Parliamentary Questions for the Minister for Health

Hazel Asks the Health Minister

Healthcare Spending by Government and Individuals

2 April 2024

Ms Hazel Poa asked the Minister for Health in the last three years, what is the breakdown of expenditure on the key components of public healthcare, such as drugs, manpower, medical technology, research, administration and real estate.

Ms Hazel Poa asked the Minister for Health in the last three years, what is the total expenditure by the Government on subsidised medical care for (i) Singapore citizens (ii) permanent residents and (iii) foreigners.

Ms Hazel Poa asked the Minister for Health for each year from 2021 to 2023, what percentage of patients’ healthcare expenditure was paid by (i) the Government (ii) employers (iii) MediSave (iv) MediShield and (v) individuals, with a breakdown by citizens, permanent residents and foreigners.

Mr Ong Ye Kung: The Tables below provide the breakdowns for the financial years where data is available:

Cord Blood Banking Service

10 January 2024

Ms Hazel Poa asked the Minister for Health whether the Ministry will consider strengthening the Healthcare Services (Cord Blood Banking Service) Regulations 2021 to provide more provisions for consumer protection given the irreplaceable nature of cord blood.

Mr Ong Ye Kung: Private cord blood banking is an elective, for-profit service, where parents pay to store their child’s cord blood for potential future use. There have been 14 withdrawals for transplants since the establishment of cord blood banking services in 2001.

The Healthcare Services (Cord Blood Banking Service) Regulations 2021 set licensing requirements for cord blood banks in the collection, handling, processing, storage and distribution of cord blood. The requirements are aimed at assuring the viability of the cord blood units released for transplant purposes. The Ministry of Health will review areas to strengthen these regulations, where appropriate, arising from the Cordlife incident.

Private Insurance Plans for Pre-Existing Conditions

7 November 2023

Ms Hazel Poa asked the Minister for Health (a) whether the Ministry has studied how private insurance plans, such as Integrated Shield Plans, can remain sustainable without having to reject new applications based on pre-existing conditions; and (b) whether there are any plans to explicitly forbid private insurance companies from rejecting new applications for insurance plans based on pre-existing conditions and, if not, why not.

Mr Ong Ye Kung: For insurance plans to remain sustainable without rejecting individuals with pre-existing conditions, a large risk pool comprising both healthy and unhealthy individuals is necessary. This is why MediShield Life (MSHL), our national health insurance scheme, was designed to cover all Singapore Residents from birth, regardless of pre-existing conditions.

Integrated Shield Plans (IPs) and other private health insurance plans offer optional coverage on top of MSHL. As these are private products, underwriting decisions are subject to insurers’ commercial and actuarial considerations.

If insurers cannot reject applicants with pre-existing conditions, they may have to increase premiums for all policyholders to ensure that their insurance risk pool remains sustainable.

Depending on their underwriting practices, insurers may still offer coverage to applicants with pre-existing conditions, but with exclusions or risk loading, that is, higher premiums. This allows such applicants to benefit from some coverage without adversely affecting other policyholders.

Tobacco Control

7 November 2023

Ms Hazel Poa asked the Minister for Health (a) which of the MPOWER tobacco control interventions recommended under the World Health Organisation Framework Convention on Tobacco Control have yet to be implemented in Singapore; and (b) what steps will the Government take to ensure that Singapore achieves best-practice levels in all MPOWER measures.

Mr Ong Ye Kung: Singapore has implemented all of the recommended MPOWER measures. We have attained the highest level of achievement in the following areas: monitor tobacco use and prevention policies, offer help to quit tobacco use and warn about the dangers of tobacco (health warnings). Areas in which Singapore has yet to attain the highest level of achievement are: protect people from tobacco smoke, warn about the dangers of tobacco (mass media), enforce bans on tobacco advertising, promotion and sponsorship and raise taxes on tobacco.

The Ministry of Health will continue to review and enhance our tobacco control measures and work with the relevant agencies to reduce the prevalence of smoking in Singapore.

Suicide Rates Among Young People

2 August 2023

Ms Hazel Poa asked the Minister for Health what measures will be taken to address the rising suicide rates, especially among the young people.

Mr Ong Ye Kung: Suicide is tragic, personal, complex and multi-faceted. The best interventions include building mental resilience, encouraging help-seeking, spotting early indicators for crisis intervention and supporting individuals in crisis, with support from multiple stakeholders.

This will be addressed in the next Sitting together with similar Parliamentary Questions for a more holistic reply. [Please refer to “Addressing Rise in Suicide Cases and Making Mental Healthcare Assistance Readily Accessible”, Official Report, 03 August 2023, Vol 95, Issue 110, Oral Answers to Questions section.]

