Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
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“The Ministry of Health (MOH) takes a multi-pronged approach to curb the illicit sales and use of e-vaporisers. The Health Sciences Authority (HSA) monitors illicit sales of e-vaporisers via social media and messaging platforms and regularly carries out operations to target sales of e-cigarettes on these platforms. HSA also collaborates with platforms such as Instagram, Facebook and Carousell to remove postings on the illegal sales of such products. The Immigration and Checkpoints Authority (ICA) assists to detect illegal imports of e-vaporisers at the checkpoints and refers them to HSA for enforcement. The enforcement activities are complemented by public education efforts by HSA to deter the public from vaping. In schools, MOH and the Health Promotion Board (HPB) work with the Ministry of Education (MOE) to raise awareness on the harms of vaping and encourage children and youths to lead a nicotine-free lifestyle. Schools take a serious view of vaping and school-based disciplinary action is also taken for students caught using or possessing e-vaporisers, including suspension or caning for boys. HPB will also be launching a digital campaign on staying vape-free in early 2023 to raise awareness on the negative health effects of vaping and address the misconceptions around vaping.”
“As mentioned in the Prime Minister’s New Year’s Day message, we will review the remaining few COVID-19 measures to arrive at a new post-COVID-19 norm. This is currently in progress, as we monitor the situation following the recent festive holidays, the Northern Hemisphere winter and the opening up of China.”
“The Ministry of Health (MOH) takes into account national and regional demographic and demand trends in planning for public hospital services in Singapore. In that regard, Sengkang General Hospital (SKH) provides outpatient obstetrics and gynaecology (OG) and general paediatric services, including pre- and post-natal screening and basic fertility consultation, to cater to families with young children living in the northeast region of Singapore. However, public inpatient OG and paediatric services are centralised in KK Women and Children’s Hospital (KKH), National University Hospital (NUH) and the Singapore General Hospital (SGH). This allows for the consolidation of specialty and subspecialty expertise and resources to deliver the best outcomes for patients. Being a small compact city with relative short travel distances, this is a practical and effective arrangement.”
“Thank you. The two questions are related. We reviewed this and we deemed this as a permanent feature. Of course, all features are reviewed from time to time. Yellow Fever, MERS – they have all become endemic diseases in their parts of the world. We do not want them to become endemic diseases in our part of the world, which therefore means that this is quite a permanent feature, that as of now, we feel is necessary, to prevent such diseases from coming into Singapore.”
“Travelers suspected of being infected can be referred for further medical assessment and isolation if necessary. These are dynamic information, based on their recent travel history and how they feel, and therefore, not captured in existing Government systems.”
“Mr Speaker, the Member asked me a supplementary question on this topic during my Ministerial Statement at the last Sitting. I do not think I gave a full nor clear answer, so, I thank him for the opportunity to answer this now. In the course of the COVID-19 pandemic, the Ministry of Health (MOH) reviewed our need for data collection at the borders and we decided to implement the digital SG Arrival Card system for purposes of disease control. Specifically, we want to guard against importing infectious diseases of concern, such as Yellow Fever, Middle East Respiratory Syndrome (MERS) and Ebola. The SG Arrival Card system resulted in a few changes from past practices. First, previously, only foreigners are required to submit health information on a physical card. Now, all travellers are required to submit a health declaration because all travellers are subject to the risk of infectious diseases – not just the foreign travellers. Second, the mode of submission was digitalised – and I hope, became more convenient. Third, the information required has been streamlined and simplified to only three questions to ascertain the risk of a traveller being infected with the current diseases of concern. Specifically – if I may elaborate – one question was targeted at Yellow Fever transmission. Travellers at risk of Yellow Fever infection and do not have a valid relevant vaccination certificate are assessed and may be quarantined to protect against the risk of importation of Yellow Fever in Singapore. This is a serious matter for Singapore because the Aedes aegypti mosquito vector that spreads Yellow Fever is present in Singapore. Another question is targeted at MERS-Coronavirus and Viral Hemorrhagic Fevers.”
“Achondroplasia is a genetic condition that causes abnormal bone and cartilage growth, leading to short stature and disproportionate growth. MOH does not collect data on the number of patients diagnosed with achondroplasia, but globally, the condition affects around one in every 30,000 newborns. The drug Vosoritide, sold under the brand name Voxzogo, is intended to increase linear growth in children with achondroplasia. Vosoritide is currently not registered in Singapore. MOH has therefore not assessed the drug for clinical and cost effectiveness, nor conducted pricing negotiations with the manufacturer. Further, given the limited size of the Rare Disease Fund (RDF), funding support is focused on rare conditions that are life-threatening and where the treatment is effective in extending the patient's lifespan. Vosoritide is just one example. With medical advances, there will be novel and high-cost treatments for many medical conditions. Healthcare authorities in the world are finding themselves needing to review their healthcare financing policy, including healthcare insurance system, to ensure treatments remain cost effective and affordable.”
“This question has been addressed in my reply to Question Nos 7 and 8 for Oral answer on the Order Paper for 10 January 2023.”
“This question has been addressed in my reply to Question No 20 for Oral answer on the Order Paper for 10 January 2023.”
