Stronger for the Next Pandemic
Mr Speaker Sir,
1. As of 31 December 2022 and as reported in the White Paper, 1,711 people in Singapore had died of COVID-19 infections.
2. The Ministry of Health (MOH) estimated an additional 2,000 deaths over the course of the pandemic, that is above the expected number of deaths based on pre-pandemic trends.
3. These individuals might have died of undiagnosed COVID-19 infections, or COVID-19 could have worsened some other underlying conditions leading to their deaths.
4. All in, over 3,700 deaths estimated. Most of them older with comorbidities, underlying illnesses, many unvaccinated, and affected most severely by COVID-19. We will never know the exact number, or all the names and faces of every victim of the pandemic crisis.
5. Never had Singapore gone through a crisis that inflicted such a heavy toll on the lives of our fellow men and women, since independence. Nothing even comes close. This is indeed the crisis of a generation.
6. Behind every passing, there were family members, loved ones, doctors and healthcare workers doing their best to comfort and save them. At MOH, and I am sure in this House, we mourn their deaths and extend our deepest condolences to their families.
An Unprecedented Crisis
7. COVID-19 put in contrast our desire to survive and live versus the purpose of living.
8. This same challenge was faced by every country and region: how to navigate out of this dangerous conundrum, regain your normal lives while protecting the lives of people as much as possible.
9. Each country and region faced this challenge and took its own path. Some by choice, others forced by circumstances. I would say how each country or region faired in the COVID-19 challenge essentially boiled down to the following three judgment calls.
10. First, whether in the early stages of the pandemic, we effectively made hospitals the singular defence against the virus. Here, past experiences mattered.
11. Many countries in Europe or the Western Hemisphere deal routinely with Influenza, including very challenging winter season outbreaks.
12. The Influenza playbook was proven to be inadequate for COVID-19. So the virus spread widely, hospitals effectively became their singular defence, which became overwhelmed, leading to many deaths.
13. On the other hand, places like Singapore, South Korea and China had experienced SARS or MERS. We had the processes and capabilities in place and moved quickly to contain our initial outbreaks with stringent border measures, testing and isolation of cases, tracing and quarantining of individuals.
14. We used our entire public health arsenal. We succeeded in preventing our hospitals from being overwhelmed, especially in the initial stages of the pandemic, before there were vaccinations.
15. If there was one thing the Prime Minister constantly reminded the MTF Chairs, it was this golden instruction – protect our hospital capacity. We took it very seriously.
16. Because when the entire weight of a country’s health rests on hospitals, even if that was not the intention, it will not just be COVID-19 patients who would die, but everyone needing urgent medical attention.
17. In many countries, doctors had to turn away patients who were very ill. When a hospital bed or ventilator became available, doctors had the heart-wrenching task of deciding whose life to save.
18. This judgement call – the careful husbandry of our hospital beds, before the great majority of our population was vaccinated - is the primary reason why Singapore kept our COVID-19 mortality rate low.
19. Second, vaccination coverage. Most countries rolled out national vaccination programmes and achieved varying levels of coverage and resilience.
20. Those were confusing times, because the vaccines were new and anti-vaxxers were out in full force, spreading falsehoods and half-truths, to persuade people to avoid vaccinations.
21. I know of friends who do not want to take the vaccines. But it is one thing to have a personal preference, and another to make it a public campaign, because that affects other lives.
22. I had to exercise my authority under POFMA when I judged that a circulating falsehood was misleading people into avoiding vaccines. The law was designed for such occasions, especially when lives are at stake.
23. It is worth stating in this House again, that the weight of global evidence clearly shows that COVID-19 vaccines are effective and safe. Our latest MOH data shows that during the Omicron waves of 2022, vaccines lowered the probability of severe disease and deaths for the elderly by more than five times.
24. Do COVID-19 vaccinations have side effects? Definitely they do. If a medicine has effect, it can have side effects.
25. We were clear and transparent, and published the incidence of side effects every quarter.
26. The incidence of severe adverse effects for the vaccines has been low, typically five to seven per 100,000. A great majority recover on their own, without even going to hospitals. Hence, the benefits far outweigh the risks.