Elective Admissions into Hospitals

9 May 2023

Ms Hazel Poa asked the Minister for Health (a) for each month since January 2022, what percentage of hospital admissions are elective admissions of Singaporean and foreign patients respectively; and (b) what are the policies relating to deferring elective admissions when hospital bed occupancy rates exceed 85%.

Mr Ong Ye Kung: For 2022, elective admissions form around 23% of total hospital admissions in the public hospitals. In general, the proportion of non-resident foreigners¹ who are admitted to our public hospitals constitutes less than 0.5% of total admissions.

To manage bed capacities better, especially when the public hospitals anticipate a surge in emergency admissions, hospitals may temporarily defer non-urgent electives. Patients requiring urgent medical care, including those requiring urgent elective procedures, will still be prioritised for admission.

Note(s) to Question No(s) 18:

¹ Excludes Work Permit/pass holders, dependant pass holders and foreign students.

Debt Collection by Hospitals

9 January 2023

Ms Hazel Poa asked the Minister for Health (a) in each year from 2011, what are the numbers and percentages of cases where hospitals engage authorised debt collection agencies to collect the arrears on their behalf; (b) under what circumstances will they do so; (c) what is the median hospital bill size and arrears owed in such cases; and (d) whether debt collection agencies will be engaged even when the patient is applying for MediFund and other forms of financial assistance.

Mr Ong Ye Kung: From 2017 to 2021, the median number of bills followed up upon by collection agencies (CAs) was 194,740, which is 2.44% of the total bills. These outstanding bills had a median outstanding amount of $103.86.

CAs are engaged after patients have been unresponsive to reminders via SMS, phone calls and letters for around three months. Patients applying for financial assistance will not be followed up with by CAs.

Arrears Owed by Patients in Restructured Hospitals

8 November 2022

Ms Hazel Poa asked the Minister for Health in each year since 2011 (a) what is the total arrears owed by patients in restructured hospitals; (b) what is the amount of arrears that has been written off as bad debt; and (c) what is the percentage of patients who default on their bills.

Mr Ong Ye Kung: Between 2018 and 2021, the annual net new arrears incurred by patients and write-offs at the restructured hospitals were around 2.5% and 0.8% of total bills issued respectively. About $50 million to $70 million of bad debts were written off every year, mainly incurred by patients with financial difficulties. Data prior to 2018 is not readily available.

Nutri-grade Labelling Requirements for Beverages

20 October 2022

Ms Hazel Poa asked the Minister for Health since the announcement of Nutri-Grade labelling requirements for beverages made on 30 December 2021, whether there is a reduction in sugar consumption through beverages and, if so, what is the reduction level.

Mr Ong Ye Kung: Since the announcement of the Nutri-Grade measures in March 2020, sales of prepacked beverages with higher sugar content (Grades C and D) have fallen from 49% of all prepacked beverages sold in 2019, to 40% in 2021. This is likely due to reformulation by manufacturers and change in demand from consumers.

Fees under Healthier SG Plan

20 October 2022

Ms Hazel Poa asked the Minister for Health whether there will be any difference in fees paid to family doctors and healthcare clusters for locals and foreigners under the Healthier SG plan.

Mr Ong Ye Kung: Under Healthier SG, participating general practitioner (GP) clinics will receive an annual service fee for the time and effort taken to care for and manage each enrolled resident. This service fee will not be differentiated by nationality.

At the same time, Singapore Citizens (SCs) and Permanent Residents (PRs) will receive an onboarding consultation and annual check-ins that are fully subsidised with the family doctor they are enrolled with. SCs will further receive fully subsidised nationally recommended health screenings and vaccinations. Foreigners are not eligible for these subsidies.

Life Expectancy by Racial Groups

2 August 2022

Ms Hazel Poa asked the Minister for Health what is the current life expectancy in Singapore by racial groups.

Mr Ong Ye Kung: As of 2021, the life expectancy of Chinese, Malay and Indian residents in Singapore were 84.3, 79.4 and 81.31¹ respectively.

Life expectancy is influenced by various factors, such as prevalence of severe diseases, chronic conditions and lifestyles. MOH will continue to work with other agencies and social organisations to improve these social determinants, with the aim of sustaining increases in life expectancy over time for all ethnic groups.

Note(s) to Question No(s) 37:

¹ a) Data for 2021 are preliminary.

b) Due to small number of deaths and smaller population size, Life Expectancy data for Indians may see larger year to year fluctuations;

c) As the 2021 data on life expectancy assumes that the pandemic affected higher mortality rates are held constant over a lifetime, the life expectancy figures for 2021 should be interpreted with the understanding that they may not be representative of the number of years that individuals can expect to live if mortality rates were to return to pre-pandemic levels.

