Removal of More COVID-19 Restrictions and Its Impact on Hospitalisation Rates and Vaccine Programme

Mr Yip Hon Weng asked the Minister for Health with regard to the current COVID-19 Omicron wave (a) whether the hospitalisation rate of 1.9% is expected to rise as more restrictions are removed; (b) what is the highest hospitalisation rate that our public hospitals can currently accommodate; and (c) whether the Government will look into mandating targeted vaccines against the Omicron variant.

I am very thankful that the number of questions on COVID-19 has decreased significantly.

Mr Yip Hon Weng asked about COVID-19 hospitalisation rates that our public hospitals can accommodate. As our society becomes more resilient to COVID-19 due to vaccinations as well as safe recovery from infections, we have observed that the incidence of hospitalisation has fallen in the most recent Omicron infection wave, compared to previous waves.

However, it is not possible to estimate a hospitalisation incidence rate which our healthcare capacity can handle, because it is also a function of the transmissibility of the variant and the number of people who get infected on a daily basis during a big wave. So, what we need to do is to continue to keep our vaccinations "up to date", prevent ourselves from falling severely ill if we are infected, we must exercise social responsibility, such as staying at home and self-testing when not feeling well, and do whatever we can to optimise our hospital capacity. We have been and will continue to re-allocate our healthcare resources on a dynamic basis to where they are needed most.

Mr Yip Hon Weng also asked about vaccines. We are bringing in bivalent vaccines into Singapore. It is provided for in our agreements with the pharmaceutical companies. The Health Sciences Authority (HSA) has completed the evaluation of the Moderna bivalent vaccine and a decision will be announced soon. The bivalent vaccines will target both the ancestral strain of COVID-19 and the Omicron variant. Our intention is to update our vaccines for the National Vaccination Programme as the formulations improve. We will share more details when the arrangements are confirmed.

Nevertheless, existing vaccines remain highly protective against severe disease, including for the Omicron BA.5 variant. If you are eligible to receive another vaccine dose, please receive your vaccination without delay and not wait for variant-specific vaccines, as COVID-19 is still spreading in the community.

I will now turn to the Member’s question about COVID-19 in children. As of 29 August 2022, amongst young people under the age of 18 who are infected with COVID-19, the incidence of Multisystem Inflammatory Syndrome in Children (MIS-C) was 5.7 per 100,000 for those fully vaccinated, versus 38 per 100,000 amongst those not fully vaccinated.

The Member also asked about children’s vaccinations for COVID-19, such as whether Novavax will be made available for those aged 18 and below and whether the vaccines have long-term effects on children. Currently, HSA as well as the Expert Committee on COVID-19 Vaccination (EC19V) are independently evaluating the Novavax vaccine for young persons aged 12 to 17. Novavax has not submitted the application for its vaccine to be administered to children under 12.

There is so far no evidence suggesting COVID-19 vaccines result in potential risk of toxicity to humans or developmental defects in children. There are no plans to include COVID-19 vaccinations into the National Childhood Immunisation Schedule at this point as the pandemic situation is dynamic and the recommendations continue to evolve with new data. MOH will review this when appropriate.

Assoc Prof Jamus Lim asked about vaccination-differentiated measures. At the height of an infection wave, measures are taken to prevent our healthcare system from being overwhelmed. However, when cases are lower and steady, many of these measures, including mask-wearing, for example, have been removed. Others, such as vaccinations and vaccination-differentiated safe management measures (VDS), are kept in some form, in anticipation of another infection wave. This is the nature of crisis management – we stand down many measures when they are not needed but we need to keep some, in anticipation of something worse happening later.

While VDS is mandated for specific settings, such as events with more than 500 participants at any one time, business owners and employers also have the flexibility to implement conditions of service that are relevant to their settings, such as requiring the donning of masks, as well as adopting vaccination-related instructions for customers or for workers.

Nevertheless, as the Multi-Ministry Task Force (MTF) had explained in previous replies, we are reviewing vaccination requirements, from one of counting number of doses and boosters we are taking, to ensuring that our vaccination is "up to date". This will be a more enduring posture as we live with COVID-19 as an endemic disease. We expect to complete this review in the next couple of months and will review VDS at the same time.

Thank you, Mr Speaker. I thank the Minister for the reply. I have two supplementary questions. I note the Minister's response on adding COVID-19 vaccinations into the National Childhood Immunisation Schedule. It will give assurance to parents that the COVID-19 vaccination does play an important role to better protect children against severe complications, such as Multisystem Inflammatory Syndrome in children. What else is the Ministry doing to encourage more parents to vaccinate their children for COVID-19?

My second supplementary question is when will MOH allow children below the age of five to get the COVID-19 vaccination, since other countries, such as the US, have allowed COVID-19 vaccines for babies aged six months to toddlers aged four years?

On the second question first, children under five, we have the supplies; it is part of our supply agreement. HSA has also approved the use of the Moderna vaccine, which is a two-dose vaccine, on children aged six months to under five years old. But because cases are now low and we also want to vaccinate children below five and give the booster for children aged six to 12 years at the same location, it is more convenient for parents to bring siblings often falling into both age groups together to the vaccination centre. But the older age groups, those in Primary schools, many of them are also getting into examination mode and given that the current situation is stable, the cases are relatively low, our intention, as we have announced at the MTF press conference, is to time it around end-October or early November, when examinations are over, so that, with peace of mind, parents can bring their children – those from six months up to 11 years old – either for their primary series or for their booster. That is our current plan. Details will be announced once we are ready.

As we open up vaccinations to all the children for booster or primary vaccination, we want to continue to disclose as much medical information as we can, for example, as the Member has asked, "What is the MIS-C rate for children who are fully vaccinated and not vaccinated?" We can tell there is huge difference. Therefore, it is through encouraging parents through transparent information that we hope more parents will bring their children to get vaccinated.

Sir, I understand the desire by the Ministry to allow the private sector to retain maximum flexibility in terms of VDS, but I am wondering if the public sector will move towards a complete removal. I ask, in part, because I believe many of us still have residents that – for religious, health or personal reasons – have chosen not to be vaccinated.

I think it is difficult to adopt a blanket policy to say all in the public sector shall not insist on VDS. It all depends on the settings. For each setting, it depends on whether it is crowded, whether seniors are present in those settings, what is the risk of transmission. So, I think we always need to take a differentiated approach.

We must remember that as we increasingly treat COVID-19 as endemic, "endemic" does not mean that it is not there. Endemic means to acknowledge that it is there and we have to adjust to our normal life and normal procedures in order to live with the virus. And one of the principles to do so is to make sure that, according to the risk of different settings, we adopt the necessary measures to manage the risks. Therefore, it is in this spirit that we allow employers and building owners to impose their own VDS requirements should they need to.

Nevertheless, as I mentioned in my main reply, we are reviewing VDS together with the requirements for vaccinations and it should be completed in the next couple of months.