“There are two possible reasons. First, tertiary hospitals in the central region like Tan Tock Seng Hospital, Singapore General Hospital and National University Hospital were built with larger bed capacities to cater to comprehensive healthcare needs. Second, regional hospitals being located in housing estates cater to the high demand for healthcare services by residents, especially during the pandemic. New hospital bed capacity will be progressively added with the opening of Woodland Health Campus and Tan Tock Seng Hospital Integrated Care Hub from 2023. A new hospital in the Eastern region is also being planned to meet bed demand. More importantly, our population needs to stay healthy, which is why we launched the Healthier SG national strategy.”
“Pharmaceutical medicines are stringently evaluated by Health Sciences Authority (HSA) before approval as they contain potent medicinal ingredients and are used in the management of medical conditions and diseases. Approved medicines are listed on HSA's website: https://www.hsa.gov.sg/e-services/infosearch. Complementary health products and cosmetic products do not require approval by HSA but need to meet stipulated standards for safety and quality, and the addition of potent medicinal ingredients is prohibited. For all marketed health products, HSA conducts post-market surveillance to monitor their safety. Local websites and e-commerce platforms are monitored to detect and disrupt illegal online sales of adulterated health products. Consumers play an important role in safeguarding themselves against potentially harmful health products. HSA regularly issues press releases on the sales of illegal health products as well as advisories on making discerning choices in the purchase of health products. HSA issued a press release advising particular caution when purchasing products for use in young children following the recent detection of an adulterated skin cream used on a four-year-old child. The case is currently under investigation. Anyone caught selling adulterated health products can be fined up to $100,000 and/or jailed for up to three years.”
“We have included questions on vaping in the National Population Health Survey. However, due to the illegal nature of vaping products, self-reported data from a survey conducted by health authorities may not be reliable. MOH is reviewing various methods to better estimate the vaping prevalence.”
“My response will also cover the matters raised in the written question by Ms He Ting Ru on today’s Order Paper. Under current MOH guidelines, restructured hospitals are not to collect deposits from subsidised Singapore Citizens for non-elective inpatient treatments and day surgery procedures which are claimable under MediShield Life and/or MediSave. There are exceptions, such as where patients refuse to settle long-standing bills despite having the means to do so. For elective procedures which are claimable through MediShield Life and/or MediSave, restructured hospitals may collect a small deposit of no more than $50. This is to discourage no-shows and avoid wastage of hospital resources. Deposits may also be collected from Permanent Residents, foreigners and Singapore Citizens who opt for private care. The amount of deposit to be collected is generally based on the remaining out-of-pocket cost, after accounting for MediShield Life coverage, MediSave, employment coverage and private insurance. Where patients have difficulty in affording the deposit, restructured hospitals may waive the deposit for them or explore provision of financial assistance. In the event of medical exigencies, no individual will be denied timely treatment, regardless of citizenship status. MOH does not track data on the number of procedures or treatments postponed or cancelled due to an inability to put up the required deposit.”
“We have always had an SG Arrival Card for foreigners and it is physical. But because of COVID-19, everything went digital. So, now, the SG Arrival Card has become a digital declaration for all foreigners, as well as returning residents arriving by air and sea. And in that process, the Ministry of Health (MOH), with the Immigration and Checkpoints Authority (ICA) has very thoroughly gone through and reduced the questions to the bare minimum, to the extent that the Member feels it may not be so helpful. Maybe we will review to see whether we can add a few more questions.”
“We have always had an SG Arrival Card and it is physical. But because of COVID-19, everything went digital. So, now, the SG Arrival Card has become a digital declaration. And in that process, the Ministry of Health (MOH), with the Immigration and Checkpoints Authority (ICA) has very thoroughly gone through and reduced the questions to the bare minimum, to the extent that the Member feels it may not be so helpful. Maybe we will review to see whether we can add a few more questions. [Please refer to "Safe and Orderly Restoration of Singapore's Air Connectivity", Official Report, 9 January 2023, Vol 95, Issue 79, Ministerial Statements section.] [(proc text) Written statement by Mr Ong Ye Kung circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] I wish to make the following factual correction to the reply given during the discussion on the Ministerial Statements at the Sitting of 9 January 2023. My reply should read as follows:”
“Between 2019 and 2021, Junior Doctors – that is, Medical Officers and Residents – took an average of between 14 and 18.9 days of annual leave. The lowest utilisation was in 2020 during the height of the pandemic. The Ministry of Health (MOH) does not track if leave days applied for were cancelled or forfeited as such decisions are made at the institution or departmental level. Healthcare institutions (HCIs) use various methods, including electronic logging and surveys, to monitor the work hours and well-being of junior doctors. Based on annual surveys, about 90% of residents have had at least 10-hour intervals between duty periods and after in-house calls. Other proxy indicators such as late-night transport claims are also used to ensure that working hours are accurately reported. To date, we have not detected any systemic under-reporting of working hours. In addition, MOH Holdings (MOHH) has a whistle-blowing channel for all junior doctors to make anonymous reports. MOHH takes such feedback seriously and will investigate reported incidents. The medical fraternity has a responsibility to take care of their juniors and take this duty seriously as a core undertaking of the profession. MOH has commissioned a national committee, chaired by a senior doctor, to lead initiatives to promote and improve the well-being of junior doctors in the public healthcare system.”
“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.”
