Progress of nation-wide COVID-19 vaccination programme

Hazel Asks the Health Minister

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.

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.

Source : Oral Answers to Questions