VACCINATION OUR PRIMARY DEFENCE IN LIVING WITH COVID-19

Since 29 August 2022, we stepped down almost all of our Safe Management Measures (SMMs), save for mask-wearing in healthcare facilities and public transport. Vaccination remains our primary line of defence as we forge ahead and learn to live with COVID-19.

2. As of 6 October 2022, average daily infections in the community over a 7-day period rose from around 2,600 a week ago to 4,400. Hospitalised cases have also increased from 247 from a week ago to 342, and the number of Intensive Care Unit (ICU) cases has increased from 9 to 13 within the same period. This is likely due to increased social activities, SMMs being stepped down, and also the BA.2.75 and BA.2.10 Omicron subvariants, which have been detected around the world, now circulating in Singapore.

3. The increase in daily cases is not unexpected, as we open up our society and economy. What is important is to protect our healthcare capacity, and ensure that infections do not translate into large numbers of severely ill patients. So far, there is no evidence that the subvariants result in more severe illness. Nevertheless, we need to each keep our COVID-19 vaccination up-to-date as vaccination has become our primary defence against COVID-19.

4. We will therefore roll out primary vaccination for children aged 6 months to 4 years (Para 8a), booster vaccination for children aged 5 years and above (Para 8b), and bivalent vaccines as boosters for those aged 50 and older, or persons yet to achieve minimum protection (Para 23-24). Further, instead of counting the number of shots and boosters we receive, we will transit to a new definition of up-to-date vaccination. This is similar to Influenza vaccination, where individuals are advised to take them periodically, so as to protect ourselves against new strains of the endemic Influenza virus as they arise.
LIFTING OF VACCINATION-DIFFERENTIATED SAFE MANAGEMENT MEASURES (VDS)
5. We have learned to live with the COVID-19 virus, having weathered several infection waves and progressively lifted SMMs. As we resume normalcy in our daily activities, we will lift VDS fully from 10 October 2022. This means that VDS will no longer be required for (i) events with more than 500 participants at any one time, (ii) nightlife establishments where dancing among patrons is one of the intended activities, and (iii) dining in at F&B establishments, including hawker centres.

6. VDS has served us well in our journey to safe reopening, helping to protect non-fully vaccinated persons by reducing their exposure to settings with a higher risk of transmission, and in turn keeping our healthcare system from being overwhelmed when population-wide vaccination and infection rates were not yet sufficiently high. However, even as VDS is lifted, non-fully vaccinated persons continue to face a higher risk of severe disease. We urge such persons to come forward to be vaccinated, or continue to take their own precautions and minimise social interactions to protect themselves.

7. While we have eased most SMMs at this juncture (Annex A), we must continue to remain vigilant and be ready to respond to any dangerous new variants. Should the situation worsen, we may need to put in place the necessary measures at short notice, so as to protect the public, safeguard our healthcare workers and conserve hospital capacity. This may include standing up an appropriate level of VDS, as was necessary during the height of the pandemic.

VACCINATION FOR CHILDREN
8. To ensure that our children attain a minimum level of protection and remain up-to-date with their vaccinations, the Ministry of Health (MOH) will be rolling out the following from 25 October 2022:

a. For children aged 6 months to 4 years to receive their primary vaccination with Moderna/Spikevax vaccine; and
b. For children aged 5 to 11 years to receive a booster dose with Pfizer-BioNTech/Comirnaty vaccine.

