Vaccinated-differentiated Safe Management Measures

ADJOURNMENT MOTION

The Deputy Leader of the House (Mr Zaqy Mohamad): Mr Deputy Speaker, Sir, I beg to move, "That Parliament do now adjourn."

Question proposed.

Mr Deputy Speaker: Ms Hazel Poa.

VaccinatION-Differentiated Safe Management Measures

6.39 pm

Ms Hazel Poa (Non-Constituency Member): Mr Deputy Speaker, my family and I are fully vaccinated and not affected by the Vaccination-differentiated Safe Management Measures, or VDS. However, I watch with concern the latest VDS measures. With effect from 15 January, the unvaccinated will not be allowed to go back to their workplace even if they tested negative. I am particularly disturbed by this latest measure that puts the livelihoods of the unvaccinated at risk.

Many Singaporeans are similarly concerned and anxious. Former Singaporean tennis player, Jaime Wong, started a petition on this issue on 1 January 2022. She was a national tennis champion and represented Singapore in many international competitions, including SEA Games and the International Tennis Federation Fed Cup.

In her petition, she shared that, with effect from 15 January, she would no longer be able to continue her profession as a tennis coach nor enter the tennis school that she started because she is unvaccinated. This petition has garnered over 6,000 signatures. It is heartening to note that amongst them are fully vaccinated Singaporeans acting out of concern for the livelihoods of the unvaccinated.

We aspire to be an inclusive society. This means that we need to accept differences, not just differences in race, language, religion or culture but also differences in opinions and views. We need to respect decisions that may be different from ours. What is the justification for preventing the unvaccinated from returning to their workplace? It is not for fear of infecting others, because vaccination does not stop the transmission of COVID-19.

The risk is, therefore, mainly to themselves, not others. They bear the brunt of their decision not to be vaccinated. I understand that the Government is concerned about the health of the 52,000 unvaccinated employees. But I also believe that these 52,000 people are, at least, as concerned about their own health and safety as the Government is, if not more so.

They must have strong reasons, based on their own individual circumstances and personal medical history, for sticking to their decision not to vaccinate, despite the VDS measures that had been progressively put in place, placing various restrictions on their movements and activities. To them, the risk, or cost, of vaccination must have been significant. This latest measure that threatens their livelihood would just place them between a rock and a hard place.

There are many legitimate questions on the vaccines that are as yet unanswered. For example, what are the long-term effects? What are the effects of repeated jabs administered every six months? Harbouring doubts about vaccination is not unreasonable.

When faced with a situation that is relatively new and where there are many gaps in our knowledge and information, it is always a good idea to keep an open mind, treat current knowledge with caution and not be too absolute in our measures because new knowledge could emerge later to prove us wrong. A good example would be the Government's stand on masks in the initial stage of the pandemic. Let us learn from that experience.

Japan has a policy of no discrimination against the unvaccinated and they achieved a vaccination rate of 79% of their population versus our 87%. So, yes, our VDS probably pushed up our vaccination rate by a few percentage points, but there is the question of degree and the law of diminishing returns.

It is often said that punishment must fit the crime. The same principle should apply to non-criminal actions as well. The consequences that we seek to impose should fit the action. In making the choice between the risk of COVID-19 infection and the risk of adverse effects of vaccination and, where the risk falls primarily on themselves, is the loss of livelihood a befitting penalty? This ban on the unvaccinated returning to their workplace and, thus, risking their livelihoods, is too harsh. Even though the Government has asserted that every effort will be made to enable them to work from home, this is not always practical for every job affected. The new measure is essentially “licence to terminate”.

And what is the expected benefit of imposing such a strong measure? Even without this latest measure, on 5 December 2021, we achieved a vaccination rate of 96% of the eligible population then.

With the threat of loss of livelihood, will we achieve 97%, 99%? Will the number of daily COVID-19 cases drop from 840 to 830?

Government policies are made based on macro considerations and statistics designed to benefit the majority. Just as there are exceptions to every rule, there will always be a small group which would be adversely affected. While it is understandable that Government policies cannot possibly cater to every single individual, we can, at least, recognise the existence of exceptions and leave room for them. Do not put them between a rock and a hard place.

