Update on Singapore's COVID-19 Vaccination Programme

Ms Joan Pereira asked the Minister for Health whether there is a hotline number for members of the public who have had their COVID-19 vaccinations to call if they have queries regarding post-vaccination symptoms and for clarifications and assurance.

Ms Foo Mee Har asked the Minister for Health whether staff and volunteers working in mosques can be prioritised for COVID-19 vaccination in preparation for conducting terawih and qiyamullail during the holy month of Ramadan.

Assoc Prof Jamus Jerome Lim asked the Minister for Health (a) to date, what proportion of persons aged (i) over-70 years (ii) 60 to 70 years and (iii) under 60 years have taken the COVID-19 vaccine; and (b) what measures are in place to increase the voluntary take-up of the vaccine.

Ms Sylvia Lim asked the Minister for Health (a) what is the proportion of persons invited to make COVID-19 vaccination appointments who have been rejected due to them failing the pre-vaccination questionnaire; and (b) how is the Ministry adjusting its vaccination plans to minimise wastage of vaccines.

Mr Abdul Samad asked the Minister for Health (a) what is the number of workers in the essential services sector who have gone through the COVID-19 vaccination; and (b) what are the criteria for the selection of workers.

Mr Sharael Taha asked the Minister for Health whether volunteers and staff at congregational and worship services can be considered as frontline staff and prioritised for COVID-19 vaccination.

Mr Murali Pillai asked the Minister for Health (a) whether he can provide an update on the COVID-19 vaccination programme; and (b) whether the Ministry intends to measure the antibody levels of persons (either as a class or individually) over time after they have been vaccinated to assess whether these persons retain immunity against the COVID-19 virus.

Sir, we would like to thank everyone for their support of our vaccination programme. We will continue our efforts to encourage the take-up of the vaccine. Vaccination is free for all Singaporeans and long-term residents. We have expanded the number of vaccination centres to 31 today and there will be a total of 40 vaccination centres islandwide by mid-April, so that individuals can be conveniently vaccinated near their home or place of work.

Our supply of vaccines remains limited by the ability of vaccine manufacturers to deliver, given the high levels of global demand. This has resulted in limited booking slots in recent days. I apologise for the inconvenience caused to those who have not been able to book earlier. As more supplies arrive, we will progressively open more slots.

We have had to prioritise our vaccinations, starting with our healthcare workers, vulnerable elderly and those involved in COVID-19 operations. The Expert Committee on COVID-19 Vaccination had also recommended that we prioritise those personnel whose job roles are of critical importance to the functioning of Singapore and are at higher risk of exposure to and onward transmission of COVID-19. This is critical to ensure that key sectors would be able to continue functioning effectively even during a local outbreak, and further reduce risks to our vulnerable populations and the community at large. Such personnel include those involved in safeguarding our borders and maintaining law and order, those involved in the provision of utilities such as water, energy and telecommunications services, workers who ensure the supply of essential food items, and land transport workers involved in ensuring that our transport services are kept running.

Religious workers might also face potential risks as they may engage in regular and non-transient contact with worshipers and devotees, including the elderly and vulnerable. Older religious workers, aged 45 and above, are already eligible for vaccination. Religious workers are also required to comply with safe management measures in the conduct of religious services and in other engagements with worshippers or devotees.

We continue to make steady progress with our vaccination programme. As of 3 April 2021, around 1.52 million COVID-19 vaccine doses have been administered. Around 1.05 million individuals have received at least one dose of the vaccine, of which more than 468,000 individuals have received their second dose and completed the full vaccination regimen.

To date, about 60% of eligible seniors aged 70 and above, and close to 70% of eligible seniors aged 60 to 69 have received the COVID-19 vaccination or booked their vaccination appointments.

We have recently invited citizens and residents aged 45 to 59 to begin to register for their vaccinations and close to 500,000, or about half, had done so. We are encouraged by the strong response. Those who have registered will progressively receive invitations through SMS to make appointments for their vaccination. This may take some time given the number of people who have registered. To date, about 17% of eligible individuals have received the vaccination or booked their appointments and we expect the rest should receive the SMS by the middle of May and they can expect a booking slot by early June.