27. Fortunately, the great majority of public trusted our recommendations to take the vaccines. We achieved over 90% vaccine coverage. And I thank the Workers’ Party, for supporting this very pivotal national effort to vaccinate our population.
28. Our collective judgement to achieve high vaccination coverage is the other big reason why we could minimise the number of deaths due to COVID-19.
29. Then came the third judgement call, which is having achieved high population immunity, when should we open up. For many countries in Europe and America, after the virus had already spread widely, with many people infected and with many deaths, their population immunity was high and they could afford to open up early.
30. In the course of the pandemic, many people also urged MOH and the MTF to open up quickly just like these countries. The desire is understandable, but they overlooked the key difference between us and them – they had paid the price in human lives, which we refused to pay.
31. We, along with a small handful of countries, managed the situation tightly, contained the spread of the virus, and used the time to vaccinate as many people as possible.
32. Then came a time to open up, and switch playbooks, from a zero COVID-19 strategy to something closer to managing a bad Influenza season. This was a major psychological leap for doctors, for MOH, and for society.
33. Countries adopted different timetables to re-opening. Australia probably took the first step, followed by Singapore. China did so only recently.
34. Looking back, in all three decisive moments of judgment, I think we collectively made the right calls.
35. Despite this, COVID-19 has been a humbling experience. We have a duty to learn from the crisis and ensure that those whose lives were lost to COVID-19 did not pass in vain.
36. It will not be in vain. We have translated the trials and tribulations of the pandemic into six areas of improvements, to better prepare Singapore for the next pandemic. Let me go through them.
Strengthening Hospital Capacity
37. First, we will strengthen our hospital capacity.
38. Our healthcare system was severely tested during the pandemic. At one point, we were monitoring bed availability, capacity and caseloads almost by the hour, to detect any signs of imminent collapse.
39. Fortunately, we had safe management measures (SMMs) in place and high coverage of vaccinations, which protected our hospitals.
40. At that time, many questions were asked, including in this House - why didn’t we plan for more hospital capacity in anticipation of a pandemic crisis? If we did, we could have relaxed the SMMs.
41. However, this would not be a realistic course of action. To illustrate, even with vaccinations and SMMs, at the peak of the Delta wave in 2021 we had almost 1,300 patients hospitalised and 140 in ICU.
42. If we had relaxed the SMMs, the number would have easily doubled, probably tripled.
43. So this is equivalent to three to four, full general hospitals set aside as spare capacity during peacetime, to be deployed only during a surge. It is not realistic to set aside so much spare capacity.
44. We should not size the healthcare system to take on the full brunt of the next pandemic. This pandemic has taught us that true resilience must come not just from adequate infrastructure, but also from our social resilience – from our collective behaviour.
45. That said, with delays in our infrastructure development due to COVID-19 and rising hospital workload post-crisis, our healthcare system today is less resilient than ideal.
46. Dr Wan Rizal and Mr Gerald Giam raised concerns in this area, which I agree with, especially the stress on healthcare workers.
47. Our public hospital bed occupancy has risen, from a pre-COVID level of 87.6% in 2019, to 93.1% in 2022.
48. This is largely driven by patients staying longer in hospitals. From an average of 6.1 days in 2019, to 7.0 days in 2022. That increase alone explained for all increases in occupancy.
49. And why is that so? Because we are seeing more older patients with complex conditions, who require longer stays. The percentage of senior patients aged 65 and above has risen from 39% in 2019 to 43% in 2022.
50. Many of them are frail, and with comorbidities. We also found an increasing number being hospitalised because of other viral infections, or respiratory illnesses, including pneumonia.
51. We cannot rule out that this could be the after-effects of being infected with COVID-19 for some, or a rebound in other types of infections post-crisis. It may also simply a result of our population ageing rapidly.
52. As I have explained to this House, MOH is doing many things to address this. This includes the recent announcement to strongly protect healthcare workers against abuse and harassment.
53. However, a post-crisis initiative which I have yet to explain are the Transitional Care Facilities (TCFs).
54. TCFs are for medically stable patients from public hospitals waiting for long term care arrangements, such as home or nursing home care. During the pandemic, we set up 500 TCF beds across five sites, operated by private operators.