Death of Child at NUH Emergency Department

5 April 2022

The following question stood in the name of Ms Hazel Poa –

To ask the Minister for Health (a) what is the result of the investigation into the case involving an expectant mother losing her child after being left unattended for a long time at the emergency department of the National University Hospital (NUH); (b) whether there are any previous similar cases; and (c) what steps will be taken to prevent future recurrence and to address the wider problem of overload situation at hospitals’ emergency departments.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, my answer will address Question No 5 from Ms Hazel Poa from today’s Order Paper and also similar related questions raised by Ms Ng Ling Ling¹, Mr Edward Chia² and Dr Wan Rizal3,4.

It was with a heavy heart that I read about the unfortunate incident that happened at National University Hospital (NUH) two weeks ago. I would like to offer my deepest condolences to the family for their tragic loss. The couple has had discussions with the NUH team and the matter has since been closed between the two parties.

The family had put up a social media post recently acknowledging this and further acknowledged that the mother had not been left unattended for two hours. Indeed, she received attention and care from the NUH Emergency Department (ED) team from the time that she arrived. They further noted that the sad and unfortunate outcome of the pregnancy was not the result of her experience at the hospital. Out of respect for the couple’s request for privacy and confidentiality reasons, I will not go into details of the case.

NUH has investigated the matter thoroughly and reviewed their processes, in consultation with MOH and the Director of Medical Services. Their clinical care processes are appropriate, but there were some areas for improved communications and the coordination for transfers between the ED and the Delivery Suite. NUH has implemented these improvements.

COVID-19 has resulted in the public hospitals’ EDs facing very high demands and our healthcare workers have been working continuously to attend to all patients with COVID-19 and those with non-COVID-19 conditions. All patients will be triaged based on presenting history, symptoms and clinical parameters so that those with life-threatening conditions are prioritised. No patient will be denied care.

I would like to offer my heartfelt thanks to all healthcare workers for their professionalism and dedication in caring for all their patients.

Note(s) to Question No(s) 5:

¹ To ask the Minister for Health (a) whether public hospitals’ emergency departments have a waiting time threshold before patients are being attended to; (b) for an emergency department which has crossed its coping threshold, whether emergency cases can then be diverted to the next nearest public hospital; and (c) whether there is a process for obstetric emergencies to be directed to KK Women’s and Children Hospital once a public hospital emergency department is not able to attend to such emergency within the waiting time threshold.

² To ask the Minister for Health whether the Ministry can provide more details on the investigation process for the recent NUH Accident and Emergency Department occurrence involving a pregnant woman, in terms of (i) reference for the review (ii) timeline for completion of the review and (iii) seniority of the individuals leading this review.

³ To ask the Minister for Health in light of the case involving an expectant mother losing her child at the NUH emergency department (ED) recently (a) whether the Ministry will consider reviewing the protocols to mitigate similar occurrences in the future; and (b) what steps will be taken to address the workload for healthcare workers in the ED.

⁴ To ask the Minister for Health whether counselling and mental health support will be provided for the staff and family members involved in the case of an expectant mother losing her child at NUH recently.

COVID-19 Vaccination Differentiated Measures

10 January 2022

Ms Hazel Poa asked the Minister for Health whether vaccination-differentiated measures will be imposed on children.

Dr Wan Rizal asked the Minister for Health (a) whether hospitals will be able to cope with the possible surge of infections due to the emergence of the COVID-19 Omicron variant; and (b) what are the measures and steps taken to ensure that processes and protocols remain efficient.

Mr Ong Ye Kung: These questions for written answers have been addressed by oral reply to Question Nos 1 to 12 on the Order Paper for 10 January 2022.

4 April 2022

The Minister for Health (Mr Ong Ye Kung): Mr Speaker, Sir, may I address Question Nos 19 and 20 in today’s Order Paper and also Parliamentary Questions for oral answer filed by Mr Leong Mun Wai, Assoc Prof Jamus Lim and Ms Hazel Poa¹ for the Sitting on 5 April, please?

Mr Speaker: Please proceed.

Mr Ong Ye Kung: Mr Liang Eng Hwa asked if we will review the safe management measures (SMMs), given that we have passed the peak of the Omicron wave. As the Member is aware, the relaxed rules came into effect on 29 March 2022, which is why we are all seated together today, and we have also transitioned to a Vaccinated Travel Framework on 1 April 2022.

It is a decisive but calibrated move. We did not declare a Freedom Day nor did we declare the pandemic to be over, as some countries did. Taking a cautious step-by-step approach has served us well throughout the pandemic and we will continue to do so.