We thank everybody for their patience.

People under the age of 45 have also been patiently waiting for their turn. Based on current schedule, we plan to begin inviting them in June to book their slots. If all goes well, we will complete the vaccination programme as scheduled by the end of the year.

Some members of the public may wish to receive their vaccination early for a variety of reasons. Since 16 March, we have opened up an appeals channel for Singapore Citizens and Permanent Residents who need to travel overseas on compassionate grounds, for employment or study purposes. Applicants will need to meet certain criteria. These are listed on www.vaccine.gov.sg/appeal. They will need to submit sufficient documentation to support their appeal. We will prioritise appeals with earlier travel dates if they are able to complete the two-dose regimen prior to departure.

Close to 98% of those who booked appointments for COVID-19 vaccinations in the last 30 days have showed up for their appointments. We estimate that about 1% of those who turned up were rejected because of concerns about allergies and contra-indications. We encourage everyone to be vaccinated when your turn comes and to turn up at the vaccination appointments that you have made so that you do not deny another person the opportunity.

However, such cases do not result in vaccine wastage. We closely monitor the appointment bookings and historical take-up rate, and deliver the appropriate number of vaccine doses to the vaccination sites. Unopened vials can be stored at the vaccination sites for at least three days. Vaccination site providers will start a new vial only when they have checked that there are individuals awaiting vaccination, to avoid vaccine wastage. At the end of the day, to utilise any balance remaining in a multi-dose vial and further minimise wastage, there are pre-planned lists of individuals who will be invited to be vaccinated. These could be staff who are working at the vaccination sites or frontline volunteers who have an active role in engaging seniors on vaccinations.

As with other established vaccines, people who receive the COVID-19 vaccine may experience common side effects, such as pain at the injection site and fatigue. Should the side effects persist or get worse after a few days, they should see a doctor and seek medical attention.

In very rare cases, the COVID-19 vaccine can cause a severe allergic reaction, such as difficulty breathing, swelling of face, throat, eyes or lips, a fast heartbeat, dizziness and weakness or a bad rash all over the body. In the event of a severe allergic reaction, please call 995 or visit the nearest hospital immediately.

Members of the public can also visit www.vaccine.gov.sg or the MOH website to further understand the post-vaccination symptoms.

MOH will be conducting further studies to monitor and review the extent and duration of immunity provided by the COVID-19 vaccines. This includes collecting selected post-vaccination samples from groups such as healthcare workers, frontline staff and seniors, to monitor the persistence of antibodies up to 24 months. Currently, in line with international practices, there are no plans to test the serology of everyone who is vaccinated in Singapore. We will share more details about the studies once they are completed.

Vaccination is a key enabler to reduce the risk of community transmission and allow more economic and community activities to resume. As more vaccine stocks arrive, we will continue to expand our vaccination programme to more segments of the population, so that all Singaporeans and long-term residents in Singapore will have the chance to be vaccinated by end-2021.

Thank you, Speaker. I would like to ask the Senior Minister of State for Health two supplementary questions. The first is, the Senior Minister of State did explain about the measures taken to minimise wastage but I would nevertheless like to ask whether a standby system can be arranged to allow those who are not yet eligible for vaccination but willing to wait on standby basis at vaccination centres, to take the place of those who did not turn up, assuming the frontline people and volunteers have already had their turn. So, whether a standby system can be arranged for those who are willing, as it will take to the end of the year for the rest of the population to get their jab.

The second question relates to prioritising vaccination candidates. Would mosque staff and volunteers involved in additional night prayers during the holy month of Ramadan be considered to be at increased risk of infection, given that they are expected to serve at least 250 congregants a day?

Mr Speaker, I thank the Member for the suggestion for a standby system. We will continue to study how best to deal with the challenges of prioritising those most at risk, those who have some urgent need and having some equitable distribution across our population, even as we try to cover as many people as possible before the end of the year. But we will study her suggestion.

