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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“Based on data from the Singapore Mental Health Study 2016, the lifetime prevalence of psychotic disorders in Singapore is estimated to be 2.3%1. However, IMH did not collect data on specific occupations of those who had psychotic disorders. There is a need to increase mental health literacy and awareness. This will also help reduce the stigma of mental health conditions. Since 2018, the National Council of Social Service has been driving the Beyond the Label campaign. The Health Promotion Board is also developing a one-stop portal on mental health resources to provide curated and accurate information on mental health conditions. Under MOE's refreshed Character and Citizenship Education curriculum, students are taught the importance of respect and empathy for others, how to protect themselves against cyber bullying, to help look out for their peers and to speak up against and report bullying to school authorities. The Institutes of Higher Learning have also strengthened their cyber wellness curricula to enhance the teaching of digital well-being and online ethics. The Media Literacy Council has also been educating the public on cyber wellness and the avenues available for help when facing online harassment. The Protection from Harassment Act (POHA) can be used to protect individuals with mental health conditions from being attacked or harassed on social media. Harassers may be charged under the Act and victims may also obtain a Protection Order under POHA to restrain persons from publishing harassing communications about them.”
“Within the community, initiatives, such as KidSTART, led by the Early Childhood Development Agency, actively screens for paternal depression during home visits and directs appropriate individuals to polyclinics for further assessment. We will continue to review the need for further mental health screening at existing service touchpoints in both public and private healthcare sectors, to support new and expectant parents. In that regard, MOH is formulating a Child and Maternal Health and Well-being Strategy, which will include ways to better support the mental well-being of new and expectant mothers and their spouses.”
“Currently, there is support for the mental health of expectant mothers and their spouses. Obstetricians in both the public and private sectors already provide mental health screening and support for expectant mothers. This helps to identify the mental health concerns, such as antenatal and post-natal depression symptoms. Since 2007, the KK Women’s and Children’s Hospital (KKH) and National University Hospital (NUH) have been screening and providing early intervention for perinatal mental health conditions. Under the post-natal intervention programmes, the hospitals provide depression and severe anxiety screening at two to eight weeks post-partum, during outpatient post-natal reviews at the specialist clinics. The programmes also accept referrals from the private sector. As of December 2020, more than 165,000 women have benefited from the programmes. In addition, the Singapore General Hospital (SGH) has a psychiatry clinic located within the obstetric-gynaecology specialist outpatient clinic, which will support women with antenatal and post-natal depression symptoms. Women with depression will be managed by a multidisciplinary team comprising a psychiatrist, case manager, occupational therapist and psychologist. The women and their family members will be given useful contacts and information on managing their emotional health. Hospitals may also assess the spouses for signs of distress, tiredness, difficulty in coping with the pregnancy, or paternal post-natal depression. Where appropriate, the affected spouse is offered a referral to the polyclinic or mental health professionals.”
“MOH takes reference from the Screening Test Review Committee (STRC) recommendations for the population-based screening tests offered under the Screen for Life (SFL) programme. The STRC reviews robust scientific evidence to ensure that the tests are safe, suitable and cost-effective in detecting the condition screened for at a population level. The Body Mass Index (BMI) and waist circumference are both considered suitable population screening tests for obesity by the STRC. The BMI test was first included under SFL over the waist circumference measurement as the former was considered a more practical method to measure overweight/obesity, especially in mass screenings and is done together with screening tests for diabetes, hypertension and hyperlipidaemia. To complement the BMI test, MOH is already in the process of including waist circumference measurement under SFL to assess individuals for abdominal obesity, as it is an indicator for higher cardiovascular risk and will be implementing it soon.”
“Today, all travellers, including foreign domestic workers (FDWs) who have a recent travel history to higher-risk countries/regions within the last 21 days prior to departure to Singapore would be subjected to a 14-day isolation at a dedicated Stay-Home Notice (SHN) facility. They are also subjected to a COVID-19 polymerase chain reaction (PCR) test on arrival and on Day 14 of arrival, as well as self-administered Antigen Rapid Test (ART) tests on Days three, seven and 11 of arrival. All travellers must test negative on their Day 14 PCR test to be released from the SHN.”
“The number of suicide cases by age group is publicly released in the Report on Registration of Births and Deaths by the Immigration and Checkpoint Authority (ICA) on an annual basis. The annual number of suicide cases by age group in the past five years is summarised at Table 1. Persons who are greatly distressed and attempt to take their own life require help and the criminal justice system may not be the best option to deal with attempted suicides. As of 1 January 2020, attempted suicide was decriminalised via the Criminal Law Reform Act 2019. The number of attempted suicides that the Police had attended to in the past five year is summarised at Table 2. Suicide prevention spans several sectors including health, social and education, and are based on four key strategies: (a) building mental resilience; (b) encourage help seeking and early identification; (c) supporting at-risk groups; and (d) providing crisis support. Efforts under these strategies are integrated with mainstream mental health and well-being programmes implemented in various settings. These programmes received over $28 million from Government grants and community funds in Financial Year 2020.”
“To complement the efforts of public agencies, there are several ground-up initiatives within the community to support vulnerable pregnant women. Safe Place, an initiative by Lakeside Family Services, provides unsupported pregnant women and mothers with newborn babies a temporary place to stay for up to four months after giving birth and offers them case management and counselling services. In addition, Babes Pregnancy Crisis Support provides casework and counselling for teenagers aged 21 and below who have difficulty in coping with their pregnancy, to help them make informed decisions regarding their pregnancy and parenting roles and provide them with parenting and self-care skills. It also offers befriending services to support the teenagers in their social and emotional well-being.”