That said, we were able to make this decisive move as we observed that the number of daily cases had been steadily declining in recent weeks. More importantly, the number of severe cases needing to be hospitalised had also declined. It is in this context that the Multi-MinistryTask Force (MTF) assessed the further easing of our SMMs and resumption of many normal activities to be appropriate.

These relaxations will likely cause an uptick in daily cases, which we should be able to ride through without any major changes to our public health posture. Once cases subside further, we will consider further easing of the SMMs. This can include reviewing distancing rules between tables in F&B settings that Mr Liang Eng Hwa specifically raised, and I want to assure Mr Liang that I am aware that one metre versus 80 centimetres makes a huge difference to F&B establishments. It also makes a huge difference in terms of transmission. So, we have to weigh the costs and benefits.

We will also review TraceTogether, SafeEntry, as well as Vaccination-Differentiated Safe Management Measures (VDS) which various Members have asked about. Let me go through the three measures in turn.

On TraceTogether, and in response to Ms Hazel Poa and Assoc Prof Jamus Lim, MOH no longer relies on TraceTogether for contact tracing for the general public. Cases who self-tested positive and go on to Protocol 2 do not upload their TraceTogether data, and we rely on them to do the responsible thing to inform their contacts to self-monitor. So, there is really no need to compare the data between self-reporting and TraceTogether because, having vaccinated the vast majority of our population and being determined to live with COVID-19, we have passed that stage of the pandemic where we contact trace every case.

Having said that, agencies that look after more vulnerable sectors, such as schools or preschools, continue to use TraceTogether for contact tracing. Further, the aggregated statistics generated by TraceTogether and SafeEntry can give us a good idea of the settings that are more susceptible to transmission of the COVID-19 virus.

So, on the whole, the costs and benefits of TraceTogether change as we make further progress in living with COVID-19. MTF will, therefore, review its relevance and application to stand it down when it is no longer needed, while maintaining the capability to restart it should we encounter a more dangerous variant of concern.

For SafeEntry and VDS, I will address them together because they are closely related. Today, SafeEntry is the most convenient way to check the vaccination status of an individual entering premises. If we decide to do away with VDS, then there is no need for SafeEntry.

As of now, VDS is still needed. Even as we know that the Omicron variant is less severe than Delta, unvaccinated or non-fully vaccinated persons are still a lot more likely to fall very ill if they are infected. As of now, we have about 3.5% of our adult population that is not fully vaccinated and they account for over one-fifth of cases that require ICU care or die.

While the patient load at our public hospitals has eased, hospitals are still very busy. With the recent easing of SMMs and the resumption of visitors to hospitals starting today, workload will go up for our healthcare workers. The more cautious and correct course of action now is to keep VDS and not to risk having more non-fully vaccinated patients getting infected and needing hospital care and adding workload to our healthcare workers.

Make no mistake. Individuals who choose not to be vaccinated impose a cost, sometimes a significant one, on our hospitals in terms of workload, businesses in operating SafeEntry checks and enforcement agencies in conducting checks. When we are sure that the situation in hospitals is stable and improving, we will review the VDS and consider if we can reduce the number of settings or remove it completely. Then, it will be a matter of individual responsibility of these non-fully vaccinated individuals to take precautions to avoid high transmission settings, or better still, change their mind and get vaccinated.

Finally, Assoc Prof Jamus Lim asked if COVID-19 can be treated like Influenza at some point, as an endemic disease. This is the objective set out by MTF last year and we are making good progress, as a country. I should clarify, however, what “endemicity” means. It does not mean we treat COVID-19 as if it is not there. It is, in fact, the opposite, because endemicity means the disease is constantly there, circulating at a rate that is more predictable and not likely to disrupt normal lives. Like Influenza, which kills tens of thousands of people every year, we will need to continue to take precaution and adopt appropriate SMMs in order to manage the risk and damage from COVID-19.

We are still some way to treating COVID-19 as an endemic disease, because the virus is still circulating around the world and evolving. The virus continues to spread widely in other countries, especially among those whose people are not well vaccinated, leading to significant evolutionary pressure. There is, therefore, still a risk of it mutating into something more dangerous, into a variant of concern.

So, while we have eased up the SMMs and reopened our borders, the pandemic crisis is not over. We will have to continue to monitor the local and global situation, do our part to keep our country safe and continue to work together to tackle whatever challenges that may come our way.

Note(s) to Question No(s) 19-20:

¹ To ask the Minister for Health with regard to COVID-19-positive cases, for the past two months (a) how many cases were detected (i) using TraceTogether and SafeEntry and (ii) through declarations by COVID-19-positive patients; and (b) which method is more effective in detecting COVID-19-positive patients.