The point she makes about the prioritisation for workers in certain religious settings highlights the need for continued safe management measures and vigilance from everybody involved. But if there are specific individuals who might have particularly high risks, we will look at their situation and try our best to accommodate.

Mr Speaker, I have two sets of clarification for the Senior Minister of State. First of all, could he confirm that there has actually been a change in the advice given to certain groups of people who initially were considered to be ineligible or asked to defer their vaccinations. By that, I mean in the initial stages of the online screening, people were asked whether they had allergies and whether they suffered from certain conditions, but I think there is now new advice given that these people who were originally considered not eligible, actually can take the vaccination. So, I would like him to confirm that there has been an update or a change in those instructions.

And in that light, first, has the online screening been modified so that we do not exclude people who can actually take the vaccination; and secondly, are we catching up on those who were deemed to have failed the online screening initially but now with further scientific evidence they are actually eligible to take the vaccination? How are we catching up with those people?

Ms Lim is correct; indeed, the advice has shifted. It is severe anaphylactic reactions that we are most concerned about. And as an increasing number of people has been vaccinated, we have confidence over the situations in which someone previously thought to be ineligible might now go forward and have the vaccine. Indeed, the online systems and our various guidance to people manning counters and hotlines has changed.

The way in which we are catching up is that the citizens involved remain as part of our patients, the patients of the healthcare providers, the vaccine system will continue to track this process. Most people are able to go forward and complete the vaccination. If there are individuals who have been deemed ineligible, I would reinforce that this is about deferring the appointment and the consultation to a time where they might subsequently become eligible. We will continue to pay close attention to this segment of the population.

Mr Speaker, Sir, I thank the hon Senior Minister of State for his answer to my Parliamentary Question. I understand that he mentioned that the Government does not intend to measure the antibody levels of persons as it stands now. May I please ask the reasons for this, given that, at least amongst some quarters, the understanding is that the effectiveness of the vaccination may peter out after several months? Also, would there not be a need to guard against variants and, in particular, the effect of this vaccination against variants?

Mr Speaker, I thank the Member for his questions. As I have mentioned, we are studying the matter of antibody levels. I think before we make a decision about how we would look at what is happening in the population, let us, first, do those studies.

For most vaccinations previously, that has not been the approach to go with a population-wide antibody assay. It is also logistically very difficult and would place a burden on our population. So, we need to be sure that it is useful and necessary before we would do such a thing.

However, with the issue of variants, assaying a set of antibodies to a prior vaccination is not going to be necessarily useful to inform the clinical risk for a new variant that perhaps was not there when the vaccination was delivered.

So, I think there are two separate issues – the issue of virus variants is being closely studied by our experts as well as international experts; and the matter of if, when and whether we should be doing serology and antibody testing is also being studied. So, let us complete those studies before we make any decision on that basis.

Thank you, Mr Speaker. Two quick questions for the Senior Minister of State. Given the diversity of vaccines that will eventually be deployed, I am wondering if there has been any effort by the Government in persuading take-up based on specific types of vaccines. I am thinking, in particular, certain of my elderly residents may have a preference, for instance, for the Sinovac versus mRNA vaccines.

Related to this, the second question is whether the Ministry will actually have a threshold target for coverage associated with herd immunity and, if so, what would the next phase of relaxation of control measures look like were we to attain that threshold.

Mr Speaker, I thank the Member for the questions. The take-up rate is healthy across the vaccines that have been licensed and are being used in our various centres. But Sinovac has not been licensed yet. So, it is a bit premature to talk about that at this point in time.

The target is for as many of our eligible residents as possible to be vaccinated. Herd immunity, indeed, is useful. But you can also imagine that we would perhaps want to make sure that individuals who want to travel overseas would also continue to be protected and that requires them to be vaccinated because, once they are overseas, they will not benefit from herd immunity here in Singapore. So, let us get that number as high as possible and we hope to be able to offer the vaccinations to all eligible Singaporeans along with residents by the end of 2021.

