Vaccinated-differentiated Safe Management Measures

Mr Deputy Speaker, I thank the Member for her speech on matters related to VDS.

The Member raised several points for clarification, including the removal of the concession to allow unvaccinated workers to return to the workplace with a negative Pre-Event Test (PET) result and also her queries relating to extension of VDS to children.

Earlier today, the Minister for Health had responded to questions from Members. He highlighted our threefold response in living with COVID-19: vaccination and boosters, bolstering our healthcare capacity and calibrating our SMMs. Each is important in our response to Omicron and in ensuring that, in the longer term, we can resume our normal lives as far as possible.

Our experience over the past few months shows that VDS will enable us to continue our path of safe and calibrated reopening whilst, at the same time, minimising the risk of hospitalisation to preserve healthcare capacity, in particular, limited hospital and ICU resources.

It is important to note that non-fully vaccinated persons who are infected with COVID-19 are more than seven times more likely to become critically ill in ICU, compared to those who are fully vaccinated – 0.5% of cases versus 0.07% – and 12 times – 1.7% of cases versus 0.14% – more likely to die.

Among seniors aged 60 and above, the incidence of fully vaccinated and non-fully vaccinated cases who are critically ill in the ICU are 1.9 and 35.9 per 100,000 population respectively. The incidences of fully vaccinated and non-fully vaccinated seniors who died are 0.3 and 8.2 per 100,000 population respectively.

As a result, throughout the pandemic, we find that two-thirds of our ICU beds are occupied by individuals who are unvaccinated. They are also more likely to be administered therapeutics, which are not cheap. So, although a small proportion of our population, they take up a disproportionate amount of medical and hospital resources and contribute to a significant amount of workload of our hospital staff. These are not mere statistics. It is actual resources being drained because of people who fall ill because of COVID-19.

The basis for VDS is, therefore, twofold.

First, by putting restrictions on their social activities, we protect the unvaccinated by preventing them from being overly exposed to the virus. The Member earlier said, well, it is just for them, right? But that is not true because the second point is that, if fewer unvaccinated people get infected, we preserve our hospital capacity whilst allowing the rest to carry on normal activities as much as possible.

Let me now elaborate on these points, including how VDS contributes to our safe reopening and transition to living with COVID-19.

To set the context, the emergence of the Delta variant in May 2021 required quick action to be taken to contain the numerous outbreaks of clusters in the community and to minimise the risk of our healthcare capacity being overwhelmed. The Multi-Ministry Task Force (MTF) thus decided to significantly tighten our SMMs, resulting in a move to Phase Two (Heightened Alert) in May 2021.

At the same time, we further ramped up our vaccination efforts, resulting in improved vaccination rates, particularly among seniors. Members will remember that our vaccination programme kicked off one year ago in early January 2021. By 9 August 2021, 72% of our entire population had completed their full regimen or received two doses of COVID-19 vaccines, with 81% receiving at least one dose.

With this high level of vaccination coverage and through our collective efforts as a nation to comply with the strict Phase Two (Heightened Alert) measures, the daily number of COVID-19 cases fell to double digits. The MTF thus restarted the process of resuming more economic and social activities through a calibrated risk-based approach aimed to protect the unvaccinated whilst not placing further strains on our healthcare system. We thus introduced VDS for selected premises, activities and events from 10 August 2021.

Through VDS, we eased measures for those who are fully vaccinated rather than hold everyone back in order to reduce the risk to the unvaccinated.

Fully vaccinated persons have good protection against the virus and are at lower risk of becoming dangerously ill if infected with COVID-19. This would mean that they would not strain our resources. So, vaccination is still a very important and powerful measure in the many things that we are doing to protect our community from COVID-19.

We resumed dining in F&B establishments for groups of up to five vaccinated persons, with exemptions for children aged 12 and below. We also allowed significant increases in event sizes, such as congregational and worship services, live performances and MICE, up to 500 persons, as long as all attendees were fully vaccinated.

Unvaccinated individuals, on the other hand, need to be more prudent in interacting with larger groups of people, especially in mask-off settings, which are high-risk. Hence, the strict measures will continue to apply to them. It will not matter if they are tennis coaches; the virus does not discriminate because it will impact you more severely if you are unvaccinated.

