Expert Committee on COVID-19 Vaccination Expands Medical Eligibility for mRNA Vaccines

    The Expert Committee on COVID-19 Vaccination recommends extending the use of the mRNA COVID-19 vaccines by Pfizer-BioNTech and Moderna to population subgroups previously restricted. This is following the Committee’s monitoring and review of local and international vaccination data.

Pregnancy and Breastfeeding

2          In the initial roll-out of the vaccination programme, data from the vaccination of pregnant and breastfeeding women was limited. Hence, additional caution had been exercised to recommend pregnant women to defer vaccination, and breastfeeding women to consider suspending breastfeeding for 5-7 days after vaccination. Internationally, the mRNA COVID-19 vaccines have since been rolled out to large populations, including pregnant and breastfeeding women.

3          Now that more data and experience have been accrued for these populations, the Committee has observed no evidence to suggest that the Pfizer-BioNTech or Moderna COVID-19 vaccine causes harm to pregnant women or their babies. The Committee recognises that the amount of data collected on this group is comparably smaller than data on the general population, and long-term monitoring will still be needed. The Committee assessed that the known benefits of COVID-19 vaccine outweigh the potential risks, and pregnant women can be vaccinated. Pregnant women should discuss the risks and benefits of the COVID-19 vaccine with their doctors to make an informed decision whether to proceed with the vaccination.

4          The Committee now recommends that there is no need to suspend breastfeeding after receiving the Pfizer-BioNTech or Moderna COVID-19 vaccine. This is because the data and experience has demonstrated that it is safe for women to be vaccinated without curtailing breastfeeding.

Cancer Patients on Treatment

5          Cancer patients on active treatment [1] remain a vulnerable population that is at an increased risk of complications from COVID-19 disease due to their weakened immune system from their cancer treatment. There is also currently no evidence of safety issues or increased rates of adverse events from mRNA COVID-19 vaccines in this group. A weakened immune system may reduce the vaccine efficacy, but unless this is severe, the vaccine can still offer good protection against COVID-19. The extent and severity of immunosuppression vary across the different modalities of cancer treatment.  As such, cancer patients on treatment should discuss their suitability to receive the vaccine with their treating specialists, and thereafter be vaccinated in a hospital setting.

6          Cancer patients who are on hormonal therapy can already be vaccinated at the community vaccination centres and can continue to do so.

Severe Cutaneous Adverse Reactions (SCAR)

7          Persons with a history of SCAR [2] were previously contraindicated against the Pfizer-BioNTech or Moderna COVID-19 vaccines, out of an abundance of caution. The accrued international data is reassuring, and the Committee has determined that it is safe for this group to be vaccinated.

Way Ahead

8          The Committee is currently reviewing local and international safety data on vaccinating persons with a history of anaphylaxis due to food and other medicines, with a view to allowing this group to receive the mRNA COVID-19 vaccines safely. The Committee intends to complete this review in the next two weeks and to develop guidelines that will allow such persons to be safely vaccinated. We will update the recommendations when this review is completed.

9          Given the local and international data accrued, the Committee recommends that the medical eligibility for using the Pfizer-BioNTech or Moderna vaccines can be safely expanded. The Committee will continue to refine its recommendations based on the emerging evidence. We strongly encourage all persons who are now medically eligible to be vaccinated when the vaccine is made available to them.

[1] Active treatment is defined as chemotherapy, immunotherapy or radiation therapy that individuals have undergone in the past three months or have planned to undergo in the next two months.

[2] Severe Cutaneous Adverse Reactions (SCAR) include Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Drug Rash with Eosinophilia and Systemic Symptoms, Drug-induced Hypersensitivity Syndrome.