Safe and Orderly Restoration of Singapore's Air Connectivity

Thank you, Speaker. I have two clarifications for Minister Ong.

First, as the bivalent vaccine booster shot is currently optional, I would like to ask the Minister whether the take-up rate among our elderly and the at-risk groups is adequate.

The second question – given that there have been news reports on the increased transmissibility and re-infection rates of some of the virus' sub-variants circulating now, are more extensive communication efforts being planned to encourage more people to take their bivalent boosters as soon as possible?

First, vaccination has always been optional. We have never made it compulsory, but because of the cooperation and social consciousness of Singaporeans, we have attained a very high vaccination rate.

Today, instead of measuring bivalent take-up rate, let us measure the up-to-date vaccination rate. The up-to-date rate is not bad at all. It is about 60% for the whole population. Amongst those aged 80 and above, it is actually 67% to closer to 70%. So, we are quite encouraged by it.

As I mentioned just now, bivalent vaccination is happening at about 13,000 doses per day, which is a very healthy volume.

But I think the Member raises an important question – how do we ensure that people continue to take it? We have never made it compulsory. We will continue to use the measures that have worked.

First, make it very convenient. We now have Joint Testing and Vaccination Centres (JTVCs) throughout the island. You do not have to make an appointment. Just walk in.

Secondly, for seniors, we make it even more convenient by bringing in mobile teams to the heartlands, so that they can just go downstairs and get the vaccination.

Thirdly – and I think that is MOH's job, the Multi-Ministry Task Force (MTF)'s job – continue to publicly explain the benefits of vaccination, because the benefits far outweigh the risks of getting COVID-19 and the risk of having severe illnesses.

Finally, work with all our on-the-ground partners – general practitioners (GPs), Traditional Chinese Medicine (TCM) physicians, our advisors, our volunteers on the ground – continue to carry and to take the message to the masses, explain the benefits, and hopefully, more people will come.

I think there is a momentum. If more people take the vaccinations, when they meet each other for coffee, they find that their friends have taken them, they feel the fear of missing out (FOMO), and then, they will take too. So, I think just keep that going. It is essential.

Thank you, Mr Speaker. I have two questions for the Minister for Transport.

First, given the heightened risk profile of international travellers, would Singapore consider temporarily tightening the mask-wearing policy to require masks to be worn on board all flights entering Singapore, so that we can reduce the risk of in-flight COVID-19 contamination? I think we all believe that masks act as the first line of defence against the spread of the virus.

Second, as Minister Ong mentioned earlier, COVID-19 wastewater surveillance has shown to be a valuable tool. Airplane wastewater surveillance could potentially be an option. Would Singapore consider stepping up sampling wastewater taken from international aircraft entering Singapore to track any emerging new variants?

I would leave the wastewater question to the Minister for Health, who can speak on it more authoritatively.

On the point on mask-wearing, today, specifically with respect to China, the airlines already require mask-wearing for their crew as a precautionary measure. Also, China already requires mask-wearing for flights going in and coming out. So, in a sense, that has already been addressed.

Our general posture on mask-wearing is really for compliance with the source country's or destination country's requirements. If you are going to a country that requires the wearing of masks whilst in flight, then the airline will advise you to do so, and then, you wear the mask; and likewise, on the return leg.

In general, we have aligned our mask-wearing protocols with the protocols that we have worked out with MOH for the domestic setting. That continues to be the way we will operate unless there are material reasons for us to make a deviation or an exception.

Minister Iswaran left the wastewater testing to me. As I mentioned in my Statement, wastewater testing, at least for the ones we use in Singapore, works by detecting viral fragments from solid waste, not from urine. Therefore, we used it in dormitories, in housing estates, even in nursing homes, which is quite a challenge because many old folks use diapers. Therefore, for a flight from China to Singapore, it is quite a short duration. So, I think that the use of wastewater test will capture a very small sample and is, therefore, not very useful.

Clarification. Thank you, Sir. Minister Ong said we required the tourists, the in-flights, people – if they did board the plane, they have to declare their vaccination status right now. What is the definition of a full vaccination for that matter, because in Singapore, the full vaccination status, it is three shots if you take non-mRNA. So, what is the definition of that?

