Janil Puthucheary
Singapore
“Sir, I thank Ms Lee for her two supplementary questions, which address what are our targets and what is it that we measure. Indeed, the issue of how we should think about recycling and waste disposal will be at the heart of our review of our Zero Waste Masterplan.”
“Another strategy that we are embarking on is the strengthening of the reuse of waste residue and treated toxic industrial waste before and after they are landfilled.”
“Sir, about half of our recycling material is exported. It is processed overseas. There are business arrangements between businesses here in Singapore and businesses in the region or overseas, to be able to handle the recycling of waste and recycling of material, whether domestic or non-domestic, already today.”
“Sir, I thank Ms Poh for her questions. Indeed, we do have to shift behaviours. The incentives and disincentives around recycling and waste disposal are an important part of it. We will consider her suggestion on looking at the fees.”
“The heat advisory that goes out is clearly defined. In my original answer, I explained what a heat wave was. There are clear definitions that we have been using in Singapore since 2016, if I recall. It was then last revised in 2023.”
“Sir, in the planning of schools, the Ministry of Education ensures that our students can access a primary school near their homes. Except for a small number, 15 of Special Assistance Plan schools, all primary schools offer the three official mother tongue languages.”
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“We are continuing to bring in more vaccine supplies, and we encourage all eligible Singaporeans to take up the vaccines to protect themselves and others around them.”
“Mr Speaker, Phase Three is a new normal which will last until the time when there is evidence on vaccine effectiveness in preventing future outbreaks, and a substantial proportion of the population is vaccinated and the rest of the world also has the virus under control. Since we entered Phase Three of our reopening on 28 December 2020, we have seen increased COVID-19 outbreaks in many countries around the world and the emergence of more transmissible viral variants. Several weeks ago, we also faced an increase in unlinked cases and community cases in Singapore. Hence, even within Phase Three, we had tightened community safe management measures and recalibrated the pace and scale at which activities were able to resume. While the outbreaks in several countries have abated in recent weeks, we need to remain vigilant. We will continue to find ways to allow our economy and our society to further reopen in a safe way. But given the dynamic situation here and around the world, we will need to adjust our safe management measures from time to time. We do not expect to move out of Phase Three any time soon. The vaccines approved in Singapore have been shown to be effective in providing protection against the COVID-19 virus. We are still awaiting more evidence about how effective they will be about preventing transmission. We are also closely monitoring their effectiveness against new viral variants. Meanwhile, our best strategy is to continue to be disciplined about safe management measures and achieve a high level of vaccination within our population to boost our collective immunity. Singapore has made good progress on our vaccination programme.”
“Mr Speaker, I thank the Member for the question. Certainly, the affected staff member will have healthcare and will be followed up quite closely. But, I would like to reassure that there were no adverse effects, no side effects that were detected, despite what is obviously an error. The nature of adverse effects and side effects from vaccines is that they are present within hours to days usually, after a vaccination. We are quite assured by the health and comfort, and the status of the staff member affected. But we will continue to pay close attention and stay in close touch with the staff.”
“Sir, I would like to thank the Member for the question. The vaccination centres, the places where vaccination for COVID-19 is being done, vary quite significantly, both in terms of the locale and the size, the nature of the space. And so, the matters to be audited are going to be different. But some of the fundamentals with respect to skill sets, the equipment, the fundamental processes and most especially, the safety of the patient are not going to change. So, the frequency and the specifics of the audits will very much depend on which sites we are talking about, what were the previous findings the last time we engaged with them and what we believe are the areas of risks. But we are paying very close attention to all of these and the personnel at the sites, have very clearly at the top of their mind, the safety of the process. And I am reassured by this when I go and visit them, and I have visited a number of them, the attention to detail is quite significant; they are making sure that they want to keep the process as safe as possible for Singaporeans. So, the nature of the audits, the details that the Member is asking, will vary quite significantly, so I do not have a clean or clear answer. But, indeed, all the sites will be engaged in that process with MOH and our vaccine operations group.”
“Mr Speaker, I thank Mr Giam for the questions. If members of staff at the vaccination sites are over-worked or over-stretched, they are not alone. There are staff members who are not assigned to a given station, who are available to relieve them in place and there are other staff members who are supernumerary to a given station, with a specific role of roving around and watching for incidents or the need to step in and assist. There is also a professional domain supervising process that exists, whether you are non-clinical staff or clinical staff, whether you are nursing or medical. These are part of the practice of clinical medicine. These standard operating procedures, these are practices extended into all the vaccination sites to deliver these crisis vaccination operations. When it comes to the issue of autonomy and job control, in delivering these COVID-19 vaccinations as a national exercise to deal with the crisis of a pandemic, we have sub-divided the various steps into very specific tasks so that we can ensure safety, supervise the process as well as administer the vaccines to as much of our population as are going to take it up. So, there is not a lot of opportunity for autonomy and flexibility in terms of job roles, job re-creation or job re-design. If Mr Giam is interested in these processes outside of the COVID-19 vaccination operations which is what he filed the question for, I would be happy to have a larger discussion on this matter.”
