Vaccination for Primary School Students and Possibility of Vaccination-differentiated Measures for Preschools and Primary Schools

Ms Foo Mee Har asked the Minister for Education whether vaccination will be made a requirement for eligible children in order for them to attend school in person.

Mr Speaker, Sir, there are, currently, no plans to make COVID-19 vaccination a requirement for physical attendance in our preschools or primary schools. The focus at this point in time is to ensure our students are well-protected against COVID-19 as we begin vaccination for those aged five to 11. We have seen an encouraging start to the vaccination exercise for our children. We will continue to work with our parents to achieve a high vaccination rate so that it would be possible to resume as many school activities as possible in the coming months. The pace, extent and approach towards resuming these school activities would depend on various factors, including vaccination rates as well as the overall national posture.

Students whose vaccination appointments are during school hours, as well as those feeling unwell from vaccination, will be excused from school. Schools will help students catch up on missed lessons and work. We strongly encourage parents to get their child vaccinated as early as possible to keep our children, families and the wider community safe and resilient against COVID-19.

Thank you, Mr Speaker. Sir, I have two supplementary questions.

The first pertains to a subject I believe that was covered both by the Minister for Health and the Minister for Education. This concerns the apprehension some parents have over the administration of mRNA vaccines for their children. These parents anecdotally are not anti-vax per se. Some of them may have taken the mRNA vaccine on their own, but the concern is really a visceral one, that is, about the long-term effects, the fact that this vaccine is referred for emergency approvals and so forth, even though I think some have been granted FDA approval, Pfizer-BioNTech specifically.

To that extent, will the Ministry of Health (MOH) allow such parents to wait until non-mRNA traditional protein-based vaccines are approved for their children's inoculation, so as to give them more choices and to assuage their concerns?

The second question follows. I understand that one such non-mRNA vaccine company, Novavax, submitted data for approval under Singapore's Pandemic Special Access Route (PSAR) on 22 November. The Director of Medical Services confirmed a few days ago, on 5 January, that he was very optimistic Novavax would be authorised as a non-mRNA booster. My question is, if Novavax or any other non-mRNA vaccine maker has submitted data for the authorisation for use for children above the age of 12, and, if so, when can these vaccines be expected to be introduced in the National Vaccination Programme?

Just a very short follow-through on that: with regard to the point made by the Minister for Health on the 270 days that are required, the limit before you take a booster and then to be recognised still as being vaccinated, would there be some flexibility to allow Novavax at least to get on this programme and to allow more individuals to then be considered fully vaccinated?

Thank you. I can fully appreciate parents' concern about mRNA vaccines for children. They will be concerned about the long-term effects and whatever side effects there may be. Just a few facts. The children's vaccine, Pfizer-BioNTech/Comirnaty, has gone through extensive clinical trials. And during the clinical trials, it was proven and shown to be safe and effective.

Specifically, myocarditis, which is what most parents are concerned about in children, it occurred. Currently, there are about 8.5 million already vaccinated in the US and the incidence rate is about one in a million. And as Senior Minister of State Janil Puthucheary mentioned, we have to balance this against the downside of getting infection. If you are infected, the chances of myocarditis are 45 in a million and also other effects, such as MIS-C, which can make the child really sick. [Please refer to “Clarification by Minister for Health”, Official Report, 10 January 2022, Vol 95, Issue 44, Clarification section.] And we have seen a handful, one or two a week, when Delta was at its peak and they are admitted to ICU. Thankfully, all of them recovered.

So, there is a good track record of safety and efficacy for the children's vaccine. On the other hand, for children who are infected with COVID-19, while, generally, children are more resilient, we have seen cases of myocarditis and MIS-C. So, it is a pandemic crisis. We do have to weigh those costs and benefits.

I do have to add one more fact, which is that, for the children's vaccine, it is a diluted form. They are not taking the same adult vaccine. Pfizer-BioNTech, for example, is one-third the dose of an adult's.

So, these are the facts and parents will have to make the right decision. As of now, we are quite encouraged that many parents are coming forward and the paediatric vaccination exercise is actually gathering pace, and many parents are coming forward to protect their children.

On the question of Novavax, it is being assessed by the Health Sciences Authority (HSA). We need to let the scientists do their work. I think we should consider putting it into our National Vaccination Programme. We have always wanted a good portfolio of mRNA and non-mRNA vaccines. But, as for the timing, I think it may take a while more, including for delivery, plus another process for assessing whether it is suitable for children, there is another set of data, another set of trials. So, I do not know how long it would take.

