During the Parliament sitting on Monday, Singapore's Minister for Health, Gan Kim Yong was quizzed by various MPs about COVID-19 vaccinations, since the first batch of the Pfizer-BioNTech vaccines was received on 21 December 2020.
In two written responses to the Parliamentary questions, Singapore's Minister for Health, Gan Kim Yong gave an update of the progress of the vaccination programme, vaccinations for seniors, adverse effects of the vaccine, vaccine supply, as well as whether those who require to travel for work or studies will be able to gain priority access to the vaccines.
In the first written statement, Gan emphasised that the safety and wellbeing of Singaporeans remain the Government's top priorities for the vaccination programme.
"Only vaccines that meet strict standards of safety, quality and effectiveness will be used for our population," he said.
He noted that for the 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 are safe and effective. Communication also has to be clear on when and how individuals can get vaccinated.
Gan said: "The Ministry of Health (MOH) has made available general information as well as 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 instance, those not recommended for the vaccine at this stage include:
- Pregnant women.
- Children below 16 years of age.
- 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.
Additionally, individuals who are unwell or have had fever in the last 24 hours are also advised to postpone their vaccination until they have recovered.
Before being vaccinated, every individual will go through a screening process at the vaccination site. This comprises a declaration of any relevant medical conditions based on the vaccination screening form provided. A final check will also be done by a trained healthcare personnel to assess the individual’s suitability and fitness for vaccination. The healthcare personnel will have on-site access to an individual’s salient medical history in the National Electronic Health Records, if necessary, before the individual is allowed to be vaccinated.
Progress of the vaccination programme
As of 31 January 2021, more than 155,000 individuals have received their first dose of the vaccine, Gan revealed.
Over the next few weeks, the Government plans to set up more vaccination centres 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," he shared.
On top of those centres, the polyclinics and selected Public Health Preparedness Clinics (PHPCs) will also serve as vaccination sites.
Currently, vaccinations are performed at 9 polyclinics and around 20 PHPCs. From 1 February 2021, all 20 polyclinics across Singapore will also begin offering COVID-19 vaccinations.
"Our polyclinics and PHPCs are wheelchair accessible," Gan noted, adding that to reach out to seniors with more serious mobility issues the MOH has set up mobile vaccination teams.
Vaccinations for seniors
Vaccination for seniors in the community has started, with all seniors to receive personalised letters inviting them to make an appointment for their vaccinations online or in-person at selected Community Centres.
Community volunteers from the People’s Association and our Silver Generation Ambassadors will also be conducting house visits to answer queries and help seniors to book an appointment if necessary.
"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 Organisation’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," Gan said.
However, he noted that 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.
Adverse events post-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 in the first place.
Thankfully, 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."
Currently, the incidence rate of anaphylaxis locally is about 2.6 per 100,000 doses administered. Overseas, incidence rates reported is around 1 to 2 per 100,000 doses administered, after millions of vaccine doses have been administered.
"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," Gan said.
He added that 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."
Singapore has signed advance purchase agreements with Pfizer-BioNTech, Moderna and Sinovac, and the Government is in discussions with a few other pharmaceutical companies.
However, due to commercial sensitivities and confidentiality undertakings in these agreements, the specific quantity of the vaccines ordered or the delivery schedules cannot be disclosed.
"While there will be some delays to the shipments of the Pfizer-BioNTech vaccines 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," Gan said.
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.
Hence, priority is given to the following groups due to the nature of their work or risk of fatal illness if infected:
- Healthcare workers.
- 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.
- Essential workers, such as those in security services, and aviation and maritime workers, who have a higher risk of exposure to infected individuals in the course of their work.
In the second written statement, Gan noted that while the Government understands that some Singaporeans wish to travel overseas for personal reasons and are anxious to get vaccinated early, at this point when vaccine supplies are limited, the priority for vaccination needs to be given to healthcare and frontline workers, and seniors.
"We are therefore unable to provide vaccines at this time to these Singaporeans and seek their understanding. When there is greater certainty in our vaccine supply, we will consider allowing individuals to receive early vaccination. We will announce further details when available," he said.
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