“To ensure that such lapses do not occur again, we have instructed vaccination providers to adhere strictly to the protocols. All vaccination providers must also undergo training to familiarise themselves with these guidelines, protocols and operational workflow prior to the commencement of their vaccination operations. MOH also conducts audits periodically to ensure that safety standards are adhered to. To ensure that each staff member in the vaccination process is assigned a manageable workload, there are specific stations within the vaccination sites for registration, screening, vaccination and monitoring. There are clearly defined roles undertaken by staff across the stations. Staff should leave their positions only once their immediate task has been completed. Should there be a need to step away, there must be proper documentation and handing over of roles and duties to other staff members. The public healthcare institutions (PHIs) have planned rostered breaks and staff rotations so that staff have sufficient rest during and between their shifts. The PHIs will also continue to train and hire more healthcare professionals, so that there will be adequate staffing to cater for these work-rest cycles and meet service demands. I would like to reassure Members of this House that MOH continues to place the utmost importance on the safety of our staff and patients in the vaccination process.”
“Sir, during the COVID-19 vaccination exercise for staff at the Singapore National Eye Centre (SNEC) on 14 January 2021, a member of staff was given five doses of the Pfizer-BioNTech COVID-19 vaccine in one injection. The error was discovered within minutes. SNEC and the Ministry of Health (MOH) have followed up closely with the affected staff member, who remains well with no adverse reaction nor any side effects. MOH and SNEC have identified that the error was due to a lapse in communication among the vaccination team. They had been preparing and administering the vaccinations at that time. The staff in charge of diluting the vaccine had been called away to attend to other matters during the preparation of the vaccine before the dilution of the doses in that particular vial had been carried out. A second staff member had mistaken the undiluted doses in that vial to be ready for administration. Following this incident, as a safety measure, the vaccination exercise at SNEC was immediately stopped. Subsequent vaccinations for staff members were continued at the Singapore General Hospital. SNEC is not involved in Singapore’s vaccination exercises for any other groups. Medical protocols are in place at all COVID-19 vaccination sites to ensure the safety of vaccinated individuals and to provide guidance on the management of the vaccination process. Clear, written instructions on the preparation and administration of the vaccine are used. There is a designated and segregated area for the preparation and administration of the vaccines. There must be clear labelling to differentiate diluted and undiluted vaccine vials. These instructions are disseminated to and used as training materials for the staff involved in the vaccination process.”
“Mr Speaker, may I have your permission to take Question Nos 3, 4 and 5 together, please?”
“Similarly, the Institute of Mental Health (IMH) operates a 24-hour Mental Health Helpline to assess and triage cases, and activate home visit teams if necessary. For cases of attempted suicide, the Police may engage the next-of-kin to link them up with support services or refer the individual to IMH for assessment and treatment. Sir, these services continued to operate throughout the pandemic, including during the circuit breaker period, to ensure that seniors at risk of social isolation remain supported. Befriending engagements were conducted remotely where feasible in place of physical home visits. SGO also engaged about 21,000 seniors who have little or no social support during the circuit breaker period through weekly or fortnightly calls to monitor their well-being. Community mental health services also remained accessible with safe management measures in place for persons, including seniors, with mental health needs. The Government also set up the National CARE Hotline to offer an additional avenue of emotional and psychological support to public who are facing distress due to the pandemic. I wish to just record my thanks to the officers and volunteers of all of these services, whether formal agency-driven services or those from voluntary organisations, who reached out to all these persons in need during the difficult times through the circuit breaker and the subsequent pandemic. We will continue to improve our inter-agency and multi-pronged efforts to support seniors in the community, especially those at-risk of suicide. 2.28 pm”
“For example, staff and volunteers from the Silver Generation Office (SGO), local grassroots organisations, social service agencies and senior activity centres proactively and regularly reach out to seniors living alone or who are at risk of social isolation, to provide companionship and encourage them to participate in social activities. From May 2021, we will be rolling out a new eldercare centre service model. Under this new model, eldercare centres will serve as key touchpoints to all seniors, regardless of their housing type, income or frailty levels, and will reach out to seniors to proactively engage them. Seniors can also sign up with CareLine, which is a 24/7 social support hotline that provides tele-befriending services as well as emergency response to seniors in distress. Third, we also have targeted support for seniors who may be at higher risk of suicide and their family. Under the Community Resource, Engagement and Support Teams (CREST) programme, Community Outreach Teams reach out to at-risk elderly and their care-givers to provide basic social-emotional support and education on coping with mental health needs, and link them and their care-givers to community resources for further support. Family Service Centres also provide case management and counselling support to low-income and vulnerable individuals and families, including seniors, to help them with issues such as family, financial and emotional difficulties. Fourthly and lastly, there are services in place to support crisis intervention. For instance, the Samaritans of Singapore (SOS) operates a 24-hour hotline to counsel persons in distress.”