“Healthcare professionals are legally required to notify the Police if they suspect that an offence, such as suspected sexual assault or physical abuse, has been committed under section 424 of the Criminal Procedure Code (CPC). In addition, healthcare professionals are bound by professional ethical codes to make decisions in the best interests of their patients and to refer patients with needs that they are unable to address, to other avenues for appropriate care. Pregnant women with identified needs are provided with psychosocial support and referred to medical social workers, nurses, care coordinators, as well as social and community services for relevant assistance as part of routine obstetric care. For example, to better support pregnant women from low-income families with symptoms of depression and anxiety, the National University Hospital (NUH) launched a pilot programme, Promoting Parental emotional health to Enhance child Learning (ProPEL), in 2018 to provide tailored interventions to these women during pregnancy and until the child turns one year old. Under this programme, case managers and social workers provide support and deliver cognitive-behavioural therapy and occupational therapy-based interventions through home visits, where necessary. In addition, under the KidSTART Home Visitation Programme, which is led by the Early Childhood Development Agency (ECDA), in partnership with the KK Women’s and Children’s Hospital (KKH) and NUH, home visitors equip low-income pregnant mothers and parents or caregivers of newborns with knowledge on early childhood development, health and nutrition up till the child is three years old.”
“These questions have been addressed via a Ministerial Statement by the Minister for Health, in his capacity as Co-Chair of the Multi-Ministry Task Force, on 26 July 2021. [ Please refer to "Fifth Update on Whole-of-Government Responses to COVID-19", Official Report, 26 July 2021, Vol 95, Issue 33, Ministerial Statement section. ]”
“In 2020, the Government provided around S$349 million in subsidies to 13,850 nursing home residents for nursing home services. This translates to an average of S$2,100 monthly or S$25,200 annually spent on each subsidised nursing home resident.”
“These questions have been addressed via a Ministerial Statement by the Minister for Health, in his capacity as Co-Chair of the Multi-Ministry Task Force, on 26 July 2021. [Please refer to "Fifth Update on Whole-of-Government Responses to COVID-19", Official Report, 26 July 2021, Vol 95, Issue 33, Ministerial Statement section.]”
“The only registered Oral Morphine one milligram per millilitre (1mg/ml) Syrup (Statex) in Singapore was discontinued in 2019 as the plant ceased manufacturing the product. The Agency for Logistics and Procurement Services (ALPS) then brought in Oramorph 2mg/mL syrup, which contains Ethanol, for use in public healthcare institutions (PHIs). This was the only alternative that we were able to source for at that time. Doctors were advised to offer non-alcohol based medications with the same analgesic effect instead of oral morphine solutions for their patients who could not take ethanol containing medication. ALPS has since procured a non-ethanol containing morphine syrup, Ra-morph 1 mg/ml preparation for the PHIs. Each preparation is clearly labelled with the formulation and dosage instructions. Doctors, pharmacists and nurses work together to educate patients and caregivers on the differences in the medications and help them to switch from one formulation to another, when necessary.”
“Riders are optional private insurance products that are paid for by policyholders in cash, to provide as-charged and zero co-payment coverage. Since 2019, MOH has required a minimum 5% co-payment for all new rider products to mitigate the risk of a "buffet syndrome" and avoid unsustainable healthcare cost and insurance premium increases. Some insurers have chosen to implement the co-payment directly, through claims-based pricing (CBP), or a combination of the two. Regardless of the healthcare insurance plans they choose, all Singapore Citizens and Permanent Residents are covered under MediShield Life, which is a basic health insurance plan that provides lifelong protection against large hospital bills regardless of pre-existing conditions. This protects the interests of all policyholders, including older Singaporeans who have pre-existing conditions. This can be supplemented with optional Integrated Shield Plans (IPs) if higher coverage is preferred. MediSave can be used for MediShield Life and IP premiums, and these are not subject to CBP. Policyholders should carefully assess the terms of their private rider policy plans and consider discussing with their insurer a plan that is suitable for their needs. There is currently no evidence to show that CBP shifts claims to public hospitals.”
“The Silver Generation Office (SGO) complements this, by conducting targeted and frequent outreach to frail seniors and seniors who are living alone. If seniors decline assistance, SGOs will continue to build trust with the senior’s caregivers or community partners and establish at least one emergency contact whom the senior can approach in times of need. CareLine, a 24/7 social support hotline, provides tele-befriending as well as emergency response services to seniors in distress. As of May 2021, CareLine has supported around 10,000 vulnerable seniors and has been collaborating with SGO and the ECs. Seniors may also contact other support hotlines such as The Seniors Helpline operated by Sage Counselling Centre, and Samaritans of Singapore Hotline, which provide counselling and suicide prevention resources. MOH will continue to work closely with our partners to develop community resources and build their capabilities to better support the mental health and well-being of the population.”
“MOH adopts a multi-pronged approach, comprising upstream prevention, supportive care as well as crisis intervention for those at-risk of mental health difficulties. Under this approach, there are several channels of help: The Institute of Mental Health (IMH)'s Mental Health Helpline, available to the public 24 hours daily, provides counseling for those suffering from psychological and psychiatric problems. Within the community, Family Service Centres (FSCs) provide case management and counselling support to low-income and vulnerable individuals and families, to help them deal with financial and other difficulties. In addition, there are dedicated programmes for the young and old. IMH’s Community Health Assessment Team (CHAT) conducts outreach and mental health assessments for young people between 16 and 30 years old. In 2020, CHAT has performed more than 760 mental health assessments and close to 200 webCHAT sessions. The Agency for Integrated Care (AIC) has been working with community partners to provide persons at risk of mental health conditions or dementia, with related information and link them to community resources. As of end 2020, we have set up 50 community outreach teams and reached out to more than 54,000 people in the community. AIC also supports and conducts e-training courses and provides relevant materials for community partners, including faith-based organisations. Various initiatives are also in place to pre-empt social isolation, which is often associated with higher rates of depression and higher suicide risks. For example, befrienders based in Eldercare Centres (ECs) make regular home visits and check-in calls to seniors needing support.”
