1. I will talk about three aspects of the endemic new normal.
a) The standing down of Trace Together/Safe Entry (TT/SE) system;
b) Latest vaccination guidelines for COVID-19; and
c) New financing arrangements for COVID-19 related treatment, testing and care.
TT/SE
2. At the height of the pandemic, TT/SE has been very useful and play an important role. Through smart phone apps, tokens and also check-in stations for various premises, it helped us contact trace individuals exposed to the virus and slowed down the transmission of the virus.
3. Our general approach has been to collect and retain data only for pandemic response. In addition, Parliament passed the COVID-19 (Temporary Measures) (Amendment) Bill in February 2021 which states that contact tracing data can only be used for investigation or criminal proceedings in respect of a serious crime.
4. Over the past several months, we have been stepping down the TT/SE system. We have not been announcing every step but we have been taking stock and this is what we have done over the past months.
a) Since April last year, we stopped collecting TT tokens from individuals who are infected with COVID-19. In the past, we asked them for their tokens or their apps, and downloaded the data so that we knew their contacts.
b) Since October last year, we stopped requiring SE check-in when we lifted the Vaccination-Differentiated Safe Management Measures (VDS).
c) The Ministry of Health has also deleted all identifiable contact tracing data from all our databases and servers.
d) TT data is retained for one serious criminal case, and that was a murder case. This is for legal reasons because the conviction can be challenged at any point in time. This is as provided by the law that was passed in February 2021 as I mentioned just now.
5. We will take further steps to transit to the endemic new normal. Individuals may now uninstall your TT apps if you wish to. If you have enough space in your smartphone, you can keep them too. Enterprises may do likewise for their SE business apps.
6. We also encourage individuals to return your TT tokens so that we can refurbish and recycle them should we need them in future. The TT token return exercise will start next Monday 13 February 2023. It will run for four weeks and take place at all 108 Community Clubs and Community Centres across Singapore.
7. With these steps, the TT/SE system will be regarded as dormant but we will have it ready for reactivation should the need arise, like the emergence of a dangerous Variant of Concern (VOC).
8. Hence, we will keep the apps available in all the app stores. We will also keep basic information like registration details such as name, business UEN and contact numbers, so that if ever activated, individuals and enterprises do not have to go through so many steps to re-set-up and re-register. That arrangement will put us at a higher and better state of preparedness.
Vaccinations
9. If you recall, some time back, the availability of effective vaccines was a turning point of the pandemic. Our high vaccination coverage is one of the key reasons why we could progressively restore normal lives, while maintaining one of the lowest mortality rates in the world, and arriving at the today’s DORSCON Green and endemic new norm.
10. Today, around 83% of our population have achieved minimum protection. Around half are up to date with their vaccination with additional boosters. Many have also safely recovered from infection.
11. In Singapore, we have a very strong hybrid immunity, a combination of protection arising from vaccination as well as safe recovery from COVID-19. We estimated that probably close to 90% of residents here have already gotten COVID-19.
12. Over the past months, our data also showed that this hybrid immunity stayed very strong. Every month we look at the data expecting that after a certain number of months it should start to drop, but it has not dropped. It is because of this hybrid immunity which has protected individuals from severe illnesses even if infected with COVID-19.
13. This is good news. With this, the risk of COVID-19 infections leading to severe illness or deaths has become comparable to other endemic respiratory diseases, such as influenza or pneumococcal infections.
14. But towards the end of last year and the beginning of this year, we continued to worry because of three imminent risks. One was the year-end travel season when many Singaporeans travelled. Number two was the Northern Hemisphere winter when diseases usually spread. And three was the shift in China's policy away from dynamic zero. All three posed significant risks. We were worried about it but today, those risks have substantially passed.
15. We cannot rule out the future possibility of dangerous VOCs from emerging but the uncertainties and risks we face now is significantly lower compared to one or two months ago. In light of this, the Expert Committee on COVID-19 Vaccination (EC19V) has updated its recommendations on vaccination requirements for COVID-19 for 2023, while monitoring further developments. MOH agrees with these recommendations:
a) Let me start with the general population. For everyone five years and older, they are recommended to attain minimum protection, i.e. three doses of mRNA vaccine or four doses of Sinovac – no change from previous recommendations. Having minimum protection is part and parcel of the endemic new norm. Individuals should proceed to get their vaccination if they have not done so.
b) Second, the most vulnerable groups who are individuals aged 60 and above, medically vulnerable persons, or residents of aged care facilities. Many of them are currently protected by boosters or recent recovery from COVID-19, but this will likely wane over time because of their vulnerable status. Hence, they are recommended to take a booster dose of COVID-19 vaccine at an interval of around one year after their last booster dose – essentially an annual booster, very much like influenza. The difference is currently, the recommendation for them is to take 5 to 12 months after their last dose. Now we move to annual vaccination for this group.
c) Third, younger and healthy persons. They are much less affected by COVID-19 infections, especially if they have already attained minimum protection. Hence, individuals aged 12 to 59 will be offered an additional booster around 12 months after their last dose, if they choose to take it. This is a notch down from the current guidelines, which is that they are recommended to take it.
d) Fourth, children aged five to eleven. They should attain minimum protection. They are not eligible for boosters. No change from now.
e) Fifth, children aged six months to four years. They are recommended to complete their primary vaccination series which means two doses of mRNA. They are also not eligible for further boosters. No change from now.
