Update on Booster Programme Roll-out and Help for Pregnant and Post-partum Women to Get COVID-19 Vaccine

3 Dr Tan Wu Meng asked the Minister for Health what avenues of support are available for pregnant or post-partum women who are not yet vaccinated against COVID-19 because of medical reasons and who have to visit their loved ones in hospital given the cost of the self-paid pre-visit COVID-19 test.

4 Mr Chua Kheng Wee Louis asked the Minister for Health in view of the COVID-19 dose-sharing agreement with Australia (a) whether there are sufficient vaccines for the national vaccination programme by providing details on (i) the current stock of COVID-19 vaccines and (ii) the remaining number of doses that have yet to be delivered under existing supply agreements and when these are due to be delivered; (b) whether the Government has completed its assessment on the need for a booster shot; and (c) whether additional contracts have been signed to reserve additional doses if required and, if so, what are the expected delivery schedules.

5 Ms He Ting Ru asked the Minister for Health (a) whether the costs of regular testing under the "Vaccinate or Regular Testing” (VoRT) regime will be fully borne by the Government for individuals who are able to secure a doctor's certification confirming their ineligibility for COVID-19 vaccination; and (b) how long is the VoRT regime expected to persist given that full-vaccination coverage of the population is now at 80%.

6 Mr Alex Yam asked the Minister for Health (a) of those who refuse COVID-19 vaccination but not on medical grounds, what are the main reasons for them doing so; (b) whether the Ministry will implement a more targeted approach to address those who have concerns about the different vaccines; and (c) whether tougher action will be taken against persons who persistently spread misinformation to undermine the vaccination campaign.

7 Mr Alex Yam asked the Minister for Health in light of reduced vaccine efficacy against COVID-19 variants that is of concern in other countries whether the Ministry will (i) review the speed of relaxation of measures and the opening up of borders (ii) consider the requirement for booster shots and (iii) share what are the long-term outlook and healthcare plans for an COVID-19 endemic Singapore.

8 Mr Chong Kee Hiong asked the Minister for Health (a) whether the Ministry will consider subsidising regular Antigen Rapid Tests (ART) for those who are unable to take the current slate of vaccines due to medical or health reasons; and (b) what proportion of the population needs to be vaccinated before it will be possible for those who are not vaccinated due to legitimate reasons to be able to enjoy the same treatment as those who are fully vaccinated in more and higher exposure risk activities.

9 Dr Lim Wee Kiak asked the Minister for Health when the COVID-19 vaccination rate of 80% is reached by September 2021 (a) what is the Ministry's plan to wind down the vaccination centres islandwide; and (b) whether there will be permanent vaccination centres and associated facilities should future booster doses be required.

10 Dr Shahira Abdullah asked the Minister for Health with Singapore achieving 80% COVID-19 vaccination status and moving into endemic status (a) whether the Ministry will stop tracking the number of COVID-19 infection cases; (b) what other forms of tracking and measures will be relaxed when Singapore reaches endemic status; and (c) what other thresholds or criteria must be reached before we do.

11 Mr Dennis Tan Lip Fong asked the Minister for Health whether there are further plans to diversify COVID-19 vaccine sourcing.

12 Mr Murali Pillai asked the Minister for Health whether he can provide details of the Ministry’s programme announced in July 2021 to provide booster shots of the COVID-19 vaccine.

13 Mr Seah Kian Peng asked the Minister for Health whether there are already plans in place to secure COVID-19 booster jabs following the completion of the first round of COVID-19 vaccinations.

14 Assoc Prof Jamus Jerome Lim asked the Minister for Health given how Singapore had committed to advanced purchase agreements for COVID-19 vaccines as early as June 2020 (a) what were the reasons behind the delay that led to the first receipt of shipments only in December 2020; and (b) what were the constraints that inhibited a more rapid vaccine rollout rate, at least until April 2021.

15 Mr Pritam Singh asked the Minister for Health when does the Government plan to start COVID-19 booster vaccination for the general population.

16 Mr Leon Perera asked the Minister for Health (a) in relation to the four-stage roadmap to transit Singapore to a “COVID-19 resilient nation” announced on 6 August 2021, what are the criteria for reaching each of the stages; (b) whether further details can be provided about the restrictions which will be eased at each of the stages; and (c) whether the Government will consider further easing COVID-19 restrictions given that the milestone of eight in 10 people in Singapore being fully vaccinated has been achieved.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, with your permission, may I take Question Nos 3 to 16 together?

Mr Speaker: Yes.

