Ministerial Statement by Mr Ong Ye Kung, Minister for Health on Singapore’s Response to the Current Global COVID-19 Situation, 9 January 2023

1.            Mr Speaker Sir, since 8 January 2023, China has started resuming outbound leisure travel and removed quarantine requirements for returning travellers into China.

2.            Singaporeans are naturally worried that this will lead to more people here, especially the vulnerable, falling severely ill.  Further, there are concerns that this will trigger a fresh infection wave that can bring back social restrictions and undo what we have achieved painstakingly over the past three years.

Government is Acutely Aware of the Concerns

 3.            The Government, and certainly the Multi-Ministry Taskforce (MTF) and MOH, are acutely aware of these concerns because protecting Singaporeans and maintaining our freedom and normal lives have been our primary objectives throughout this pandemic journey. 

4.            As I have said a few times publicly over the past months, the pandemic is not over and we need to be especially mindful that when China opens up, there will be risks and uncertainties because the virus would be sweeping through a population of 1.4 billion, mostly  COVID-19 naive. This is now happening.

5.            In addition, we have also anticipated that there would be a “winter wave” of infections across  countries in the northern hemisphere. This  has also happened  in many countries such as  the US, Europe, Japan and South Korea.

6.            Prior to this, many countries have dismantled all their border measures.  A few have now reinstated the measures and announced new  measures.  As for Singapore, we have never dismantled all our border measures, and have kept relevant measures precisely because we anticipated these risks.

Our Measures Have Produced Good Outcomes

7.            Today, I will explain why we decided on our current measures, and why they are appropriate given our current context and circumstances. But before that, let me report on the outcomes of the measures. After all, the proof of the pudding is in the eating.

8.            Imported infections today account for  about 5% to 10% of total cases reported every day. Cases have fallen and sometimes it can be 15% to 20%. By and large, throughout the pandemic 5% to 10% of total cases reported every day. The four weeks running up to 1 January 2023 was probably one of the most difficult periods of the epidemic in China. 

9.            During those four weeks, there were about 200 travellers from China who were detected to be COVID-19 positive. That is a low number because every day our total reported cases is about 1,000. They  accounted for less than 5% of our total imported infections. ASEAN countries accounted for over 50%, rest of Asia around 15%, Europe 11% and the Middle East 9%.

10.         Amongst all our imported cases in those four weeks, seven developed severe illness and had to be hospitalised.  Three were from the Middle East, two from ASEAN, and one each from China and Europe. Most were Singaporeans returning from these countries and regions. These are not large numbers, so the impact on our healthcare system was very small. 

11.         Since 1 January 2023, and today I did a further check, there has also been no severe infection cases coming from China.

12.         Why is it that travellers from China accounted for a very small percentage of imported infections and severe cases when  China is experiencing a huge  infection wave?

13.         There are two main reasons, due to the measures we put in place and backed up by our high vaccination coverage which is being kept up to date.

14.         What are the reasons and measures? First, travel volumes between Singapore and China have been very low throughout the pandemic.  As of now, we run 38 weekly flights from China to Singapore, compared to around 400 flights pre-COVID. This translates to between 700 and 1,000 arrivals from China every day. Less than 10% of pre-COVID volume.

15.         China’s opening up to the world is great news and something we are looking forward to, so that we can restore our rich and substantive people-to-people links.  As China opens up, the Ministry of Transport will carefully calibrate any adjustments from the current low travel volume, at least until the infection wave has clearly subsided in China.

16.         Many scientists believe that the current infection wave in China has  started to subside, especially the major Chinese cities. It will probably take a few more weeks for the trend to be very clear, and we can then progressively restore pre-COVID  flight volumes between our two countries.

17.         The second reason is that we have been maintaining a test requirement for at-risk travellers. Many Singaporeans have forgotten about it. Travellers have to be either fully vaccinated based on the World Health Organization’s vaccination definitions or produce a negative pre-departure test (PDT) result before heading to Singapore.

18.         That is why when Singaporeans are overseas, you have to produce your vaccination certificates to the airlines at the point of checking in at the airport.  This is so that we know if you are required to produce a negative PDT result before you are allowed to board the plane.