The Government has revealed that there are 52,000 unvaccinated employees. What is the number of unvaccinated self-employed persons or gig workers? What is the breakdown by age and industry? How many of them are expected to lose their jobs? Has the Government studied the impact on these 52,000 unvaccinated employees and an unknown number of unvaccinated SEPs before making its decision? They are not mere statistics; they have elderly parents, they have children.

For those who lose their current jobs because they are unvaccinated, what is the likelihood of them finding another? Measures that threatened livelihoods should never be taken lightly. They may become marginalised if they are unable to regain employment. The prospect of an impending GST hike does not help matters.

Throughout the pandemic, the Government has taken great pains to keep our borders and our economy open, even at the risk of importing COVID-19 cases. For the sake of economic gains, the Government has chosen to manage the health risk. Please now extend the same consideration to the unvaccinated, recognise the importance to them of keeping their livelihood and allow them to manage their health risk.

What is the risk of overwhelming our healthcare system by allowing the 52,000 unvaccinated employees to return to their workplace?

Earlier today, the Minister for Health shared that the unvaccinated comprise two-thirds of the ICU cases. This is presumably based on a period of time when our vaccination rate was lower and the proportion of unvaccinated people in the population higher. Based on MOH's statistics, our vaccination rate reached 50% on 18 July 2021. Therefore, for the bigger part of 2021, more than half of our population was unvaccinated.

While it is undeniable that the unvaccinated are more prone to serious cases, attributing the high number of unvaccinated cases of ICU or death in 2021 to the current small number of unvaccinated is misleading. These are not ratios we can use to project into the future.

Focusing on the 52,000 unvaccinated employees, I do not have the information that will allow me to get a good estimate of the expected number that will fall seriously ill. For example, the age breakdown of the unvaccinated is a key piece of information. However, as a ballpark figure would help form a clearer picture by indicating the order of magnitude, I have used whatever limited information I can find to arrive at a rough estimate.

Assuming the number of daily cases to be 800 out of a population of 5.5 million, applying that proportion to the 52,000 unvaccinated employees gives us 7.6 cases.

MOH's COVID-19 statistics from 1 May to 15 December 2021 showed that, amongst the unvaccinated, the percentage of COVID-19 cases requiring ICU ranged from 0.051% to 0.53% for those aged 20 to 49, 2.4% for those aged 50 to 59 and 7.2% for those aged 60 to 69.

The 52,000 unvaccinated employees are working age. So, assuming that most of them are below the age of 60, I used the ICU rate of 2.4%, which is the highest rate amongst those under 60. Applying the rate of 2.4% on the 7.6 cases gives us 0.18 case requiring ICU per day.

If the number of cases were to double to 1,600 per day, that would give us 0.36 cases requiring ICU. If the number of daily cases reaches 3,000, that would give us 0.68 ICU cases, bearing in mind that Omicron is expected to be more infectious but less severe, as shared by Minister for Health earlier today.

I would be happy to receive more accurate figures from MOH. However, based on what I currently see, there does not appear to be any basis to fear that allowing the unvaccinated to return to the workplace would overwhelm our ICU facilities.

We urge the Government to rescind the ban on the unvaccinated returning to their workplace from 15 January and continue with the current arrangement of using testing as the means to control the spread of COVID-19.

Vaccination-differentiated safe management measures (VDS) on children. The vaccination of children aged five to 11 started in December last year, with only the mRNA option. There are differing schools of thought on COVID-19 vaccinations and even more so for the vaccination of children, with several medical doctors publicly opposing it. The unanswered question on the long-term effects of mRNA vaccines is even more relevant for children who have another 70 to 80 years ahead of them.

Parents are, understandably, uncertain and anxious. Making the decision on behalf of their children is more stressful than making decisions for themselves. Heavy on their minds is whether VDS will be imposed on their children.

In light of the fact that COVID-19 is milder in children, can the Government commit to not imposing VDS on children for at least another year to give parents more time to digest new information, monitor developments and perhaps wait for more vaccination options to become available?

At this point in time, is the Government able to give an indicative timeline for the assessment of inactivated virus vaccines, like Sinovac, for children and the required conditions for approval? This information will be helpful for parents making their decisions on the vaccination of their children.

In conclusion, we urge the Government to rescind the ban on the unvaccinated returning to the workplace from 15 January and commit to not imposing VDS on children for at least another 12 months.

Mr Deputy Speaker: Parliamentary Secretary Rahayu Mahzam.

6.49 pm

The Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam): Mr Deputy Speaker, I thank the Member for her speech on matters related to VDS.