Projected Healthcare Spending

14 February 2022

Ms Hazel Poa asked the Minister for Health what is the projected annual healthcare spending for the next decade.

Mr Ong Ye Kung: As stated in my address at MOH’s work plan seminar on 25 May 2021, Singapore’s National Health Expenditure could increase from $22 billion in 2018 to $59 billion in 2030 as our population ages.

Quarantine Procedure

26 July 2021

Ms Hazel Poa asked the Minister for Health (a) what is the current quarantine procedure for foreign domestic workers (FDWs) arriving to work in Singapore; (b) under what circumstances can these FDWs be released early from their Stay-Home Notices (SHNs); and (c) to date, how many FDWs have been released early from their SHNs.

Mr Ong Ye Kung: Today, all travellers, including foreign domestic workers (FDWs) who have a recent travel history to higher-risk countries/regions within the last 21 days prior to departure to Singapore would be subjected to a 14-day isolation at a dedicated Stay-Home Notice (SHN) facility. They are also subjected to a COVID-19 polymerase chain reaction (PCR) test on arrival and on Day 14 of arrival, as well as self-administered Antigen Rapid Test (ART) tests on Days three, seven and 11 of arrival. All travellers must test negative on their Day 14 PCR test to be released from the SHN.

COVID-19 Vaccination Programme

1 February 2021

Ms Hazel Poa asked the Minister for Health whether a vaccination advisory service can be provided to members of the public to seek clarifications about their suitability for COVID-19 vaccination in view of their particular medical conditions such as allergies and past reactions to vaccines.

The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, may I have your permission please to address Question Nos 1 through to 12 on the Order Paper today?

Mr Speaker: Yes, please.

Dr Janil Puthucheary: Thank you, Sir. My answers will also address questions filed by Mr Kwek Hian Chuan Henry1,2 for future Sittings.

Mr Speaker, the safety and well-being of Singaporeans remain our top priorities for the vaccination programme. Only vaccines that meet strict standards of safety, quality and effectiveness will be used for our population.

For our vaccine programme to be successful, education and outreach play a crucial role. Singaporeans need to understand why vaccination is important in the fight against COVID-19 and be confident that the vaccines we are using are safe and effective. We must also communicate clearly when and how they can get vaccinated.

MOH has made available general information and detailed advisories through multiple channels.

The MOH website provides information on the groups currently deemed contraindicated or not, as recommended by the Expert Committee on COVID-19 Vaccination (EC19V), to take the COVID-19 vaccine. For example, pregnant women, children below 16 years of age, or those with a history of anaphylaxis or severe allergies such as eye, mouth or facial swelling, difficulty in breathing and/or a fall in blood pressure, are not recommended at this stage. Persons who are unwell or have had fever in the last 24 hours are also advised to postpone their vaccination until they have recovered.

Members of the public may call the MOH COVID-19 hotline for assistance if they have any medical queries. They may also consult their own regular family doctor. All our medical practitioners have been provided with the detailed clinical definitions of indications and contraindications to vaccination, including, for example, what is considered a history of anaphylaxis or severe allergies, or the definition of “a severely immunocompromised person”. They will be able to advise any individual on vaccine-related queries, including evaluating the specific individual’s suitability for vaccinations.

Every individual will go through a screening process at the vaccination site before being vaccinated. Each person will have to declare their relevant medical conditions based on the vaccination screening form provided. A final check on the individual’s suitability and fitness for vaccination will be assessed by a trained healthcare personnel at our vaccination centres and polyclinics. These personnel will have onsite access to an individual’s salient medical history in the National Electronic Health Records if necessary, before the individual is allowed to be vaccinated.

We have made good progress in our vaccination programme. As of 31 January 2021, yesterday, more than 155,000 individuals have received their first dose of the vaccine.

More vaccination centres will be set up over the next few weeks to ensure that everyone can conveniently receive their vaccinations. The vaccination centres will be located in high population catchment areas as well as along public transport routes for greater accessibility. In total, we are planning to set up around 40 vaccination centres, with each vaccination centre planned for an estimated capacity of about 2,000 vaccinations per day on average.

Besides the vaccination centres, the polyclinics and selected Public Health Preparedness Clinics (PHPCs) will also serve as vaccination sites. Currently, vaccinations are performed at nine polyclinics and around 20 PHPCs. From 1 February 2021, today, all 20 polyclinics across Singapore will also begin offering COVID-19 vaccinations. Our polyclinics and PHPCs are wheelchair accessible. To reach out to seniors with more serious mobility issues we have set up mobile vaccination teams.

We have begun vaccinations for seniors in the community. All seniors will receive personalised letters inviting them to make an appointment for their vaccinations. They will also be able to make appointments online, or they can visit selected Community Centres near them to book an appointment in-person.

