Review of Safe Management Measures with Stability after COVID-19 Omicron Virus Wave

Mr Lim Biow Chuan asked the Minister for Health (a) what is the overall cost to businesses to maintain Vaccination-Differentiated Safe Management Measures just to cater to unvaccinated residents; and (b) whether requiring unvaccinated residents to bear their own medical costs will be sufficient deterrence to residents who choose not to be vaccinated.

Mr Liang Eng Hwa asked if we will review the safe management measures (SMMs), given that we have passed the peak of the Omicron wave. As the Member is aware, the relaxed rules came into effect on 29 March 2022, which is why we are all seated together today, and we have also transitioned to a Vaccinated Travel Framework on 1 April 2022.

It is a decisive but calibrated move. We did not declare a Freedom Day nor did we declare the pandemic to be over, as some countries did. Taking a cautious step-by-step approach has served us well throughout the pandemic and we will continue to do so.

That said, we were able to make this decisive move as we observed that the number of daily cases had been steadily declining in recent weeks. More importantly, the number of severe cases needing to be hospitalised had also declined. It is in this context that the Multi-MinistryTask Force (MTF) assessed the further easing of our SMMs and resumption of many normal activities to be appropriate.

These relaxations will likely cause an uptick in daily cases, which we should be able to ride through without any major changes to our public health posture. Once cases subside further, we will consider further easing of the SMMs. This can include reviewing distancing rules between tables in F&B settings that Mr Liang Eng Hwa specifically raised, and I want to assure Mr Liang that I am aware that one metre versus 80 centimetres makes a huge difference to F&B establishments. It also makes a huge difference in terms of transmission. So, we have to weigh the costs and benefits.

We will also review TraceTogether, SafeEntry, as well as Vaccination-Differentiated Safe Management Measures (VDS) which various Members have asked about. Let me go through the three measures in turn.

On TraceTogether, and in response to Ms Hazel Poa and Assoc Prof Jamus Lim, MOH no longer relies on TraceTogether for contact tracing for the general public. Cases who self-tested positive and go on to Protocol 2 do not upload their TraceTogether data, and we rely on them to do the responsible thing to inform their contacts to self-monitor. So, there is really no need to compare the data between self-reporting and TraceTogether because, having vaccinated the vast majority of our population and being determined to live with COVID-19, we have passed that stage of the pandemic where we contact trace every case.

Having said that, agencies that look after more vulnerable sectors, such as schools or preschools, continue to use TraceTogether for contact tracing. Further, the aggregated statistics generated by TraceTogether and SafeEntry can give us a good idea of the settings that are more susceptible to transmission of the COVID-19 virus.

So, on the whole, the costs and benefits of TraceTogether change as we make further progress in living with COVID-19. MTF will, therefore, review its relevance and application to stand it down when it is no longer needed, while maintaining the capability to restart it should we encounter a more dangerous variant of concern.

For SafeEntry and VDS, I will address them together because they are closely related. Today, SafeEntry is the most convenient way to check the vaccination status of an individual entering premises. If we decide to do away with VDS, then there is no need for SafeEntry.

As of now, VDS is still needed. Even as we know that the Omicron variant is less severe than Delta, unvaccinated or non-fully vaccinated persons are still a lot more likely to fall very ill if they are infected. As of now, we have about 3.5% of our adult population that is not fully vaccinated and they account for over one-fifth of cases that require ICU care or die.

While the patient load at our public hospitals has eased, hospitals are still very busy. With the recent easing of SMMs and the resumption of visitors to hospitals starting today, workload will go up for our healthcare workers. The more cautious and correct course of action now is to keep VDS and not to risk having more non-fully vaccinated patients getting infected and needing hospital care and adding workload to our healthcare workers.

Make no mistake. Individuals who choose not to be vaccinated impose a cost, sometimes a significant one, on our hospitals in terms of workload, businesses in operating SafeEntry checks and enforcement agencies in conducting checks. When we are sure that the situation in hospitals is stable and improving, we will review the VDS and consider if we can reduce the number of settings or remove it completely. Then, it will be a matter of individual responsibility of these non-fully vaccinated individuals to take precautions to avoid high transmission settings, or better still, change their mind and get vaccinated.

Finally, Assoc Prof Jamus Lim asked if COVID-19 can be treated like Influenza at some point, as an endemic disease. This is the objective set out by MTF last year and we are making good progress, as a country. I should clarify, however, what "endemicity" means. It does not mean we treat COVID-19 as if it is not there. It is, in fact, the opposite, because endemicity means the disease is constantly there, circulating at a rate that is more predictable and not likely to disrupt normal lives. Like Influenza, which kills tens of thousands of people every year, we will need to continue to take precaution and adopt appropriate SMMs in order to manage the risk and damage from COVID-19.