The Member raised several points for clarification, including the removal of the concession to allow unvaccinated workers to return to the workplace with a negative Pre-Event Test (PET) result and also her queries relating to extension of VDS to children.

Earlier today, the Minister for Health had responded to questions from Members. He highlighted our threefold response in living with COVID-19: vaccination and boosters, bolstering our healthcare capacity and calibrating our SMMs. Each is important in our response to Omicron and in ensuring that, in the longer term, we can resume our normal lives as far as possible.

Our experience over the past few months shows that VDS will enable us to continue our path of safe and calibrated reopening whilst, at the same time, minimising the risk of hospitalisation to preserve healthcare capacity, in particular, limited hospital and ICU resources.

It is important to note that non-fully vaccinated persons who are infected with COVID-19 are more than seven times more likely to become critically ill in ICU, compared to those who are fully vaccinated – 0.5% of cases versus 0.07% – and 12 times – 1.7% of cases versus 0.14% – more likely to die.

Among seniors aged 60 and above, the incidence of fully vaccinated and non-fully vaccinated cases who are critically ill in the ICU are 1.9 and 35.9 per 100,000 population respectively. The incidences of fully vaccinated and non-fully vaccinated seniors who died are 0.3 and 8.2 per 100,000 population respectively.

As a result, throughout the pandemic, we find that two-thirds of our ICU beds are occupied by individuals who are unvaccinated. They are also more likely to be administered therapeutics, which are not cheap. So, although a small proportion of our population, they take up a disproportionate amount of medical and hospital resources and contribute to a significant amount of workload of our hospital staff. These are not mere statistics. It is actual resources being drained because of people who fall ill because of COVID-19.

The basis for VDS is, therefore, twofold.

First, by putting restrictions on their social activities, we protect the unvaccinated by preventing them from being overly exposed to the virus. The Member earlier said, well, it is just for them, right? But that is not true because the second point is that, if fewer unvaccinated people get infected, we preserve our hospital capacity whilst allowing the rest to carry on normal activities as much as possible.

Let me now elaborate on these points, including how VDS contributes to our safe reopening and transition to living with COVID-19.

To set the context, the emergence of the Delta variant in May 2021 required quick action to be taken to contain the numerous outbreaks of clusters in the community and to minimise the risk of our healthcare capacity being overwhelmed. The Multi-Ministry Task Force (MTF) thus decided to significantly tighten our SMMs, resulting in a move to Phase Two (Heightened Alert) in May 2021.

At the same time, we further ramped up our vaccination efforts, resulting in improved vaccination rates, particularly among seniors. Members will remember that our vaccination programme kicked off one year ago in early January 2021. By 9 August 2021, 72% of our entire population had completed their full regimen or received two doses of COVID-19 vaccines, with 81% receiving at least one dose.

With this high level of vaccination coverage and through our collective efforts as a nation to comply with the strict Phase Two (Heightened Alert) measures, the daily number of COVID-19 cases fell to double digits. The MTF thus restarted the process of resuming more economic and social activities through a calibrated risk-based approach aimed to protect the unvaccinated whilst not placing further strains on our healthcare system. We thus introduced VDS for selected premises, activities and events from 10 August 2021.

Through VDS, we eased measures for those who are fully vaccinated rather than hold everyone back in order to reduce the risk to the unvaccinated.

Fully vaccinated persons have good protection against the virus and are at lower risk of becoming dangerously ill if infected with COVID-19. This would mean that they would not strain our resources. So, vaccination is still a very important and powerful measure in the many things that we are doing to protect our community from COVID-19.

We resumed dining in F&B establishments for groups of up to five vaccinated persons, with exemptions for children aged 12 and below. We also allowed significant increases in event sizes, such as congregational and worship services, live performances and MICE, up to 500 persons, as long as all attendees were fully vaccinated.

Unvaccinated individuals, on the other hand, need to be more prudent in interacting with larger groups of people, especially in mask-off settings, which are high-risk. Hence, the strict measures will continue to apply to them. It will not matter if they are tennis coaches; the virus does not discriminate because it will impact you more severely if you are unvaccinated.

With access to premises, activities and events being brought under the VDS framework, the hope was that this would also encourage the unvaccinated to get their vaccination so that they can participate in the community and society safely.