16. We will continue to monitor the situation and track the data. The recommendations will be constantly reviewed. The EC19V recommended these guidelines for 2023, and they will continue to update that periodically based on the endemic situation and the strength of our population hybrid immunity.
Financing Testing and Treatment
17. Throughout the pandemic, COVID-19 testing and treatment have been provided generally free of charge or at a very low fee, practically for all residents. Given that COVID-19 was an unfamiliar disease, it is important that we remove the uncertainties and concerns on the cost of testing and treatment. We maintained that policy for almost three years.
18. In DORSCON Green, we are establishing an endemic new norm and living with the disease. This includes practically removing all border and safe management measures and managing COVID-19 routinely, like common diseases.
19. Hence, I seek everyone's understanding that we also need to transit to a new normal for financing arrangements and cannot continue with the 100% subsidy. The following changes will therefore be implemented.
a) First, inpatient treatment in a hospital or COVID-19 Treatment Facility will revert to the funding framework of S+3M, i.e. S for government subsidy and 3M for MediSave, MediShield Life and MediFund. This applies to all patients, regardless of their vaccination status. I want to assure lower income Singaporeans that financial assistance will always be available to them to help defray their hospital bills.
b) Second, Community Isolation Facilities (CIF). We set these up in the early stages of the pandemic for COVID-19 patients who are generally well but cannot isolate at home for various reasons. With COVID-19 becoming an endemic disease, it should be treated like influenza, and there should be no need for CIFs. Nevertheless, we will be retaining some for now, for individuals who somehow prefer not to self-isolate at home. But individuals will have to pay for their stay at the CIF, and they cannot tap on S+3M. But we will procure them at a fairly low rate and we will also charge a low rate for people who want to use it.
c) The third change applies to individuals with acute respiratory infection who seek treatment at polyclinics and GP clinics. With Protocols 1-2-3 stepped down, patients will now have to pay for any ART and PCR tests that are required for their treatment, subject to prevailing subsidies, and consistent with how we treat other illnesses. On the other hand, we will continue our surveillance programme so that we can monitor the evolution of the virus. For those tests, they will continue to be free of charge because they are part of our national surveillance programme.
d) Fourth, we will continue to offer free COVID-19 vaccinations and the use of oral antivirals in primary care settings, outpatient settings in hospitals and nursing homes. These drugs can help to reduce the onset of more serious complications, thereby reducing admissions to hospitals and reduce the strain on our system and our healthcare workers. This is also aligned with Healthier SG because when we roll out Healthier SG in the second half of this year, we intend to offer nationally recommended vaccinations free of charge to all Singaporeans when they are eligible.
20. The changes we announced today will be effective 13 February 2023. However, for the new financing arrangements, we will start 1 April 2023, to give more time for transition.
Closing
21. On a personal note, it has been a privilege to serve in the MTF. I joined halfway and it has been a very challenging and meaningful experience. I am very thankful that I am given this opportunity to do my part for this crisis of a generation.
22. While we establish a new norm, my MOH colleagues are very mindful that for us, life is actually no longer the same. Healthcare workers will largely be masked up at work, a constant reminder that the COVID-19 virus is still with us, and we have to be ready for the next VOC or the next pandemic.
23. Our Emergency Departments in our hospitals continue to be very busy. This is partly due to an immunity debt because we took so many precautions, including masking, and partly because of the ageing population.
24. In fact, the more society stands down, the greater the responsibility for the healthcare system and our healthcare workers.
25. Today's announcement is significant but does not mean that our state of alert and preparedness is over. As I discussed with a Cabinet colleague, we are now in ‘senang diri’ position, but not ‘keluar baris’. I don’t know if this is the best analogy. For others at Green, you are at ‘keluar baris’, but you cannot book out yet. For yet others, you can book out, but not yet ORD. For others ORD, but not yet MR.
26. You get the idea. We are all taking one step down, at ease, but we must be ready for the next VOC or pandemic and especially for the healthcare sector, we have to be ready.
27. COVID-19 has taught us valuable lessons and helped us build significant capabilities and certainly for the healthcare sector. We will use them to the fullest and do our best to improve the health of our people. Thank you.