We are still some way to treating COVID-19 as an endemic disease, because the virus is still circulating around the world and evolving. The virus continues to spread widely in other countries, especially among those whose people are not well vaccinated, leading to significant evolutionary pressure. There is, therefore, still a risk of it mutating into something more dangerous, into a variant of concern.

So, while we have eased up the SMMs and reopened our borders, the pandemic crisis is not over. We will have to continue to monitor the local and global situation, do our part to keep our country safe and continue to work together to tackle whatever challenges that may come our way.

Thank you, Sir. Sir, in the Minister's reply, he mentioned that SafeEntry is still needed to protect 3.5% of the eligible population who are not vaccinated. It is now down to 3.5%. So, can I ask the Minister, from an equity standpoint, does it make sense to inconvenience the 96.5% of the population, just so that we can deter the 3.5% unvaccinated from entering the premises? Does it really make a difference in terms of the public health outcomes? Or is it just a move to basically disincentivise those unvaccinated from going there or to nudge them to get vaccinated?

I will answer the Member's questions in a straightforward way. Is it equitable? Actually, not quite. So many of us are doing so much to protect that 3.5%. Is it, therefore, to protect public health outcomes? The answer is yes. As I have explained, hospitals are not out of the woods. I just visited Ng Teng Fong General Hospital this morning. They are very busy.

We can see cases coming down. We feel, generally, safer. We are prepared to gather together without safe distancing, take off our masks when we are outdoors. In the hospitals, it is still a crisis situation. Every day, we have hundreds of people coming to the emergency department. Many of them with chronic illnesses, some infected, but they do not know about it. But that is the outcome of two over years of focusing on COVID-19. The business-as-usual (BAU) workload has built up. Chronic cases have become more serious. So, hospitals are now busy. Healthcare workers need all our support. So, while we understand it is not exactly an equitable situation when you look at businesses, you do not want, at this point, to add workload to our healthcare workers.

So, I will say the fair thing to do – we are just coming down the slope of the transmission wave. Let us go through it a bit more, make sure our hospitals are in a better position, healthcare workers have a breather. Then, I think we consider whether we can remove the VDS.

Sir, I hate to belabour this point, but really, I know that the doctors, the healthcare workers have been trying to get the unvaccinated people vaccinated, but to no success. So, I do not see how the number of vaccinated people will go up. The question that many people have asked is, when will all this end? Like what Mr Liang Eng Hwa said, all these are at great inconvenience to the malls, because they have got to have manpower to man the entry and exit points of the malls. It inconveniences the shoppers who have to go into the malls, because now they have fewer entry and exit points.

So, surely, MOH ought to consider the principle of self-responsibility, which is that, those who choose to be unvaccinated have to take the consequences of their action. I mean, if they choose to do so despite all our efforts to persuade them, then they have to take responsibility.

Thank you. I agree with Mr Lim Biow Chuan. At some point, the rules must be more relaxed. VDS will be stepped down. The cost need not be incurred by businesses, and those who choose not to be vaccinated take the responsibility. It is in my answer actually. I just do not think it is now because have a care for healthcare workers at this point – they are still very busy.

But the Member is right that the vaccinated number is unlikely to go up further. We are at 97% – probably, the highest in the world. How to go up further? Maybe go up marginally, but what we can wait for is for cases to go down further, for hospital situation to be eased; then, we will be in a position to review this and make the right decision.

Thank you, Speaker. And if I may just build off the questions that Members Liang Eng Hwa and Lim Biow Chuan have asked, I wonder if the Ministry is looking at specific milestones or quantitative triggers that would then bring about further easing and the evolution of measures, such as SafeEntry.

Thank you. The MTF Co-Chairs have repeatedly been asked when is the next milestone, when is the next date, when is the next KPI to be reached and then we will open up further. We have always tried to avoid that approach that many countries took, that when we reach vaccination at X%, let us open up; on this day, let us open up. Because the virus has, over and over again, proven that it is totally unpredictable.

So, we would really rather not tie our hands that way but we always look at the entire situation, look into all the unforeseen circumstances, look at the hospital situation, cases, severe cases, vaccination rate, take everything into consideration and make a judgement call. And, so far, it has served us well. We tighten up when we have to, to keep everyone safe and we also ease up when we can and letting economic and social activities resume as normally as possible.