MYOCARDITIS CASES DUE TO COVID-19 VACCINATION AND VACCINE INJURY FINANCIAL ASSISTANCE PROGRAMME

NOTICE PAPER NO. 1892
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 9 MAY 2023

Name and Constituency of Member of Parliament
Dr Tan Wu Meng
MP for Jurong GRC 

Question No. 4570

To ask the Minister for Health (a) among the myocarditis cases which have been diagnosed in Singapore patients after receiving COVID-19 vaccinations, how many of these cases have reported the initial symptoms within (i) one day (ii) two days and (iii) one week of the vaccination; (b) how many of these cases have been referred to the Vaccine Injury Financial Assistance Programme (VIFAP); and (c) what are the VIFAP outcomes for such cases.

NOTICE PAPER NO. 1892
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 9 MAY 2023

Name and Constituency of Member of Parliament
Dr Tan Wu Meng
MP for Jurong GRC 

Question No. 4571

To ask the Minister for Health whether there is updated information as of April 2023 on (i) the number of Vaccine Injury Financial Assistance Programme (VIFAP) applications that have been received for persons presenting with cardiac conditions after COVID-19 vaccination and (ii) the number of such VIFAP cases that have undergone further retrospective review in light of subsequent updated information on COVID-19 vaccination side effects including myocarditis.

NOTICE PAPER NO. 1898
NOTICE OF QUESTION FOR  WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 10 MAY 2023

Name and Constituency of Member of Parliament
Mr Shawn Huang Wei Zhong
MP for Jurong GRC

Question No. 3002

To ask the Minister for Health (a) what are the long-term measures taken to ensure that our elderly have adequate protection against COVID-19; and (b) whether further COVID-19 vaccinations are required in the long term.

Answer

1     Mdm Deputy Speaker, may I have your permission to answer Question 5 and 6 together? My response will also cover the matters raised in the written question by Mr Shawn Huang which is scheduled for a subsequent sitting. I would invite Member to seek clarifications, if need be. If the question has been addressed, it may not be necessary for him to proceed with the Question for future sitting.

Update on Current Infection Wave

2      Let me first give an update on the current COVID-19 infection wave.  By all indications, the wave peaked about two weeks ago, at an estimated 4,000 infection cases per day.  It has since subsided, to about 3,000 infections per day. 

3     The key strains circulating are XBB.1.9, XBB.1.16 and XBB.2.3 – each accounting for about a quarter of all infections. The World Health Organization (WHO) has re-designated XBB.1.16 from being a Variant Under Monitoring to a Variant of Interest.  There is however no evidence, internationally or locally, that any of the variants have a clear growth advantage over the others or can lead to more cases of severe illnesses. The Ministry of Health (MOH) will continue to monitor the characteristics of the various strains. 

4     There are now over 300 patients infected with COVID-19 and in our hospitals. It is a fraction of hospitalisations at the peak of the pandemic crisis. That was during the Delta wave, with about 1,800 patients. Nevertheless, that added significant workload to our hospitals. We should also see the number of COVID-19 hospitalisations falling in the coming weeks as the infection wave subsides.   

5     This is the first infection wave we have encountered after transiting to DORSCON Green and treating COVID-19 as an endemic disease. We have weathered through it, without imposing any further public health measures.  Many members of the public are in fact not aware that we are undergoing a COVID-19 infection wave. This is what we have planned for and is another important and noteworthy milestone. 

Importance of Vaccinations

6     However, we can maintain this public health posture provided that we continue to take our COVID-19 vaccinations. It is of critical importance that we understand that COVID-19 did not become a milder disease and hence we transit to DORSCON Green. It is in fact still a dangerous disease. But our population resilience has strengthened due to vaccinations, boosters, and recovery from infections, which enabled us to treat it as an endemic disease.  

7     So it is of critical importance that we continue to take vaccinations based on MOH’s latest recommendations, to keep the level of our resilience high.  

8     To illustrate what I just said, let me share some data collated over the first four months of 2023. Seniors aged 60 and above continue to be more vulnerable to developing severe illnesses if infected with COVID-19.  