19.         Over the past months, many Singaporeans have written to the Ministry of Health (MOH) and I to feedback that this current rule  causes a lot of inconvenience. They asked whether it can be done away with because they have to show their vaccination certificate at the check-in counter. Some of them have to access their HealthHub with their Singpass. We have been explaining to them that it is important to maintain it, to manage the risks that we are currently facing, because unvaccinated and infected travellers coming from anywhere in the world are at risk of severe infection and can add to our healthcare load. 

20.         Spain – one of the most highly vaccinated countries in Europe – has just announced that they are implementing the same test requirement as Singapore.  So in summary, there are three groups of countries with varied responses as a result of China opening up.

21.         First, most of ASEAN, Middle East, Africa, South America, New Zealand - which are not imposing any border measures.

22.         Second, several countries – namely Australia, Canada, several EU countries such as Belgium, France, Germany, Sweden, India, Japan, UK, US, – are imposing a 100%  pre-departure test requirement on all travellers from China.

23.         Third, just Singapore and Spain, which have the policy of being either fully vaccinated or producing a negative  PDT result. Thailand was putting in some of these measures, but I have just read that they are taking them out again. So we are neither the tightest nor the most liberal, but somewhere in between, and we do not discriminate because severe cases can originate from any country or region in the world, as shown by our data. 

24.         Mr Speaker Sir, our current measures – controlling the number of travellers and requiring PDT for the unvaccinated at-risk travellers, have led to low imported infections and even fewer severe cases from China, at the time when the virus is spreading widely in the country.

25.         I cannot speak for other countries, but I will now explain why the measures have worked so far for us, and are appropriate in our current context. Minister Iswaran will further elaborate on what MOT is doing with regard to air travel. 

26.         But we cannot be complacent. The measures may work now, but not permanently. We will continually assess the situation and if need be, make adjustments or implement new measures.  At all times, our decisions must be based on science, evidence and data. 

Be Clear-Eyed About the Key Risks

27.         Let me first explain our key concerns at this stage of the pandemic. To do so, it is worthwhile recapitulating how far we have come.

28.         At the early stages of the pandemic, infections were our primary concern, because it was a disease that could lead to many severe episodes and deaths, and there were no vaccines or treatments available. Under those circumstances, we adopted a zero COVID policy. 

29.         This meant tight border measures, testing every passenger and quarantining them before allowing them to move around in our community. The same considerations applied within the community, where we implemented contact tracing, quarantined close contacts, and imposed strict safe management measures, including a circuit breaker.  

30.         Then effective vaccines were developed, and they changed our considerations fundamentally. With the great majority of our population vaccinated, and many recovered safely from relatively mild infections, our population has developed strong hybrid immunity. 

31.         Today, the probability of COVID-19 infections leading to severe illnesses or deaths for our population has become very low – comparable to Influenza or Pneumococcal infections, both of which are endemic diseases that we have been living with for many years and we have also been encouraging vaccination for. 

32.         To illustrate, in the past 30 days, the number of COVID-19 patients in the Intensive Care Unit (ICU) is in the low single digit, and there were 25 days out of the 30 where there were  no COVID-19 deaths. 

33.         Based on the severity rate today, annual deaths caused by COVID-19 infections is similar to that caused by Influenza infections. Hence, with extensive vaccination coverage, we can treat COVID-19 as an endemic disease.  Like Influenza, top line infection numbers should no longer be our pre-occupation.  

34.         To illustrate, at the peak of the year-end XBB wave, we were registering a 7-day moving average of over 8,500 infection cases a day. Despite the high top line number, we carried on living life normally. We did not  impose further social restrictions. We did without masks.

35.         However, we were watching the situation in our hospitals very carefully because it is the bottom line of number of severe cases and deaths that matter. As it turned out, hospitals were very busy, but not overwhelmed. And we rode through that wave.

36.         Our greater concern goes beyond hospital workload and capacity, to the evolution of the epidemic itself.  Today, the infection waves around the world are driven by variants known to us – XBB, BA.2, BA.2.75, BA.5, BA.5.2, BF.7, BQ.1.1, BN.1 etc. and XBB.1.5 now. We know their characteristics, and that existing vaccines continue to be effective in preventing severe illnesses of these variants. 