“If I am not wrong, the US has not come to a conclusion and neither have we. We are studying this actively whether we need a third dose as a booster, when and what kind of strategy – whether you use back mRNA or use a heterologous strategy. So, these are all being studied. And when the Expert Committee has made a decision, we will make the information public.”
“Thank you. On the issue of the Sinovac vaccine, I have explained earlier. Rather than doing serology tests – and amongst our experts, there are also different interpretations of serology tests – I think the easiest thing is to go back to what I have said just now. As of 5 July, Sinovac has submitted all the required data for us to do a proper evaluation under our PSAR framework. So, let HSA do its work. It is trying to do it as fast as it can. And if the Sinovac vaccine or other vaccines in time get approved under PSAR, naturally, we will want to take a more inclusive approach in recognising them. As for helping our immediate neighbours, all these purchase agreements have quite strict contractual requirements. So, we cannot take delivery and then donate to another country or region. Our contracts require us to discuss with the suppliers. But, certainly, where we can help, we will want to help our immediate region because it is only when every country around the world and in the region recovers from COVID-19 that we will really be able to live with COVID-19 as an endemic disease.”
“The basis of projection is because we watch the number every day. I do. Right now, those who have taken the first jab, it is already 76% and that is over the whole population, including those under 12. And if you break it down by age bands, it is well over 80% – 85% to 88% – except for the most senior group, age above 70, which is at 76%. So, just based on who has taken the first dose and so long as they turn up for second doses which they tend to, by the time we reach National Day, we should be close to 70% receiving two doses. And we believe that if that momentum continues, by September, I think there is a very good possibility that we will reach 80%. Assoc Prof Jamus Lim is right that, if that comes about, that means vaccine hesitancy in Singapore is actually much lower, compared to other countries. And I think this is a function of us working together as a united people, trusting each other, with trust between Government and people. And that is what helped us overcome vaccine hesitancy. We still have a lot of work to do for those who are older, but let us continue this work.”
“The answer is yes. I think the quick test centres, in time to come, are likely to be almost a national infrastructure for living with endemic COVID-19. I can imagine buildings and employers requiring that their employees should be tested once every 14 days or seven days before coming to work as a precaution, as part of living with COVID-19. And the easy way to do it, either you buy a self-test kit from the pharmacy or you walk into one of these quick test centres, do a self-swab or do a breathalyser test. And, under those circumstance, I think we need to study the demand pattern and, if need be, we will need to operate on more days of the week or for longer hours. Right now, it is five days, 10.00 am to 5.00 pm, I think, because many of the F&B outlets find that weekends are not suitable for them. But as we move into the next phase and, judging by the demand, we will have to adjust the timing.”
“Sorry, Mr Deputy Speaker, I missed out one question by Mr Gerald Giam just now. He mentioned whether we are rushing dose one and dose two by keeping only a three-week duration and whether a longer duration will make the vaccine more effective. That is the hypothesis of one study and it is not conclusive. There are many other studies that show that three weeks for the Pfizer-BioNTech vaccine and four weeks for the Moderna vaccine is an appropriate duration and delivered good efficacy. So, I think the conclusion is not definite.”
“I did not quite get the second question so maybe Minister Lawrence Wong can help answer that later. Whether we can make vaccination compulsory like we did for measles, mumps and rubella (MMR) and others, it is not time yet to think about that proposition. Because as of now, the use of the vaccine is under PSAR, the Pandemic Special Access Route. So, it is under emergency use, in a pandemic situation. To make it mandatory, I think is not quite consistent. In time to come, when COVID-19 is really endemic, maybe it is a policy that governments around the world will have to consider. On the third question, which is related to Ms Nadia Samdin's question, how do we distinguish between those who knowingly choose not to vaccinate versus those who cannot get vaccinated? From a public health point of view, they are actually the same. They are equally vulnerable and we ought to treat them the same. If you are not vaccinated, to protect you, best not to join the big events. It cannot be that because your intention is different, we let you join. That would not make sense from a public health point of view. Having said that, as I mentioned earlier, we will think of measures, such as you get yourself tested and you can join or, in time to come, when our vaccination rate is very high and our collective resilience is so strong, we actually do not need much of that differentiation.”
“The next step is for those regions that have also controlled their infections and have a risk level about the same as ours – we can, for example, open up for vaccinated travellers, to and fro, without the need for Stay-Home Notices (SHNs) but require a series of tests. I think whatever step we take, we must always make sure that it does not raise our risk level but maintain or even lower our risk level. That would be our approach.”
“There were a couple of questions. One on the Sinovac vaccine. Actually, if one is vaccinated with Sinovac now, it does reflect in your Health Hub app and in brackets the letters "SAR". So, it is recorded that you are vaccinated. I think the question is whether it should then be conferred the concessions, should we have differentiated safe management measures? I would say that, currently, there are different vaccines and every vaccine has a different efficacy. From a public health point of view, it would not make sense to just treat every vaccine the same. I mentioned in my Statement just now that the efficacy of the Sinovac vaccine against the Delta variant, because of the places that it has been applied and administered, that data is still being built up. At the same time, when Sinovac applied to HSA for Pandemic Special Access Route (PSAR) approval earlier, the data was not yet complete. But that data has now been submitted, early this month. So, we have a lot of data now before us. The data on efficacy against the Delta variant is building up. We have got data submitted to HSA. We will assess them robustly and if it is approved under PSAR, naturally, it will be recognised. The third question, if I get correctly, is if we allow travel lanes to open, whether we will ensure that travellers to Singapore are also vaccinated. As explained by Minister Lawrence Wong just now, I think we have to open up travel very carefully, step by step. If not, you will inject infections into our community and make things go out of control again. So, for example, we have unilateral opening for very safe regions. So far, it has not caused community spreading because we assessed those regions and know that they are very safe.”
