefinitely as these measures also pose a burden to businesses, institutions and organisations. Can the Ministry share what are the plans to nudge the remaining unvaccinated individuals to get vaccinated, especially those who are not medically exempted? We can now leverage on non-mRNA vaccines with high efficacy, like Novavax and oral anti-viral medication, for treatment of patients who are at risk of severe disease.

In conclusion, Mr Speaker, Sir, I understand and support the need to continue enforcing COVID-19 safe management measures. There is continued evidence that our existing public health measures help to reduce transmission even within the same household. There is still much we do not know much about COVID-19. Studies continue to reveal new possible long-term health complications associated with the virus, such as cognitive decline.

As we move towards improved vaccines and treatment, avoiding or delaying an infection is important. We are not yet out of the woods. Our healthcare workers continue to struggle with large numbers of COVID-19 cases and they deserve a long overdue break.

Our residents are also frustrated and weary. This has been a long drawn-out battle. While things have definitely been looking up in the past year with the vaccines and boosters, we are still extending and introducing COVID-19 management measures. We need more specific goal posts and simplified measures. This is so that the light at the end of the tunnel does not seem out of reach. I support the Bill.

1.35 pm

Ms Sylvia Lim (Aljunied): Mr Speaker, this Bill seeks to extend the operation of Part 7 of the COVID-19 Temporary Measures Act for a year, from 8 April this year to the same date next year. Part 7 of the Act concerns the making of control orders by the Minister for Health for the purpose of preventing, protecting against, delaying or otherwise controlling the incidence of transmission of COVID-19 in Singapore.

Sir, the Act was first enacted in April two years ago, at the start of the pandemic. Two years on, some other parts of the Act are no longer in force or will expire soon. This is a welcome indication that the general direction is to move towards normalcy in our lives and interactions.

On Part 7, the proposal in the Bill to extend its operation by another year appears to be prudent, since COVID-19 is still spreading widely in Singapore. Furthermore, in the months ahead, we do not know whether any variant of concern may emerge. It is, therefore, sensible to empower the Minister for Health to issue control measures, if assessed to be necessary to protect public health, including not overwhelming healthcare services.

Nevertheless, looking at where Singapore stands today, it is a matter of time before control measures should be further rolled back or discontinued altogether. Two years on into the pandemic, we are in a much stronger position on health impacts.

Firstly, COVID-19 is probably endemic now. Our official case numbers, as of today, stand at more than 885,000, or 16% of the Singapore population. Taking into account cases not officially reported, the percentage of the population who have contracted COVID-19 is probably significantly more.

Secondly, there is wide vaccine coverage of our population today. As at 9 March, the MOH reports that 91% has been fully vaccinated, with about 69% having received booster jabs.

Further, there are more prevention and treatment options, including a wider range of vaccines, including non-mRNA ones, as well as anti-viral oral drugs to treat COVID-19 patients. That said, the fact that COVID-19 is spreading widely through our population, even with such high vaccination rates, should lead us to continue to review whether the control measures we currently have in place remain fit for purpose. They also add significant cost to businesses and entities which need to implement them and inconvenience members of the public.

Sir, all in all, we are in a much better position to deal with the health impacts of COVID-19 than at the start of the pandemic. As such, while I support the Bill as prudent, the next one year should ideally see Singapore continue to move significantly towards normalcy. There are promising signs here and elsewhere, with the reopening of international borders, and I note that the Minister for Transport announced this week that Singapore is aiming to restore international air travel through Changi Airport to at least 50% of pre-pandemic levels this year.

Indeed, regular reviews on the efficacy and necessity for any control measures are warranted, so that our people and businesses can return to vibrant economic and social lives as soon as practicable.

Mr Speaker: Senior Minister of State Koh Poh Koon.

1.38 pm

Dr Koh Poh Koon: Mr Speaker, I thank both Members who spoke for their support of the Bill and I totally agree with some of the sentiments they have about challenges we face, how far we have gone and some of the things that we should look forward to in the year coming. Members of the House, however, have also sought clarifications on some issues and allow me to take the House through some of them.

Mr Yip Hon Weng asked how we can do more to encourage persons who are sceptical of the mRNA vaccines to take up vaccination to protect themselves. As previously highlighted in Parliament, the Novavax Nuvaxovid vaccine has been authorised by the Health Sciences Authority (HSA) and recommended by the expert committee on COVID-19 vaccination for use under our National Vaccination Programme, as an alternative to the mRNA vaccines.

The first batch of Nuvaxovid vaccine is expected to arrive sometime in the months ahead, barring any shipment delays. This will provide those who may have hesitancy receiving the mRNA vaccine an alternative and I hope they do take this seriously and consider getting themselves vaccinated. Even though Omicron causes less severe disease than the Delta strain, during this recent Omicron wave, the 3% of adults who were partially or unvaccinated contributed to 20% of our ICU cases, occupied two-thirds of our ICU beds and caused about 30% or so of the mortality that we see.