“Integrated Shield Plans (IPs) are optional private health insurance products, subject to market competition and commercial considerations. They protect policyholders on top of MediShield Life, hence covering not only hospitalisation bills, but also day surgeries and selected outpatient treatments, such as kidney dialysis, cancer drug treatments and services, and radiotherapy. In recent years, most insurers have introduced new outpatient IP benefits, such as long-term parenteral nutrition and continuation of autologous bone marrow transplant. The Ministry of Health (MOH) is constantly in dialogue with the insurers, and understand that they regularly review their coverage to account for changes to care delivery, medical advances and patient needs, while bearing in mind affordability of premiums.”
“The mortuaries managed by hospitals and the Health Sciences Authority (HSA) are only meant to temporarily store deceased persons before they are claimed. There are existing processes to facilitate the timely transfer of the deceased to families for funeral preparations. In the past decade, mortuaries were able to meet the actual demand for mortuary space. Nevertheless, the hospitals and HSA had also established contingency plans to cater to potential surge in the demand for mortuary space. This involves the deployment of mobile refrigerated containers near the existing mortuaries to add capacity.”
“As part of the preparation of the roll-out of Healthier SG, the Ministry of Health (MOH) has been engaging general practitioners (GPs) through different channels, to encourage them to join Primary Care Networks. Today, over half of GPs have done so, and we expect the numbers to rise. There are some concerns expressed by GPs, although these may or may not be the reasons for not joining. These include digitalisation, administration of Healthier SG benefits including drug subsidies and the impact on operating costs and patient volume. These concerns are being addressed. A list of participating GP clinics will be available on HealthHub when residents register for Healthier SG.”
“The Ministry of Culture, Community and Youth (MCCY) and the National Youth Council (NYC) regularly survey and poll our youths to understand how they feel and what challenges they face. These feedback channels indicate that youths want greater access to mental health information and services at both schools and workplaces. Specifically, youths want clearer information on the support provided, the costs of mental health services and how the services would be delivered. They also prefer services tailored to, or conducted by their immediate social groups, such as those catering to their occupations or run by peers with similar experiences. In addition, research studies are also conducted by public healthcare institutions and institutes of higher learning to study the prevalence of mental health conditions among youth.”
“The Ministry of Health (MOH) does not track the number of delay discharges due to lack of suitable care arrangements at home. However, we do monitor the number of patients who are medically stable for discharge from public hospitals and yet have stayed for more than 21 days. Over the past three years, there is a daily average of 220 such patients in the public hospitals. These patients are typically awaiting finalisation of care arrangements, such as arrival and training of domestic helpers or admission to care facilities or services. To enable timely discharges, MOH has been expanding the Interim Caregiver Service, which provides time-limited personal care at home for such patients.”
“Tinnitus is a perception of a buzzing, ringing or hissing sound in the absence of an external source. Common causes of tinnitus include age-related hearing loss, noise-induced hearing loss and earwax impaction. Other pathological causes include perforation of the eardrum, fluid in the middle ear, as well as Meniere's disease, which is an inner ear disorder with other associated symptoms of dizziness, hearing loss and blocked ear. Large population studies worldwide have found that the prevalence of tinnitus increases with age and peaks between 60 and 69 years of age. Locally, 17% of 72,000 Singaporeans aged 60 and above who had undergone hearing screening under Project Silver Screen between 2018 and 2020 reported "ringing in the ear". There are no clinical studies reporting that tinnitus is a contributory cause of noise complaints in neighbour disputes.”
“The Health Promotion Board has been working with food operators to offer lower-calorie meals and encourage switch to using healthier ingredients, such as healthier cooking oils, wholegrains and low-sodium salt. Identifiers such as "lower in calories" or "higher in wholegrains" are featured on storefronts and in menus, to help consumers identify the healthier options. The Nutri-Grade labelling and advertising measures, which came into effect on 30 December 2022 for prepacked beverages, will be extended to freshly prepared beverages by end-2023. Our National Population Health Survey conducted between July 2020 to June 2021 showed that people are engaged in lesser leisure physical activities. However, this is expected because of the prevailing safe management measures then and as the population ages. Through Healthier SG, we are actively promoting healthier lifestyles as a national health strategy.”
“Vaccination remains our primary line of defence against COVID-19. At this time, the efficacy and safety of nasal COVID-19 vaccines are still being studied internationally. MOH, together with the EC19V, and other experts will continue to review the national vaccination strategy to best protect our population.”
“My response will also address the questions by Mr Melvin Yong Yik Chye1 and Dr Wan Rizal2 which are scheduled for a subsequent Sitting. Our current vaccine recommendation is for persons aged five years and above to complete three mRNA or Novavax/Nuvaxovid doses, or four Sinovac-CoronaVac doses to achieve minimum protection. Thereafter, persons aged 12 years and above should receive one additional dose between five months and one year from their last dose to keep their vaccination up to date. The bivalent vaccines are recommended for the additional doses. This is not very different from vaccination against influenza, which is an endemic disease where the virus is constantly evolving and mutating. Annual vaccination is, therefore, recommended for influenza and commonly practised in many countries. The Ministry of Health (MOH) and the Expert Committee on COVID-19 Vaccination (EC19V) recommend up-to-date COVID-19 vaccinations for all eligible persons, young and old, because the benefits of vaccination outweighs the risks of being infected. As of 31 December 2022, about 90% of individuals aged 60 years and above have achieved minimum protection and about 60% are up to date with their vaccinations. The proportions are similar for those aged 18 to 59 years. MOH will continue to facilitate vaccinations. Currently, all eligible persons can walk-in to the Joint Testing and Vaccination Centres to receive additional doses beyond minimum protection, without an appointment. Mobile vaccination teams are also deployed to housing estates and nursing homes to make it more convenient for seniors to get vaccinated. The People's Association and the Silver Generation Office have also been reaching out to our seniors to encourage them to get their vaccinations and keep them up to date.”