Dr Janil Puthucheary: Sir, we have achieved an 80% COVID-19 vaccination rate as at the beginning of September and a number of Members have asked for greater clarity on our vaccination and booster strategy, and our approach on community measures as we transition into a COVID-19 resilient nation.

Sir, we have been experiencing an exponentially rising wave of infections in the community since 23 August. To curb the spread of infection in previous waves, we implemented circuit breaker and Heightened Alert measures, which significantly suppressed the rise of infections. The measures worked. But they were painful. They were painful to many families, workers and businesses. It is also not a sustainable way to battle the virus for the long term.

So, we will need to open up social and economic activities, otherwise many people and businesses will suffer and we risk permanently damaging our ability to earn a living. But we have to do so safely, which means reducing the number of people falling very sick to a minimum and, for this, vaccination continues to be key.

When we achieved 70% of our population having received the full regimen of the vaccine, the Multi-Ministry Task Force, presented a four-stage transition plan. It is a cautious, calibrated approach, not a sudden opening.

At this point let me address Assoc Prof Jamus Lim’s question on delays in our vaccination programme. Our vaccination programme has not been slow at all. We were one of the earliest countries to secure vaccine supplies, with the first shipments of the Pfizer-BioNTech vaccines arriving in mid-December 2020, one of the fastest to roll out a vaccination programme, and we now have achieved a vaccination coverage that is one of the highest in the world. In fact, 81% of our population have completed their full regimen and 85% have received at least one dose as of 9 September.

Members have asked about the criteria for moving from one stage to the next. I can understand the desire for transparent and pre-determined criteria. This is of great interest to all of us. But other than vaccination rates, we also need to consider case numbers, the transmission trajectory, our social behaviour in adherence to the Safe Management Measurements (SMMs) and the status of the testing regimes. So, while we have achieved our vaccination target of 80%, taking all this into account, we have decided to pause the transition plan, given the rising number of cases currently. We are not reversing course; neither are we charging ahead.

Having studied the safety and efficacy data, we will commence our booster programme for the vulnerable. Persons aged 60 years and above may receive a vaccine booster six to nine months after their second dose, while immunocompromised individuals will receive a third dose of the vaccine two months after their second dose.

The Expert Committee on COVID-19 vaccination (EC19V) will continue to observe global and local data, particularly on the risk of adverse reactions, before recommending additional population groups for booster vaccines. They are also actively studying a heterologous strategy involving non-mRNA vaccines. We are negotiating with suppliers to provide us non-mRNA booster shots and a few are preparing their applications.

We have a deliberate strategy to procure a portfolio of vaccines that use different technologies to improve our chances of securing vaccines that will continue be safe and effective against COVID-19. Due to commercial sensitivities and confidentiality undertakings in our agreements with vaccine manufacturers, we are unable to disclose more information regarding our current stock of COVID-19 vaccines, the remaining number of doses to be delivered and their delivery schedules.

This also applies to our dose-sharing arrangement with Australia. We do not need those particular doses at this point in time, but Australia’s vaccine programme does. We will need more doses in the future as we increase our booster programme and Australia will return the favour by sending us some doses at the appropriate time.

With 81% of our population fully vaccinated, we will close four vaccination centres on 30 September 2021 and may scale down other centres. We will also increase the number of Public Health Preparedness Clinics (PHPCs) which offer vaccinations from 79 currently to around 100 by end of October 2021. Those who are unable to go to our vaccination centres or PHPCs will be visited by our mobile and home vaccination teams.

Pregnant and breastfeeding women are strongly encouraged to take up the COVID-19 vaccination because they will benefit from the protection. They are more likely to develop severe symptoms if infected with COVID-19. All of our experts and professionals, such as the EC19V, the College of Obstetricians and Gynaecologists in the Academy of Medicine Singapore, and the Obstetrical and Gynaecological Society of Singapore, have advised that pregnant and breastfeeding women can receive a COVID-19 vaccination.

Since last year, hospitals have facilitated patients who are nursed in isolation settings to have contact with their family and loved ones through video-conferencing. This is an option to consider taking up if one wishes to communicate with a loved one who is hospitalised, without needing to make a physical visit to the hospital.

To encourage vaccination take-up, MOH has been working closely with stakeholders to address the concerns of those who have not yet taken COVID-19 vaccination because of medical complications due to pre-existing diseases, or misinformation over the vaccines and their side effects, or those who simply do not see the need for vaccinations. MOH has issued clarifications and corrections and, where necessary, applied the Protection from Online Falsehoods and Manipulation Act (POFMA) to debunk the falsehoods.