55. The TCFs have proven to be very valuable. It is as good as adding 500 more beds to our acute hospitals.
56. We have therefore decided that TCFs will become a medium or even long-term feature of our healthcare system. We will retain the current facilities, including continuing to use Hall 9 of Changi Expo primarily as a TCF. We have about 200 beds there. I thank the Ministry of Trade & Industry for sacrificing some exhibition space for MOH.
57. Today, we do not have a TCF in the West, and will start one there in the coming months, in close proximity to Ng Teng Fong General Hospital.
58. We will also continue to expand the community and step-down care sector, such as community hospitals and nursing homes.
Boosting Pandemic Preparedness and Response
59. Second, we will boost our pandemic preparedness and response. This means having the capability to quickly understand what is this virus or pathogen that we are dealing with, and what actions to take.
60. When dealing with any infectious disease, we generally need to understand six key characteristics in order to formulate the right response –
· How it spreads – for example, between persons in close proximity or airborne;
· The length of its incubation and infection periods;
· R or reproduction number, a measure of infectiousness;
· How deadly it is;
· Who are the vulnerable groups – for example, is it seniors, children or both; and
· How to treat and prevent it.
61. Without good answers to these six basic questions, we will be fighting in the dark. As Dr Tan Wu Meng and Mr Yip Hon Weng have pointed out, we need strong public health scientific and research capabilities to quickly assess these key characteristics.
62. That is the objective of PREPARE, or the Programme for Research in Epidemic Preparedness and Response, that I launched in November last year. This is our national epidemic Research and Development plan and a major initiative arising from the crisis.
63. It will also strengthen our international pandemic research partnerships – to build a network of partners and allies, to play our part in strengthening global surveillance of emerging pathogens.
64. We will leverage GISAID, which played an instrumental role during the COVID-19 pandemic. GISAID is a global non-profit platform for open sharing of genomic data of viral pathogens and is the world’s largest repository of SARS-CoV-2 sequences.
65. Singapore will work closely with GISAID, and they have established a base here in collaboration with A*STAR.
66. After we understand the characteristics of a dangerous pathogen, what do we do with the information?
67. Having gone through SARS, H1N1 and the various phases of COVID-19, we have developed a range of responses. The characteristics of the pathogen will determine our response.
68. DPM Wong explained this briefly in his opening speech but let me elaborate a little. Mr Speaker Sir, can I show a chart on screen please? [Slide 1 on screen]
69. We can plot pathogens on a graph – the horizontal axis measures transmissibility, and vertical, severity. It is a simplified way of presenting the six key characteristics I just spoke about.
70. At the top right corner is Disease X – the disaster we dread, where the pathogen has high transmissibility and high severity and is deadly.
71. Toward the top-left lies diseases like SARS (in red), with high mortality but low transmissibility. This favours a strict containment approach – with extensive contact tracing, chase down and isolate every last case, until the virus is eventually wiped out, which we did.
72. As for COVID-19 (blue dots). When it first appeared, the wildtype strain was slightly southeast of SARS. This is why in the early phases of the pandemic, we treated it like SARS and adopted a zero-COVID-19 policy.
73. Over time, the virus mutated and evolved to become more transmissible. But with vaccination, we were able to suppress the severity of these strains. [Slide 2 on screen] Overall, with vaccination, later variants are closer to where Influenza (green dot) is on the vertical axis.
74. That is why we are able to open up, and move towards living with the virus. [End slideshow]
75. So using this framework, what happens when a new pathogen of concern emerges in the future?
76. We may have to respond quickly with appropriate border and domestic SMM measures, to minimise infections and buy time.
77. Then with good science and the local and global capabilities I just described, we hope to quickly ascertain key characteristics of the pathogen, where it lies on the graph, and then determine the right responses. Concerted efforts to develop or secure effective therapeutics and vaccines will proceed in parallel.
Restructuring MOH
78. Third, MOH will restructure to strengthen our organization. This is something we also did, in the wake of the SARS outbreak in 2003.
79. MOH put in place a pandemic preparedness plan involving the primary care sector, which evolved into today’s Public Health Preparedness Clinics (PHPC) Scheme.