“So, actually the number of people who is need it, is not very high. Notwithstanding, this is something we will look at.”
“On hospital capacity, indeed, this is one of the key considerations I mentioned in the Statement just now. Today, the number of COVID-19 inpatients is actually low. I cannot remember how many exactly, but it is in the low tens. So, it is not actually burdening our hospital system. However, the hospital system utilisation of non-ICU wards is high because we are ageing – more people are falling sick. COVID-19 affected that indirectly because it delayed the opening of some major public health facilities. Woodlands Healthcare campus, for example, was delayed for two to three years. We hope it can start opening by the end of this year. It will greatly relieve the burden currently of the high utilisation rate of hospital beds. You cannot rush the building of a hospital, but what we can do, which I have announced and explained in this House before, is to set up step-down facilities, particularly Transitional Care Facilities (TCF) that proved to be very helpful. That means for patients who do not require acute care, but waiting for step-down or rehabilitative care, they can go to a TCF first. So, that can temporarily relieve the situation. Manpower is another constraint, but we are recruiting, building up. We lost a number of good nurses, especially foreign ones, because the competition heated up. But we are recruiting again. These are some of the things we need to do, and you are right: we have to be very alert should there be a new variant or big influx of severe cases and implement the necessary measures. As for Paxlovid, we are constantly reviewing if more clinics can dispense them. But so far, because of the fact that we are a very highly vaccinated population and Paxlovid is prescribed for people who are at-risk.”
“This is one of those things that MOH gets all the time. If you succumb and then you remove it, and then, one day you regret, that you should have kept it. We have always had an SG Arrival Card and it is physical. But because of COVID-19, everything went digital. So, now, the SG Arrival Card has become a digital declaration. And in that process, MOH, with the Immigration and Checkpoints Authority (ICA) has very thoroughly gone through and reduced the questions to the bare minimum, to the extent that the Member feels it may not be so helpful. Maybe we will review to see whether we can add a few more questions. [Please refer to "Clarification by Minister for Health", Official Report, 9 January 2023, Vol 95, Issue No 79, Correction by Written Statement section.] But the purpose is, it is not targeted at COVID-19 but targeted at Middle East Respiratory Syndrome (MERS), at Ebola, Mpox and so on, that can arise and can infect travellers. While travellers declare whether they feel well or unwell, the fact is they leave behind a contact. So, if someone falls sick, goes to a doctor and we detect is MERS, for example – we are always on the lookout for MERS – we know which flight the person came off, who are their close contacts and if we want to do contact tracing, we can do so through the SG Arrival Card mechanism. It is one of those things we keep in the background – useful to have, and if we need to trigger some action, the information will be valuable.”
“You got more applause than me. [Laughter.] I cannot disagree with what the doctor just summarised. To see a summary of what I have just said, my speech will be on the MOH website. [Laughter.]”
“There will be some damage to livelihoods and inconveniences but, at least, we stand down. But if your nightmare comes true, that it is very transmissible and very deadly, then, you have to hunker down. We have to hunker down again, back to almost square one – contact tracing, SMMs, border measures, everything come in, again, to buy us even more time. Even more time for what purpose? Even more time so that a new effective vaccine can come on stream. With mRNA technology, hopefully, that can happen in 100 days and that is why it is important to go onto the mRNA platform. The Member asked about protocol to respond to a new dangerous variant. This is roughly the idea. But when something like that happens, expect lots of uncertainties, some confusion. It would not be straightforward, a lot of judgement calls will be required.”
“And soon, you have a big border control system, testing everyone before they board; testing everyone after they board, dedicated a taxi driving you to your homes and then using devices to make sure they stay at home. And then, that is still not foolproof, because one day, a traveller may pass it to a driver, and the driver goes home, he goes for big lo-hei dinner, passes it to many other people. And then, next thing you need to think about is safe management measures (SMMs), social restrictions. We always have the mindset that border measures are a substitute for domestic community measures. Actually, it is not. They are all complementary; they go together. Once you implement one, you must be prepared that the rest are going to follow because that is how transmissible the virus is. One is not the substitute of the other. They all come in a package, unfortunately. Third point is that certain protocol that the Member mentioned: PDT, OAT, SHN or combination, can buy us time. And that can be very valuable. Therefore, why do we buy ourselves time? Let us say we detect something that sounds serious, which you can recall, when we first detected Omicron coming from Africa, we have to implement a combination of those measures. We know it will not shut out the virus, but it buys us time for scientific data to come out, because in a matter of weeks, you can know the characteristics and the parameters that matter. How long does it incubate? How fast does it transmit? To what extent does it translate into severe cases? Does it affect old people more or young people more? That is actually an important parameter. Once you know these parameters, then you can decide your next step. If the parameters turned out that it is not something very serious, then you can stand down, false alarm.”