So, they do pose a significant load on our healthcare resources and, therefore, VDS is still necessary to protect the unvaccinated and prevent our healthcare system from being overwhelmed. Once the Omicron wave has subsided, we will be in a better position to ease our measures further.

COVID-19 therapeutics were mentioned by Ms Sylvia Lim and, indeed, they have been authorised by HSA. But I must explain that they are meant to mitigate the risk of progression to severe illnesses from COVID-19 infection. Whereas vaccination serves as a more preventive role, that goes further upstream to prevent COVID-19 infection and not allow severe illnesses to take place in the first place. Therapeutics are, therefore, complementary and not substitutes for vaccination.

Let me share some data, which are actually quite compelling. Non fully-vaccinated adults infected with Omicron variant, which supposedly is already milder than Delta, are up to 18 times more likely to end up in ICU and 38 times more likely to die from COVID-19 infection, compared to vaccinated and boosted adults.

In fact, we see that the unvaccinated children between zero to 11 years old are at risk of Multi-System Inflammatory Syndrome for Children (MISC), that some Members may have read about in the newspapers as well. The incidence in an unvaccinated child can be as high as 470 cases per million infections.

Even for the adult population of all age groups, an unvaccinated person is at risk of a one-in-10 chance of getting long COVID-19 after a COVID-19 infection and it has been proven time and again that vaccination can reduce this risk significantly. So, vaccination is still key to us remaining safe, both on a personal level and at the system level.

Mr Yip Hon Weng also sought clarification on the rationalisation of SMMs that the MTF recently announced and whether they can be further simplified. In fact, as explained, this rationalisation is, itself, a way to simplify the SMMs into just five key parameters. It makes it easier for the public to understand and, in the coming weeks, as we see the cases continue to show a sustained decline, we can then further ease measures along these key parameters.

I note Mr Yip Hon Weng has actually filed a Parliamentary Question on the restrictions at coffee shops and canteens. So, I seek the Member's understanding that my colleagues at MSE will look into this and address it at a subsequent Sitting.

Mr Yip Hon Weng asked if we might consider a shorter period of extension of Part 7 and base the extension on specific indicators. Ms Sylvia Lim also mentioned that the control measures should be constantly reviewed and make sure that they are fit for purpose. I agree with her. In fact, we monitor the weekly infection growth rate, the R number, as an indication of virus transmissibility as well as other matrices, like mortality rate, hospital occupancy and our healthcare manpower.

But each variant, as we have seen in the past two years, has somewhat different characteristics and slightly different behaviour, compared to each other and, therefore, no single set of parameters can be solely relied upon and we have to remain nimble and take all factors into account in designing any of these restrictions.

As mentioned in my opening speech, we take a calibrated approach in the control measures and have made progressive adjustments to the SMMs as the COVID-19 situation evolves. Members will certainly recall, when the pandemic first started, we actually went into a circuit breaker and, subsequently, a series of Heightened Alert phases, as we cautiously, gradually, tried to reopen social and economic activities to manage the infection risk in our largely unvaccinated population at that time.

With good progress in our national vaccination efforts towards the end of 2021, our collective resilience and immunity and defence against the virus were strengthened. So, we were able to ride through the wave of Delta infection without resorting to a circuit breaker again and, therefore, we have calibrated some of the measures in dealing with this virus as our own situation evolves.

When this current Omicron wave hit us, our population had achieved a high vaccination and booster rate, allowing us to then continue on with our progressive reopening and our move towards endemicity, without further tightening of restrictions.

Such a move would have been unthinkable one-and-a-half years ago and our healthcare system at that time could well have been overwhelmed if the same numbers of daily infections were to be seen at that point.

So, this clearly attests to the effectiveness of the mRNA vaccines and the trust and unity of our people in responding to the call to get vaccinated and boosted. Our adjustments to Protocols 123 and the maintenance of some SMMs have allowed us to ride through this wave currently without causing our healthcare system to collapse.

Like Members, I, too, hope that we can eventually dispense with the restrictions. In a best-case scenario when COVID-19 ceases to be a threat before the end of 12 months, regulations that are no longer relevant can be repealed and Part 7 can be allowed to lapse. In the opposite scenario, if a variant that can cause more severe illness takes hold, the regulations under Part 7 will continue to be important for the protection of public health.

Sir, a one-year extension will provide the flexibility for us to adjust and calibrate COVID-19 measures accordingly and I thank Members for their support of this amendment. Mr Speaker, I beg to move.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Dr Koh Poh Koon)].

Bill considered in Committee; reported without amendment; read a Third time and passed.