37.         What worries us most now, is the emergence of a new, unknown and more dangerous variant of concern. Our main worry is that with the virus continuing to spread throughout the world, there is a higher chance that a new variant of concern may emerge – from anywhere in the world.

38.         It may possess worrying characteristics – escape vaccine protection, be more infectious, more likely to lead to severe illnesses  which would be very bad news.  A nightmare variant can knock us back to almost square one.

39.         We must then be prepared to hunker down. We may need to reinstate measures such as strict border controls, quarantine for travellers, social restrictions including limit on group sizes, until a new and effective vaccine is developed. 

40.         So in short, our key concerns are first, the emergence of a new and more dangerous variant, and second, even in the absence of a new dangerous variant, to protect our healthcare system against having too many severe cases. 

41.         These set the context of our border measures in response to the infection wave in China, and the winter wave in many countries. I will explain what we are doing to address the two key concerns.

A Global Surveillance System

42.         Let me start with the most important concern, the emergence of a new and more dangerous variant. 

43.         The most common measure we have read in the papers in response to the opening up of China is COVID test on travellers but they do  not help detect new variants of concern. It tells us if the travellers are infected with COVID-19, but does not identify the variant.

44.         New variants can emerge from anywhere in the world and not just China. To detect new variants, we need an effective global surveillance system, where samples from infected persons all around the world are systematically collected, the viral genomes sequenced and then shared on a global platform. This is best done by countries for their own local cases, rather than relying solely on traveller surveillance, because they can only provide a delayed snapshot.

45.         Fortunately, such systems exist today. The most commonly-used global COVID-19 genomic sequence platform is run by the non-profit organisation called GISAID. The data is publicly accessible and protects the ownership rights of the source country.

46.         Today, GISAID  hosts  all shared genome sequences of the four viral pathogens of global interest currently: namely COVID-19, Influenza, Mpox and Respiratory Syncytial Virus (RSV). 

47.         Singapore actively contributes to GISAID, which in turn works with many countries. GISAID has established a base in Singapore, in collaboration with A*STAR, and MOH and GISAID have developed a strong working relationship. 

48.         Hence, when a major COVID-19 infection wave broke out in China, GISAID collaborated with the various Centres for Disease Controls in major Chinese cities and provinces to obtain viral sequencing data.

49.         Today, Beijing, Shanghai, Guangzhou, Sichuan, Zhejiang, Jiangsu, Fujian, and Inner Mongolia contribute up to date viral genome sequences to GISAID, on a weekly basis. Just today, you can find genome sequences from the province of Anhui. The data are analysed and processed in their office in Singapore. 

50.         There are still gaps in the data, so GISAID is working with the Chinese authorities to expand the data capture. So far, the data shows that the epidemic in China is driven by variants that are well-known and have been circulating in other regions of the world. The dominating ones are BA.5.2 and BF.7.

51.         Our local sequencing efforts on infected travellers from China further supports this. The majority are BA.5.2 and BF.7 strains, which have already been detected in Singapore and other countries for many months. Our assessment is also consistent with that of the WHO’s Technical Advisory Group on Virus Evolution, which just released its findings on 4 January 2023.

52.         This is a huge relief. What we fear and worry most – a new dangerous variant that evades vaccine protection, coming out from China as the virus spreads throughout their population, has not materialised yet. But we will continue to stay vigilant and plug ourselves deeply into the global surveillance system. 

Protecting Hospitals 

53.         Our second concern is to protect our hospital system. 

54.         When China announced that it will start to allow leisure visits in an orderly way, many people around the world is imagining a surge in COVID-19 infections from an increase in tourists from China. Singaporeans are asking if we should implement some of the measures other countries are implementing.

55.         Let us examine the effectiveness of these measures in protecting our hospitals.

56.         First, some countries conduct PCR tests on travellers from China after arrival.  But a shortcoming of on-arrival tests is that they are too late, because the travellers are already within your  borders. Further, PCR tests are sensitive and are bound to yield a large number of positive cases from countries that are experiencing or have just experienced a big wave. Even recovered travellers will shed dead viral fragments for quite some time, a few weeks, even though they are no longer infectious. We therefore did not consider doing this, as it would merely confirm what we already know and expect. 