80. Polyclinics and PHPCs served as our first line of defence, to test and treat COVID-19 cases, and support home recovery. They also administered vaccinations and helped in surveillance efforts. Contrary to what Mr Leon Perera said, our family doctors have and will continue to make an immense contribution during the pandemic, and in the future.
81. We set up the National Public Health Laboratory (NPHL). It conducts laboratory surveillance of infectious diseases and aids in outbreak investigations.
82. When COVID-19 first emerged in Wuhan, it was the scientists from NPHL who designed the PCR test for COVID-19, just two days after scientists from China shared the first whole genome sequences with the world.
83. We established the National Centre for Infectious Diseases (NCID), which opened its facilities in 2019, to provide high standard infectious disease clinical management.
84. These organizational enhancements after SARS built up capabilities that helped us respond to COVID-19. Given what we have learnt from the COVID-19 pandemic, we should once again review our organisation structure, to better prepare ourselves for the next pandemic.
85. One big lesson this time, is that we need to rely on a wide repertoire of responses. As I explained in the charts earlier, each pathogen has unique characteristics needing different responses. In fact, COVID-19 shifted around in the chart, requiring us to change playbooks along the way.
86. Specifically, for a severe but less transmissible disease like SARS, we need an individual centric approach, comprising testing, isolation, tracing, quarantine – that is precise, accurate and as error-free as possible.
87. For less severe but highly transmissible pathogens like the Delta or Omicron variant, it becomes almost impossible to contact trace and isolate, especially as the disease increases and spreads exponentially. It is of no use insisting on gold-standard accuracy and precision.
88. Instead, we need to manage the exponential growth of infected persons, through population-based interventions – mask wearing; ART tests in the community; self-testing; self-quarantine for those exposed; and home recovery for those with mild symptoms.
89. The individual centric, clinical approach; and population-based, public health approach are not mutually exclusive. In fact, they complement one another and we adopted both during different phases the COVID-19 pandemic.
90. We should institutionalise both sets of capabilities for the long term and be able to deploy both with flexibility and dexterity in future pandemics.
91. To do so, we will set up a new Communicable Diseases Agency (CDA), under MOH. It will oversee disease preparedness, prevention and control, surveillance, risk assessment and outbreak response.
92. This new agency will consolidate the relevant public health functions that today reside in MOH, NCID and Health Promotion Board. The NPHL is a critical national resource and will be transferred to the CDA. The CDA will maintain oversight of the clinical facilities in NCID.
93. Many countries, such as South Korea, UK and US, have similar set ups. Many of these countries are also reviewing their organisational set up after the COVID-19 pandemic.
94. In addition, MOH will separately retain a permanent Crisis Strategy and Operations Group, or CSOG, in the ministry.
95. CSOG was established during the pandemic and grew steadily as the pandemic progressed. It is the machinery behind all the pandemic-related operations that we are familiar with – contact tracing, home quarantine, conveyancing to isolation facilities, testing, vaccinations, and home recovery.
96. CSOG was staffed by officers from various ministries, contract staff, and also staff from industries affected by COVID-19. For example, we had quite a number of SIA pilots, cabin crew and hotel staff working in CSOG.
97. Today, most of these staff have returned to their industries. We are sad to see them go, but yet happy for them. The operations have scaled down greatly.
98. Nevertheless, we will keep a permanent CSOG force to maintain surge readiness for a mid-sized outbreak and other health emergencies. This includes preparing healthcare institutions to be crisis ready.
99. In peacetime, when there are no emergencies, they help operationalise Healthier SG, as the skillsets required are fairly similar. This is not surprising, because both are public health focused.
100. In addition, we will set up a Healthcare Reserve Force, made up of ex-healthcare workers and volunteers. We will train and equip them to reinforce our operations teams during larger surges, and they will complement the existing pool of SG Healthcare Corps volunteers.
101. Finally, we will change the title of the DMS. Instead of the Director of Medical Services, he will be called the Director General of Health, which more accurately describes his role as the main overseer of both clinical and public health of Singaporeans. This will take place after the changes to the Healthcare Services Act come into effect later this year. This House has already approved these changes.
102. With these changes, MOH will be organised to place emphasis on both clinical services and public health. They require different instincts, considerations, capabilities and skillsets. Both are important and critical and will be institutionalised and built up within MOH.