“Sir, there were 400 reported cases of suicide in 2019, of which 122 cases involved persons 60 years and above. The number of attempted suicide cases was about 1,000 in 2019. We do not have the breakdown of number of suicides or attempted suicides by those who live alone or have depression. We also do not have the breakdown of attempted suicides by age. The number of Singapore residents aged 65 years and above who live alone has increased from 47,000 in 2016 to 67,600 in 2019, representing 9.7% and 11.6% of our resident population aged 65 years and above respectively. The causes of suicide are complex and multi-faceted, often involving family, social and mental health issues. Therefore, the Government works closely with MSF and community partners on multi-pronged approaches, comprising promoting mental health and well-being, raising awareness on suicide prevention, and providing professional support and crisis interventions to at-risk groups, including targeted support for older adults. First, in upstream intervention, we seek to build public awareness on the importance of good mental well-being. For example, the Health Promotion Board (HPB) conducts training sessions on mental well-being and change management for the general population, to help them recognise the signs and symptoms of poor mental health. Under the Seniors’ Health Curriculum programme, HPB also conducts a series of healthy ageing workshops, which include psychosocial education modules, to equip seniors with knowledge and skills to self-care and manage mental well-being, including when and where to seek help if necessary. Second, we have services and programmes to provide support to older adults with social and emotional needs.”
“Mr Speaker, may I have your permission to take Question Nos 19, 20 and 21 together, please?”
“I thank the Member for the question. If there is indeed a case of COVID-19 at the WEF Special Annual Meeting, the prevailing measures that we have for a COVID-19 case at any of the events that we are organising, will be in place. All the various measures as well as the regulations around contact tracing, isolation and subsequent follow-up will be followed. The protocols are being put in place and are being operationalised already, because we are already hosting and organising events. This will be at a larger scale and it will involve a wider group of delegates and attendees but the fundamentals of our approach will be the same.”
“Mr Speaker, MOH is working with various Government agencies and the World Economic Forum to put in place the necessary public health and safe management measures to ensure that the WEF Special Annual Meeting in Singapore can be conducted safely. To actively detect any cases of COVID-19, we will implement rigorous testing arrangements for local and foreign event attendees, in lieu of them serving Stay-Home Notices. We will also implement safe management measures such as mask-wearing, safe distancing and mandating the use of TraceTogether technology to minimise the risk of transmission and to facilitate the identification of close contacts for isolation. In addition, a physical segregation of event attendees from the local community will reduce the risk of infections spreading from event attendees to the local community at large, and vice versa. Over the next few months leading up to the Special Annual Meeting, MOH will continue to assess the COVID-19 situation locally and globally, and adjust the public health measures for the event as necessary. We will work with the Forum to clearly communicate these measures to attendees so that the event can proceed safely.”
“Mr Speaker, I thank Ms Sylvia Lim for the question. We certainly have the capacity and the capability to vaccinate our population by the third quarter of this year. There is some uncertainty in terms of the take-up rate. So, if, for example, there are members of the public who will need further explanation and who will need persuading that this is the right thing and the safe thing to do, or if there are members of the public who require further medical screening, this process will take some time. Over the next few months, we can also anticipate that further information will be available from the vaccination process that is happening around the world. So, there is a band that we are aiming for somewhere between the end of the third quarter and the end of the year. Ultimately, the outcome will be determined by a combination of our supply as well as the willingness and the engagement of Singaporeans and long-term residents to go forward to have the vaccination. Our ability to deliver on this is present and will be present. But we hope that the communication, outreach and engagement necessary in order to make this happen is something that Members of this House will assist with.”
