| Q1 | Which vaccines are approved for use in Singapore?
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| | The Health Sciences Authority (HSA) has assessed that the Pfizer-BioNTech and Moderna COVID-19 Vaccines meet safety and efficacy standards. HSA has authorised their use locally under the Pandemic Special Access Route (PSAR) which facilitates early access to vaccines and medicines during a pandemic, such as COVID-19.
This is supported by the Expert Committee on COVID-19 Vaccination (EC19V) which has also reviewed the clinical data on Pfizer BioNTech and Moderna COVID-19 vaccines*. Only vaccines deemed suitable for use in target population subgroups, and where overall benefits outweigh the known risks, are recommended for use by the Expert Committee.
* Links to Press Releases (27 Dec 2020 and 3 Feb 2021): 1. Expert Committee Submits Recommendations on Singapore’s COVID-19 Strategy 2. Government Accepts Recommendations of Expert Committee on COVID-19 Vaccination
3. HSA Grants Interim Authorisation for Moderna COVID-19 Vaccine in Singapore
4. Second COVID-19 Vaccine Authorised for Use in Singapore |
| Q2 | Vaccines for COVID-19 have been approved for use in a shortened timeframe compared to other vaccines or drugs. How can we be sure that scientific rigour has not been compromised? |
| | An accelerated development timeline for vaccines against COVID-19 was possible given the following: a. Significant investment and dedication of resources from vaccine manufacturers to the ramping up of vaccine production; moreover, the mRNA technology platform had already been in development for many years prior to the COVID-19 pandemic. b. Strong global partnerships between many different partners including international organisations, governments, researchers and manufacturers; c. Given the pandemic situation, recruitment for and conduct of the randomised controlled trials to identify the differences in disease risk between those given vaccines and placebo, are able to be conducted more quickly than in the absence of a pandemic. d. Many trials have performed their trial phases concurrently, allowing for sufficient data to be produced in a shorter time. Safety, scientific or ethical integrity have not been compromised, and no short-cuts have been made, but the unique circumstances and factors described above have allowed accelerated development.
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| Q3 | How effective is the vaccine? How long does the protection last? |
| | Based on Phase 3 trial data from Pfizer-BioNTech and Moderna, the efficacy of the vaccines in preventing symptomatic COVID-19 disease, after completion of the vaccine regimen, is about 95%. The vaccines continue to be effective for at least two months with no signs of waning protection. MOH will continue to monitor and review further data on the duration of immunity.
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| Q4 | If it is a single dose, what will the efficacy be? |
| | Two doses of the Pfizer-BioNTech and Moderna COVID-19 vaccines are required to achieve optimal protection against COVID-19. Persons should complete two doses of either the the Pfizer-BioNTech and Moderna vaccines, based on the respective vaccination schedules.
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| Q5 | Can vaccinated persons get infected with COVID-19? Are they less able to transmit the disease? |
| | The Pfizer-BioNTech and Moderna COVID-19 vaccines were shown to be about 95% effective in preventing symptomatic disease. That means that some vaccinated persons may still be vulnerable to infection.
We are awaiting further data on whether vaccination will completely prevent onward transmission of infection. Based on experience with vaccination for other diseases, there is likely to be some increase in protection against onward transmission, even if it is not 100% protection. Most vaccines that protect from viral illnesses also prevent transmission of the virus by those that are vaccinated. |
| Q6 | Who should not get the mRNA-based COVID-19 vaccines?
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| | The mRNA-based COVID-19 vaccines are not recommended for (1) pregnant women, (2) severely immunocompromised persons, and (3) children under the age of 16 years for Pfizer-BioNTech COVID-19 vaccine and children under the age of 18 years for Moderna COVID-19 vaccine for now, until more efficacy and safety data become available for these subgroups.
Persons with a history of anaphylaxis to any drugs, vaccines, food, insect stings or unknown triggers SHOULD NOT receive the mRNA-based COVID-19 vaccines. Anaphylaxis is a severe life-threatening reaction with two or more of the following three criteria:
a) Hives or face/eyelid/lip/throat swelling;
b) Difficulty breathing;
c) Dizziness.
A history of having been prescribed an Epi-Pen suggests anaphylaxis risk and such persons SHOULD NOT receive the Pfizer COVID-19 vaccine at this time.
Persons who had history of an allergic reaction to other vaccines may be allergic to specific components of vaccines which could also be present in the COVID-19 vaccine. These persons may require consultation with a specialist to determine if the person is suitable for vaccination with a mRNA-based COVID-19 vaccine. The vaccination sites will be able to provide the referral to the specialist and will be fully subsidised. These individuals SHOULD NOT be vaccinated with the mRNA-vaccines until they have been evaluated on the suitability of the vaccination with mRNA vaccines by the specialist.