“Oh, it should not be the case. But if you can give me the contact, we will be more than happy to help them facilitate and make an appointment. There are 20 over clinics that are doing that now.”
“Thank you. I think, first of all, is to try to explain to the seniors, which I have tried a lot, which is that the mRNA vaccine actually has been developed for many, many years. It is not something so novel and so new. It went through all the rigorous evaluation by different authorities and then approved and, so far, even in Singapore, a few million people have taken it, around the world even more and it is proven to be safe and effective. Every vaccine will have side effects, including Sinovac, including mRNA. So, it is a good vaccine and, as far as possible, we want to persuade everyone, including our seniors, to take the mRNA vaccine. But for those who are simply not comfortable or they are contra-indicated for mRNA vaccine and they want to take the Sinovac vaccine, we now have made it available under the Special Access Route. They can make an appointment. It may involve some waiting, but they will eventually get their vaccinations. I have reported just now that 72,000 people have gotten their doses. For all those who have taken the Sinovac vaccine, only 10% are Singaporean seniors above 60 years old. So, the great majority of Singaporean seniors actually still prefer the mRNA vaccine. So, make the appointment. You have got to wait a while, but you eventually will get the vaccine.”
“How did the virus get into the Jurong Fishery Port? As I mentioned earlier, phylogenetic study shows that there is likely to be multiple points of entry because there are slight genetic differences in the virus and the infections across the cluster. We will continue to see if we can trace the sources of the infections. But as of now, it does not help us to suppress the cluster. It helps us understand the infections, the infiltration, how it happened and it helps us strengthen the safe management measures in future.”
“Thank you. I will provide some answers, then I will invite Minister Grace Fu to supplement with her clarifications. First, on the differentiation. I would not call it discrimination because there are good public health reasons to differentiate the treatment between those who are vaccinated and not vaccinated. The differentiation helps protect those who are not vaccinated. The Member asked about whether TraceTogether app can indicate vaccination status. I believe it already does. Mine does; it says that I am vaccinated. You can check yours. Second is that children or seniors who, because of medical conditions, are not allowed to be vaccinated, whether they get left out. Earlier on, when we came out with the "two-five rule", one of the criticisms is that it was so confusing. And indeed, the confusion arises because of the exemptions we were trying to give. For example, in a group of five, all vaccinated, but you allow up to two children below 12 who cannot get vaccinated, but can join part of the group. So, I think, when we do our mid-term review, we will also take into account these provisions. And as for those who cannot be vaccinated or unvaccinated for some reason, but want to join such a group, we had earlier also allowed them to take a PET (Pre-event Test). If you are negative, you can join the group. This is something we will consider as we do our mid-term review. Lastly, I do want to reiterate a point I made earlier. When we get to a very high level of vaccination rate, there should be very little differentiation between vaccinated and unvaccinated, because collectively, we will be very resilient. By then, there will probably be justification for lesser differentiation. As for the point on whether seafood is safe, seafood is absolutely safe to consume.”
“There is a last question by Mr Pritam Singh on vaccine supplies. Supplies continue to be in shortage throughout the world. Many developing countries are still trying to secure supplies and, in the earlier stage of the pandemic, we, too, were short of supplies. But, fortunately, we had negotiated advance purchase agreements (APAs) with major suppliers in the early stage of the pandemic. And, lately, we were able to bring forward and confirm some of the deliveries. So, as of now, for the past month or two, we have not had a supply problem. Our constraint now is we need more people, especially our seniors, to come forward and get vaccinated.”
“Mr Deputy Speaker, Sir, Singapore is one of the few countries to have come through the last 20 months of the pandemic with very few fatalities. And we can look forward with confidence to living with an endemic COVID-19 because a high proportion of our population will be fully vaccinated. Most of the developing world still has little access to vaccines. And even among the countries and regions which have the vaccines, Singapore is unique. We have one group, including the US, UK, Israel and many EU countries, which went through major episodes of widespread transmission, hospitals overwhelmed, with many fatalities. They are now highly vaccinated and opening up their economies and societies. And then, there is another group, the likes of Australia, New Zealand, Hong Kong, maybe South Korea, who kept the pandemic under control, but are now finding it a challenge to get their people vaccinated, partly because their lives have not been very threatened by COVID-19. This will make us perhaps the only country in the world, which has not suffered a collapse of our hospitals nor a high death toll and at the same time, achieved a very high vaccination rate in our population. This uniqueness is due to the unity of our people, the trust amongst them and between the people and Government. Mr Deputy Speaker, Sir, we can look towards the road ahead with confidence and optimism. [Applause.]”
“As a Government, we need to recognise that our society is diverse, with different segments of the population having different opinions, needs and wants. When these differences cannot be reconciled, we agree to disagree, we live and let live. At the same time, we do our best to unite and forge a consensus, for what is a society without shared commonalities? This is what a responsible Government needs to do across a range of issues: from education, healthcare and public housing, to racial harmony and free trade. We must always try to strike the right balance between forging a consensus as well as respecting diverse views. It is the same when it comes to learning to live with COVID-19. On the one hand, we have the young, vaccinated individuals who feel that we should open up and allow vaccinated individuals to enjoy more social activities. On the other hand, we still have a sizeable segment of older Singaporeans who for medical or other reasons are yet to be vaccinated and who remain vulnerable. Differentiated safe management measures is something we have to put in place for public health reasons and to protect the unvaccinated. At the same time, we must do our best to get more of the vulnerable vaccinated. As I reported just now, we are making progress. As for the non-vulnerable, as more of you get vaccinated, when you show more consideration to others, you are also doing your part to better protect the vulnerable. Remember, our children, our nieces or nephews, younger brothers and sisters under 12, will not be vaccinated for a while yet. When we work together as a people, we will bring ourselves to a much stronger and more resilient position and our transition to living with COVID-19 will gather pace.”