“Mr Speaker, I thank Mr Sharael Taha for the question. Certainly. We will make available information through our MFA colleagues and their Missions overseas as to how Singaporeans overseas can receive help. But in terms of Singaporeans overseas wanting to have vaccinations and if they plan to return to Singapore to have those vaccinations, I would point out that the total duration required for the vaccination process is not short. With the Pfizer-BioNTech vaccine, you need about 21 or 25 days between the two doses, and immunity is only achieved about two weeks after the second dose. So, Singaporeans overseas who are planning to return to Singapore in order to have their vaccination need to plan for that length of time, if they have a view that they need to be likely immune before they return back to where they are residing.”
“Mr Speaker, I thank Ms Pereira for the question. Indeed, the Member is absolutely right that when a member of the public attends a vaccination centre or the polyclinic, the PHPCs, the screening process includes a healthcare professional going through your medical history as well as the medication that you have received and, if that member of the public has any queries or uncertainties, please let us know and the staff will have access to the information through the National Electronic Health Records and will be able to pull up what they need to. Ultimately, if they are still not sure and there is a need to cancel the vaccination at all, you merely can defer the appointment until perhaps a fuller consultation with a healthcare professional who understands the situation of that senior and can make a recommendation. But, in general, the information is available and we will be able to help assure that member of the public as to whether or not they can go forward with the vaccination. But to answer the Member's specific point, to make that absolutely clear in the communication upfront that the people who are administering the vaccination will have access to these critical pieces of information is a very useful suggestion and I thank the Member for that.”
“Mr Speaker, I thank Mr Pritam Singh for his questions. I do not have an update on the certification of the Moderna and Sinovac vaccinations. That will be a process for the professional teams to study the data and make sure that our licensure process is applied with its usual rigour for all therapeutic interventions. Our plans have not changed. Our plans will, of course, be contingent upon the supply of vaccines and the questions from the Members indicate that their understanding and concern about how the supply of vaccines will affect our plans. Currently, our plans have not changed and we anticipate our programme to proceed as previously discussed.”
“Mr Speaker, I thank the Member for his questions. It is something to be considered. We will be opening up the registration process and we will be looking for an indication of interest from members of the public who are eligible in this phase as well as in the future.”
“But, in short, consult the doctor and get some specific advice on your individual case.”
“Mr Speaker, I thank Mr Alex Yam for the questions. There are no plans to change our targets for vaccination roll-out. Again, I cannot discuss the specifics around our arrangements in terms of purchases and supply volumes to the reschedules. But our plans remain unchanged. For vaccine production locally, indeed, it is something that I am sure will be explored. But ultimately, it comes down to the licensure of a specific vaccine that is demonstrated to be safe and effective for our population. For nursing mothers, the short answer is they should consult their health practitioner, the family doctor or one of the hotlines of our service provider to get specific advice about their case as to whether or not they should proceed with the vaccine, delay the vaccine, delay breastfeeding, have the vaccine immediately. It depends on the specific individual case of the mother. But if I could sum up the position and explain some of the reasons for the confusion, there is no absolute contraindication for a breastfeeding mother to proceed with vaccination. It is simply that we do not have enough information at this point to be so clear that they should do it without ceasing breastfeeding for five to seven days. Ceasing breastfeeding for five to seven days is the general advice that we would give for medications because that is the length of time that it exists in breast milk and thereafter it is safe. One way to look at it is if the mother has to weigh up the risks to her and her child should she come down with COVID-19 infections. Hence, on balance, it is probably better for her to get the vaccination, protect herself, her child and her family. But an option is then to delay the vaccination until breastfeeding has ceased. That is also a viable way for these mothers to proceed.”
“Mr Speaker, I thank Mr Murali Pillai for the suggestion and we will look at it. It is a good idea. I would just suggest that it is not too different from the current duties and responsibilities for donees and deputies with respect to the medical care for the people under their guardianship. So, there is not going to be a lot of difference from that. But the specific information as to how they would exercise those duties and responsibilities, indeed, we should make very clear and we should do so.”
“Mr Speaker, I thank Mr Darryl David for his suggestions. This has begun. MOH, together with all the different Government agencies involved are coordinating a whole-of-Government communications approach. MCI is supporting this as well. We will produce material in a variety of languages, we will produce material for different levels of interests – the top line messages all the way down to the detailed advisories for the healthcare practitioners. And we will distribute this across a variety of channels – letters, online, mainstream media, broadcast media. We would ask for Members of this House to also assist us participating in this communication, to make sure that we do reach every Singaporean, every resident, explain to them the essential nature of this vaccine operation. This is to protect them, their loved ones, the community, their family and the whole country. Every single vaccination that we are able to get done, will break a chain of transmission and slow down the spread of COVID-19. Explain to them that this is a medical process and medical processes will have risks. Hence, we have put in place a very stringent, controlled environment and a series of control processes to minimise that risk and monitor them and help them thereafter. Explain to them that the vaccination is safe, the technology that has been developed, the specific vaccines that have been licensed are well researched and we have many millions of data points to assure ourselves of the safety and effectiveness of these vaccines.”