103. Let me now address a question that relate to public health measures, specifically, on the issue of masking.
104. Mr Gerald Giam suggested that the Government was not forthright with the people - that during the initial stages of the pandemic, we did not impose masking requirements not because of public health reasons, but because we did not have enough supply of masks.
105. This is incorrect. In the initial stages of the pandemic, there was no clear understanding of the characteristics of the COVID-19 virus. We therefore aligned our policy to WHO’s recommendations, which even up to March 2020 maintained that, I quote, “a medical mask is not required for people who are not sick, as there is no evidence of its usefulness in protecting them”.
106. The risk of shortage of masks for healthcare workers, which would put their lives in danger, was a serious concern, but not the basis of the prevailing public policy on masking.
107. We reviewed and changed our masking policy in April 2020, that was also when WHO changed its guidelines, once the evidence on how the virus spreads became clearer. Particularly, there was now clear evidence that there was asymptomatic transmission.
108. Nevertheless, as acknowledged in the White Paper, the issue of masking is one area where our decisions could have been better. But there was no question that during this period, the Government was totally forthright with the people.
Updating Legislation
109. Fourth, we need to update our laws.
110. The Infectious Diseases Act, or IDA, is the principal legislation for the prevention and control of infectious diseases. It empowers MOH to take various public health actions for disease outbreaks, such as contact tracing, isolation of infected persons, testing of contacts, or the disinfection of premises, etc.
111. The IDA also provides for the Minister for Health to declare a public health emergency, in very grave public health situations. That will activate extensive powers for the Minister, such as controlling the movements and gatherings of people, and imposing curfews.
112. While COVID-19 was a crisis and a serious threat, we did not declare a public health emergency. We wanted to restrict group sizes, but not to control movements of people. We were not planning to impose curfews nor invoke the Requisition of Resources Act to marshal resources.
113. In other words, the emergency powers under the IDA were too blunt and heavy compared to the public health measures and SMMs we needed at that time.
114. Instead, Parliament enacted Part 7 of the COVID-19 (Temporary Measures) Act, or CTMA, to provide us temporary, complementary powers to the IDA.
115. This ad-hoc legislation allowed us to deploy a broad range of tools to tackle COVID-19 at multiple layers, without declaring a public health emergency. This House just extended Part 7 of the CTMA for another year.
116. Ideally, we should review and amend the IDA. As it stands now, the IDA envisages only two worlds of public health - peacetime or public health emergency, with no gradations in between.
117. COVID-19 taught us that in a prolonged pandemic, we can go through different phases. So the IDA must be amended to deal with a wider range of scenarios. It needs to be more future proof. Once the amendments are tabled and if passed by the House, we can and intend to rescind Part 7 of the CTMA.
118. We will put forth the full proposal to the House later this year. Just to share some preliminary thinking, we envisage four public health situational tiers under the amended IDA:
· Baseline – which is a peacetime state;
· Outbreak management – where a pathogen of concern is detected, and measures may need to be implemented urgently to manage disease outbreaks. These include contact tracing and quarantine, testing, border controls, and masking. These will buy us time to understand the six characteristics of the pathogen;
· Public Health Threat – where more stringent, widespread and longer-term control measures and restrictions are needed. These include various SMMs and restrictions, up to and including a Circuit Breaker-like imposition; and
· Public Health Emergency – where very stringent measures such as curfews and requisition of public health assets and manpower may be effected.
119. When these changes come into effect, we can use the four situational tiers to replace the current DORSCON colour coding. It is more intuitive to tell the public that there is an outbreak, a threat, or an emergency, as opposed to colours. And the law spells out what measures could take place under each state.
120. Will this prevent the panic buying that we saw during COVID-19 when we declared DORSCON Yellow and Orange? Not on its own. Anxiety will not disappear just because we replace colour coding with situational descriptors.
121. Whether a people panic during a crisis, depends a lot on the information they are getting, and whether they know what to do, to protect themselves and contribute towards societal resilience.
122. If people listen to rumours, do not know what to do, they are likely to rush to the supermarkets and stock up on toilet paper and instant noodles.
123. But I believe that with the experience of SARS, H1N1 and now COVID-19, the Government knows much better what measures are necessary and appropriate, and the people of Singapore understand much better what to do in a pandemic crisis. With that, there is a lower chance of having a panic.