With access to premises, activities and events being brought under the VDS framework, the hope was that this would also encourage the unvaccinated to get their vaccination so that they can participate in the community and society safely.

Despite our cautious approach to reopening, the heightened transmissibility of the Delta variant resulted in new clusters emerging by end August 2021. This put great pressure on our healthcare system. The number of cases was sustained at 3,000 per day, as mentioned by Minister Ong Ye Kung earlier, and, the serious cases, who had to be seen in hospitals, resulted in 100 to 170 cases occupying ICU beds each day.

Sixty-six percent of ICU patients were unvaccinated or partially vaccinated individuals. They took up scarce medical resources, which are needed for others who are very sick individuals, including those with non-COVID-19 conditions who require expensive therapeutics.

To stabilise the situation, we had to roll out revised healthcare protocols and tighten our SMMs again. But we were able to allow more activities to continue during this Stabilisation Phase, compared to the earlier Phase Two (Heightened Alert) period due to VDS. VDS has also allowed us to safely resume more activities even after we exited the Stabilisation Phase on 22 November 2021.

With more social interactions taking place over the year-end holidays, case numbers did not see a surge. We now face a prospect of another surge of cases due to the Omicron variant.

We are in a better position than before, as our vaccination coverage has improved greatly over the past few months to 87% of our entire population completing their full regimen, with 89% receiving at least one dose. But we need to decide whether we want to tighten up all our SMMs again, which would affect the lives and livelihoods of both the vaccinated and unvaccinated, or do we calibrate our measures so that we only tighten up for those who are unvaccinated and who would be more likely to impose strains on our healthcare system.

These decisions are not taken lightly. We need to calibrate; we need to balance.

Further adjustments to our VDS policies have thus been made to ready us for these potential increases in cases as well as to allow us to better understand the nature of the Omicron variant and its differences from the Delta variant. These include the removal of the concession for unvaccinated individuals to produce a negative Pre-Event Test (PET) result prior to participating in a VDS event or activity and the reduction of the exemption period for recovered persons to enter VDS settings from 270 days to 180 days.

Through VDS, we hope to keep the unvaccinated individuals protected from infection whilst allowing the rest of society to continue with their normal activities.

In line with our overall reopening approach, the MTF announced the introduction of the Workforce Vaccination Measures (WVM), which required that, from 1 January 2022, unvaccinated individuals who were medically eligible for vaccination would be required to produce a negative PET result before entering the workplace so as to mitigate the risks of workplace transmission. The MTF subsequently announced on 14 December 2021 that up to 50% of those who can work from home will be allowed to return to the office from 1 January 2022 as we would be in a better position to ease the current default work-from-home posture with the WVM in place.

However, we have seen the emergence of a more transmissible Omicron variant, which, with the Delta variant, significantly raises the risk of contracting COVID-19, compared to a year ago. To strengthen our protection against a large wave of cases locally and to keep our workplace safe, the MTF announced that, from 15 January 2022, unvaccinated workers, barring those medically ineligible, will not be able to return to the workplace even with a negative PET result.

As of 2 January 2022, there were about 48,000 employees who had not taken any vaccine dose. This is a reduction from the 52,000 reported on 19 December 2021, as we have seen more employees coming forward to get vaccinated. Among the unvaccinated employees, those aged 30 to 39 form the largest group at 16,000. Whilst a negative PET is an indicator that the person is not infected with COVID-19, the unvaccinated individual has no protection against the virus. And if you think about it, if all the 48,000 get COVID-19, it would, indeed, impact on our healthcare system.

This decision was taken in consideration of many different factors and in consultation with many different stakeholders. This move was supported by the tripartite partners who recognised the public health imperative of vaccination and the urgency to sustain business activity to protect livelihoods. A fully vaccinated workforce would be able to operate more safely and sustainably.

We still allow employees who are certified medically ineligible for vaccines under the National Vaccination Programme (NVP) to return to the workplace, given that they constitute only 0.3% – a very small proportion – of unvaccinated workers. However, whilst such employees are exempted from WVM, MOM and the tripartite partners have guided employers to give special consideration, such as allowing them to work from home, if they are able to do so, and redeploying them to suitable jobs which can be done from home, if such jobs are available.