57.         As for wastewater tests, these are best done on residential premises like dormitories and housing estates, because viral fragments can only be detected from solid wastes.  So the sample capture from plane toilets for a relatively short duration flight from China to Singapore is likely to be very small and of limited use.

58.         The second measure is PDT, which can be useful because it will sieve out COVID-19  positive passengers, prevent them from boarding the plane, reduce the number of imported infections and severe cases, and hence lower burden on our hospitals. So PDT tests can be useful.

59.         However, as I explained earlier, there is already low travel volume between Singapore and China, which is currently  less than 10% of pre-COVID-19 norms.  This already limits the number of imported infections more so than imposing a blanket PDT requirement on all travellers from China.

60.         I believe China is also acting cautiously and increasing outbound traffic in steps, and not make a sudden full opening.   

61.         Minister Iswaran will explain how we will increase the number of flights between Singapore and China in a calibrated fashion, as the infection wave continue to subside in China, while ensuring that the health of Singaporeans and healthcare resources are not compromised.

62.         I reported earlier that over the past four weeks, travellers from China accounted for less than 5% of imported infections and one out of seven severe cases. 

63.         If we impose PDT on all travellers from China, questions will also arise about travellers from other regions that contribute more infections and severe cases. How about local community settings which we know are conducive to spreading the disease and can drive infection numbers and severe cases?

64.         Further, by triggering PDT on travellers from one part of the world experiencing high infection numbers, are we contributing to an international precedent of imposing tests on travellers from countries experiencing an infection wave? How will other countries treat travellers from Singapore when we encounter another infection wave?

65.         Instead of imposing blanket PDT specifically on travellers from one region or one country, we decided very early on that we should encourage adequate vaccination amongst all the travellers coming to Singapore, from all parts of the world. This directly reduces the risk of importing severe cases and protecting our hospital system.

66.         That is why we have until now maintained the requirement that incoming travellers either are fully vaccinated based on WHO definition, or have to undergo a professionally administered or supervised PDT.  

67.         Mr Speaker, in Mandarin please.

68.         中国对外开放，是世界抵抗冠病疫情的  重要里程碑，也是许多国家、行业，企业，家庭，人民期待已久希望看到。对新加坡来说，这是重要的发展，能让我们恢复以往的人文交流，促进两国之间的全方位合作。

69.         虽然看到的事发生了，好多公众却觉得担忧。大家恐怕中国的开放会导致  新加坡国内疫波再抬头，政府再次施行社会安全措施。几年来争取到的自由，会不会功亏一篑？

70.         卫生部深刻理解  这方面的担忧，也会继续维持我们的  高度警戒。因此，我们要使用科学证据和数字，策划出最有效  的防疫措施。

71.         让我们先看看数字吧。去年十二月，应该是中国疫情  最严重的阶段。

72.         那时候，大约有200名来自中国的旅客被检测出  感染了冠病。这占我们总输入型病例  不到百分之五。比起我们全国总病例，占不到百分之一。

73.         现在，许多染上冠病的人士，尤其是那些接种过疫苗的人士，病症都是轻微的。所以我们注重的是严重，需要入院疗养的病人，的患者。

74.         去年十二月，来自各个国家地区，在所有输入型  病例当中，有七个人的病情严重，需要入院治疗。他们当中，三个来自中东国家、两个来自亚细亚国家，另外各有一人来自中国和欧洲。他们大多数都是从这些国家地区回国的新加坡人。病重的人数不多，所以对我们医疗体系影响是很小。

75.         为什么中国的冠病病例激增，却在输入型以及病重的病例当中，只占了非常小的部分呢?