In the meantime, Omicron is upon us, highly transmissible, and we do not want to rule out that even a small percentage of children can get very sick; we might be looking at a significant absolute number. So, I would suggest, as Senior Minister of State Janil Puthucheary has advised, get your child vaccinated with mRNA, given the circumstances. It is not perfect, but I think, given the circumstances, cause and benefits, the right thing to do now is to get your child vaccinated as quickly as possible.

Likewise, for the 270 days, I can understand what the Leader of the Opposition is suggesting – whether we should wait for Novavax. But again, Omicron is upon us. While I hope we have the luxury of time to wait for a non-mRNA vaccine to be available, but, with the impending Omicron wave, I think we should act quickly and, therefore, we set the validity period of 270 days.

Mr Speaker, I thank the Ministers and the Senior Minister of State for their replies. My supplementary question is for Senior Minister of State Janil Puthucheary. Some young children may have undetected medical conditions and, especially allergies, if their parents do not send them for non-mandatory medical reviews. As such, I wish to ask whether MOH would advise all young children to undergo a medical review before going ahead with the COVID-19 vaccination. This is similar to how some adults with underlying medical conditions are advised to get clearance from the doctor in the early stages of the vaccination drive.

Sir, I thank the Member for his question. The answer is partly in the last line that he stated, which is, that we took that approach in the early stages of the adult vaccination drive because, at that time, the amount of data that we had was less and the amount of experience that we had was less. Now we know a lot more about both the disease as well as the vaccination, including in children.

So, the approach for children is not so different from adults. If they have an underlying condition – and there is a list that the doctor will know about it – then some review needs to happen. But if the child is otherwise healthy, then the recommendation is to proceed with the COVID-19 vaccination.

The issue of allergies is slightly different in that, for any drug, you cannot necessarily tell whether an allergy will happen or not happen on the basis of prior underlying conditions. Hence, the team at the site of the vaccination is trained to then detect and deal with the rare allergies that do happen. And again, our experience with COVID-19 is, it does not happen any differently from other vaccinations that we are giving to children on a regular basis.

So, the short answer to the Member's question whether all children should go for medical review prior to COVID-19 is "no".

Thank you, Sir. I have got two supplementary questions. The Government has been encouraging the use of ART swabbing to prevent the spread of viruses. However, in many situations, self-reporting of ART results is not allowed. Instead, people are required to conduct the test only at approved testing centres, which not only costs more but is more inconvenient. Can we move to a regime where people are trusted to accurately report the ART results, just like how it is done in schools and, indeed, here in Parliament? This will reduce the cost for many people and make administrative procedures at events more efficient.

Second question: there is a tendency for some activities to be prohibited, even though the transmission risk is low. Can the lead agencies issue more specific advisories to organisations based on the actual prevailing risk of viral spread, so that we move closer on the path towards normalcy?

Thank you for those suggestions. Relying on individuals to self-report ART results, this, as Mr Gerald Giam has acknowledged, is actually in place. It is not quite in Parliament because you do get informed by an SMS that you are negative. But there are many settings where we do rely on self-reporting. Workplace, for example, a lot of meetings, events you go to, you do a self-test.

We have an entire protocol, what we call a protocol tool, that is based on self-testing – that you self-test and, if you are positive, you stay home for 72 hours. After that, daily tests and only when you are negative, you come out. It is totally an honesty-based system. If you are negative, you come out; and if you are positive, you stay at home.

So, the answer is, yes, we very much support what Mr Gerald Giam has said, and it is already in place. Can we do more? We are doing more. You will notice that, recently, MOH announced that we are now working with general practitioners (GPs) and primary care-providers. Previously, we could see a primary care-provider or a GP and when you say you are sick, he can only prescribe you a PCR test, which will be taken to a lab and reported by the lab. But now, he can also prescribe you an ART test. Essentially, he can trigger Protocol 2.

So, we are moving in that direction. And I must say that, to overcome this crisis, it is really not just the Government, but it requires the cooperation, civic-mindedness and sense of self-responsibility of every individual in our population.

The next question is more specific: rules on different settings. That is what we have been doing, too. If the Member has any specific suggestion on specific settings, we would be happy to hear them and we are constantly tweaking them. But just one word of caution. Sometimes, when you tweak more, it becomes more complicated and people do compare: "Why is it for this setting I am allowed to do this? Why is it for that setting I am not allowed?" And you start to have invidious comparisons and people start to get confused. So, we are also very mindful to keep rules as simple as possible because simplicity is an essential ingredient for people to exercise self-responsibility. What they do not understand, they cannot self-enforce.