“Thank you. Very critical question. What do we do when we detect a new dangerous variant? Let me make a few points. One, there are a lot of sub-variants. Omicron alone, there are about 650 Omicron sub-variants. So, if you jump at every one, you will be jumping every day, twice, right? Because sub-variants can really differ very minimally; just like a human, you are wearing a different shirt, different watch, different shoes, different earrings. That is about it. You are essentially still the same person. So, we cannot jump at every sub-variant, no matter how sexy the name sounds. There are just so many sub-variants. But keep our eyes and ears on the ground with the global surveillance system. Look out for those that is more dangerous. If there is one, then we think about what we should do. And we can see how some countries are implementing. Mr Melvin Yong suggested masks on planes – which is not unthinkable – pre-departure test (PDT) and so on and so forth. But a popular one is PDT. The second point to note is that PDT is not foolproof. In fact, it is quite leaky. Why? Because, first, you can be incubating and when you test before you board the plane, you are negative, but on the plane or upon arrival, you develop disease and you become positive. And then, leaks will happen. Therefore, if you want PDT to be a little more tight, you also implement an OAT, on-arrival test. But still, for a short flight, you might be incubating before you board and also during landing. And then, for the next three days you are incubating. And therefore, that is still not enough, you want to be even tighter, you implement SHN, stay-home notice. All these sounds familiar. That was what we did – PDT, OAT, SHN.”
“We do require medical insurance if you are not fully vaccinated. But the Member is right that, in Singapore, as Members are aware, MOH has revised our vaccination status definition. We require minimum protection, which is three shots for mRNA, or four shots for Sinovac. And after that, we require another additional shot five to 12 months after the previous shot to keep yourself up to date. So, our definition is quite a tight one. The World Health Organization (WHO) has a more relaxed definition. We know our definition is different and stricter than WHO's, which is currently applied on travellers. It is not practical to fully align the vaccination definition for people living here and for travellers from all around the world, because every country has their own definition. And that is why we use the WHO definition, which is less strict on travellers from all sources. Having said that, the current definitions have worked well for us so far. I mentioned the outcome from December. So, it has obviously worked well. But we will have to study if there is a need to review the definitions for vaccination status based on the development of the disease threat.”
“Minister Iswaran left the wastewater testing to me. As I mentioned in my Statement, wastewater testing, at least for the ones we use in Singapore, works by detecting viral fragments from solid waste, not from urine. Therefore, we used it in dormitories, in housing estates, even in nursing homes, which is quite a challenge because many old folks use diapers. Therefore, for a flight from China to Singapore, it is quite a short duration. So, I think that the use of wastewater test will capture a very small sample and is, therefore, not very useful.”
“If more people take the vaccinations, when they meet each other for coffee, they find that their friends have taken them, they feel the fear of missing out (FOMO), and then, they will take too. So, I think just keep that going. It is essential.”
“First, vaccination has always been optional. We have never made it compulsory, but because of the cooperation and social consciousness of Singaporeans, we have attained a very high vaccination rate. Today, instead of measuring bivalent take-up rate, let us measure the up-to-date vaccination rate. The up-to-date rate is not bad at all. It is about 60% for the whole population. Amongst those aged 80 and above, it is actually 67% to closer to 70%. So, we are quite encouraged by it. As I mentioned just now, bivalent vaccination is happening at about 13,000 doses per day, which is a very healthy volume. But I think the Member raises an important question – how do we ensure that people continue to take it? We have never made it compulsory. We will continue to use the measures that have worked. First, make it very convenient. We now have Joint Testing and Vaccination Centres (JTVCs) throughout the island. You do not have to make an appointment. Just walk in. Secondly, for seniors, we make it even more convenient by bringing in mobile teams to the heartlands, so that they can just go downstairs and get the vaccination. Thirdly – and I think that is MOH's job, the Multi-Ministry Task Force (MTF)'s job – continue to publicly explain the benefits of vaccination, because the benefits far outweigh the risks of getting COVID-19 and the risk of having severe illnesses. Finally, work with all our on-the-ground partners – general practitioners (GPs), Traditional Chinese Medicine (TCM) physicians, our advisors, our volunteers on the ground – continue to carry and to take the message to the masses, explain the benefits, and hopefully, more people will come. I think there is a momentum.”