Secondly, do we require – maybe Minister for Transport can advise us – do we require an air traveller to buy COVID-19 insurance as he comes to Singapore?

We do require medical insurance if you are not fully vaccinated. But the Member is right that, in Singapore, as Members are aware, MOH has revised our vaccination status definition. We require minimum protection, which is three shots for mRNA, or four shots for Sinovac. And after that, we require another additional shot five to 12 months after the previous shot to keep yourself up to date. So, our definition is quite a tight one. The World Health Organization (WHO) has a more relaxed definition. We know our definition is different and stricter than WHO's, which is currently applied on travellers. It is not practical to fully align the vaccination definition for people living here and for travellers from all around the world, because every country has their own definition. And that is why we use the WHO definition, which is less strict on travellers from all sources.

Having said that, the current definitions have worked well for us so far. I mentioned the outcome from December. So, it has obviously worked well. But we will have to study if there is a need to review the definitions for vaccination status based on the development of the disease threat.

Thank you, Mr Speaker. I want to thank Minister for Health and the Minister for Transport for the very useful Statements that help to prepare Singaporeans as China opens up, to lead as normal a life as possible as we have been very steadfast, as we had our opening measures.

I wanted to seek a clarification from Minister Ong. Should a new and dangerous variant emerged, what is likely the protocol that will be adopted, as most Singaporeans have cooperated and been fully vaccinated, and also gotten used to the concept of living with COVID-19 as an endemic as a way of life?

A clarification for Minister Iswaran: what is MOT's projected timeline for travellers from China to return to pre-COVID-19 volume?

Thank you. Very critical question. What do we do when we detect a new dangerous variant?

Let me make a few points.

One, there are a lot of sub-variants. Omicron alone, there are about 650 Omicron sub-variants. So, if you jump at every one, you will be jumping every day, twice, right? Because sub-variants can really differ very minimally; just like a human, you are wearing a different shirt, different watch, different shoes, different earrings. That is about it. You are essentially still the same person. So, we cannot jump at every sub-variant, no matter how sexy the name sounds. There are just so many sub-variants.

But keep our eyes and ears on the ground with the global surveillance system. Look out for those that is more dangerous. If there is one, then we think about what we should do. And we can see how some countries are implementing. Mr Melvin Yong suggested masks on planes – which is not unthinkable – pre-departure test (PDT) and so on and so forth. But a popular one is PDT.

The second point to note is that PDT is not foolproof. In fact, it is quite leaky. Why? Because, first, you can be incubating and when you test before you board the plane, you are negative, but on the plane or upon arrival, you develop disease and you become positive. And then, leaks will happen.

Therefore, if you want PDT to be a little more tight, you also implement an OAT, on-arrival test. But still, for a short flight, you might be incubating before you board and also during landing. And then, for the next three days you are incubating. And therefore, that is still not enough, you want to be even tighter, you implement SHN, stay-home notice. All these sounds familiar. That was what we did – PDT, OAT, SHN. And soon, you have a big border control system, testing everyone before they board; testing everyone after they board, dedicated a taxi driving you to your homes and then using devices to make sure they stay at home. And then, that is still not foolproof, because one day, a traveller may pass it to a driver, and the driver goes home, he goes for big lo-hei dinner, passes it to many other people. And then, next thing you need to think about is safe management measures (SMMs), social restrictions.

We always have the mindset that border measures are a substitute for domestic community measures. Actually, it is not. They are all complementary; they go together. Once you implement one, you must be prepared that the rest are going to follow because that is how transmissible the virus is. One is not the substitute of the other. They all come in a package, unfortunately.

Third point is that certain protocol that the Member mentioned: PDT, OAT, SHN or combination, can buy us time. And that can be very valuable. Therefore, why do we buy ourselves time? Let us say we detect something that sounds serious, which you can recall, when we first detected Omicron coming from Africa, we have to implement a combination of those measures. We know it will not shut out the virus, but it buys us time for scientific data to come out, because in a matter of weeks, you can know the characteristics and the parameters that matter. How long does it incubate? How fast does it transmit? To what extent does it translate into severe cases? Does it affect old people more or young people more? That is actually an important parameter. Once you know these parameters, then you can decide your next step. If the parameters turned out that it is not something very serious, then you can stand down, false alarm. There will be some damage to livelihoods and inconveniences but, at least, we stand down.