Mr Speaker, I have two questions for the Minister for Health. One is regarding a question that I raised in my Parliamentary Question (PQ), which is yet to be answered. With quite a significant proportion of Omicron coming from imported cases, I had asked the Minister for a breakdown by country of origin of imported COVID-19 Omicron cases. So, if the Minister for Health could shed some light on that.

My second question relates to his answer that boosters have shown to increase protection against infection and severe illness, including Omicron, substantially; whether MOH will contemplate imposition of booster jab as a requirement for VTL travellers, beyond the current requirement of two jabs only and that would be deemed as vaccinated. So, whether we will bump up the requirement to a booster jab.

I must apologise to the Member. I did not mean to drop her question but it will be addressed by Minister Iswaran later in the next set of questions, especially on the specific breakdown on the number of imported cases.

As for booster jabs, it is a serious issue that the Member has raised because we do know that two doses do not last forever. The European Union (EU) has already implemented a guideline which is similar to ours: nine months' validity or 270 days. So, I think the world will converge towards some form of validity, I believe, and, naturally, this will become a requirement in due course. That is my conjecture.

Mr Speaker, Sir, if I may, let me explain our thinking at this point in time. Of course, I caveat that by saying that whatever our considerations current at this point in time will, subsequently, have to take into account the prevailing national posture and also the development of the virus and its mutation.

At this point in time, we would very much like to have all our children be able to attend school and participate in as many of the core activities as much as possible. Having said that, of course, there are also activities beyond the core curriculum that may pose a higher risk to our students. And for those higher-risk activities, we will then have to consider if differentiated measures will be required.

For example, at this point in time, we have already put in place some additional measures for some of these activities that the students are participating in, and these apply to our secondary, Junior College (JC) and Millenia Institute (MI) students. Just to give an example. Today, if they do team sports under the pilot, only the fully vaccinated students who have taken an onsite ART will be allowed to participate in team sports in groups of up to 10. For some other students who are participating in the band or the choir, they would also have to take some other additional measures to safeguard themselves and their fellow participants.

So, this is how we will go about considering the participation of our students in some of these particularly higher-risk activities in the sense that they have a higher-risk of transmission. But as far as possible, we would like to have our students participate in the core curriculum all together because this adds to their overall social emotional development beyond their academic development.

Thank you, Mr Speaker. I just have one supplementary question which is, essentially, the PQ that I asked. Given what we know about COVID-19 today over the last one, two years of experience, may I ask if the Government would consider publishing the key quantitative and qualitative matrix and thresholds before decisions are made to change the safe management measures?

I do understand the need to be nimble. But, basically, having that decision-making framework and matrix published would actually help businesses and consumers to have greater confidence and clarity and, certainly, better than the situation where some people feel a certain sense of nervousness whenever the Multi-Ministry Task Force (MTF) holds a press conference, especially those in F&B businesses which are most affected by the dine-in rules.

The Member reiterated his question, but I may have to reiterate my answer. As alluded to in the Member's supplementary question as well, we also do not want to be too rigid in setting the parameters or trigger points, for example, if we cross this, therefore, it will shut down from five to two and so on and so forth.

I think there are so many twists and turns in this pandemic, we would rather be a bit more nimble and to be able to adapt.

But we take the Member's point, and we have always adopted this position that we do not go for "Freedom Day", neither do we go for zero COVID-19. We want to strike a balance, preserve the healthcare capacity; at the same time, allow people to live life as normally as possible, businesses to be able to operate and survive. Each time we make a decision, we do explain why. We do show all the data – hospitalisation, ICU and so on and so forth – to give the full rationale, with numbers, why we decide that way. So, I also hope that, over time, people will begin to understand what our key considerations are, even though we may not be able to pinpoint trigger points.

I should say that, ultimately, it is not about the numbers that cause all this uncertainty. It is a fact that we are in the middle of a pandemic and our society, for two years, we were not entirely ready in the first year in terms of our resilience. Last year, we were much better, and I do believe that, in 2022, we will be even better and that is most important. Remember, in 2020, when we faced a wave – it was hardly a wave, it was just clusters – we went into circuit breaker. Last year, in 2021, when we faced a wave, we went into what we called "Phase Two (Heightened Alert)". Group size was down to two. Restaurants did not close towards the end of the year, but they operated with dine-in group size of two. Hopefully, this year, we can ride through waves with a much more liberal posture and that is how we keep on improving. And that is most important to our businesses.

Thank you, Mr Speaker. I have two questions for the Minister for Health, and this is with regard to averting a testing crunch that we see around the world amidst an Omicron-driven wave.

