MINISTRY OF HEALTH’S RESPONSE TO CALL TO SUSPEND COVID-19 VACCINATION

The Ministry of Health (MOH) is aware of a recent post by the People’s Power Party to call for suspension of COVID-19 vaccination. It cited “studies and analyses by prominent medical experts”, which claimed that COVID-19 vaccines caused high incidences of severe side effects. It also attempted to draw associations between high vaccination rates and excess deaths.

MOH categorically rejects these egregious and false claims. Our response to each of these so-called experts is laid out in detail in the Annex.

The COVID-19 pandemic took the lives of millions around the world, paralysed healthcare systems in many jurisdictions, and brought economies to a standstill. We need to draw the right conclusions and follow the scientific evidence on the safety and effectiveness of COVID-19 vaccines.

In a pandemic of this nature, excess deaths are inevitable. The primary reason why Singapore recorded one of the lowest excess death rates in the world during the pandemic, is because the majority of Singaporeans took the vaccines. The high level of vaccine protection in our society averted many COVID-related deaths, protected our healthcare system from being overwhelmed, and allowed us to preserve lives and livelihoods. The normalcy in our daily lives today is in large part due to the protection that COVID-19 vaccines provide.

During our previous JN.1 wave, the incidence rate of COVID-19 hospitalisations and ICU admissions among seniors aged 60 years and above who were not vaccinated was almost twice that of those who kept their vaccination updated. Multiple international and local studies conducted over other past waves have also consistently demonstrated the effectiveness of vaccination in preventing severe outcomes (such as emergency department attendance, hospitalisation, ICU admission and death), especially among older persons^{i, ii, iii, iv, v, vi, vii}. 

In addition, vaccination and boosting mitigate the risk of developing long-term conditions after COVID-19 infection, such as cardiovascular, cerebrovascular and thrombotic complications^viii.

This is why keeping up to date with additional vaccine doses is pertinent even as COVID-19 becomes endemic, much like vaccination against influenza and pneumococcus. COVID-19 waves occur from time to time and can cause severe disease among those who are older or medically vulnerable. The vaccines will be able to protect individuals and prevent deaths.

There are side effects to any vaccination. In this regard, Singapore has been transparent in reporting the incidence of side effects of COVID 19 vaccination. Until July 2023 when the safety profiles of the vaccines have been reviewed to be consistent with no new safety signals, we reported this on a regular basis, which showed that most side effects were mild, and that the reporting rates of severe side effects remained rare at 7 per 100,000 doses (0.007%). Most recovered smoothly after rest and treatment. In particular, we highlighted the relatively higher incidence of myocarditis amongst the young males, at about 1 in 100,000 doses (0.001%). 

Real world data in the US shows that young men ages 18 to 29 years had seven to eight times the risk of myocarditis/pericarditis after COVID-19 infection, compared to after COVID-19 vaccination^ix. This is supported by other studies, including a systematic review which reported similar findings that the risk of myocarditis is more than seven times higher in persons who had COVID-19 infections than in those who received the vaccine^x. As such, the benefit of vaccination continues to outweigh the risk for all ages.

In comparison, the long term effects of COVID-19 infections without the protection of vaccines can be much worse, with patients registering heart, respiratory and other complications post infection, collectively referred to as “Long COVID” sometimes. 

That is why international and national health authorities continue to recommend COVID-19 vaccination. MOH’s recommendations on COVID-19 vaccination are evidence-based. We have been and will continue to monitor the safety and effectiveness of COVID-19 vaccines and adjust our recommendations accordingly.

There is a very large body of scientific evidence that overwhelmingly shows that the protection from COVID-19 vaccines outweighs the side effects. Yet, several groups continue to spread misinformation, either by quoting scientific literature out of context or sharing materials from non-credible sources who cannot be held accountable, to cast doubts on the safety and effectiveness of COVID-19 vaccines. At least the People’s Power Party has consolidated these reports, to give us the opportunity to rebut them at one go. We also note that the list of scientific articles cited by the People’s Power Party were mostly from the same group of authors, including some who have been reported to be promoting messages against COVID-19 vaccination. We urge the public to verify information found on the Internet against authoritative sources.

MINISTRY OF HEALTH 

3 JUNE 2024

ⁱ Wee LE, Pang D, Chiew C, et al. Long-term Real-world Protection Afforded by Third mRNA Doses Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections, Coronavirus Disease 19-related Emergency Attendances and Hospitalizations Amongst Older Singaporeans During an Omicron XBB Wave. Clin Infect Dis. 2023 Oct 13;77(8):1111–9.

ⁱⁱ Tan CY, Chiew CJ, Pang D, et al. Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study. Lancet Infect Dis. 2023 Dec;23(12):1343-1348.

ⁱⁱⁱ Tan CY, Chiew CJ, Lee VJ, et al. Comparative effectiveness of 3 or 4 doses of mRNA and inactivated whole-virus vaccines against COVID-19 infection, hospitalization and severe outcomes among elderly in Singapore. Lancet Reg Health West Pac. 2022 Dec 2;29:100654.

^iv Tan CY, Chiew CJ, Lee VJ, et al. Effectiveness of a Fourth Dose of COVID-19 mRNA Vaccine Against Omicron Variant Among Elderly People in Singapore. Ann Intern Med. 2022 Nov;175(11):1622-1623.

^v Tan CY, Chiew CJ, Pang D, et al. Vaccine effectiveness against Delta, Omicron BA.1, and BA.2 in a highly vaccinated Asian setting: a test-negative design study. Clin Microbiol Infect. 2023 Jan;29(1):101-106.

^vi DeCuir J, et al. Interim Effectiveness of Updated 2023-2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years - VISION and IVY Networks, September 2023-January 2024. MMWR Morb Mortal Wkly Rep. 2024 Feb 29;73(8):180-188.

^vii Bello-Chavolla OY, et al. Effectiveness of a nationwide COVID-19 vaccination program in Mexico against symptomatic COVID-19, hospitalizations, and death: a retrospective analysis of national surveillance data. Int J Infect Dis. 2023

^viii Lim JT, Wee LE, Tay AT, et al. Long-term Cardiovascular, Cerebrovascular, and Other Thrombotic Complications in COVID-19 Survivors: A Retrospective Cohort Study. Clin Infect Dis. 2024 Jan 25;78(1):70-79.

^ix Cardiac complications after SARS-Cov-2 infection and mRNA COVID-19 .. (2022, April 8). https://www.cdc.gov/mmwr/volumes/71/wr/mm7114e1.htm?s_cid=mm7114e1_wnuary%202021%E2%80%93January%202022%20|%20MMWR%20(cdc.gov)

^x Voleti, N., Reddy, S. P., & Ssentongo, P. (2022). Myocarditis in SARS-CoV-2 infection vs. COVID-19 vaccination: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.951314