Despite our cautious approach to reopening, the heightened transmissibility of the Delta variant resulted in new clusters emerging by end August 2021. This put great pressure on our healthcare system. The number of cases was sustained at 3,000 per day, as mentioned by Minister Ong Ye Kung earlier, and, the serious cases, who had to be seen in hospitals, resulted in 100 to 170 cases occupying ICU beds each day.

Sixty-six percent of ICU patients were unvaccinated or partially vaccinated individuals. They took up scarce medical resources, which are needed for others who are very sick individuals, including those with non-COVID-19 conditions who require expensive therapeutics.

To stabilise the situation, we had to roll out revised healthcare protocols and tighten our SMMs again. But we were able to allow more activities to continue during this Stabilisation Phase, compared to the earlier Phase Two (Heightened Alert) period due to VDS. VDS has also allowed us to safely resume more activities even after we exited the Stabilisation Phase on 22 November 2021.

With more social interactions taking place over the year-end holidays, case numbers did not see a surge. We now face a prospect of another surge of cases due to the Omicron variant.

We are in a better position than before, as our vaccination coverage has improved greatly over the past few months to 87% of our entire population completing their full regimen, with 89% receiving at least one dose. But we need to decide whether we want to tighten up all our SMMs again, which would affect the lives and livelihoods of both the vaccinated and unvaccinated, or do we calibrate our measures so that we only tighten up for those who are unvaccinated and who would be more likely to impose strains on our healthcare system.

These decisions are not taken lightly. We need to calibrate; we need to balance.

Further adjustments to our VDS policies have thus been made to ready us for these potential increases in cases as well as to allow us to better understand the nature of the Omicron variant and its differences from the Delta variant. These include the removal of the concession for unvaccinated individuals to produce a negative Pre-Event Test (PET) result prior to participating in a VDS event or activity and the reduction of the exemption period for recovered persons to enter VDS settings from 270 days to 180 days.

Through VDS, we hope to keep the unvaccinated individuals protected from infection whilst allowing the rest of society to continue with their normal activities.

In line with our overall reopening approach, the MTF announced the introduction of the Workforce Vaccination Measures (WVM), which required that, from 1 January 2022, unvaccinated individuals who were medically eligible for vaccination would be required to produce a negative PET result before entering the workplace so as to mitigate the risks of workplace transmission. The MTF subsequently announced on 14 December 2021 that up to 50% of those who can work from home will be allowed to return to the office from 1 January 2022 as we would be in a better position to ease the current default work-from-home posture with the WVM in place.

However, we have seen the emergence of a more transmissible Omicron variant, which, with the Delta variant, significantly raises the risk of contracting COVID-19, compared to a year ago. To strengthen our protection against a large wave of cases locally and to keep our workplace safe, the MTF announced that, from 15 January 2022, unvaccinated workers, barring those medically ineligible, will not be able to return to the workplace even with a negative PET result.

As of 2 January 2022, there were about 48,000 employees who had not taken any vaccine dose. This is a reduction from the 52,000 reported on 19 December 2021, as we have seen more employees coming forward to get vaccinated. Among the unvaccinated employees, those aged 30 to 39 form the largest group at 16,000. Whilst a negative PET is an indicator that the person is not infected with COVID-19, the unvaccinated individual has no protection against the virus. And if you think about it, if all the 48,000 get COVID-19, it would, indeed, impact on our healthcare system.

This decision was taken in consideration of many different factors and in consultation with many different stakeholders. This move was supported by the tripartite partners who recognised the public health imperative of vaccination and the urgency to sustain business activity to protect livelihoods. A fully vaccinated workforce would be able to operate more safely and sustainably.

We still allow employees who are certified medically ineligible for vaccines under the National Vaccination Programme (NVP) to return to the workplace, given that they constitute only 0.3% – a very small proportion – of unvaccinated workers. However, whilst such employees are exempted from WVM, MOM and the tripartite partners have guided employers to give special consideration, such as allowing them to work from home, if they are able to do so, and redeploying them to suitable jobs which can be done from home, if such jobs are available.

From the start of the COVID-19 pandemic, we had adopted a special approach to fully cover the costs of COVID-19 medical treatment for Singapore Citizens, Permanent Residents and Long-Term Pass Holders (SC/PR/LTPHs) who had not recently travelled. This special approach was intended to avoid financial considerations adding to the public uncertainty and concern when COVID-19 was an emergent and unfamiliar disease.