My first question is, in the event of such a wave, how do we plan to avoid a run on testing facilities in our healthcare system for people who are keen to get a test – either PCR or ART – and this includes, of course, primary care providers that the Minister has mentioned in his answer, but also, importantly, emergency departments? How do we avoid a run on healthcare facilities for people who are keen to get a test ordered?

The second question is about self-testing. How do we plan to ensure an adequate supply of ART kits to keep prices of these kits steady?

On the second question first, to keep prices steady and affordable, I think competition helps, choices help. So, we are constantly on the lookout for kits that are effective as well as lower priced. In that way, we bring them in and, recently, we have done so – FlowFlex, for example, is below $5 – and we will continue to be on the lookout. There have been many kits out there that claim to be cheaper but are not as effective. So, HSA does not approve all of them just unquestioningly. And we will continue to do that.

As to the Member's question on how to prevent a run on testing facilities, number one, is to try as much as possible to plan ahead, have supply agreements signed, stock up. This is what we have been doing. And we will continue to monitor the situation, bearing in mind that we have seen in other countries where there has been a run.

Second, a run happens when people panic. So, to prevent a run, do not make people panic. Omicron can be scary, it can go up a few times, it can be 10,000 cases, 15,000 cases a day. That is why we are telling the people now that it can reach that level. That is why we started what we called "Protocols 1, 2, 3", specifically Protocol 2, which sensitises people to self-test, self-report and self-discipline. And we have extended this now to GPs to also trigger Protocol 2. That way, I think people are sensitised to "when I need a test, what do I do after a test?" And when people know what they need to do, they do not panic, there is much less chance of a run on any testing facility.

Thank you, Mr Speaker. I would like to ask the Minister for Education to confirm again, although I think he might have said so just now, that the VDS measures will not be applied to children below 12 years old for as long as it is and maybe at least until the non-mRNA vaccines are available for the kids. Because there is a strong request from the parents that, at least, there should be more choices for vaccines and the VDS measures will not be applied to the children. I also received feedback from residents that some teachers have already practised VDS measures in schools. So, can the Minister confirm whether the teachers are practising that or if any officers in the schools are practising that, that it is against the Government's policy at the moment?

Mr Speaker, Sir, can I seek a clarification from Mr Leong Mun Wai and further information on which schools and what VDS measures have which teachers been practising, please?

Mr Speaker, Sir, I would really appreciate if Mr Leong Mun Wai could give me the information on which teacher in which school has practised what VDS measures so that we can take the feedback seriously and then, look into the necessary follow-up, if possible.

Mr Speaker, Sir, if I may just repeat my answer in case Mr Leong Mun Wai was not around when I answered this just now. My specific answer was that, at this point in time, we have no plans on applying any VDS in our schools and that is because of the reasons that I have mentioned. We want, as far as possible, for our students to be able to participate in the core curriculum, in the school activities. For certain selected activities that may be deemed of higher risk, we may consider applying specific measures for them.

And I have raised two very specific examples. One, for example, of students participating in the playing of wind instruments or the choir; and two, students participating in sports activities that may require physical contact or close physical contact. I also caveated my explanation by saying that, of course, we will have to look at the overall national posture and how the virus will continue to evolve for us to adjust our policies accordingly.

Thank you, Speaker. I have a clarification for the Minister for Health regarding the COVID-19 statistics that he cited earlier and also, in general, statistics reported by the Government. I have come across cases of individuals who did self-testing by ART and, they were positive. But they did not report themselves to the authorities or to any clinics.

With home recovery now as the default response to any positive COVID-19 test, does Minister agree that the risk of unreported cases is, actually, quite high? And to that extent, we need to be quite careful when we look at the official statistics recorded by the Ministry.

I take the Member's point. In every country, they also have a concept of what they call "ascertainment rate", which is, of the underlying cases, how many are uncovered and reported. And every country knows that it cannot be 80%, 90% or 100%. Especially when you have a Delta wave or Omicron wave that is highly transmissible, you do want people to take self-responsibility, take care of themselves, isolate themselves and, in these cases, they may not be reported. So, they do happen in every country.

To think about it, when we face an endemic disease, whether it is chicken pox or influenza, we cannot report every case and that is what endemicity means, which is, many people get it, many people are able to recover without it being officially reported. That is part and parcel of endemicity.

But notwithstanding that, testing remains important for us, first, to exercise self-responsibility; second, to have a sense of what is the prevalence of the virus in the community. And we continue to do quite a fair number of tests: over 20,000 PCR tests a day; over 150,000 ART tests a day. Some self-monitored, not reported, but many are. That will always give us a consistent measure of the prevalence of the virus in the community. And we will continue to do so in a practical way.