“Mr Speaker, the factor that is taken into account as to whether a vaccine is licensed for us here in Singapore, is quite simply that they have strict standards of safety, quality and effectiveness. And that is the process through which the licence is evaluated for the vaccine and how we manage the process going forward. I am afraid we cannot talk too much about the agreements that we have with the various companies because of the confidentiality of those undertakings.”
“That is, hence, why we are monitoring them for 30 minutes and perhaps we are monitoring them for longer than necessary at 30 minutes. Nevertheless, the use of a single online process as well as the network that we have talked about – I mentioned earlier in my reply about how we are administering the vaccination process as well as administering the vaccination doses – means that there is a certain set number of places where information can flow into. And members of the public should approach either the place where they had their vaccinations, call the hotline where they made the booking, turn up to any one of our medical service providers, and the information around that adverse event will flow through to a single interface and we will have sight of that across our nation so that we track the adverse events very, very closely. But as I explained in the earlier reply, our adverse events are well within the expected rate.”
“Mr Speaker, I thank Dr Lim for his questions. Our wastage rates are low. I do not have the specific number at this point in time, but in general, a vial is supplied to have around five doses. Because of the way the manufacturer does this, usually there is a bit more inside the vial. And I can tell you on average we are getting more than five doses per vial because of the way in which we have centrally controlled the thawing distribution as well as the training for the people who do the vaccinations. So, our wastage rates are low and well-managed. I do not have a specific number at this point in time that I can share with Dr Lim. For the early vaccinations, indeed, we have set up a national appointment booking system and we have a single online portal. So, at the appropriate juncture, we would encourage members of the public who are interested to receive the vaccine – whether it is an early vaccination or as part of your schedule – to register their phone number, register their details on the portal; we will get in touch with you as soon as possible. The suggestion about early vaccinations for grassroots leaders and other volunteers going out to convince seniors or to help seniors make the appointment, is well taken. It may not be possible to ensure that everybody has a vaccination at that point in time, but perhaps we can go at least to the point of ensuring they have a booking and then when you are facing the senior, you can say, "Well, I have not got it yet, but here is my appointment and I know that I am going to get it because I have committed to doing so." For the adverse event reporting, I would point out that almost all adverse events documented from vaccinations, tend to have an onset very close to the administration of the vaccination.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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”.”
“Mr Speaker, may I have your permission please to address Question Nos 1 through to 12 on the Order Paper today?”
“Mr Speaker, I thank the Member for his questions. I think we have to take the view that GPs and their clinics have to do the broad base of primary care in terms of access. And then, when it comes to certain domains, people have to leverage on the strengths and skills sets that are available in that team. And so, we have GPs that go on to take special trainings so that they can provide mental healthcare services. Some will focus on dermatology; some will focus on children care services or maternal care services. I think the key issue is to ensure that there is access for anybody who needs care for mental health condition. And they have a choice, in terms of going to the polyclinic or going to a private GP and that they then have a network of support services from the community care teams, the allied healthcare teams and the referral services in the hospitals, and that these can be accessed either by the polyclinic route or by the private GP. That is the intent to which we work towards. I think to insist that this be compulsory across every single clinic perhaps is not in the right spirit of how care should be delivered. You make sure that the broad base of access is there and for certain specialised domains, you improve understanding, you improve access and the teams should then make referral to GPs, polyclinics and centres where they have the full suite of services to be able to care for people with these conditions.”
“In addition, persons with mental health conditions can also tap on other avenues of support available in the community, such as the community outreach teams, which provide basic emotional and psycho-social support and service linkage for persons with mental health issues. To date, we have a network of 43 community outreach teams across Singapore. MOH will continue to work with polyclinics, GPs and community mental health partners to build up our mental health services in the community, so that holistic and timely support is provided for persons with mental health conditions.”