9     But amongst these seniors, the incidences of severe illnesses, i.e. the infected persons need to be hospitalised or required oxygen supplementation, differ depending on the vaccination status of the individuals. Please bear in mind that the incidence rates I am about to cite are overestimates because of under-reporting of milder cases of COVID, but the point in comparison is still the same –

a. For seniors 60 and above and who are unvaccinated, about 7.5% developed severe illnesses and have to be hospitalised.  

b. For those with minimum protection, i.e. three doses of mRNA or Novavax vaccines or four doses of Sinovac, the rate of severe illnesses was about 4%.  Half that of those were unvaccinated.

c. For those with minimum protection and kept their vaccination updated, i.e. most of them got themselves boosted and their last shot was less than 12 months ago, the incidence of severe illnesses is even lower, at 3.4%.  

10     Hence, if you are aged 60 and above or are vulnerable due to underlying illnesses, please get your minimum protection of three shots of mRNA or Novavax vaccines or four shots of Sinovac as soon as possible, if you have not already done so. 

11     If you have minimum protection, please take a booster every year. This will enhance your protection against the Omicron variants and minimise the risk of being infected and developing severe illnesses. 

12     Unfortunately, despite the benefits of vaccinations, amongst seniors aged 60 and above, the proportion who are updated with their vaccinations have been declining, from 58% in the beginning of this year, to 50% currently. Because once they pass their 12-month mark, they are no longer updated. So every week, that number drops. If this trend continues, our resilience against COVID-19 will weaken over time, making ourselves vulnerable to the virus again. 

13     Falling vaccinations, even amongst the vulnerable segments of the population, is due to a few reasons. 

14     First, there is a common thinking amongst seniors and amongst the public, that I seldom go out of my home, and hence I need not take further vaccinations. This is not recommended. The current Omicron variants are highly infectious, and we no longer impose social restrictions. So even if you do not go out of your home, it can find their way to your home, through visiting family members or anyone you may come into contact with. It is much better to get the vaccination and consider going out from time to time, meet friends, have coffee, join us for group exercises. It is actually good for your health.

15     Second, some seniors are also concerned about the risk of side effects if they take further vaccination shots. To date, hundreds of millions of doses of vaccines have been administered globally. The incidence of severe adverse reactions is very low in Singapore, at about seven in 100,000 doses and is even lower at one in 100,000 doses with the latest bivalent mRNA formulations.  These severe adverse reactions mostly include myocarditis, anaphylaxis, serious allergic reactions, and most resolved after some treatment. 

16    Let me summarise. If you belong to a vulnerable segment of the population and choose not to take further vaccinations, there is a significant chance that you will get infected by the Omicron variants at some point, which can cause severe illnesses like hospitalisation and requiring oxygen supplementation.  

17     If you attain minimum protection and keep your vaccination status updated, the chance of developing severe illnesses will be significantly reduced.  There is an added risk of developing severe adverse reaction after vaccinations, but that is very low, especially with the new bivalent formulations.  

18     In other words, the benefits of the COVID-19 vaccines continue to far outweigh the risks, and you should keep your vaccination updated. This is the recommendation of both the Expert Committee on COVID-19 Vaccination (EC19V) and Health Sciences Authority (HSA). 

Myocarditis and VIFAP

19     Specifically on myocarditis, it is a known illness associated with infections, including by the COVID-19 virus.  It can also occur, albeit at a lower probability, when taking COVID-19 vaccines and tend to affect young males aged 12 to 30 years old. 

20     The local incidence of vaccine-related myocarditis in this age group is low at about one in 100,000 doses and is even lower at 0.1 in 100,000 doses with the latest bivalent mRNA formulations. 

21     As of 27 April 2023, out of more than 17 million COVID-19 vaccine doses administered in Singapore, there were 160 reports of myocarditis and pericarditis linked to the vaccines. 

22     32% of these cases had initial symptoms reported within one day of vaccination, another 20% reported within two days and another 24% reported within one week. The majority of cases of myocarditis from vaccination are generally mild and respond to treatment. 

23     As of 27 April 2023, about 340 Vaccine Injury Financial Assistance Programme (VIFAP) applications are cardiology related. 81 of the applications were approved and financial assistance have been extended to the applicants.  

24     Myocarditis was picked up as a safety signal and reported in June 2021. A look-back at VIFAP applications from before June 2021 did not identify anyone with myocarditis. At present, the COVID-19 vaccines are not known to be causally associated with any other cardiac conditions other than myocarditis.