76.         主要的原因是，往返于新中两国的人次，自冠病疫情爆发以来，就维持在非常低的水平。

77.         目前，我们每周只有38趟来自中国的航班，比疫情前的大约400趟少了很多。搭乘这些航班进我国的人，大约每天有700到1000人，不到疫情爆发前的一成。

78.         此外，一直以来我们都有要求高风险的旅客进行检测。旅客要入境我国之前，必须提呈冠病疫苗的接种证明。没有的话，就要提供阴性的检测证明。

79.         因为我们已经预料会有今天这个的情况，所以保留了这两个非常关键的边境措施。

80.         许多科学家相信，中国的疫情已经过了最高峰。在这段最艰难的时间，新加坡疫情情况保持稳定，可以看出我们这些措施是有效的。

81.         但措施不可能是永久有效的。政府抗疫跨部门工作小组会仔细的观察不断改变的疫情局面，检讨我们的措施。需要的话，我们会改变或实行新的疫情措施，抗疫措施。

82.         现在，让我大略说明我们现阶段疫情的一些主要担忧。第一，就是出现一个新型，而且更危险的变种毒株；第二是保护和保障我们的医疗系统。

83.         新型毒株有可能源自任何一个国家或地区。要尽快地发现新毒株的出现，需要一个有效的国际监测系统。

84.         这个国际系统名称GISAID。它正在和中国各大城市或省份  的疾病预防控制中心合作，收集相关的病毒基因排列数据。目前，北京、上海、广州、四川、浙江、江苏、福建，内蒙古和安徽，每个星期都会提供最新的基因  排列数据给GISAID。这些数据在GISAID  位于新加坡的办公处进行分析和处理。

85.         GISAID的研究显示，目前在中国传播的病毒毒株，都是已经在其他国家和地区传播过的。目前的疫苗也可以针对这些毒株提供很好的保护。 这个发现，让大家松了一口气。

86.         至于保护和保障我国的医疗体系， 最重要的是鼓励所有入境我国的旅客，无论来自哪一个国家和地区，接种冠病疫苗。这么做可以直接降低入境感染者病重的风险，而且保护我们的医疗体系。

87.         说到底，最好的防卫措施，也是每个人都能够做到的，就是接种疫苗，而且确保  我们更新疫苗接种状态。

88.         有些人问我，一支过一支地打，要什么时候才可以打得完，几时可以不需要再接种疫苗？

89.         说老实话，冠病疫苗已经成了我们新常态的一环。就像流行性感冒跟其他地方性疾病一样，我们鼓励人们每年接种一次疫苗，就可以避免很多人因为染病病重或病逝。

90.         就如李显龙总理也在他2023年新年献词中所说，在去年年底的旅游旺季，以及中国冠病病例激增之后，如果本地的疫情保持稳定，我们有望解除最后的防疫限制，正式进入疫后常态。

Part of a New Norm

91.         Mr Speaker Sir, the latest worry about the outbreak in China is part of the new norm. Today it is China, tomorrow another region may experience a major wave.

92.         In fact, many regions in the northern hemisphere are experiencing rising infections of both COVID-19 and Influenza over the winter season. New infection waves are bound to start in Singapore from time to time, over and over again, as variants with immune escape emerge, protection from vaccines and previous infections wane, and re-infections increase.

93.         While we step up global surveillance and consider border measures whenever we feel threatened, remember the best defence and which everyone of us can play a part, is to have up to date vaccinations.  

94.         Some people are asking when is vaccination going to end? How many shots of booster must we take? To be very honest, COVID-19 vaccinations have become part of the new norm.  For an endemic disease like Influenza, vaccinations are encouraged every year, which will help avoid many deaths. 

95.         The current situation where we feel threatened by rising infections around us, is a clear illustration why vaccination needs to be an integral part of our on-going defence against endemic COVID-19.

96.         I am heartened that most Singaporeans are responding to this. As of 31 December 2022, about 60% of individuals aged 18 years and above are up-to-date with their vaccinations. Today about, 13,000 individuals are taking the bivalent vaccine on a daily basis. With the introduction of the bivalent formulations for both Moderna and Pfizer, you have two brands to choose from, I hope more would step forward to get better protection.

97.         As we move into this new norm, we will never be complacent, but our responses need to be based on science, evidence and data. We are ready to adjust policies whenever necessary.

98.         We will always do our best to maintain our way of life and not go back to the days of lockdowns unless absolutely necessary.

99.         And as the Prime Minister said in his New Year’s Day message, if the situation continues to be stable after the year end travel season and the infection wave in China, we can look forward to making final adjustments to our remaining social restrictions to establish a post-pandemic normalcy.