Persons who had history of an allergic reaction to previous dose of the Pfizer COVID-19 vaccine or Moderna COVID-19 vaccine or any of its components SHOULD NOT be vaccinated with the mRNA-vaccines.
Persons with a history of the following severe drug reactions SHOULD NOT be vaccinated with the mRNA-based vaccines. This includes:
a) Stevens-Johnsons Syndrome (SJS)
b) Toxic Epidermal Necrolysis (TEN)
c) Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)
d) Drug-induced Hypersensitivity Syndrome (DiHS)
Persons with atopy (such as eczema, allergic rhinitis or asthma) can be vaccinated.
A person with a family history (but NOT a personal history) of anaphylaxis CAN be vaccinated.
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| Q7 | Who are considered severely immunocompromised and should not receive the mRNA-based vaccine?
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| | The following are some examples of severely immunocompromised persons, but there may be other examples not on this list. If in doubt, patients are encouraged to discuss their suitability for COVID-19 vaccination with their doctor. Individuals will also be assessed by the medical personnel at the vaccination sites for their suitability to receive the vaccination before they are vaccinated.
• Transplant within the past 3 months (solid organ or stem cell)
• On cancer chemotherapy, immunotherapy or radiation therapy
• Aggressive immunotherapy (e.g. Rituximab) for non-cancer conditions
• HIV infection with CD4 < 200 cells/mL
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| Q8 | If a person cannot currently receive the mRNA-based COVID-19 vaccines i.e. is contraindicated against the vaccine, does it mean that the person will not be able to be protected against COVID-19 through vaccination?
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| | Persons for whom the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 vaccine is contraindicated at this time may be able to get vaccinated with these vaccine(s) if data becomes available that it is safe to vaccinate them. Alternatively, they may be able to get vaccinated with other suitable COVID-19 vaccines, when available.
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| Q9 | Can individuals with a history of NSAIDS-induced angioedema or multiple allergies be vaccinated with the mRNA-based vaccine?
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| | While we previously advised that individuals with history of NSAIDs-induced angioedema or history of multiple allergies defer vaccination with a mRNA-based COVID-19 vaccine, emerging local and international scientific evidence had shown individuals with NSAIDs-induced angioedema CAN be vaccinated with a mRNA-based COVID-19 vaccines, as long as there are no other life-threatening signs and symptoms suggestive of anaphylaxis
Individuals with multiple allergies CAN be vaccinated, as long as the allergies are not life-threatening (i.e. anaphylactic) in nature. It is the severity of the allergy, and not the number of allergies that determines if a person can be vaccinated.
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| Q10 | Can persons with active cancer be vaccinated?
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| | Persons with active cancer who are NOT on treatment with chemotherapy, radiotherapy or immunotherapy CAN be vaccinated. Based on the experts’ advice, active cancer not on treatment can be defined as:
• Not being on any of the above treatment in the past 3 months AND
• Not having planned treatment of the above in the next 2 months
Persons with a history of cancer, who are in remission, CAN be vaccinated.
Persons on active cancer chemotherapy, radiation therapy or immunotherapy SHOULD NOT receive the mRNA-based COVID-19 vaccines.
Persons on active cancer hormonal therapy CAN be vaccinated.
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| Q11 | Can persons with prior COVID-19 infection be vaccinated?
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| | Recovered persons who have not completed COVID-19 vaccination may receive a single dose of vaccine. This applies to recovered persons who are unvaccinated and recovered persons who had received one dose of vaccine before being infected. There is evidence shown that a single dose of vaccine can further boost the immunity against COVID-19 in persons who have recovered from a COVID-19 infection.
Recovered persons should discuss with their doctors on when to receive the vaccine. The general recommendation is to wait at least 6 months from the date of infection before receiving the vaccine dose.
No routine testing by PCR or serology is required before getting COVID-19 vaccination to determine eligibility for vaccination.
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| Q12 | Can a woman who is breastfeeding receive the mRNA-based COVID-19 Vaccine?
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| | Women who are breastfeeding can be vaccinated. Out of an abundance of caution, women can consider suspending breastfeeding for 5-7 days after receiving the vaccine. If a woman feels she is unable to suspend breastfeeding and still wishes to get vaccinated, she can be vaccinated.
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| Q13 | How soon after vaccination can a woman try to conceive? Can a woman be vaccinated if she is pregnant? If she received the first dose of vaccine and then became pregnant, can she get the second dose?
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| | Women who are planning a pregnancy are advised to consider deferring conception for 1 month after completing the second dose, out of an abundance of caution. This does not apply to male vaccine recipients.