From the start of the COVID-19 pandemic, we had adopted a special approach to fully cover the costs of COVID-19 medical treatment for Singapore Citizens, Permanent Residents and Long-Term Pass Holders (SC/PR/LTPHs) who had not recently travelled. This special approach was intended to avoid financial considerations adding to the public uncertainty and concern when COVID-19 was an emergent and unfamiliar disease.

Today, the vaccines have since become widely administered and there is sufficient evidence that they confer protection to reduce the risk of serious illness and death. Those aged above 12 who remain unvaccinated by choice have decided to do so despite knowing that this places them at a higher risk of requiring costly inpatient care, which adds to the strain on our healthcare system. The special treatment of the Government fully covering the costs of COVID-19 medical treatment will, therefore, not apply to this group. This will also be the case for individuals aged above 18 who do not come forward for their booster within 270 days or nine months from their last dose.

Depending on the severity of the patient's condition and the type of COVID-19 facility where care is rendered, the bill size would vary, but these patients who are unvaccinated by choice may still tap on the regular healthcare financing arrangement to help pay for their bills, where applicable. While the median bill size for COVID-positive patients receiving treatment in acute hospitals who require both ICU care and COVID-19 therapeutics is estimated to be about $25,000, access to means-tested Government subsidies and MediShield Life coverage can reduce the bill to about $2,000 to $4,000 for eligible Singaporeans in subsidised wards. SCs and PRs may also use their MediSave balance to help fund any remaining post-subsidy amount, subject to the claim limits that apply.

With regard to extending VDS to children in the community, public, preschool and school settings, there are, presently, no plans to do so for those aged 12 and below.

The focus at this time is to ensure our children are well-protected as we begin vaccination for those aged five to 11, using the paediatric doses of the Pfizer/BioNTech/Comirnaty COVID-19 vaccine. We will, periodically, review our policies as the extension of the national COVID-19 vaccination programme to children aged five to 11 progresses.

Earlier today, we had also addressed concerns that were raised by Members. And we acknowledge that these are some legitimate concerns that parents may have. But given all the facts we have and in the current situation that we are facing, it is still highly encouraged for parents to bring their children if they are eligible for the vaccination.

In summary, increasing population immunity through vaccinations and boosters, reinforced with VDS, has been integral to our COVID-19 response in protecting the vulnerable and ensuring that our healthcare system can cope with the incoming Omicron wave, as well as any future infection waves. Singapore is now in a better position to achieve our goal of being a COVID-19 resilient nation.

I have explained earlier in my speech why we cannot apply the two-thirds ICU statistics to the current situation because of the changing vaccination rate. The data in 2021 is based on a case where, for the first half of 2021, more than 50% of the population was unvaccinated. Therefore, it is not reasonable to apply those statistics to the current small number of unvaccinated.

So, I presume that in implementing this strong measure which risks 48,000 livelihoods, MOH must have done studies on what is the impact, specifically on the number of expected job loss versus the additional burden on the hospital ICU utilisation. Can the Parliamentary Secretary provide us with the statistics for this?

Mr Deputy Speaker, I was not earlier privy to the questions that the Member was going to ask in terms of the specific numbers, so, I do not have specific data. But I do have some points to respond to the Member's queries.

One, I think even if you are looking at 48,000 of the workers that are now currently unvaccinated and just talking about 1% of them, that is already a high number and that is already going to tax our ICU bed capacity. So, that is one. We are actually just looking at how, even with that small number, it is going to impact and tap on scarce resources which could very well be deployed for other needs within the community.

Two, in terms of studying the implication on them, I appreciate that there will be concerns. But we are also talking about the whole of nation. We are talking about economic stability, the normal way of life that everyone else craves for. We need to consider also how the economy will be impacted by just this small number taxing on our healthcare system and, because of these numbers, we then have to adjust and calibrate our SMMs. All these are done to balance.

For those who are able to go out and are better protected, they then are able to have access to different things. But for those who are then at-risk of getting COVID-19 and having severe illnesses, I think there have to be implications on the consequences that we have to accept and appreciate and, therefore, make a decision, calibrating all these needs and not talking about just one group, and a small group at that.