“Hence, we have to do what is practical and reasonable, which is to have VIFAP applications reviewed by a panel of medical experts, who will consider them against known evidence about the vaccines. A few Members have also asked about the Sinovac vaccine. The Sinovac vaccine is called CoronaVac but we always just call it Sinovac. Sinovac is the company; the vaccine is CoronaVac but for simplicity, we just refer to it as the Sinovac vaccine. As at 25 July 2021, about 72,000 persons have received at least one dose of the Sinovac vaccine and about 17,000 persons have received their second doses. Amongst them, 28% are Singapore Citizens and they are mostly young. Of those who have taken the Sinovac vaccine, only 10% or in fact, less than 10% are Singaporean seniors above 60 years old. If the supply of 200,000 doses which the Government has procured is insufficient to cater to the demand, private clinics can bring in additional supply, as is the case for any other WHO EUL vaccine under the Special Access Route. As of 9 July 2021, HSA had received 10 adverse event reports following vaccination with the Sinovac vaccine. The events comprise mainly allergic reactions such as itch and rashes. As for concessions on safe management measures, the data on the efficacy of the Sinovac vaccine against the Delta variant is still building up. Sinovac has also recently submitted the required safety data for their application for the Pandemic Special Access Route approval to HSA. HSA and our Expert Committee are going through the various data. When the evidence justifies it, we will certainly want to extend the concessions to individuals who have received the Sinovac or other vaccines which may qualify. Mr Deputy Speaker, Sir, let me conclude.”
“Wastewater testing is an increasingly strategic resource as we learn to live with COVID-19. Where we place the sites is very important. We can deploy them in areas where we suspect transmission is happening, such as around the markets that are currently affected, or where we know many unvaccinated seniors live. Such testing is non-intrusive and would give us valuable early warning when COVID-19 starts to take hold in a locality; we will know very early. And that will prompt us to take further public health measures in the affected residential estates. Mr Darryl David, Dr Lim Wee Kiak and Mr Murali Pillai asked about the safety of the COVID-19 vaccines. MOH has been publishing monthly safety data updates on our website. It also gives an age breakdown of the affected persons and indeed, the majority are young people. As of 30 June 2021, HSA had received 12 reports of myocarditis and pericarditis occurring in persons after receiving a dose of the mRNA-based COVID-19 vaccine. While there is a small increased risk among those in the younger age groups relative to the baseline rate, the local incidence rate remains low. One of the reported cases is a full-time National Serviceman in the Singapore Armed Forces who is below 30 years old. None of the cases was from the Singapore Police Force and Singapore Civil Defence Force. We implemented the Vaccine Injury Financial Assistance Programme or VIFAP to give greater peace of mind to people taking the vaccinations. But remember that with or without vaccination, there is a baseline number of disease cases amongst our population. Since the vast majority of Singaporeans have stepped forward to be vaccinated, there will naturally be numerous incidents which just happen to coincide with vaccinations.”
“Antibody testing is not required after vaccination under Singapore’s National Vaccination Programme and we are actively reviewing the need for vaccine boosters. We are also continually reviewing Singapore’s portfolio of COVID-19 vaccines. We plan to bring in non-mRNA vaccines that are robustly assessed for quality, safety and effectiveness. This should happen before the end of the year, subject to supply and regulatory approval. Testing will remain very important, even as we transit to living with COVID-19. Because it is only through testing that we can know if we are infected and do the civic-minded thing in excusing ourselves from work and staying home. But we have to make testing simple, accessible and affordable, even more so than now, so that we can all do our part. I believe many Members have done the breathalyser testing just now. So, it is one example of a test that is non-intrusive, simple, easy, accessible and fast. Since mid-June, we have progressively rolled out regular Fast and Easy Tests for staff working in higher-risk settings. This includes a network of 16 Quick Test Centres, which we intend to expand further. In response to Ms Joan Pereira’s question, the Quick Test Centres will support small businesses by allowing their staff to walk in and get themselves tested and have their results recorded. At some point, I believe, the Quick Test Centres should also be using breathalyser tests. We will continue to work with NEA to deploy wastewater testing across Singapore. Mr Dennis Tan asked about this. Currently, NEA has deployed 270 auto-samplers across about 200 sites. Every site can have a few, two or more auto-samplers. We are increasing this to 500 auto-samplers across 400 sites by end of this year.”
“When our whole society is very highly vaccinated and we have transitioned to living with COVID-19, we should make very little differentiation between the vaccinated and the unvaccinated. But during this period of transition, when we are still building up our resilience, differentiation by vaccination status is a practical way to open up some activities first while protecting those who are still vulnerable. The MTF will revisit this during our Phase Two (Heightened Alert) midpoint review and Minister Lawrence Wong will speak more about that later. Let me address several other questions from Members. Mr Murali Pillai will be comforted to know that MOH actively monitors international developments in medical treatment options for COVID-19. This is done through the National Centre of Infectious Diseases (NCID) and an expert committee. They have developed national treatment guidelines which are constantly updated based on new evidence. They provide guidance to our doctors on the use of evidence-based medical treatment options for COVID-19 patients. Our local institutions have also been participating actively in international multi-centre trials investigating novel COVID-19 therapeutics. These trials have generated important data on new COVID-19 treatments such as remdesivir. We will continue to closely monitor developments in COVID-19 treatments, proactively procure therapeutic agents which are shown to be effective and maintain a stockpile based on projected needs. To Mr Leon Perera’s question, factors that affect COVID-19 vaccine efficacy are an area of active study in Singapore. Persons who have contracted COVID-19 are clinically assessed for risk factors and scientific papers on the correlations may be published in future.”