“While we step up global surveillance and consider border measures whenever we feel threatened, remember the best defence – and which every one of us can play a part – is to have up-to-date vaccinations. Some people are asking when the vaccination is going to end. How many shots of booster must we take? To be very honest, COVID-19 vaccinations have become part of the new norm. For an endemic disease like influenza, vaccinations are encouraged every year, which will help avoid many deaths. COVID-19 is heading the same way. The current situation, where we feel threatened by rising infections around us, is a clear illustration why vaccination needs to be an integral part of our ongoing defence against an endemic COVID-19. I am heartened that most Singaporeans are responding to this. As of 31 December 2022, about 60% of individuals aged 16 and above are up to date with their vaccinations. Today, about 13,000 individuals are taking the bivalent vaccine on a daily basis. And now, with the introduction of the bivalent formulations for both Moderna and Pfizer – we have two brands to choose from – I hope more will step forward to get better protection. As we move into this new norm, we will never be complacent, but our responses need to be based on science, evidence and data. We are ready to adjust policies whenever necessary. We will always do our best to maintain our way of life and not go back to the days of lockdowns, unless absolutely necessary. As the Prime Minister said in his New Year's Day message, if the situation continues to be stable after the year-end travel season and the infection wave in China, we can look forward to making final adjustments to our remaining social restrictions to establish a post-pandemic normalcy. [Applause.] 3.32 pm”
“To protect our healthcare system, it is most important to encourage all travellers coming to Singapore from any part of the world to have adequate vaccination. This directly reduces the risk of importing severe cases, and hence, protects our own hospital system. Ultimately, our best defence is also what everyone can do – to get vaccinated and make sure our vaccination is up to date. Some people ask me: "We keep going for one booster shot after another. When will these vaccinations come to an end? When can we stop vaccination for COVID-19?" To be honest, COVID-19 vaccination has become part of the new norm. Just like any other endemic diseases like influenza, we encourage people to go for vaccinations every year. This will help prevent many from falling severely ill or even death. As Prime Minister Lee said in his New Year's Day message, if the situation continues to be stable after the year-end holiday season and the infection wave in China, we can look forward to making final adjustments to our remaining social restrictions to establish a post-pandemic normalcy. (In English): Mr Speaker, Sir, the latest worry about the outbreak in China is part of the new norm. Today, it is China. Tomorrow, another region may experience a major wave. In fact, many regions in the Northern Hemisphere are experiencing rising infections of both COVID-19 and influenza over the winter season. New infection waves are bound to start in Singapore from time to time, over and over again, as variants with immune escape emerge, protection from vaccines and previous infections wane, and re-infections increase.”
“In addition, we have been maintaining a test requirement for at-risk travellers. These travellers have to be either fully vaccinated or produce a negative PDT result before heading to Singapore. It is precisely because we have anticipated the situation today that we have kept these two very important border measures. Many scientists believe that the current infection wave has already started to subside in China. During this difficult period, these measures have proved to be effective to keep Singapore's COVID-19 situation stable. However, it is impossible that measures can work permanently. The MTF will continue to monitor the ever-changing situation and review our measures. If needed, we will change our COVID-19 measures accordingly. Let me now explain the key concerns that we have at this stage of the pandemic. First, the emergence of a new and more dangerous variant, and second, to protect our healthcare system. A new variant of concern may emerge from any part of the world. To detect new variants as soon as possible, we need an effective global surveillance system. This global system is called GISAID. GISAID now collaborates with the various CDCs in major Chinese cities and provinces to obtain viral sequencing data. Today, Beijing, Shanghai, Guangzhou, Sichuan, Zhejiang, Jiangsu, Fujian, Inner Mongolia and Anhui contribute up-to-date viral genome sequences to GISAID on a weekly basis. The data is analysed and processed in their office in Singapore. The GISAID data so far shows that the pandemic in China is driven by variants that are well-known and have already been circulating in other parts of the world, and current vaccines are effective against these variants. This is a huge relief.”
“Although what we yearned for has indeed happened, many people are worried that this could trigger a fresh wave of infection in Singapore and bring back social restrictions, and the freedom we have worked so hard for the past several years might also be lost. MOH is acutely aware of these concerns and will remain highly vigilant. Therefore, we need to use science, evidence and data to formulate the most effective COVID-19 policies. Let us look at some figures. Last December was probably one of the most difficult periods of the pandemic in China. During that time, there were about 200 travellers from China detected to be COVID-19 positive. They accounted for less than 5% of our total imported infections, and less than 1% of our total infections. Currently, most COVID-19 positive cases are mild, especially for those who have been vaccinated. So, what we need to focus on are those severe cases who need to be hospitalised. Last December, amongst all the imported cases, seven developed severe illnesses and had to be hospitalised – three were from the Middle East, two from ASEAN, and one each from China and Europe. Most of them were Singaporeans returning from these countries and regions. These are not large numbers, so the impact on our healthcare system was very limited. Why is it that travellers from China account for such a small percentage of our imported infections and severe cases, despite China experiencing a big infection wave? The main reason is because travel volumes between Singapore and China have been very low throughout the pandemic. As of now, we run 38 weekly flights from China, compared to around 400 flights pre-COVID-19. This translates to between 700 to 1,000 arrivals from China every day, less than 10% from pre-COVID-19.”
“I reported earlier that over the past four weeks, travellers from China accounted for less than 5% of imported infections, and one out of seven severe cases. If we impose PDT on all travellers from China, the question will also arise: how about travellers from other regions that contributed to more infections and severe cases? How about local community settings which we know are conducive to spreading the disease and can drive infection numbers and severe cases? Further, by triggering PDT on travellers from one part of the world experiencing high infection numbers, are we contributing to an international precedent of imposing tests on travellers from countries experiencing an infection wave? How will other countries treat travellers from Singapore when we encounter another infection wave? Instead of imposing a blanket PDT specifically on travellers from one region or one country, we decided very early on that we should encourage adequate vaccination amongst all travellers coming to Singapore, from all parts of the world. This directly reduces the risk of importing severe cases and protecting our hospital system. That is why we have, until now, maintained the requirement that incoming travellers either are fully vaccinated based on the WHO's definition, or have to undergo a professionally administered or supervised PDT. Mr Speaker, in Mandarin please. (In Mandarin): [Please refer to Vernacular Speech.] China's opening up to the world is a major milestone in the world's fight against COVID-19. It is great news for many countries, industries, enterprises, families and individuals. To Singapore, this is also an important development because it allows us to restore our rich and substantive people-to-people links.”