Primary Vaccination in Children Aged 6 Months to 4 Years

9. MOH has accepted the recommendation of the Expert Committee on COVID-19 Vaccination (EC19V) that children aged 6 months and above be vaccinated against COVID-19. Following the Health Sciences Authority’s (HSA) authorisation of the Moderna/Spikevax vaccine for use in children aged 6 months to 5 years, the EC19V recommends the vaccine for primary vaccination for this age group. The recommended dosage of the Moderna/Spikevax vaccine for those aged 6 months to 5 years, is two doses of 25 micrograms each, spaced eight weeks apart. The vaccine from Pfizer BioNTech/Comirnaty, which is a three-dose vaccine for children aged 6 months to 4 years, has also been approved and we are awaiting delivery. It should be available by the end of the year.
10. While clinical data showed that the risk of severe COVID-19 in young children is generally very low, there is still a higher risk of hospitalisation compared to older children and severe disease can occur. Based on studies of the vaccine, the EC19V has assessed that the Moderna/Spikevax vaccine is beneficial for protection against severe COVID-19 in children aged 6 months to 5 years. This protection would be important with ongoing transmission of the BA.2.75 and BA.2.10 subvariants, and the possibility of future COVID-19 variants.

11. Vaccinations for children aged 6 months to 4 years will begin on 25 October 2022. From 18 October 2022, parents or guardians of children aged 6 months to 4 years may register their interest for their child or ward to receive the Moderna/Spikevax vaccination via https://child.vaccine.gov.sg. For additional details on the registration process and the list of designated vaccination sites for children, please refer to Annexes B and C respectively. Children aged 5 years will follow the vaccination programme for those aged 5 to 11 years old, which is already in place.

12. Children receiving other non-COVID-19 vaccines are recommended to receive their COVID-19 vaccine at a minimum interval of 14 days before or after any other vaccines.
Extension of Booster Vaccination Programme to Children Aged 5 to 11 Years
13. The Ministry of Health (MOH) has also accepted the EC19V’s recommendation for children aged 5 to 11 years to receive a booster dose of the Pfizer-BioNTech/Comirnaty vaccine, which is so far the only COVID-19 vaccine recommended for this age group.

14. Local and international data showed that antibody levels and vaccine protection against COVID-19 hospitalisation decline with time in children aged 5 to 11 years, just as it does with adolescents and adults. The Pfizer-BioNTech/Comirnaty booster will help sustain protection against severe disease. Side effects are generally mild, similar to those from the first two doses. The EC19V has therefore recommended all children aged 5 to 11 years to receive a booster dose of the Pfizer-BioNTech/Comirnaty vaccine from five months after their second dose.

15. Booster vaccinations for children aged 5 to 11 years will begin on 25 October 2022. Parents or guardians of eligible children aged 5 to 11 years will receive an SMS notification to book their child or ward’s Pfizer-BioNTech/Comirnaty booster dose via the personalised booking link provided. Please refer to Annex B for additional details on the registration process and Annex C for the list of designated vaccination sites for children.

Designated Vaccination Centres for Children
16. To facilitate vaccination for children, five designated Vaccination Centres (VCs) offering the Pfizer-BioNTech/Comirnaty for those aged 5 to 11 years and Moderna/Spikevax vaccines for those aged 6 months to 4 years will begin operations from 25 October 2022 onwards. They are located at:

• One Punggol;

• Our Tampines Hub;

• Queenstown Community Centre;

• Sembawang Community Club; and

• Taman Jurong Community Club.
  

17. These VCs will be manned by staff trained in administering vaccinations for children. Three polyclinics will come onboard to support vaccinations for those aged 6 months to 4 years, and four polyclinics will support vaccinations for those aged 5 to 11 years old. Selected Public Health Preparedness Clinics (PHPCs) will also come onboard to support the vaccination programme. Annex C provides the full list of designated vaccination sites for children. Parents or guardians may also visit https://www.gowhere.gov.sg/vaccine to locate the nearest vaccination site available for your child or ward.

18. MOH will also deploy mobile vaccination teams to provide the primary series and booster vaccinations for children aged 5 to 11 years in Special Education (SPED) schools and the Early Childhood Development Agency (ECDA) funded Early Intervention Programme for Infants & Children (EIPIC) centres. Eligible children in the SPED schools and EIPIC centres may receive their vaccinations via these mobile vaccination teams from 25 October and 28 November 2022 respectively. The SPED schools and EIPIC centres will keep the parents or guardians of these children updated on further details.

