Response to adjournment motion on vaccination-differentiated safe management measures

NOTICE PAPER NO. 908
NOTICE OF ADJOURNMENT MOTION
FOR THE SITTING OF PARLIAMENT ON 10 JANUARY 2022

Ms Hazel Poa, Non-Constituency Member

VACCINATION-DIFFERENTIATED SAFE MANAGEMENT MEASURES

Answer

1.     Mr Speaker, I thank the Member for her speech on matters related to Vaccination-Differentiated Safe Management Measures (VDS).

2.     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 the extension of VDS to children.

3.     Earlier today, the Minister for Health 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 Safe Management Measures (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.

4.     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 intensive care unit (ICU) resources. It is important to note that non-fully vaccinated persons who are infected with COVID-19 are more than 7 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^[1]. 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 incidence of fully vaccinated and non-fully vaccinated seniors who died are 0.3 and 8.2 per 100,000 population, respectively^[2].

5.     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 they are a small proportion of our population, they take up a disproportionate amount of medical and hospital resources, and contribute to 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.

6.     The basis of VDS is therefore two-fold. First, by putting restrictions on their social activities, we protect the unvaccinated by preventing them from being overly exposed to the virus.

7.     And the Member earlier said “Well, it is just for them, right? ” But that is not true. Because, the second point is that if you were unvaccinated, people get infected, we preserve our hospital capacity while allowing the rest to carry on normal activities as much as possible.

Rationale for VDS

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

9.     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 Taskforce (MTF) thus decided to significantly tighten our SMMs, resulting in the move to Phase 2 (Heightened Alert) in May 2021.

10.     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 2 (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.

11.     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 means that they will 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.

12.     We resumed dining in F&B establishments, for groups of up to 5 vaccinated persons, with exemptions for children aged 12 years 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.

13.     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 would not matter if they are tennis coaches. The virus does not discriminate. 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.

14.     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 earlier and the serious cases, who had to be seen in hospitals, resulted in 100 to 170 cases occupying ICU beds each day^[3]. 66% of ICU patients were unvaccinated or partially vaccinated individuals.

15.     They took up scarce medical resources, which are needed for others who are very sick individuals including those with non-COVID 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 2 (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.

16.     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^[4].

17.     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 to 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 this potential increase in cases as well as 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.

Removing the Concession to Allow Unvaccinated Workers to Return to the Workplace with a Negative PET Result

18.     In line with our overall reopening approach, the MTF announced the introduction of the Workforce Vaccination Measures (WVM) [5], 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.

19.     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 were infected with COVID-19, it would indeed impact on our healthcare system.

20.     This decision is taken in consideration of many 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.

21.     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 the WVM, the Ministry of Manpower (MOM) and tripartite partners have guided for 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.

Charging COVID-19 Patients Who Are Unvaccinated by Choice

22.     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.

23.     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 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 9 months from their last dose.

24.     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.

Extending VDS to Children

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

26.     The focus at this time is to ensure our children are well protected as we begin vaccination for those aged 5 to 11 years 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 5 to 11 progresses. Earlier today, we have also addressed concerns that were raised by Members. We acknowledge that these are some legitimate concerns that parents may have, but given the facts that we have and the current situation that we are facing, it is still highly encouraged for parents to bring their children, if they are eligible, for vaccination.

Closing

27.     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.

^[1] Based on number of cases reported from 1 September to 30 November 2021, and their clinical status as of 31 December 2021.

^[2] As of 1 November 2021.

^[3] Based on the number of cases reported from 5 October 2021 to 12 November 2021.

^[4] As of 6 January 2021.

^[5] See MOH and MOM’s joint Press Release on 23 October 2021: https://www.mom.gov.sg/newsroom/press-releases/2021/1023-implementation-of-workforce-vaccination-measures