Secure Vaccines and Medical Supplies
124. Fifth, we need to ensure we have early access to efficacious vaccines for future pandemics.
125. Without sufficient doses of vaccines, our mass vaccination strategy would have been a non-starter. But securing vaccines is an art in itself, or at best, an inexact science.
126. This is where judgement I spoke about at the start of the speech, made all the difference. How the vaccine procurement decisions were made in the early stages of the pandemic, is an important story to be told in the House today.
127. This story has a happy ending, as noted by Mr Liang Eng Hwa – despite our small size, and despite the worldwide shortage, Singapore was the first country in Asia to obtain COVID-19 vaccines, enough for all our people.
128. But we also paid a price. Here’s what happened.
129. During the early phase of the pandemic, we set up an inter-agency workgroup chaired by the Head of Civil Service, and comprising senior officials from agencies such as Prime Minister’s Office Singapore, MOH, A*STAR, Health Sciences Authority (HSA) and Economic Development Board (EDB), to develop our vaccine procurement approach.
130. The workgroup had to deal with two key immediate challenges.
131. First, COVID-19 was a new virus. Although several vaccines were concurrently being developed at that time, nobody knew which one will work and which one to buy.
132. Second, every country was clamouring for vaccines, and limited manufacturing capacity cannot meet world demand. As a small market we lack negotiating power, and this would normally push us down the queue for delivery. The situation was worsened by supply chain disruptions caused by the pandemic. But time was of essence. How to secure assured and early deliveries?
133. On the question of what to buy, the workgroup recommended a portfolio approach – don’t put all our bets on one vaccine but buy a selected number of vaccines across different technology platforms. This includes both mRNA and non-mRNA vaccines.
134. To identify the most promising candidates, the workgroup was advised by a panel of experts from the research institutes, hospitals and industry.
135. Since we did not know which vaccine candidate would work and had to buy several types, and if one does not work, we had to make sure the other one had enough volume to cover our population. Hence, we needed to over-procure, such that the combined volumes of all the vaccine candidates more than cover the population of Singapore.
136. On the question of how to secure assured and early delivery, we leveraged our relationships with the pharmaceutical companies and entered into advance purchase agreements, with fixed delivery schedules and quantities.
137. To ensure quality and safety, all selected vaccine candidates were reviewed by the HSA thoroughly, before being authorised for emergency use in Singapore.
138. The Expert Committee on COVID-19 Vaccination (EC19V) provided a second layer of independent review and gave recommendations on how to optimise use of the vaccines.
139. The first batch of Pfizer-BioNTech vaccines arrived in late 2020, Singapore being the first country in Asia to receive them. We rolled out the National Vaccination Programme shortly after, from December 2020 – again one of the first few countries in the world to do so.
140. The Moderna vaccine was added to the National Vaccination Programme in March 2021, and Sinovac and Novavax in October 2021 and February 2022 respectively.
141. While the mRNA vaccines were found to be highly effective in protecting against severe COVID-19 infection, around mid-2021, we faced two new concerns.
142. First, there were early indications that vaccine protection could wane over time, especially amongst the elderly. So boosters would be needed.
143. We therefore procured additional vaccine doses to administer boosters to the whole population.
144. Second, new COVID-19 variants were emerging. There was a real possibility that one or more might break through vaccine protection and cause major new infection waves with high number of severe cases and deaths.
145. Moderna and Pfizer-BioNTech therefore developed the new bivalent vaccines that provide better coverage against the newer virus strains. In September 2022, we took the decision to make a clean switch to these new bivalent vaccines.
146. Looking back, today, if we had gone back in time, given the uncertainties, the high stakes and challenges we faced, I think we would have done things the same way.
147. Because we secured safe and efficacious vaccines, delivered when we needed them most, Singaporeans took them with confidence, even with relief. We built up our population immunity and achieved DORSCON Green today.
148. But there is a price to be paid. Because we deliberately over-procured to mitigate the uncertainty of selected vaccine candidate not working, and the possibility of supply chains being disrupted, there would be spare vaccine stock, which will expire.