19. Persons aged 3 years and above, who are medically ineligible for the Moderna/Spikevax and Pfizer-BioNTech/Comirnaty vaccines, will be offered the Sinovac-CoronaVac vaccine under a dedicated public health programme. Participants in the public health programme will be closely monitored by trained medical personnel. MOH will contact eligible persons with detailed instructions.

DEFINING UP-TO-DATE VACCINATION AND BIVALENT VACCINES
20. We will transit from tracking the number of doses we have taken, to an “up-to-date vaccination” definition regime. Under this arrangement, everyone should keep up-to-date with the latest vaccination recommendations. Individuals are advised to adhere to the following two key recommendations, namely:

a. Individuals should ensure that they achieve minimum protection. Persons aged 5 years and above should complete three mRNA or Novavax/Nuvaxovid doses, or four Sinovac-CoronaVac doses, to achieve minimum protection.

b. After achieving minimum protection, persons aged 50 years and above should receive an additional booster dose between five months to one year from their last dose, to keep up-to-date with their COVID-19 vaccination. The updated bivalent vaccine is recommended for this. Individuals will be considered up-to-date with their COVID-19 vaccination if they have received at least the minimum protection and their last vaccine dose was received within the past one year.

21. We will consider extending Para 20(b) to other age groups later. The vaccination recommendations to meet the up-to-date definition is summarized in Annex D.

Bivalent Vaccines to Replace Current mRNA Vaccines

22. The Expert Committee on COVID-19 Vaccination (EC19V) has recommended the use of bivalent COVID-19 vaccine, to replace the current formulation.
23. This updated bivalent vaccine will provide better protection against newer COVID-19 variants. MOH will therefore replace the original Moderna/Spikevax vaccines with the updated bivalent version from 17 October 2022 for all vaccinations using the Moderna/Spikevax vaccine, for all adults aged 18 years and above.

24. Hence, for persons aged 50 and above, or for persons yet to achieve minimum protection, as they are at higher risk of severe illness from COVID-19 infection, they should take the bivalent vaccines.

25. Persons aged 50 and above, or those yet to achieve minimum protection, may walk into any Joint Testing and Vaccination Centres (JTVC) offering the Moderna/Spikevax vaccines from 17 October 2022 onwards to receive their bivalent vaccine dose. Individuals may refer to https://www.gowhere.gov.sg/vaccine to locate the nearest JTVC.

26. The Pfizer/Comirnaty bivalent vaccine is undergoing evaluation and is expected to be available by the end of this year.

Sinovac-CoronaVac Allowed for Booster Vaccination

27. There are persons aged 18 years and above who have been vaccinated with three doses of Sinovac-CoronaVac but have yet to receive a booster dose. This does not confer the minimum protection required and is a cause for concern.
28. Local data has shown that compared to two doses of mRNA vaccines, three doses of Sinovac-CoronaVac does confer protection against severe disease, with a vaccine effectiveness of 70%, compared to over 80% with three doses of mRNA vaccines. For better protection, we highly recommend those who have received only three doses of Sinovac-CoronaVac to receive the updated Moderna/Spikevax bivalent vaccine, or alternatively, the Pfizer-BioNTech/Comirnaty or Novavax/Nuvaxovid vaccine. That said, Sinovac-CoronaVac will now also be allowed as booster doses, without the need for proof of medical ineligibility to mRNA or Novavax/Nuvaxovid vaccines, to encourage those who otherwise have not received a booster vaccination to minimally receive a booster dose.

CONTINUING TO EXERCISE PERSONAL AND SOCIAL RESPONSIBILITY
 29. We urge everyone to continue to exercise personal and social responsibility through maintaining hygiene, testing and minimizing social interactions when unwell, and keeping up-to-date with vaccinations. These steps will allow our society to be more resilient as we progress steadily towards living with COVID-19 and the new variants that emerge from time to time.