But if your nightmare comes true, that it is very transmissible and very deadly, then, you have to hunker down. We have to hunker down again, back to almost square one – contact tracing, SMMs, border measures, everything come in, again, to buy us even more time. Even more time for what purpose? Even more time so that a new effective vaccine can come on stream. With mRNA technology, hopefully, that can happen in 100 days and that is why it is important to go onto the mRNA platform.

The Member asked about protocol to respond to a new dangerous variant. This is roughly the idea. But when something like that happens, expect lots of uncertainties, some confusion. It would not be straightforward, a lot of judgement calls will be required.

Mr Speaker, I thank the Member for her clarification. As I have stated earlier in my reply, whether you look at it in terms of flights or in terms of passenger volumes, we are well below where we were, in fact, 10% – or less – compared to pre-COVID-19. So, there is clearly significant scope to restore air connectivity and the passenger flows between China and Singapore.

Having said that, I am reluctant to put a timeline to this process and the reason is because there are several variables that we need to take into account. First, just from a commercial point of view, the number of applications from airlines and so on, although all indications are that there will be strong demand. But, beyond that is, of course, the public health situation that is evolving. We also need to take into account Changi Airport's own ability to manage any increases, and to do so in a manner that ensures safe and smooth travel for passengers.

So, a variety of factors. But we are quite clear that directionally, this is what we want to do as we have with the rest of the world, we want to restore air connectivity with China, and we welcome the latest announcements and moves by China.

But in the near term, if you ask me, will there be a surge? I think unlikely, but neither will we be at a standstill. Our desire is really to do this in a systematically calibrated manner because whilst the destination is important, the journey is even more so at this juncture.

Thank you, Sir. I am not sure if it is for the Minister for MOT or MOH. This is on the SG Arrival Card.

In the past before COVID-19, returning Singaporeans do not need to do health declaration at the customs. But now, we have to do it via online or physical. I mean, I can understand that we need to do some of these border checks, like PDTs, but for the SG Arrival Card where we ask some generic questions: where you come from, Africa or Latin America or Middle East. And then, ask those questions like, "in the last seven days, have you been unwell" and so on. We can say yes to all three questions, but you will still be granted entry, you will still be allowed entry to Singapore and there is no follow-up. I just want to ask whether what purpose does this serve to do that, to have that SG Arrival Card process?

This is one of those things that MOH gets all the time. If you succumb and then you remove it, and then, one day you regret, that you should have kept it.

We have always had an SG Arrival Card and it is physical. But because of COVID-19, everything went digital. So, now, the SG Arrival Card has become a digital declaration. And in that process, MOH, with the Immigration and Checkpoints Authority (ICA) has very thoroughly gone through and reduced the questions to the bare minimum, to the extent that the Member feels it may not be so helpful. Maybe we will review to see whether we can add a few more questions. [Please refer to "Clarification by Minister for Health", Official Report, 9 January 2023, Vol 95, Issue No 79, Correction by Written Statement section.]

But the purpose is, it is not targeted at COVID-19 but targeted at Middle East Respiratory Syndrome (MERS), at Ebola, Mpox and so on, that can arise and can infect travellers. While travellers declare whether they feel well or unwell, the fact is they leave behind a contact. So, if someone falls sick, goes to a doctor and we detect is MERS, for example – we are always on the lookout for MERS – we know which flight the person came off, who are their close contacts and if we want to do contact tracing, we can do so through the SG Arrival Card mechanism. It is one of those things we keep in the background – useful to have, and if we need to trigger some action, the information will be valuable.

Thank you, Mr Speaker, Sir. Just two questions for Minister Ong.

The first one is about hospital capacity. I understand that currently, in terms of bed utilisation and the intensive care unit (ICU) utilisation, the capacity levels are very high – for some of the public hospitals is 90% or even, well above 90%. So, notwithstanding the regime of PDT and full vaccination, it will just take a relatively small number of cases coming in to possibly strain the hospital capacity to a very difficult position. So, I am just wondering if the Government has thought through this extreme or worst-case scenario that might happen with the opening up, of capacity being overstrained in a public hospital system.

