Recent Decision Not to Recommend Those Aged 60 to 75 to Take Second COVID-19 Booster Shot

Assoc Prof Jamus Jerome Lim asked the Minister for Health (a) whether the recent decision not to recommend those aged 60 to 75 years from taking the second COVID-19 booster shot is due to documented adverse effects; and (b) if so, what is the incidence of adverse effects from the second COVID-19 booster shot as compared to earlier rounds of the vaccine.

Mdm Deputy Speaker, my response will also cover the matters raised in the question by Ms Joan Pereira.

Assoc Prof Jamus Lim asked about, and I quote, "the recent decision not to recommend those aged 60 to 75 from taking the second COVID-19 booster dose".

His understanding is incorrect. The current recommendation for COVID-19 vaccination is for seniors aged 60 years and above, and medically vulnerable persons, to achieve minimum protection and receive the updated bivalent booster around one year after their last booster dose.

This will naturally include the second booster shot. Instead of counting doses, the current phrasing better communicates the recommendation for the longer term: to have regular doses and maintain immunity.

COVID-19 vaccines offered under the National Vaccination Programme have been assessed to be safe for use and the benefits of such vaccines continue to outweigh the associated risks.

As of 31 May 2023, based on the Health Sciences Authority (HSA) surveillance, the serious adverse event rate of the mRNA COVID-19 vaccines in Singapore was two in 100,000 doses for the second booster dose, lower than nine in 100,000 and four in 100,000 for the primary and first booster doses respectively.

Ms Joan Pereira asked about the supply of updated COVID-19 vaccines. The bivalent mRNA vaccines against the Omicron strain currently offered under the National Vaccination Programme are the most updated formulations.

In June 2023, the US Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee noted that the current vaccines, which include those adopted by Singapore, continue to offer good protection against severe COVID-19 infections and death. The same Committee also recommended manufacturers to produce updated vaccines targeting the XBB sublineage of the Omicron variant ahead of the Northern Hemisphere fall season. Pfizer, Moderna and Novavax have indicated that they would do so and the updated vaccines may become available in the US later this year.

The Ministry of Health (MOH) will monitor these developments closely. Our contracts enable us to procure the latest vaccines, should they be assessed to be appropriate for our local situation.

I thank Senior Minister of State Janil for his response. I am asking this in part because I have had shared with me many seniors, including my own mother, who have expressed surprise that with the second booster dose, there would turn out to be severe adverse reactions. And that is especially since you would think that they would already have had earlier rounds of exposure to the vaccine, so they are surprised that indeed, they would still face these kinds of adverse side effects.

So, my supplementary question is, what will the Ministry do to reassure those who are more elderly that it is indeed safe for them to just continue to take this on a much more regular basis? Because my understanding is that many who are more elderly have decided that for the second and subsequent shots, they are fine by skipping them.

Madam, I thank Assoc Prof Lim for the question. I hope he will help in dealing with dispelling some of the misconceptions involved. As the data I quoted in the main answer shows, the second shot and the vaccines that we have here in Singapore continue to be safe, continue to have a low incidence of adverse events and risks, and, on balance, it is better for you to take the vaccine and be protected from COVID-19.

And I hope he will also help to dispel the misconception that we no longer recommend that second booster dose for the elderly. In fact, it is quite the opposite. We continue to recommend that the elderly continue to receive doses of COVID-19 vaccines and that they receive it one year after their last booster dose, and they can start to receive it from five months after their last booster dose, and persons are recommended to receive the bivalent vaccine.

If I could diverge a little from the Parliamentary Question, which is the health advice, perhaps, as to why having received one dose, you might have an event or an adverse response to a second or third dose later on, because this is not an allergic reaction, it is an immunologically mediated reaction.

What that means is that there is a spectrum of responses that the body mounts to the vaccine, some of which are mild and easily tolerated, and some of which, perhaps, you have some discomfort. That is part of how the body is responding to the vaccine. And so having had a mild response to the first vaccine does not automatically mean you will have a mild response to the second vaccine. There may be a bit more discomfort. Or it might be the other way around. In biology, it is very hard to predict exactly how you respond to any given dose.

Putting that aside, the risk of true adverse events where something goes wrong is extremely low in the data that I have quoted.

And the benefits are there, and I hope he and other Members of the House will continue to help explain to seniors especially, that vaccination is a very important public health matter. It is not just about COVID-19, it is about a wide variety of vaccinations that are available and we do encourage the seniors and our community to be as protected as possible.