“In the meantime, what we are experiencing in this current wave of transmission is also valuable because we are also witnessing a palpable shift in our collective psychology. The first, I think, is a shift away from always focusing on infection numbers. We used to get a shock when we see high daily numbers because this will mean that a week or two from then, we will see more severe illnesses and deaths. However, in recent days, that mental link is starting to be broken as we know that, with vaccinations, high infection numbers need not necessarily mean more sickness and deaths. Many people are now rightfully focusing on the number of people with severe illnesses. As of today, despite the higher infection cases over the past few days, that number is 14 and does not threaten our hospital capacity. Many friends, including Members of this House, have been texting and asking me: why do we not publish the number of people with severe illnesses so that we know that vaccination works? Actually, the media have been publishing these numbers every day for quite a while now. But our attention is always on the infection numbers. It is good that the attention is now shifting. I will not say that there is a huge psychological shift but I think the shift is starting to happen. A second shift is a greater acceptance of differentiated safe management measures between those who are vaccinated and those who are not. There have been many calls to do this. Mr Xie Yao Quan has also asked about this. This is something which the MTF has always intended to do. That was why we decided on the "two-five rule" for restaurants when the KTV cluster broke out. But it was scuttled with our reversion to Phase Two (Heightened Alert).”
“This was already the practice for all cases aged between 17 and 45, but we are now expanding the protocol to people up to 59 years old. With this change, we expect up to 60% of infected cases to recover in community care facilities instead of in acute care hospitals. Meanwhile, we will plan for the next step. This is just the first step. We will plan for the next one where perhaps 80% can be admitted to community care facilities and some can even start to recover at home. The second change is, we have shortened the length of stay in hospitals and community care facilities. Our tests have shown that the viral load in infected persons who are fully vaccinated falls very rapidly to a very low level after nine days. Previously, most people, generally, were discharged only after 21 days. We are now discharging fully vaccinated persons after 14 days from the onset of illness, with a seven-day leave of absence in addition, so long as their tests show that they are COVID-19 negative or have very low viral loads. We are reviewing our policy to allow fully vaccinated patients to be discharged even earlier and to complete the rest of the isolation period at home if their home environment is suitable. The third change is the greater use of home quarantines. For fully vaccinated persons, they can now serve their quarantine at home instead of at a dedicated Government facility, provided that their home is suitable for isolation. We expect that up to 40% of persons under quarantine can serve their quarantine at home and this will go beyond 50% in the coming few weeks as more people get vaccinated. These are amongst the first steps that we will take in the healthcare transition.”
“During an influenza season, our daily infection rates can go up to as high as 1,000 a day. Imagine we treat influenza like we treat COVID-19. This is what will happen. We will put everyone suspected of influenza infections through polymerase chain reaction (PCR) tests and then long isolated stays in hospitals. Then, everyone they come into contact with will be quarantined. A thousand cases a day. This will disrupt the lives of many people. Further, hospital beds will all be filled and many other patients who are sicker will be turned away. The healthcare system will not be able to cope and that is clearly not the way to deal with an endemic disease. So, if we want to live with COVID-19 as an endemic disease, we cannot carry on with the current healthcare protocols. They need to shift closer to how we treat influenza today – without extensive contact tracing and quarantine in dedicated facilities and hospitalising only those who are very ill. But that can only happen when the likelihood of developing a very serious or life-threatening disease as a result of a COVID-19 infection has been significantly reduced by effective vaccination of our population, especially amongst the vulnerable. With our current rate of vaccinations, we have started to take the first transition step to remodel our healthcare protocols. As of last week, we had made the following changes. First, greater use of community care facilities instead of hospitals. Vaccinated individuals aged between 45 and 59 who test positive for COVID-19 and show no or mild symptoms can be directly admitted to community care facilities instead of going first to hospitals. These community care facilities, currently, for example, are NTUC D'Resort as well as Civil Service Club (CSC) Loyang.”
“The MTF has been developing a roadmap comprising packages of measures to be implemented step-by-step over the next few months and with every step, ensuring that opening up is safe for the community. But even as we do so, we must bear in mind that until we reach a sufficiently high vaccination rate, especially amongst our seniors, we will continue to be vulnerable to unexpected setbacks – just like what we are going through now. A high rate of vaccination will provide us with a more solid and stable base as we proceed on this journey. The higher the vaccination rate, the more solid the ground we walk on. So, in a way, this is the most peculiar period of our transition, where we are clear about our mission, our will is firm, we have a broad plan but we do not have enough antibodies in all of us to ensure that we can follow through our plans without a hitch. But let us not underestimate the progress we have made. The roadmap is, in fact, being implemented as we speak. Our attention often is on the Safe Management Measures, or SMMs, such as whether we can eat in restaurants. But there at least three other important aspects, namely: (a) restoring economic and social activities, including connecting with the outside world; (b) remodelling COVID-19 healthcare protocols; and (c) shifting our collective psychology, which, I feel, is probably the hardest. Minister Gan Kim Yong will speak about restoring economic activities while Minister Lawrence Wong will speak more about enabling more social activities. Let me talk about healthcare protocols and our collective psychology. As we learn to live with COVID-19, our healthcare protocols must be remodelled. If COVID-19 is, indeed, endemic, having 200 or more cases may not be an unusual thing at all.”