Vaccines can keep down the numbers of serious cases of COVID-19, but vaccination alone is not enough to prevent infections. It needs to be complemented by pervasive testing and safe management measures to detect and ringfence infections in the community early, so as to control community transmission. We have made available Quick Test Centres to administer supervised self-swabs, but it is also the personal responsibility of individuals to conduct these tests properly.

The Vaccinate or Regular Test regime will be introduced on 1 October 2021 for workers in higher-risk settings. The Government will fund, until 31 December 2021, the test kits for employees working in these sectors who are medically ineligible for mRNA COVID-19 vaccines. We will continue to review the regime and will make changes later, on the basis of the public health assessment.

Vaccination differentiated SMMs (VDS) were introduced to protect unvaccinated individuals from being infected with the COVID-19 virus. The F&B industry, the companies and their staff, have been responsive and adaptive in implementing VDS requirements for dining in, and have been educated on the digital and non-digital forms of verification. There have been some teething issues when this was first implemented but, over time, they have been sorted out.

Mr Speaker, earlier in August, we outlined a four-stage roadmap comprising the Preparatory Stage, Transition Stage A, Transition Stage B and a COVID-19-resilient nation. We continue to work on the basis of this roadmap. Our vaccination and testing efforts, along with our SMMs and all of us exercising social responsibility, implemented together, are vital to us staying the course towards becoming a COVID-19-resilient nation.

Mr Speaker: Mr Louis Chua.

Mr Chua Kheng Wee Louis (Sengkang): Thank you, Mr Speaker. I have one supplementary question for the Senior Minister of State. In relation to my Parliamentary Question (PQ) on booster shots, I note that MOH will now offer booster shots to seniors and immunocompromised individuals, as what Senior Minister of State has said.

I was just wondering if the Government has completed its assessment on the need for a booster shot in general and what are the rollout plans for the general population, especially the healthcare workers and transport workers who are amongst the first in this country to be vaccinated? I also note in Minister Dr Tan See Leng's reply to a Parliamentary Question (PQ) of mine yesterday, for example, that protection conferred by vaccines may wane with time and new COVID-19 variants may emerge that may be resistant to our current vaccines.

Dr Janil Puthucheary: Mr Speaker, the short answer is we continue to study the matter and we have not completed that process yet. When we do, we will have a full explanation and discussion.

Mr Speaker: Mr Alex Yam.

Mr Alex Yam (Marsiling-Yew Tee): Thank you, Mr Speaker. Two supplementary questions. Currently, the vaccines that are used in Singapore are under emergency approval. First, at what stage is HSA at in providing full approval to the vaccines eventually? And, under those circumstances with an expected booster regime in the works, will the Government then consider making boosters and vaccination compulsory? This is to address the concerns I raised in relation to Question No 6.

On Question No 7, I asked in terms of concerns over efficacy of the vaccines against new variants, what is the Government's long-term plan in dealing with variants, as well as the concerns of citizens that vaccines might not be fully effective when new variants emerge?

Dr Janil Puthucheary: Mr Speaker, for full approval to be granted for any of the vaccines, not only do we need the data, but we also need the application from the manufacturer. So, the manufacturer has to make the application. The appropriate data needs to be available for our own Health Sciences Authority (HSA), and our professional experts here will need to be able to study the matter. So, we are not in a position at this point in time, to be able to answer that.

As to making the vaccine compulsory, well, firstly I think we do need to wait for that process if it happens at all. We also need to then look at our context and I imagine the Member is referring to what has happened in the US, where there has been that consideration. Our context is different. Our vaccine rates are much higher, the acceptance by our population of vaccinations has also been very different. So, well, we will look at the matter, but I think, at the moment, there is no full approval anytime soon. We will study the matter when it arises.

As for the third question about long-term plans with respect to variants, we have a number of surveillance systems in place. The first layer of defence is our integration into the international network, where variants of interest and variants of concern, the markers for that are shared through a network of professionals. The second layer of defence is our clinical staff on the ground. You have a patient in front of you and you have to make the assumption that maybe this might be COVID-19, maybe I need to send a test for this. That then allows us to activate our third layer of defence, which is laboratory surveillance when specimens are submitted, to then look for the analyses that will tell us whether it is COVID-19 and, if so, whether it is a new variant or it is a strain that we are already familiar with.

We do have a process in place and that process has been going on for some time and it is what we have used to be able to get us to this point in the COVID-19 fight already.

Mr Speaker: Ms Jessica Tan.