Community volunteers from the People’s Association and our Silver Generation Ambassadors will be conducting house visits to answer queries and to help our seniors to book an appointment if necessary. We are very grateful for the support and participation of the community in this important national effort.

The Ministry, the Health Sciences Authority and the Expert Committee on COVID-19 Vaccination, have been monitoring international reports on vaccine-related adverse events and deaths in elderly recipients. The Norwegian health authorities and the World Health Organization’s Global Advisory Committee on Vaccine Safety have found no evidence that the Pfizer-BioNTech vaccine contributes to an increased risk of death in the elderly.

Thus, we continue to offer COVID-19 vaccination for our seniors. It is important, it is vital to vaccinate and protect seniors, as COVID-19 infection in the elderly has been observed to result in severe or fatal illness. Nevertheless, the Ministry has reiterated to vaccination providers that doctors should review the medical history of seniors carefully to confirm that they are indeed suitable for vaccination, and that they should be monitored closely in the immediate period after a vaccination.

As with other vaccines, people who receive the COVID-19 vaccine may experience injection site pain and swelling, fever, headache, fatigue and body aches. These mild symptoms generally resolve within a few days.

Among those who have received the vaccine, there were four reported cases of anaphylaxis, which is the rapid onset of severe allergic reactions. The individuals, in their 20s and 30s, developed multiple symptoms such as rash, breathlessness, lip swelling, throat tightness and giddiness. Three of the individuals had a history of allergies, including allergic rhinitis and food allergy such as to shellfish, but none had a history of anaphylaxis which would have precluded them from receiving the vaccine.

Anaphylaxis can be controlled when detected and treated in a timely manner. As all vaccinated persons in Singapore are closely monitored, the symptoms in these four individuals were promptly detected and treated. All have recovered from the episode. One was under observation for a few hours while the others were discharged from the hospital after a day’s observation or treatment. None needed ICU support.

The incidence rate of anaphylaxis locally is about 2.6 per 100,000 doses administered. The incidence rates reported abroad is around one to two per 100,000 doses administered, after these other countries have administered millions of vaccine doses. Variations in the incidence rate are to be expected initially when the numbers vaccinated in Singapore to-date are relatively small as compared to other countries.

Currently, the benefits of getting vaccinated to protect oneself from the effects of severe COVID-19 disease and its complications, far outweigh the risk of any potential adverse events known to be associated with vaccination. We will continue to closely monitor the safety of the vaccine and ensure the vaccines used in Singapore are safe for our population groups.

We seek everyone’s patience and support, as we progressively roll out the vaccinations to the whole population in tandem with the shipments of the vaccines. We have signed advance purchase agreements with Pfizer-BioNTech, Moderna and Sinovac, and are in discussions with a few other pharmaceutical companies. Due to commercial sensitivities and confidentiality undertakings in our advance purchase agreements, we cannot disclose the specific quantity of the vaccines ordered or the delivery schedules.

While there will be some delay to the shipments of the Pfizer-BioNTech vaccine due to the upgrading of Pfizer’s manufacturing plant, we will continue to monitor our supplies closely to meet our target of vaccinating all Singaporeans and long-term residents in Singapore by the end of 2021.

Given the present, short-term limited supply of COVID-19 vaccines globally, there is a need to prioritise the vaccinations at this point in time. We have prioritised healthcare workers and COVID-19 frontline personnel whose work requires them to be in constant contact with individuals who may be infected. These personnel include swabbers hired by Health Promotion Board, staff working at Government Quarantine Facilities, Community Care Facilities and dedicated Stay-Home Notice facilities. Seniors are at higher risk of severe or fatal illness if infected, and hence they are also given priority for vaccination. We have also vaccinated essential workers, such as those in our security services, and our aviation and maritime workers, who have a higher risk of exposure to infected individuals in the course of their work. We must keep our essential services going.

We completely understand the anxiety of Singaporeans who wish to travel overseas for personal reasons or would like to get vaccinated early. At this point when vaccine supplies are limited, we do need to prioritise our healthcare and frontline workers and seniors, for vaccination. We are therefore unable to provide vaccines at this time to these Singaporeans outside of these groups and seek their understanding. When there is greater certainty in our vaccine supply, we will consider allowing these individuals to receive early vaccination. We will announce further details at that time. Further details on the vaccination roll-out to the rest of Singaporeans and long-term residents will be announced later on.

Note(s) to Question No(s) 1-12:

¹ To ask the Minister for Health whether the Ministry will consider a higher priority for COVID-19 vaccinations to Singaporeans who need to travel overseas for work for a period of time.