“Mr Speaker, strengthening mental health services in primary care has been one of the key focus areas under the Community Mental Health Masterplan. This is to ensure that persons with mental health conditions can access care closer to home and in a less stigmatising environment. Over the years, we have worked with the polyclinic clusters to set up mental health services in polyclinics and gradually build up the capabilities of our primary care doctors to manage persons with mild to moderate mental health conditions. Persons with mental health concerns can walk in to polyclinics and they will be attended to by polyclinics doctors who will conduct preliminary assessment and provide appropriate management, including making a referral to the mental health services, where necessary. Other than seeking help at the polyclinic, persons with mental health conditions can also seek care for mental health at nearby General Practitioner or GP clinics. Under the Mental Health General Practitioner Partnership Programme or MHGPP, we have trained over 220 GPs to identify, diagnose and manage persons with mental health issues in the community. These GPs are further supported by community intervention teams which provide allied-health services, such as needs assessment, psycho-social therapeutic intervention, counselling and psycho-education for persons with mental health conditions. Community Health Assist Scheme or CHAS subsidies are available for persons seeking mental healthcare with our MHGPP partners, who are also CHAS GP clinics.”
“But public education is key and we encourage Mr Giam and Members of this House to join us in explaining to Singaporeans the benefits of joining the TraceTogether programme.”
“Mr Speaker, I thank Mr Giam for his questions. On the issue of the distribution of tokens in the schools, we will work with MOE and see what is feasible or necessary. I would point out that in the collection at the CCs, parents or family members are already collecting for their children – so that process is happening. There are schools from my time at MOE that do allow smartphones to be carried by the children in the schools as long as they use them responsibly. So, I think there is no one-size-fits-all. We may have to look at the best possible options. I think our focus at the moment is making sure that we have an equitable distribution plan across Singapore, to address the concerns such as articulated by Mr Lim, that we have to do so in order to then allow the implementation of these TraceTogether-only SafeEntry areas to deal with high risk activities as part of that progress. I agree with him that further public education is needed and so we have to make sure that we reduce misinformation or disinformation about what the TraceTogether app is and does and what the programme is for. Indeed, there have been issues with battery drainage, partly because we are unable to standardise the smartphone or the operating system of the user, so we will have to engineer this process for a wide variety of phones that are out there. So, the team is continually iterating and improving the app and as a result, we have seen a significant improvement in performance since the app was first launched some time ago. For those residents who have had some difficulty, please keep your app updated to the latest version and hopefully you will see an improvement in battery performance.”
“I thank Ms Nadia for the question. Simply, there is a hotline and a helpline for the TraceTogether programme as a whole, there is an email address, there is a phone number and residents can contact that to let us know. If the TraceTogether token is stolen, nobody will have access to your NRIC. The NRIC is not stored on the token itself. The token has a unique identifier and any link to the NRIC is held securely in the service of the databases at the point of registration. And so, the person who has taken it from you will have no access to the personal data that is inside. So, the key issue then, is to notify us and we can re-issue and re-enrol the resident into the TraceTogether programme.”
“Yes. So, we will wait until after token distribution is completed before making it compulsory. We will make it available, but we will also have other modalities of SafeEntry check-in until distribution is completed.”
“In the mean time, residents with damaged tokens or tokens with depleted batteries can go to CCs where tokens are being distributed to exchange it for another. As we do so, we are beneficiaries of the partnership that we have with the People's Association, the CCs, but also the Agency of Integrated Care and the Silver Generation Office that has helped us then directly distribute tokens – I think more than 10,000 tokens have been directly distributed to seniors who have not been able to come down to the Community Centres. We will leverage on those types of processes and those types of partnerships to make sure this capability then continues to be available for Singaporeans in the future.”
“Mr Speaker, I thank Mr Lim Biow Chuan for the questions. We will make sure that the roll-out plan with distribution to the various CCs has happened before the TraceTogether-only SafeEntry programme is made compulsory. But once we have given everybody a chance to collect the token, once we have given everybody a chance to download the app, then for these higher risk activities, these higher risk venues, we need a way to make sure that we can open up and have these activities and yet protect the progress that we have made in the COVID-19 pandemic fight. And in order to have these higher risk activities, entry into those activities will require that the participant uses both SafeEntry and TraceTogether, the two limbs of our digital augmented contact tracing process. The way in which we do that, is we bring both processes together, using either the app or the token. Until the distribution is completed, other means of doing SafeEntry, such as using your NRIC will be available at these venues. We will have a clear plan for replacement of damaged tokens or changing out the batteries for those batteries that are exhausted. We are going to have to calibrate that over time. At the moment, as I said earlier on, we had an unexpected surge in demand, so we are focusing our efforts on that. In the next few months, we will have to think of a replacement plan for one million tokens or two million tokens or whatever the number is in between. So, I think after we get close to the end of our distribution process and we have a sense of what it is we have to manage over time, on a rolling basis, then we will come out and make it very clear how residents can exchange their tokens, replace their tokens, where and what the process will be.”
