28th Jun 2021
The Expert Committee on COVID-19 Vaccination has been made aware of an open letter on social media attributed to a group of 5 doctors, including a cardiologist, calling for a halt in the COVID-19 vaccination of our youths. The group cited reports of the US Centres for Diseases Control and Prevention’s (CDC’s) investigations into the death of a 13-year-old male after being vaccinated with the second dose of an mRNA vaccine. They also claimed that the 13-year-old male from the US had died from heart failure, and highlighted the recent international reports of the association between myocarditis and dose 2 of the mRNA vaccines in young men.
2 The said news report actually did not state death from heart failure as alleged, and the matter is still under investigation by the US authorities. The writers also chose to highlight only one of the presentations to the Advisory Committee on Immunization Practices (ACIP) of the CDC, but failed to mention the point stated in its summary slide that “available data indicate that patients generally recover from symptoms and do well”. They also failed to mention that subsequent discussions at the same meeting went on to support the vaccination of adolescents because the benefits outweighed the risks.
3 The use of safe and efficacious COVID-19 vaccines in Singapore is of paramount concern to the Expert Committee, and we are closely monitoring local and international data to ensure our recommendations are up to date. The Expert Committee had on 11 June 2021 highlighted the possibility of a small risk of myocarditis and pericarditis associated with the second dose of the mRNA vaccines, and the assessment is that the benefits of receiving the mRNA COVID-19 vaccines continue to outweigh the risks of vaccination. The data on myocarditis and pericarditis has not changed, and the Expert Committee’s assessment holds.
4 The risks of acquiring COVID-19 and suffering damaging illness outweigh the risk of vaccination. A meta-analysis of 129 studies from 31 countries involving 10,251 children found that 22.9% of children diagnosed with COVID-19 had been admitted to the intensive care unit, and 3.6% died. In the US alone, of the around 4 million children infected with COVID-19 since the beginning of the pandemic, we have seen around 380 reported cases of deaths in the age group 12 to 17 years, and COVID-19 in the young can result in Multisystem Inflammatory Syndrome in Children (MIS-C) and other prolonged disability. In the face of a more transmissible Delta variant associated with more severe COVID-19, it is imperative that we protect our children from severe COVID-19 and its complications. This will have to mean full vaccination of two doses, as studies showed that one dose of the COVID-19 vaccine confers 33% protection against the Delta variant. In fact, Israel has recently started vaccinating teenagers after the Delta variant caused school outbreaks as well, despite earlier news reports stating a more ambivalent position.
5 The data reported from the US indicates that cases of myocarditis following mRNA vaccinations are rare. In addition, among the small number of cases, almost all had resolved. Professional medical associations in the US, including the American College of Paediatrics and the American Heart Association in the US have continued to strongly encourage vaccination in everyone aged 12 years and older. Nevertheless, we understand the anxiety parents face, and hence we endorse MOH’s position to make vaccination voluntary in Singapore, even as it is strongly encouraged.
6 The Expert Committee continues to recommend the use of the mRNA COVID-19 vaccines for young men. However, as a precaution, vaccinated persons, in particular adolescents and younger men, should avoid strenuous physical activity for one week after their second dose. During this time, they should seek medical attention promptly if they develop chest pain, shortness of breath or abnormal heartbeats. The Expert Committee notes that MOH had also issued guidance to all doctors to properly advise patients on the care they receive.
7 The Expert Committee will continue to monitor the local and international data and will review its recommendations as needed.
EXPERT COMMITTEE ON COVID-19 VACCINATION
28 JUNE 2021