² To ask the Minister for Health in light of Norway’s elderly deaths after they received their COVID-19 vaccinations, whether the Ministry will review the COVID-19 vaccination requirement, or delay the vaccination till further data of the vaccine trial is fully available, for seniors who are in advanced age, very frail, or has diminishing mental capacity.

16 February 2021

Ms Hazel Poa asked the Minister for Health to date, what has been the COVID-19 vaccination take-up rate for frontline workers and those who have been offered the vaccination.

Mr Gan Kim Yong: We continue to make good progress in our COVID-19 vaccination programme. Around 73% of healthcare workers working in our public and private sector, primary care, acute hospitals and long term care have been vaccinated with at least the first dose. In addition, about 72% of COVID frontline workers and essential workers in the aviation and maritime sectors, have been vaccinated.

Healthcare workers play a critical role in our fight against COVID-19. The key measure to prevent healthcare workers from being infected with COVID-19 is adherence to strict infection prevention and control protocols, which includes donning and doffing of appropriate personal protective equipment (PPE), observing safe distancing, maintaining good personal hygiene, and adhering to safe workplace management measures at all times. These measures will remain in place even after the healthcare workers have received their vaccinations, to protect themselves, their colleagues and their patients.

In addition, all healthcare workers with acute respiratory illness of any degree of severity, are required to be tested for COVID-19 on first presentation. This ensures infections can be detected early to prevent further spread in healthcare settings.

The vaccine injury financial assistance programme (VIFAP) provides financial assistance to those who experience serious side effects linked to their COVID-19 vaccination administered in Singapore. They can submit a VIFAP application when the application process is opened.

The progress of our vaccination is currently constrained by the availability of vaccine supplies. If vaccine supplies arrive on schedule, we will have enough vaccines for all Singaporeans and long-term residents by the third quarter of this year and will be able to complete the vaccination programme by the end of this year. If we are able to secure more supplies earlier, we can accelerate the progress. However, we expect global supply chains are likely to be disrupted from time to time for various reasons. We have seen delays to our shipments due to disruptions at the manufacturer’s production facility. We continue to monitor closely the situation for any potential vaccine supply disruptions globally. We encourage all Singaporeans and long-term residents to be vaccinated when your turn comes, and to turn up at the vaccination appointments that you have made so that you do not deny another person of the opportunity.

KTPH Lab Test Error

4 January 2021

Ms Hazel Poa asked the Minister for Health what are the reasons for the wrong test results for cancer patients at Khoo Teck Puat Hospital and what measures will be put in place to ensure that such errors do not occur again.

The Senior Minister of State for Health (Dr Koh Poh Koon) (for the Minister for Health): Mr Speaker, Sir, may I have your permission to take Question Nos 17 to 21 together, please?

Mr Speaker: Yes, please.

Dr Koh Poh Koon: Sir, on 19 November 2020, Khoo Teck Puat Hospital (KTPH) was informed by its laboratory that its immunohistochemistry (IHC) tests for Human Epidermal Growth Factor Receptor 2 (HER2) were producing higher-than-expected rates of positive results for breast cancer patients. Preliminary investigations by the laboratory suggested that some of the HER2 results may be inaccurate.

Following the incident, MOH has been working closely with KTPH to ensure that affected patients are provided with adequate support. KTPH has sent the samples of all patients, who have been tested HER2 positive since 2012, when HER2 testing first started in KTPH, to external laboratories for re-testing to determine how many have received inaccurate results. Preliminary investigations by the KTPH laboratory suggest that the inaccurate results could be due to a suboptimal staining process. The KTPH laboratory has since stopped in-house testing of HER2. MOH has also issued an alert to our other public healthcare institutions to conduct a quick review of their laboratory-developed IHC tests to ensure that positivity rates are within the acceptable range. Thus far, we have not received any reports of similar risks from other healthcare institutions.

KTPH’s Department of Laboratory Medicine is subject to regular inspection by MOH as part of regulatory processes under the Private Hospitals and Medical Clinics (PHMC) Act to ensure that its laboratory facilities, systems and processes are in place to meet patient and personnel safety standards. In addition, the laboratory is accredited by the College of American Pathologists (CAP), where the last biennial inspections by peers were conducted in 2019.

As at 23 December 2020, 200 patients have been reclassified from HER2 positive to HER2 negative. Of these, eight patients were treated at private hospitals and 192 patients at Government hospitals. Eight patients are still pending retests. Joint care teams have been formed, comprising KTPH surgeons, histopathologists and the treating oncologists, to review the individual care plans for these affected patients, based on the change in their HER2 status.