149. Some months ago, MOH was asked how much of our vaccines had expired. We could only reply that about 10% of our stock had expired, because of confidentiality agreements that we have entered into with vaccine suppliers.
150. I would have preferred to be more transparent and forthcoming with information. We have since discussed with the vaccine suppliers, and they have agreed we can reveal the total value of the expired vaccines, so long as we do not give further quantitative breakdowns that enable people to estimate the cost of each dose of vaccine.
151. So these are the numbers.
152. To date, expired vaccines are about 15% of the doses we ordered, with a total value of S$140 million. In the coming months, this is likely to rise to close to 25%, as more vaccines expire. After that, it should stabilise.
153. We had tried to donate our spare vaccines. But there have been no takers, because there has been an over-supply of vaccines in the world. Manufacturers have ramped up their production capacity and demand for vaccines has been declining as the pandemic stabilised.
154. There are reports estimating that expired vaccines globally could range up to 500 million doses or more.
155. The expiry of unused vaccines was an insurance premium – the price we were prepared to pay to stave off the risk of catastrophic consequences.
156. What are these consequences?
157. To illustrate, before vaccines were available, we had to resort to a Circuit Breaker in April 2020 to contain the pandemic. The two-month Circuit Breaker cost us around $11 billion in terms of GDP loss. And we spent close to another $60 billion over two financial years to cushion the hardship for businesses and workers, not to mention the heartaches and difficulties families had to go through.
158. Without vaccines, we would certainly have had to resort to further Circuit Breakers during the Delta and Omicron waves in late 2021 and throughout 2022. But we did not have to, because we got the vaccines early and they protected us.
159. More importantly, our approach averted many deaths due to COVID-19 infections and protected Singaporeans against catastrophic consequences.
160. Let me now address a few questions regarding vaccines posed by members.
161. Ms Hazel Poa thought that MOH favoured mRNA over other vaccines in our regulatory approval. She has misunderstood. Several non-mRNA vaccines could not secure HSA’s approval because of insufficient data on safety and efficacy, and we cannot compromise on our standards.
162. Ms Hazel Poa and Mr Yip Hon Weng also asked if VDS measures were too harsh on the unvaccinated.
163. In a pandemic, measures can be harsh. The Circuit Breaker is harsh on everyone. The relevant question is whether from a public health perspective, the measures are necessary and justified.
164. We need to be mindful that while everyone should make their own medical choices, but in a pandemic, individual action affects not just yourself but also others around you.
165. When the vast majority chose to take the vaccine, they not only protected themselves but also their loved ones, and they raised our collective resilience. Those who did not take the vaccine, put themselves and others including their colleagues at workplaces at risk. Hence, VDS was needed as a public health measure. But we understand the hardship some of them had to go through, some of them were allergic to the vaccine. Therefore the moment we could step down VDS, we did so.
166. More importantly, we must continue to be prepared in case a dangerous variant of concern emerges. So this is our vaccine strategy going into the future:
167. First, MOH will maintain and periodically refresh an adequate stock of COVID-19 vaccines, to allow continued protection of the elderly and vulnerable as needed, and to facilitate a rapid response should there be a major or more severe pandemic wave.
168. Second, we will maintain a network of vaccination centres - primary care clinics, polyclinics and a baseline footprint of five to ten Joint Testing and Vaccination Centres even during DORSCON Green. With this, we will be able to administer a booster to all persons aged 50 and above and the medically vulnerable, within three weeks, if necessary.
169. Third, we are negotiating agreements to secure early access to vaccines against other pathogens with pandemic potential; these might include new influenza and other respiratory viruses.
170. Fourth, we will invest in vaccine research and development, like PREPARE I spoke about earlier. One of our objectives is to establish how to quickly develop a working vaccine based on either the mRNA or protein-subunit platform, and bring it to clinical trials locally.
171. Fifth, through the EDB’s efforts, we will be anchoring six vaccine manufacturing plants in Singapore. In response to Dr Tan Wu Meng, EDB will continue to engage other vaccine manufacturers to invest in Singapore, grow our biomedical sector capabilities, and cement our position as a pharmaceutical hub in Asia.
172. Finally, we will continue to do our part to strengthen global health security and support fair and equitable access to vaccines. There is now a global effort to develop safe and effective vaccines within 100 days of a Public Health Emergency of International Concern being declared. MOH is actively contributing to that effort.