“So, we wanted to be prudent in terms of the production and we launched the process early even as production was ramping up. And so, the lesson learnt was at that time, we did not expect the surge in demand that had occurred. Now that we understand that that is so, we have ramped up production. We have monitored the situation, we will adjust our supply accordingly and we will increase the supply to keep up with demand as needed. We had also planned for residents to pick up tokens from the CCs near them and we had not anticipated the extent to which people from all around Singapore would go to a various venues in order to collect the TraceTogether token. Hence, we have altered our distribution plan so that CCs are distributing tokens only to residents of that area. But I would like to repeat the earlier point that we will only implement TraceTogether only SafeEntry process at venues when everyone who cannot download the app has had a chance to collect a TraceTogether token. I also want to reiterate that if you have the TraceTogether app on your phone, you do not need a token, although you are free to collect one. We have discontinued distribution at mobile booths at the malls given my earlier comments, to avoid the queues and to avoid encouraging Singapore to travel all over to get these TraceTogether tokens. Dr Tan would perhaps like to know that residents of Clementi will be able to pick up their TraceTogether tokens at Clementi CC from 16 November onwards.”
“Mr Speaker, I thank Dr Tan Wu Meng for his questions. We had designated the Community Centres as the main collection point for residents to collect their tokens. But on an opportunistic basis, early in this process, we had planned to set up mobile booths at selected shopping malls around Singapore for a variety of reasons: one, to make it more convenient; and the other is to also raise awareness and participation. Our assumptions at that time were that the people, who these tokens were designed for – people who perhaps did not have a smart phone or who were reluctant to use a smart phone – were not so aware of the programme and, perhaps, needed some degree of persuasion to join the programme. Hence, we had this plan to set up these pop-up booths in malls such as Clementi Mall. We distributed 762 tokens at Clementi Mall on 25 October. The original plan was for the booth and all the booths to open for about four hours – 11 am to 3 pm. But indeed, the demand was very high. And so, we started distributing tokens early, at 10.30 am that morning, and extended the distribution all the way to 3.30 pm to allow the clearance of the queue of people who had come to collect their tokens. Dr Tan asked about the lessons learnt. Firstly, we had not projected such high demand. We had anticipated that there would be a need to persuade more people to come and get on board the TraceTogether programme. Actually, we are very heartened by the response. It shows that residents understand the value of this digitally augmented contact tracing in keeping us all safe, they are convinced and understand all the various protections we have put in place and the intent behind this programme. The concern at that time was whether or not there will be enough demand.”
“People know that we have a robust protection regime as he has repeatedly said, that is, our citizens trust us to do the right thing and we must uphold those standards and have these high expectations of our public sector officers. We are not alone in this world. There are other jurisdictions in countries, cities and states where they have different legislative frameworks for Government versus the private sector. It is not inherently a weakness. The issue is how you design both of those and whether you make it work for these outcomes. And let me say, categorically, the two are aligned to the same expectations and standards and we will refine them as needed to make sure that that is the case. However, we believe that we need these two approaches because Government is not a private company nor should it behave as such and you cannot expect a private company to behave like Government. Mr Gerald Giam goes on about the burdens that he felt as a civil servant. If the private SMEs had to comply with all the regulations that he had to struggle with as a civil servant, they would not be able to do business in quite the same way and perhaps innovation and the ease of customer relations, the ease of coming up with new products would be impeded. So, there is a difference in behaviour at the entity level and there is a difference of behaviour at an individual level. And so, we have to have the right tools to influence behaviour correctly on behalf of our citizens. That does not mean that we reduce our standards in any way and we have not done so.”
“Mr Deputy Speaker, I am glad that Mr Giam agrees largely with us. The issue then is what outcome would he achieve or would we achieve merely by putting it all under one legislation? I doubt very much there is any confusion among the civil servants about the standards that are expected of them simply because we have two legislative frameworks. The issue is whether or not the outcomes in terms of the number of data breaches, the security that we have in our systems and the trust that our citizens have in our processes would be assisted by his approach, provided he continues to agree that we are effective at maintaining very high standards within the Government. The outcomes demonstrate that we are not doing too badly in our public sector. The PDPC reports hacks and data breaches. I do not have all the numbers but I was looking at their website. For example, in 2018, in the private sector in Singapore, there were about 13 incidents of exfiltration of data through hacking and in 2019, it was 16 incidents. This is in the private sector. In comparison, in the public sector, we had three in 2018 and zero in 2019. While hacking is not the only type of breach, we can also have, for example, an accidental loss, that is, inadvertent data breaches. On PDPC's website, in 2018, there were 2,700 instances in the private sector and 4,500 in 2019. I do not have the exact number, but I know it is at least one if not two orders of magnitude lower for the public sector. We do review them and we can happily get those numbers to Mr Gerald Giam and Members of this House. But it demonstrates that our system is not ineffective.”