KTPH and the treating oncologists are in the process of actively reaching out to these patients to conduct open disclosure and assess these patients for any potential side effects due to unnecessary treatment. The more common side effects include diarrhoea, chills and fatigue – these are usually short-lasting. About 3% to 4% of those who underwent HER2-directed treatment, for example, using Herceptin, may also experience heart problems. KTPH is also reviewing the bills of these affected patients. The portion of the bills which arose from the unnecessary treatment will be fully refunded. KTPH is also ready to provide any clinical and financial support to the affected patients including on-going or follow-on treatments, if any, which may be needed as a result of this over-treatment.

The National Healthcare Group has convened an independent review committee, comprising external experts from multiple relevant disciplines in the healthcare industry. The objective is to conduct a thorough evaluation of the incident, to understand better the lapses that have occurred and recommend appropriate measures to improve the process. This ensures that any system gaps are identified and addressed swiftly to prevent recurrence of similar incidents.

The committee’s investigations are on-going right now and more time would be required to ensure a thorough review. NHG will provide an update when more information is available and these findings will be shared with the other healthcare institutions for improvement.

Ms Hazel Poa (Non-Constituency Member): I thank the Senior Minister of State for his reply. I have a few supplementary questions.

Firstly, while these errors were actually discovered in a review process, since the error actually started in 2012, why did it take so long to discover the errors? Is it a standard timeframe for enough statistics to flag up a possible error? Secondly, would the Ministry consider a second independent test for serious illnesses? The last supplementary question is about compensation to the victims. What sort of compensation is being considered and is a lifetime of free healthcare on the cards?

Dr Koh Poh Koon: Sir, let me clarify the Member’s misconception. When I said in my reply that KTPH is reviewing all the results from 2012, 2012 was taken at a point in which the test first started in KTPH. It does not mean that all the results going back to 2012 are erroneous. So, in that sense, KTPH is being prudent and careful, super kiasu, going back all the way to when the test first started. It may well be that the errors could have occurred in the last three months or six months.

I think the key point usually is when the reagent has been changed. A different brand of reagent or a different provider of the reagent could usually be the starting point of why the protocol or the test conditions were no longer as optimal as they should be.

But going back to 2012 when the test first started was really trying to be comprehensive and to be careful, to make sure that we do not miss anybody in the process. It does not mean that the test was erroneous from 2012. The results of the review are still on-going, so I do not want to prejudge the review process from the experts. Let us wait for the experts to look at all the results going back to 2012 and then decide at which point, what step of the process that could have been where the error occurred.

When it comes to the question of whether you are going to get compensation, as I said earlier, any treatment cost due to the treatment arising from a positive HER2 results, in other words, usually treatment with Herceptin as the drug, the cost of the drug likely would be refunded. Any investigation or tests or treatment of any related complications as a result of, say, Herceptin, would also be refunded as well. But to then say that this translates to a lifetime of compensation, I think that would be a little bit too far a thing to stretch because most of the complications, if any, or most of the side effects relating to the treatment, are transient diarrhoea, a bit of fever, a bit of chills. They do not have long-term consequences, they are not long-lasting and we have to take that in the correct context of medical treatment.

I hope that answers the Member’s questions.

Ms Hazel Poa: I also had a question about a second independent test for serious illnesses.

Dr Koh Poh Koon: I take that as a general question which in any form of medical diagnostics, if the clinician is unsure that a particular test alone cannot give you a high degree of probability of predicting a positive diagnosis or presence of an illness, then it behoves clinical judgement to call for a second test. But immunohistochemistry is a specific unique test. It does not necessarily mean that an alternative is available. Although in the literature, there are other alternative tests that could be done but we have to consider that against the time needed to do it because that could delay treatment, and also whether that brings on unnecessary costs.

That, I think, we should leave it to the experts to come up with the process guidelines on what is a testing algorithm to decide for Herceptin-related treatment.

Medisave Balance Upon Death

2 November 2020

Ms Hazel Poa asked the Minister for Health in respect of CPF members above the age of 55 who have passed away in 2019 (a) what is their remaining MediSave balance (i) in total and (ii) in average amount per CPF member; and (b) where do these savings go to subsequently.

Mr Gan Kim Yong: MediSave helps Singaporeans set aside part of their income over their working years to save up for healthcare expenses in old age, when their healthcare needs are typically higher. Singaporeans aged 55 and above who passed away in 2019 had remaining MediSave balances of about $300 million in total. About half of them had $10,300 or less in their MediSave accounts. These include younger members who passed away before they had drawn down their savings significantly. The remaining MediSave balance on demise is lower at older age groups, for example, for those who passed away at age 85 or older, about half had a balance of $6,300 or less.

For those who have passed away, their CPF savings, including MediSave balances, will be distributed to their beneficiaries in cash according to their CPF nomination or through the Public Trustee’s Office if no CPF nominations were made.