There is currently not enough evidence to advise on the use of COVID-19 vaccines during pregnancy. It is recommended that pregnant women defer vaccination until more data becomes available. They may receive the COVID-19 vaccine after delivery.
Women who become pregnant after the first dose and before the second dose should not receive the second dose of vaccine, but should postpone it until after delivery.
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| Q14 | Is COVID-19 vaccination safe for those with chronic illness such as hypertension, high cholesterol and diabetes?
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| | The study population for Pfizer-BioNTech’s and Moderna's phase 3 trials included persons with medical comorbidities, who were at risk of serious, life-threatening disease and death from COVID-19 infection, and there were no safety concerns reported in this group. Persons with chronic illnesses are recommended to receive the vaccine for personal protection as well as protecting their loved ones.
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| Q15 | Can I receive another (non-COVID-19) vaccine at the same time as COVID-19 vaccine? How long do I have to wait before getting other vaccines?
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| | There is no data on administering COVID-19 vaccine at the same time as other non-COVID-19 vaccines. A minimum interval of 14 days is recommended before or after any other vaccines i.e. other vaccines should not be administered 14 days or less before the first dose; or 14 days or less after the second dose of a COVID-19 vaccine.
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| Q16 | Can I donate blood after receiving the COVID-19 vaccine? |
| | The Health Sciences Authority (HSA) and the blood bank has implemented a new blood donation eligibility guideline for donors who received a COVID-19 vaccine.
The deferral period may vary depending on the type of vaccine received or if you developed symptoms after receiving the vaccine. Please click here for more information.
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| Q17 | In light of the reported deaths of elderly persons in Norway after taking the Pfizer vaccine, will the Government be reviewing the vaccination strategy in Singapore, and whether any additional precautions will be taken?
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| | MOH, the Health Sciences Authority (HSA) and the Expert Committee on the COVID-19 Vaccination (EC19V) have been monitoring international reports on vaccine-related adverse events and deaths in elderly recipients. The Norwegian health authorities and the World Health Organization’s Global Advisory Committee on Vaccine Safety have found no evidence that the Pfizer-BioNTech vaccine contributes to an increased risk of death in the elderly.
Thus, we continue to offer COVID-19 vaccination for our seniors. It is important and vital to vaccinate and protect seniors, as COVID-19 infection in the elderly has been observed to result in severe, or fatal illness. Nevertheless, MOH has reiterated to vaccination providers that doctors should review the medical history of seniors carefully to confirm that they are indeed suitable for vaccination, and that they should be monitored closely in the immediate period after a vaccination.
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| Q18 | If I am allergic to the first dose of the mRNA vaccine and will not receive my second dose, am I still protected from COVID-19? Will there be suitable alternatives in future for me?
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| | The current mRNA-based vaccines (Pfizer-BioNTech and Moderna)'s dosing regimens recommend for 2 doses to ensure that the optimal protection is provided.
Persons who are unable to receive the full 2-doses regimens of the mRNA-based vaccines may have suitable alternatives in future as more vaccine candidates are made available.
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| Q19 | Moderna is unsuitable for those below 18 years old. How will I know if I or my child is receiving the appropriate vaccine?
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| | Our National Appointment System verifies an individual’s age and will only show vaccination locations carrying the appropriate vaccine. This prevents those aged below 18 years old from selecting vaccination locations that carry the Moderna vaccine. Children 16-17 years old will only be administered the Pfizer vaccine.
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| Q20 | [Added 27 Mar] I am unsure if it is medically safe for me to be vaccinated. What should I do?
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| | MOH has put in place steps to ensure it is medically safe before you are vaccinated. Before making appointments for vaccination, you will be prompted to complete an online screening form, which contains medical questions to screen out those who are unsuitable for the current COVID-19 vaccines (i.e. Pfizer-BioNTech and Moderna). Once you have cleared the online screening, you will be invited to book your appointments for vaccination. In the event that you have booked your appointments but remain unsure if you should receive the vaccine, there will be another round of medical screening conducted at your preferred vaccination site on the day of vaccination. You may seek clarifications or further assessment with the medical professionals onsite to assist with any medical queries that you may have. If you are unsure of your allergy history, the vaccination sites are able to securely access your allergy history if required.
Alternatively, you may consult your regular doctor for advice if you should receive the COVID-19 vaccination. Please note that any charges incurred for such pre-vaccination consultation with your doctor are not covered under the COVID-19 vaccination programme. Your doctor may provide a memo on your condition which will be useful for the medical team at the vaccination site to assess your suitability for vaccination. However, the final decision as to whether you should proceed with vaccination will be made by the medical professionals at the vaccination site.
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