“It has to be used in a way that drives trust and helps us be effective in maintaining that trust with our citizens. Nevertheless, we always review these provisions. As we are reviewing the PDPA today, we will regularly review the PSGA as well as other legislation to ensure that they remain relevant and effective in safeguarding personal data for both the public and private sectors.”
“The key issue is then how do we want Government to behave and how do we want our private sector entities to behave. What we want within Government is for sharing of data to achieve that No Wrong Door, One Government responsiveness to citizens, for policy, for execution and implementation as well as for communications. For that, we need to encourage sharing of data. And because Government has roles that do not exist in the private sector, there are additional controls, because of the additional sensitive data that Government has access to. And hence we take this very, very seriously. How seriously do we take it? We prosecute and I give you three examples. In April this year, we had a civil servant arrested as a result of leaking COVID-19 case numbers, for accessing a Government COVID-19 database without authorisation to retrieve confidential records and giving that information to a friend. This person was arrested as a result. Another example also in April. A public servant and her husband arrested for wrongful communication of information, which was about the implementation of home-based learning by schools. And in December 2017, an HDB officer was fined $2,000 for giving confidential information on HDB resale transaction time and changes to the valuation process to a Straits Times journalist. We take this very, very seriously and the public sector officers who handle our data, on behalf of our citizens, know that we take this very, very seriously. The separation of the public and private sector data protection regimes in Singapore remains relevant. It remains necessary for us to keep achieving the outcomes that we want to achieve in terms of good policy, responsiveness to citizens, operating as One Government.”
“The individual would need to pursue legal action if they were looking for compensation. Mr Giam suggested that there needed to be some corollary of compensation within the public sector for these fines that the PDPA imposes, should there be a data breach. I just want to be clear that the fines are fines from the regulator and if in the private domain, an individual wishes to pursue compensation, they would have to take legal action in order to do so. For the Government, there is no special provision or exception or protection for the conduct of the Government or Government officers with respect to data; there is no special carve-out there. So, let me be clear. The PDPA and the PSGA – the IM8 provisions that Mr Giam referred to – are aligned in terms of standards, the expected behaviour of the officers and entities. And they are aligned where there is a single point for people to complain: the PDPC versus the GDSCC. There is an option for individuals to pursue mediation and an option for individuals to pursue action for compensation. One of the key other points of confusion I want to address is this idea that the PDPA is equivalent to the PSGA or the Public Sector (Governance) Act, when taken together with a whole series of other laws such as the Official Secrets Act, the Income Tax Act, the Statistics Act. This is not so. The controls are equivalent between the PDPA and the PSGA. These other laws are then on top of the PSGA, governing and controlling behaviour within specific domains. They also apply to the private sector; for example, the Income Tax Act will apply to certain private sector entities as well. So, the equivalence is between the PSGA and the PDPA.”
“The high compliance burden is precisely because the standards are high and, perhaps, more burdensome than for the private sector. Nevertheless, there is internal coherence despite the many different Acts and rules and laws that he cited, which are correct. Internally, within the Government, the data security and data privacy space is looked after by the Government Data Office, a single point of contact. There is internal coherence, so that we can operate as one Government. Externally, for members of the public that are concerned about their data security, they also have one point of contact – the Government Data Security Contact Centre or GDSCC. That was established and launched publicly on 30 April this year. Members of the public can contact that single point of contact if they are concerned. But if they contact any other arm or organisation within Government, we have our Government working as one through a No Wrong Door policy. And that is enabled precisely because there is sharing of data across Government. Nevertheless, whoever they contact, they will be referred to the Government Data Office and GovTech to handle the matter. On the issue of our Government data policy lacking transparency – Mr Giam referred to it; it is IM8 – the Government's personal data policies were published on 30 April this year. It is available on the Smart Nation website and it is there for scrutiny and for examination. And we can debate and discuss this further if he wishes. Another point of conflation and confusion that I would like to clarify, the monetary fines that are in the PDPA are fines; they are not redress to the individual. They are fines imposed by the regulator on the private sector entity. There is no specific provision for compensation to the individual as a result.”