“Thank you. The top blue line is infection. The bottom line in orange is the number with severe illnesses requiring oxygen supplementation or ICU. As Members can see, while daily infections had gone up sharply over the past couple of weeks, the number of patients with severe illnesses who required oxygen supplementation or are in ICU remained relatively low. There was a slight uptick but relatively suppressed. Currently, all of these patients with severe illnesses are either unvaccinated or partially vaccinated. But we are watching this closely because there is a time lag of one to two weeks between infection and the onset of severe illnesses. For now, it would appear that we have successfully weakened the link between infections and severe illnesses. While we are making good progress in vaccinating our people, we acknowledge that the recent reversion to Phase Two (Heightened Alert) has caused some confusion amongst members of the public. They are asking: is the MTF still committed to the path towards normalcy and living with COVID-19? The answer is a definite yes. For that is the only way for Singaporeans to regain our lives and livelihoods, for Singapore to reconnect with the world again, for our young to look into the future with hope. Some countries, like the UK, have declared a Freedom Day recently, where all social restrictions are lifted all at once. Others, like Israel and the Netherlands, opened up and saw sharp increases in infections and hospitalisations and had had to dial back very quickly. Ours will be a controlled opening. We are not going to do a big bang because, predictably, things will then blow up.”
“We have been seeing about 500 seniors coming forward on a daily basis to receive their first doses for the past few weeks. But for the past few days, that number has doubled to over 1,000 every day now. How did that come about? It is good news. But it may be due to heightened awareness as a result of more community transmission, the lifting of rules that had previously deferred their vaccinations – for those with medical conditions – and also our very intensive outreach efforts. For example, our mobile teams have gone all the way to Pulau Ubin to vaccinate seniors who are living there. We know of general practitioners (GPs) who persuaded and called up their clients, the seniors, persuaded them to go for vaccinations and then opened up their clinics for them to sit in the clinics the whole day so that they feel assured that if they feel unwell, help is always nearby, help from someone they trust, their GPs. Mr Deputy Speaker, Sir, this is a measure of the kind of society we are. We are making such an extraordinary effort with our seniors because we are not prepared to accept the high fatality rates amongst the elderly that other countries had or are still experiencing. As a result of all these efforts, 77% of our seniors 70 years and above have now received their first doses. Within a month or so, they should all have received their second doses and after that, another 14 days, they should all be strongly protected against COVID-19. Even at our current rate of vaccination – 54% or so for two doses – the preliminary evidence is that it has been effective in reducing the incidence of severe illnesses and deaths. Mr Deputy Speaker, Sir, may I show a chart on the screen, please?”
“That is no longer possible, given how transmissible the Delta variant is and as we open up, people circulate more. So, the only possible way now to eradicate infections is to go into a hard circuit breaker for at least a month, probably two. But we do not want to be locked up. Further, even if we do lock ourselves up, when the circuit breaker ends and we open up, cases will rise again. Eradication is, therefore, not possible nor sustainable. We must instead find ways to live with this virus safely. Several Members, namely Mr Yip Hon Weng, Assoc Prof Jamus Lim, Ms Raeesah Khan, were interested to find out more about our transition plans to live with COVID-19 as an endemic disease. Vaccinations are key to this transition and the national programme is progressing well. As of end of yesterday, 25 July 2021, 54% of our population has received two doses of the mRNA vaccine. And our population vaccination rate is going up by about one percentage point a day. So, by National Day, almost 70% will have received two doses. By early September, it should be almost 80% having received two doses of mRNA vaccines. This means that Singapore, by then, will have one of the highest vaccination rates in the world. It puts us in a strong position to transit to a COVID-19-resilient society. Our main worry is that our seniors, especially those 70 and above, are not sufficiently vaccinated. Today, just over 70% of them have received two doses of the vaccines. Ms Tin Pei Ling asked for an update on the home vaccination scheme. We have launched nine home vaccination teams so far. As of 23 July, 734 seniors had received vaccinations under that programme. Further, more seniors are coming forward to our vaccination centres and also our mobile vaccination teams.”
“We did this to buy ourselves time, precious time, to get more of our population vaccinated, so that we can continue on our path towards living with COVID-19 safely. The preliminary phylogenetic findings suggest that while the KTV and Jurong Fishery Port clusters were all driven by the Delta variant, it is distinct from the Delta variant that infected Tan Tock Seng Hospital and the Changi Airport clusters. The recent clusters have a Delta strain that is more closely related to what we detected in imported cases from our immediate region. However, there are also slight genetic differences between the strains in the two clusters, suggesting that there were multiple introduction points. As of 25 July 2021, the Jurong Fishery Port has a total of 792 cases. It is still growing, but now at a slower rate. The daily infection numbers over the last three days were 79, 79 and 46 respectively. Overall, we have seen a high number of daily cases at over 100 for the past several days. But the situation is stabilising, with daily infections trending down. Percentage of cases isolated or quarantined before turning COVID-19 positive is something we watch closely and it is on an upward trend which is good. That means, when a person started to be detected as positive, he is already quarantined and isolated. On 19 July, that was when the cluster first broke out, we had a total of 163 cases and only 27% were isolated before detection. Lately, this hovers around 40%. Today, we should have more than half of our cases already isolated. If we can keep raising that percentage through tracing and testing, we can progressively suppress this wave of transmission. But our objective is not to stop transmissions completely.”