“Further, PCR tests are sensitive and bound to yield a large number of positive cases from countries that are experiencing or have just experienced a big wave. Even recovered travellers will shed dead viral fragments for quite some time, for a few weeks, even though they are no longer infectious. We, therefore, did not consider doing this, as it would merely confirm what we expect, or what we already know. Then, there are also wastewater tests. For waste-water tests, it is best done on residential premises like dormitories and housing estates, because viral fragments can only be detected from solid wastes. So, the sample capture from plane toilets for a relatively short duration flight from China to Singapore is likely to be very small and of limited use. The second measure is the PDT. That can be useful because it will sieve out COVID-19 positive passengers, prevent them from boarding the plane, reduce number of imported infections and, hence, severe cases and the burden on our hospitals. So, PDT can be useful. However, as I explained earlier, there is already low travel volume between Singapore and China, which is currently only less than 10% of pre-COVID-19 norms. This already limits the number of imported infections more so than imposing a blanket PDT requirement on all travellers from China. I believe China is also acting cautiously and increasing outbound traffic in steps, and not make a sudden full opening. Minister Iswaran will explain how we will increase the number of flights between Singapore and China in a calibrated fashion, as the infection wave continues to subside in China, while ensuring that the health of Singaporeans and healthcare resources are not compromised.”
“There are still gaps in the data, so GISAID is working with the Chinese authorities to expand the data capture. So far, the data shows that the epidemic in China is driven by variants that are well-known and have been circulating in other regions of the world. The dominating ones are BA.5.2, as well as BF.7. Our local sequencing efforts on infected travellers from China further support this. The majority, as I mentioned, are BA.5.2 and BF.7 strains, which have already been detected in Singapore and other countries for many months. Our assessment is also consistent with that of WHO's Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE), which released its findings on 4 January 2023. This is a huge relief. What we fear and worry most – a new dangerous variant that evades vaccine protection coming out from China as the virus spreads throughout their population – has not materialised yet. But we will continue to stay vigilant and plug ourselves deeply into the global surveillance system. Mr Speaker, our second concern is to protect our hospital system. When China announced that it will start to allow leisure visits in an orderly way, many people around the world is imagining a surge in COVID-19 infections from an increase of tourists from China. Singaporeans, too, are asking if we should implement some of the measures other countries have announced and are implementing. So, let us examine the effectiveness of these measures in protecting our hospitals. First, some countries conduct polymerase chain reaction (PCR) tests on travellers from China after arrival. But the shortcoming of any on-arrival test is that they are done too late, because the travellers are already within our borders.”
“So, to detect new variants, we need an effective global surveillance system where samples from infected persons all around the world are systemically collected, the viral genomes sequenced and then shared on the global platform. This is best done by countries for their own local cases, rather than relying solely on traveller surveillance because they can only provide a delayed snapshot. Fortunately, such systems exist today. The most commonly used global COVID-19 genome sequencing platform is run by a non-profit organisation and it is called the Global Initiative on Sharing All Influenza Data (GISAID). The data is publicly accessible and protects the ownership rights of the source country. Today, GISAID hosts all shared genome sequences of the four viral pathogens of global interest currently: namely, COVID-19, influenza, Mpox and Respiratory Syncytial Virus (RSV). Singapore actively contributes to GISAID, which in turn works with many countries. GISAID has established a base in Singapore in collaboration with the Agency for Science, Technology and Research (A*STAR). And MOH and GISAID have developed a strong working relationship. Hence, when a major COVID-19 infection wave broke out in China, GISAID collaborated with the various Centres for Disease Controls, or CDCs, in major Chinese cities and provinces to obtain viral sequencing data. Today, Beijing, Shanghai, Guangzhou, Sichuan, Zhejiang, Jiangsu, Fujian and Inner Mongolia contribute up-to-date viral genome sequences to GISAID on a weekly basis. Just today, you can now find genome sequences also from the province of Anhui, just fresh; it came out today. The data is analysed and processed from their office in Singapore.”
“What worries us most now, is the emergence of a new, unknown and more dangerous variant of concern. Our main worry is that with the virus continuing to spread throughout the world, there is a higher chance that a new variant of concern may emerge from anywhere in the world. It may possess worrying characteristics, escape vaccine protection, be more infectious, more likely to lead to severe illnesses, which would be very bad news. A nightmare variant can knock us almost back to square one. We must then be prepared to hunker down. We may need to reinstate measures, such as strict border controls, quarantine for travellers, social restrictions, including limits on group sizes, until a new and effective vaccine is developed. So, in short, our key concerns are: first, the emergence of a new and more dangerous variant, and second, even in the absence of a new dangerous variant, to protect our healthcare system against having too many severe cases. And these set the context of our border measures in response to the infection wave in China and the winter wave in many countries. Let me explain what we are doing to address each of the two concerns. Let me start with the most important one, which is the emergence of a new and more dangerous variant. The most common measures that we have read in the papers in response to the opening up of China is COVID-19 tests on travellers. But they do not help detect new variants of concern. The tests tell us if the travellers are infected with COVID-19, but it does not identify the variant. New variants can emerge from anywhere in the world, not just China.”