Today, the vaccines have since become widely administered and there is sufficient evidence that they confer protection to reduce the risk of serious illness and death. Those aged above 12 who remain unvaccinated by choice have decided to do so despite knowing that this places them at a higher risk of requiring costly inpatient care, which adds to the strain on our healthcare system. The special treatment of the Government fully covering the costs of COVID-19 medical treatment will, therefore, not apply to this group. This will also be the case for individuals aged above 18 who do not come forward for their booster within 270 days or nine months from their last dose.

Depending on the severity of the patient's condition and the type of COVID-19 facility where care is rendered, the bill size would vary, but these patients who are unvaccinated by choice may still tap on the regular healthcare financing arrangement to help pay for their bills, where applicable. While the median bill size for COVID-positive patients receiving treatment in acute hospitals who require both ICU care and COVID-19 therapeutics is estimated to be about $25,000, access to means-tested Government subsidies and MediShield Life coverage can reduce the bill to about $2,000 to $4,000 for eligible Singaporeans in subsidised wards. SCs and PRs may also use their MediSave balance to help fund any remaining post-subsidy amount, subject to the claim limits that apply.

With regard to extending VDS to children in the community, public, preschool and school settings, there are, presently, no plans to do so for those aged 12 and below.

The focus at this time is to ensure our children are well-protected as we begin vaccination for those aged five to 11, using the paediatric doses of the Pfizer/BioNTech/Comirnaty COVID-19 vaccine. We will, periodically, review our policies as the extension of the national COVID-19 vaccination programme to children aged five to 11 progresses.

Earlier today, we had also addressed concerns that were raised by Members. And we acknowledge that these are some legitimate concerns that parents may have. But given all the facts we have and in the current situation that we are facing, it is still highly encouraged for parents to bring their children if they are eligible for the vaccination.

In summary, increasing population immunity through vaccinations and boosters, reinforced with VDS, has been integral to our COVID-19 response in protecting the vulnerable and ensuring that our healthcare system can cope with the incoming Omicron wave, as well as any future infection waves. Singapore is now in a better position to achieve our goal of being a COVID-19 resilient nation.

Mr Deputy Speaker: Yes, is it a clarification? We have got just a few minutes for clarification, Ms Hazel Poa.

7.06 pm

Ms Hazel Poa: I have explained earlier in my speech why we cannot apply the two-thirds ICU statistics to the current situation because of the changing vaccination rate. The data in 2021 is based on a case where, for the first half of 2021, more than 50% of the population was unvaccinated. Therefore, it is not reasonable to apply those statistics to the current small number of unvaccinated.

So, I presume that in implementing this strong measure which risks 48,000 livelihoods, MOH must have done studies on what is the impact, specifically on the number of expected job loss versus the additional burden on the hospital ICU utilisation. Can the Parliamentary Secretary provide us with the statistics for this?

Ms Rahayu Mahzam: Mr Deputy Speaker, I was not earlier privy to the questions that the Member was going to ask in terms of the specific numbers, so, I do not have specific data. But I do have some points to respond to the Member's queries.

One, I think even if you are looking at 48,000 of the workers that are now currently unvaccinated and just talking about 1% of them, that is already a high number and that is already going to tax our ICU bed capacity. So, that is one. We are actually just looking at how, even with that small number, it is going to impact and tap on scarce resources which could very well be deployed for other needs within the community.

Two, in terms of studying the implication on them, I appreciate that there will be concerns. But we are also talking about the whole of nation. We are talking about economic stability, the normal way of life that everyone else craves for. We need to consider also how the economy will be impacted by just this small number taxing on our healthcare system and, because of these numbers, we then have to adjust and calibrate our SMMs. All these are done to balance.

For those who are able to go out and are better protected, they then are able to have access to different things. But for those who are then at-risk of getting COVID-19 and having severe illnesses, I think there have to be implications on the consequences that we have to accept and appreciate and, therefore, make a decision, calibrating all these needs and not talking about just one group, and a small group at that.

Ms Hazel Poa: I think it is quite hypothetical using the 1% on the 48,000 —

Mr Deputy Speaker: Ms Hazel Poa, I am afraid the 30 minutes allocated for the Adjournment Motion has lapsed. Order.

Question put, and agreed to.

Resolved, "That Parliament do now adjourn."

Adjourned accordingly at 7.09 pm.