“For the past three days, the daily increase in infection for the cluster was six, five and five respectively. So, it is coming under control. Unfortunately, things got derailed due to a larger and more troublesome cluster and this is the Jurong Fishery Port cluster. On the evening of Friday, 16 July 2021, we started to detect multiple infections at the Jurong Fishery Port, as well as in Hong Lim market. This involved fishmongers, their assistants going about an honest living, collecting fishes at the fishery port, but unwittingly getting infected and then transmitting to more people in the markets and communities where they ply their trade. MOH, with the help of NEA, took immediate steps to prevent further spread by stopping the fishmongers and their assistants from setting up stalls on Sunday, 18 July 2021. It was very tough to tell them "You can't set up stalls". We then issued Health Risk Warnings which required them to undergo PCR tests and isolate themselves until they get a negative result. Of the 1,548 tested, 43 were found to be COVID-19 positive. The numbers are a bit different from what I reported earlier as we cleaned up the numbers. This indicated that significant community transmission had most likely already silently occurred in the days before 18 July 2021, Sunday. Markets are frequented by wide segments of the public, particularly seniors, of whom one-quarter are still not fully vaccinated. The risk of infections rising uncontrollably could not be ruled out. These infections could potentially result in more cases of severe illnesses or even deaths among our vulnerable senior population. Hence, the MTF decided to pre-emptively dial back to Phase Two (Heightened Alert). This came into effect on 22 July 2021.”
“The pivoted nightlife establishments cannot resume operations until they pass inspections to ensure that safe management measure protocols are in place and they have received written approval. Mr Xie Yao Quan asked if we would consider making the individuals in the KTV cluster pay for their COVID-19 medical expenses in full. We are all upset by the irresponsible behaviour of the individuals involved in this KTV cluster, but we still have a public responsibility to ensure that everyone receives the medical care that they need. We also do not want individuals, especially those who are infected, to avoid getting tested and treated, or hide where they have been from contact tracers, because they are afraid of getting penalised. This will make it harder to contain the spread and would cost us more in the long run. We were on the path towards progressive opening and the KTV cluster was a major unexpected bump on the road. The MTF deliberated on the matter, took in advice from MOH experts and came to the conclusion that, given our extensive tracing and testing efforts and our population vaccination rate for two doses was approaching 50% at that time, on balance, we felt that the cluster ought not significantly change our plans to open up. Hence, on 16 July, the MTF announced our decision to maintain our then current safe management posture. We made some adjustments to the rules for eating in restaurants, we called it the "two-five rule". Two, if you are unvaccinated; five, you can dine together, provided everyone is fully vaccinated. Based on how the cluster has developed, we still believe that was the correct call. As of 25 July 2021, that means end of yesterday, the KTV cluster has a total of 237 infected persons.”
“Mr Deputy Speaker, Sir, today, my fellow Co-Chairs of the Multi-Ministry Task Force (MTF), Minister Gan Kim Yong and Minister Lawrence Wong and I will be delivering Ministerial Statements to update Members on the COVID-19 situation in Singapore. Our Ministerial Statements will address Oral Question Nos 1 to 5 and 26 to 28 and Written Question Nos 28, 29 and 31 to 33 on today's Order Paper. It will cover questions on the KTV and Jurong Fishery Port clusters, our COVID-19 vaccination programme and our plans to transit to live normally with COVID-19. Mr Murali Pillai1,2, Assoc Prof Jamus Lim3, Mr Darryl David4,5, Mr Xie Yao Quan6,7, Mr Yip Hon Weng8, Mr Seah Kian Peng9, Ms Raeesah Khan10 and Mr Sitoh Yih Pin11 have filed Oral and Written Questions scheduled for future Sittings on these issues. As today’s Ministerial Statements would address those questions, Mr Deputy Speaker, Sir, I would like to invite these Members to seek clarifications, should they have any, on these issues after the Ministerial Statements. And should their queries be sufficiently addressed, it may not be necessary for them to proceed with their Parliamentary Questions (PQs) for future Sittings. With that, let me start. On Monday, 12 July 2021, MOH detected several COVID-19 positive cases amongst individuals who frequented KTV bars and lounges. These individuals included patrons of the bars and hostesses who worked in the lounges. These activities were considered very high risk and had been disallowed since the beginning of the pandemic. The cluster grew rapidly and MOH moved in quickly to isolate infected persons. We identified rings of contacts and tested them for COVID-19. We ordered a two-week suspension of operations in all pivoted nightlife establishments from 16 July till 30 July.”
“Mr Deputy Speaker, may I answer Question Nos 1 to 5 in my Ministerial Statement later, please?”
“As of 25 June 2021, MOH has received 292 complete applications for the Vaccine Injury Financial Assistance Programme (VIFAP), of which 267 applications have been reviewed by the independent VIFAP Clinical Panel. Of the 267 applications which have completed review, 102 applications were assessed by the Clinical Panel to have met the qualifying criteria for VIFAP. A total of $451,000 have been paid out or are in the process of being paid out to these individuals. A total of 159 applications did not meet the VIFAP eligibility criteria. Thirty-one applications are pending review by the Clinical Panel, or are pending additional medical information from the applicant’s doctor.”
“We currently do not waive quarantine measures on the basis of vaccination and there is no formal appeal process to do so. Vaccinated individuals have a lower risk of getting infected. However, if infected, they can still transmit the disease to others in the community, especially to unvaccinated individuals. Therefore, all persons in close contact with COVID-19 cases are required to be quarantined regardless of vaccination status, until we reach higher vaccination coverage levels in our community.”
“Our rate of vaccination has been contingent upon our vaccine supply. In recent weeks, we have confirmed our supply delivery and accelerated our vaccination programme. All who have registered for vaccination can expect to receive their first dose of the vaccine within the month of July. The Expert Committee on COVID-19 has recommended that the maximum interval between mRNA-COVID-19 vaccines could be extended to between six and eight weeks.”
“As at 3 July 2021, a total of 17,296 unique individuals have received one dose of the Sinovac-CoronaVac vaccine. Some individuals cannot take the mRNA vaccines due to medical reasons. Providers will not charge these groups of individuals for the vaccination and MOH will reimburse the providers directly. Vaccination with Sinovac-CoronaVac started on 18 June 2021. As at 29 June 2021, two non-serious adverse event reports have been received. MOH and HSA will continue to monitor this and will provide an update if any significant safety concern is detected.”