The second question is on the prescription of Paxlovid, which is the COVID-19 anti-viral drug. I understand that there are 36 clinics now that can prescribe it. Is there plan to expand this across the whole primary healthcare system?

On hospital capacity, indeed, this is one of the key considerations I mentioned in the Statement just now. Today, the number of COVID-19 inpatients is actually low. I cannot remember how many exactly, but it is in the low tens. So, it is not actually burdening our hospital system. However, the hospital system utilisation of non-ICU wards is high because we are ageing – more people are falling sick.

COVID-19 affected that indirectly because it delayed the opening of some major public health facilities. Woodlands Healthcare campus, for example, was delayed for two to three years. We hope it can start opening by the end of this year. It will greatly relieve the burden currently of the high utilisation rate of hospital beds.

You cannot rush the building of a hospital, but what we can do, which I have announced and explained in this House before, is to set up step-down facilities, particularly Transitional Care Facilities (TCF) that proved to be very helpful. That means for patients who do not require acute care, but waiting for step-down or rehabilitative care, they can go to a TCF first. So, that can temporarily relieve the situation.

Manpower is another constraint, but we are recruiting, building up. We lost a number of good nurses, especially foreign ones, because the competition heated up. But we are recruiting again. These are some of the things we need to do, and you are right: we have to be very alert should there be a new variant or big influx of severe cases and implement the necessary measures.

As for Paxlovid, we are constantly reviewing if more clinics can dispense them. But so far, because of the fact that we are a very highly vaccinated population and Paxlovid is prescribed for people who are at-risk. So, actually the number of people who is need it, is not very high. Notwithstanding, this is something we will look at.

Thank you, Mr Speaker. I would like to seek clarification from Minister Iswaran with regard to the transport issues that he shared earlier. The Minister mentioned just now about 38 weekly flights from China, while pre-COVID-19, there were 400. So, the Minister was trying to share the general trend that we would proceed through to pre-COVID-19. The Minister mentioned about the careful and calibrated approach.

May I seek clarification from the Minister, when he said careful and calibrated approach, he did mention about the epidemiological factors that may affect this dynamic. What does it mean, in terms of, it affecting our original plans? For the whole of this year, we will eventually try to target future flights to be achieved by this year or potentially 2024. What does this careful and calibrated approach mean, in terms of changes to our original plans, to open up to reach pre-COVID-19 levels?

Mr Speaker, I thank the Member for his clarification. Essentially, our starting point – and that has been the way since the latter half of last year – has really been to gear up our airport operational capacity to be able to manage volumes that are equal to pre-COVID-19 levels.

Indeed, that is where we are today – because Terminal 1, Terminal 3 and Terminal 4 are now fully operational. And for Terminal 2, half of that is now able to take both arriving and departing flights.

With that, and the improvements that have been made in the system and operationally, we are actually able to accommodate the volumes that were around – if I recall correctly – pre-COVID-19, which was about 68 million passengers a year.

So, that is the supply side in terms of physical capacity. A second element is the manpower aspect, where we continue to recruit, to train, in order to build up the capability for the whole spectrum of services that are essential to run the airport well.

In terms of manpower manning levels today, we are at about 90%, or slightly more. This continues to be an important effort but also a challenging one. So, this is an area which Changi Airport Group (CAG), Singapore Airport Terminal Services (SATS) and even Singapore Airlines (SIA) and others in the group, are working very hard at. But that could become one of the constraining factors.

Hence, the careful, calibrated approach, because we do not want to extend flight capacity without having the ken to deal with it at the airport side. This is the important dynamic that we are trying to balance.

Overall, as I replied to the earlier question, specifically with respect to China, we would like to restore air connectivity to pre-COVID-19 levels. There is a significant gulf as we are all well aware now from the data. The real challenge is to do this in a safe and orderly manner. This is where I think both countries are aligned and we are seeking to do this in a systematic way. I cannot give a specific time frame but what I can say is, in the near term, we will continue to do this methodically. CAAS will evaluate and approve applications. I do not expect it to be a surge, but neither are we going to be static or at a standstill.