It is a little bit premature to be then talking about the relaxation measures for the next phase when we have not reached it.

Mr Speaker, Sir, I thank the Senior Minister of State for the earlier explanation. I just want to check for the essential services workers. It was after I had submitted my Parliamentary Question that the announcement came for those who want to be vaccinated under a certain age group. But for workers in the essential services group, how do we then ensure that they are all vaccinated for the second dose in the appropriate time? The risk is because we tend to mix with migrant workers a lot and we also do a lot of engagements.

Earlier, as far as I am concerned, the first group of essential workers are those who were working during the circuit breaker period. After that, all are not being given priority to go for their vaccination. Hopefully, MOH can review this.

Mr Speaker, I thank the Member for his concern. We are, indeed, tracking the completion of vaccinations among the essential workers closely and we do so through the employers as well as some of the regulatory bodies for the relevant domain. We could not wait to complete every single essential worker before we then started with the elderly, the vulnerable or other at-risk groups.

So, we have a parallel processing, if you like, that essential workers continue to be vaccinated although most of them have largely been done so, together with the roll-out to the elderly. And, just as now, not all the elderly are vaccinated, we have started with the next group and we will, in parallel, open up to more and more segments of our population as our vaccine supplies come in. But we will continue to pay close attention to make sure that those who are vulnerable or who are at high risk or who perform these essential functions will get priority.

Sir, I have quite a large number of residents who wanted to travel for various reasons and who have made various appeals. Some of them may be for studies and some of them may be for other purposes, like looking after nephews, to attend weddings. For some reason, MOH has applied quite strict criteria to those who have made the appeals. I am asking MOH whether they will consider being more flexible about allowing people to get their vaccination earlier before they travel overseas, as contrasted to extending the vaccination programme to residents of a different age when they can be actually quite neutral about taking their vaccination earlier or later. So, we have one group who wants it earlier versus another group who are actually very neutral about whether they get their vaccination earlier. So, could MOH be a bit more flexible to allow those who want to get their vaccination earlier to get it earlier?

Mr Speaker, I thank the Member for the question. The issue is the limit of our vaccine supplies. Even though there may be some people who are a little bit agnostic about exactly when they get it and are willing to defer, the reality is that we are vaccinating people as quickly as possible, given the supplies that come in.

So, if we were to prioritise one group, it will be at the expense of another who currently wish to be vaccinated. The slots are booked and the capacity is being used up and the vaccines are being used up. So, we recognise that there are people who wish to be prioritised. We do have an appeals channel. We will try our best. There are criteria and it is very helpful that documentation is submitted to support those criteria and we will work our way through these appeals to try to help as many people to be vaccinated as soon as possible. But, ultimately, the limit is not our wish to force people who are perhaps a little bit hesitant at this point – we do encourage everybody to do it – the limit is actually the rate at which the supplies are coming in.

Thank you, Speaker. I have a supplementary question. A few elderly residents told me they felt pain in their legs and their knees the day after vaccination. One even showed me a rash at the vaccination area. So, they worry and they wonder if it was caused by the vaccination or would it go away or they needed to seek treatment. So, I would like to propose if MOH would consider having a hotline manned by a multilingual team who can speak the mother tongue and dialects. It would be helpful to assure them.

Mr Speaker, I thank the Member for her question. There are two points which are slightly separate. One is the importance of making sure that we make our materials, transactions and interactions available in multiple languages. Indeed, we will pay quite a lot of attention to this, especially on the ground at the service counters at the vaccination centres.

The separate issue is residents who then experienced symptoms after having had a vaccination. What the Member is describing is a situation where one has clinical symptoms a day after vaccination and was worried about whether these are problems where you need medical help. I would suggest that perhaps a MOH hotline manned by our non-clinical staff may not be the best first port of call for residents in such a situation. If they have clinical symptoms, if they have persistent pain, persistent fever, rash and, especially things like difficulty breathing, what they need is to seek clinical help and they should do so from the relevant hospital, polyclinic and clinical care providers that are close to them.