“Today, the probability of COVID-19 infections leading to severe illnesses or deaths for our population has become very low, comparable to influenza or pneumococcal infections, both of which are endemic diseases that we have been living with for many years and which we have also been encouraging vaccinations for. To illustrate, in the past 30 days, the number of COVID-19 patients in the Intensive Care Unit (ICU) is in the low single digit, and there were 25 days out of the 30 days where there were no COVID-19 deaths. Based on the severity rate today, annual deaths caused by COVID-19 infections is similar to that caused by influenza infections. Hence, with extensive vaccination coverage, we can treat COVID-19 as an endemic disease. Like influenza, top line infection numbers should no longer be our pre-occupation. To illustrate again, at the peak of the year-end XBB variant wave last year, we were registering a seven-day moving average infection of over 8,500 cases a day. Despite the high top line number, we carried on living life normally. We did not impose further social restrictions. We did without masks even. However, we were watching the situation very carefully in our hospitals because it is the bottom line of number of severe cases and deaths that matter. As it turned out, hospitals were very, very busy, but they were not overwhelmed and we rode through that wave. Our greater concern goes beyond hospital workload and capacity, to the evolution of the epidemic itself. Today, the infection waves around the world are driven by variants known to us – XBB, BA.2, BA.2.75, BA.5, BA.5.2, BN.1, BF.7, BQ.1, XBB.1.5 now. We know their characteristics and that existing vaccines continue to be effective in preventing severe illnesses of these variants.”
“Mr Speaker, Sir, our current measures, controlling the number of travellers and requiring PDT for unvaccinated at-risk travellers, have led to low imported infections and even fewer severe cases from China, at the time when the virus is spreading widely in the country. I cannot speak for other countries, but I will now explain why the measures have worked so far for us and are appropriate in our current context. Minister Iswaran will further elaborate on what MOT is doing with regard to air travel. But we cannot be complacent. The measures may work now, but not permanently. We will continually assess the situation and, if need be, make adjustments or implement new measures. At all times, our decisions must be based on science, on evidence and on data. Let me first explain our key concerns at this stage of the pandemic. To do so, it is worthwhile recapitulating how far we have come. At the early stages of the pandemic, infections were our primary concern, because it was a disease that could lead to many severe episodes and deaths, and there were no vaccines or treatments available. Under those circumstances, we adopted a zero-COVID-19 policy. That meant tight border measures, testing every passenger and quarantining them before allowing them to move around in our community. The same considerations applied within the community, where we implemented contact tracing, quarantined close contacts, imposed strict safe management measures (SMMs), including a circuit breaker. Then, effective vaccines were developed, and they changed our considerations fundamentally. With the great majority of our population vaccinated and many recovered safely from relatively mild infections, our population has developed strong hybrid immunity.”
“And they asked, can it be done away with at the check-in counter, where they have to – "kalang kabut" or scrambling – to show their vaccination certificate? Some of them have to log into their HealthHub with their Singpass and so on. We had been explaining to them that it is important to maintain it, to manage the risks that we are currently facing, because unvaccinated and infected travellers coming from anywhere in the world are at risk of severe infection and can add to our healthcare workload. Spain, one of the most highly vaccinated countries in Europe, has just announced that they are implementing the same test requirement as Singapore. So, in summary, there are three groups of countries with varied responses as a result of China opening up. First, most of ASEAN, the Middle East, Africa, South America, New Zealand – which are not imposing any border measures. Second, several countries, namely, Australia, Canada, and several EU countries, such as Belgium, France, Germany, Sweden, India, Japan, UK and the US, they are imposing a 100% PDT requirement on all travellers from China. And then, the third category, just Singapore and Spain, which have the policy of either you are fully vaccinated or produce a negative PDT result. Thailand, we thought, is putting on some of these requirements; I just read that it is taking them off again. So, we are neither the tightest nor the most liberal, but somewhere in-between. And we do not discriminate because these severe cases can originate from any country, any region in the world, as shown by our data.”
“First, travel volumes between Singapore and China have been very low throughout the pandemic. As of now, we run 38 weekly flights from China to Singapore, compared to around 400 flights pre-COVID-19. This translates to between 700 to 1,000 arrivals from China every day, less than 10% of pre-COVID-19 volume. China's opening up to the world is great news and something we are looking forward to, so that we can restore our rich and substantive people-to-people links. As China opens up, the Ministry of Transport (MOT) will carefully calibrate any adjustments from the current low travel volume, at least until the infection wave has clearly subsided in China. Many scientists believe that the current infection wave in China has already started to subside, especially the major Chinese cities. It will probably take a few more weeks for the trend to be very clear and we can then progressively restore pre-COVID-19 flight volumes between our two countries. The second reason is that we have been maintaining a test requirement for at-risk travellers. Many Singaporeans have actually forgotten about it. Travellers have to either be fully vaccinated based on World health Organization (WHO) vaccination definitions or produce a negative pre-departure test (PDT) result before heading to Singapore. That is why when Singaporeans are overseas now, when you go to the airport, you try to check-in with an airline, you have to produce your vaccination certificates at the point of check-in. This is so that the airlines know, and we know, whether you are required to produce a negative PDT result before you are allowed to board the plane. Over the past months, many Singaporeans have actually written to me and to MOH to feedback that this current rule causes a lot of inconvenience.”