Ms Jessica Tan Soon Neo (East Coast): Thank you, Mr Speaker. I have one supplementary question for the Senior Minister of State. He has touched on the importance of the testing regime. So, I would like to ask the Senior Minister of State, with the greater use or dependency on the Antigen Rapid Test and self-testing by individuals and organisations, how can MOH ensure the integrity of the system and the results do not prevent any undermining of the ongoing efforts to combat the current pandemic?

Dr Janil Puthucheary: Mr Speaker, I thank the Member for her question. Firstly, the testing regime is only one part of our overall effort to combat the pandemic. We have the social measures, we have the vaccination, we have the healthcare system and we also have the whole process of ring-fencing, quarantining and isolating people.

Testing runs throughout all these. But, again, there is no single testing regime. You have ART, PCR test, Rostered Regular Testing and so forth. All of these require a certain personal responsibility for an individual. They have to conduct the tests properly. They have to adhere to instructions when they are given, but we do not rely only on that. So, we have a web of processes, an ecosystem of processes. There is room in there for people to not perhaps execute some of this properly, but there is also plenty of room for people to exercise diligence and personal responsibility; and each of us then can play a part in terms of protecting ourselves, our family and our entire country.

Mr Speaker: Assoc Prof Jamus Lim.

Assoc Prof Jamus Jerome Lim (Sengkang): Thank you, Speaker. And I thank the Senior Minister of State Janil Puthucheary. I am afraid I continue to disagree with the characterisation that our rate of vaccination rollout was, in fact, as rapid as could be. Admittedly, today, our rate of vaccinations is among the highest in the world. And there was an acceleration, clear in the data, in the rate in which rollout occurred in Singapore, round about the end of March and early April. But at the same time, it is worth recalling that by 18 March, in fact, Israel's coverage was 60% for first shots. And this is in light of the fact that the Government has stated that advance purchases occurred in June 2020 and our first shipments were in December. So, I am thinking specifically, about that three-month gap between January and April, where rollout remained low.

If I may quote, this was shared in this House by Minister Ong Ye Kung that there was a concern and I quote, "that many developing countries were still trying to secure supplies... fortunately, we had negotiated advance purchase agreements." And so, given this fact that we had already negotiated these advance agreements, it is puzzling why we were not able to accelerate this rollout in the first three months of this year.

Dr Janil Puthucheary: The Member is quite free to disagree with me. We had the doses delivered to us as part of the advance purchase agreement. The manufacturers were under some strain to produce as much as they can, not just for us, but for the whole world. But I think our contractual agreements were honoured.

If the Member was suggesting that perhaps we should have renegotiated the agreements or not honoured the agreements in some way or changed it, he can hold on to that opinion. But I thank him for agreeing that, now, we have, indeed, done relatively well compared to perhaps, what the situation looked like in March. Ultimately, it is that destination which is of importance and will protect us. At the beginning of the vaccination rollout, our pace was constrained by the supply that was made available to us from the manufacturers. And I think this is something that we have explained several times.

Mr Speaker: Leader of Opposition.

Mr Pritam Singh (Aljunied): Thank you, Mr Speaker. Just two questions for the Senior Minister of State. Firstly, does the Government now have a fix on the number of Singaporeans who cannot take the vaccine for medical reasons?

The second supplementary question is, the Senior Minister of State, if I heard him correctly, replied that the Government is extending free ART testing to certain groups of employees at the workplace. Does the Government have a position on testing-related subsidies for Singaporeans who cannot take the vaccine for medical reasons and not just in workplace settings? I understand that we have got free ART kits that are being delivered to Singaporeans, but for elderly Singaporeans who still cannot take the vaccine for medical reasons or thereafter, are there going to be some subsidies for them, for additional ART kits, for example?

Dr Janil Puthucheary: Sir, the issue of not being able to take for medical reasons, unfortunately, is not an absolute cut and dry, because some of it is a continued assessment. For example, you are waiting for your chemotherapy to be completed, or as you recover from the surgery and so forth. So, it is not a fixed number. We will pay very close attention to it. It is a small number, relatively speaking.

For the second question, individuals who are unable to take the vaccine for medical reasons have some degree of vulnerability. So, perhaps, they may need to be careful about their exposure to the wider community, because the issue of testing is not going to protect them from the vulnerability they have as a result of their medical condition. So, it is not quite the same as the circumstances where you have someone who, for some reason, is allergic to the vaccine and then cannot complete a vaccination regimen, but would like to then go out and work and is otherwise healthy, and this is the situation in which we are then providing subsidies for the ART kits.