The Power of Crisis
173. Mr Speaker Sir, I will conclude with the last lesson.
174. That is to recognise that a crisis forces us to do or try new things. What we thought was not possible to do or would have taken years to implement, were accomplished in a matter of months because we were pushed by the crisis.
175. We were stretched and will not rebound to our previous equilibrium. We will reach a new equilibrium. For example, today, we are in a new era of flexible work arrangements. Our schools built up strong digital capabilities and all secondary school students have their own learning devices because of COVID-19. I am sure Changi Airport will rebound to a new level of capability post-crisis.
176. In healthcare, the changes are even more profound.
177. During the crisis, public and private healthcare providers are connected by the same IT network. Everyone downloaded and got familiarized with health apps. As pointed out by Ms Ng Ling Ling, telehealth became the norm.
178. We became converts of preventive care, as we became conscious of hygiene, got used to diagnostic tests, wearing masks, and vaccinating routinely.
179. This is really what sparked Healthier SG. It is a strategy born out of crisis and will profoundly change the landscape for healthcare in Singapore.
180. The chapter on COVID-19 is a thick one in the story of Singapore, one with high drama, dark days and personal tragedy, as well as bright spots and many high points of courage, collective will and resourcefulness.
181. There were so many men and women who fought to keep Singapore safe. I cannot name everyone, but they are reflected today in the stories of some of their brethren.
· Dr Tan Chee Keat, at Ng Teng Fong General Hospital, who was part of the team to develop a negative pressure isolation chamber used to intubate infectious COVID-19 patients, which helped keep her team safe during dangerous procedures.
· Dr Annitha Annathurai, who personally oversaw the set up of medical operations at the S11 dorm, and helped calm and assure the migrant workers there that they would be taken care of.
· Mr Salman Imtiaz, a volunteer with the SG Healthcare Corps, who helped as a vaccinator with Raffles Medical Group while pursuing his undergraduate studies at the Singapore Management University.
· Ms Christine Joy Cordevilla Solacito, Senior Staff Nurse at SGH, who used her experience with MERS and Ebola to handle early COVID-19 positive patients from Wuhan, care for ICU patients, administer chemotherapy in the isolation ward, and deliver babies for the COVID-19 positive pregnant mothers.
· Dr Wong Jia Yi with Minmed Group, who became a father three times over during the pandemic, but stayed his post, leading vaccination centres, a regional swab centre, mobile vaccination teams and home recovery operations.
· Captain Lee Jia Wei, who volunteered to care for migrant workers being isolated at Singapore Expo, and in order to protect his family, did not go home for 60 days.
· Ms Sandra Goh, a lead stewardess with Singapore Airlines, who was furloughed when borders closed, switched to become a Care Ambassador at a hospital, and is now a manager at the Specialist Outpatient Clinics at Khoo Teck Puat Hospital. She told me she could transfer her skills from cabin to ward.
· Mr Mahmod bin Mohd Yahya and Mr Humam Sufi bin Mohamed Ali, a driver-medic pair from Ambulance Medical Services Pte Ltd, who at the height of the pandemic worked 14-hour days for several weeks, making up to 16 trips a day to ferry patients to and from COVID-19 Care Facilities.
· Mr Toh Guan Ru, who between ITE and Polytechnic, requested to work for MOH to handle home recovery cases, and when he did not qualify for the COVID-Resilience Medal because his stint was slightly short, told me he was not disappointed, and was proud that he was able to help.
· I sincerely thank all of them, and the hundreds of thousands who contributed.
182. We write the story to record suffering and sacrifice, but also the strengths and remarkable commitment on the part of so many to successfully overcome the crisis.
183. We write it to remember but also to learn. If we do, then in the next chapter, our hospitals and healthcare systems will be better, our laws more complete, our vaccines and medical supplies more secure.
184. And so, we write our next chapter, not knowing whether the world will dawn bright or dark, hostile or friendly, but confident in ourselves, that Singapore has become stronger through this crisis, and can stand taller to meet the next one. Thank you Sir.
*As of 24 March 2023, the third sub-paragraph in paragraph 181 has been amended for factual accuracy.