Singapore’s COVID-19 vaccination drive boosts hopes for some normalcy

SINGAPORE — Hopes that life can return to some sort of normalcy is growing stronger by the week, as more Covid-19 vaccination centers spring up across Singapore.

It has been about two months since Singapore rolled out its vaccination program.

Professor Benjamin Seet, deputy group chief executive for education and research at the National Healthcare Group, said: “The more people who have been vaccinated, the more who will be protected against symptomatic Covid-19 disease.”

The vaccine protects people from becoming moderately to severely ill with the disease.

But Sars-CoV-2, the virus that causes Covid-19, may still find its way into a vaccinated person.

This will not make the person noticeably ill, but it is not clear if the virus can spread to others.

To fully protect the population, herd immunity is needed, experts said.

This threshold is currently not known for Covid-19, but there are some estimates which show that at least 70 per cent or more of the population needs to be vaccinated before herd immunity is reached, said Prof Seet.

Professor Mike Toole, an epidemiologist at Burnet Institute, a medical research institute in Melbourne, noted that as Singapore is not yet close to any level of herd immunity, the main impact of the current rate of vaccination would be a decrease in severe cases and hospitalizations.

The vaccine roll-out in Singapore is expected to pick up speed.

Seniors aged 70 and above, and more than 50,000 active taxi and private-hire car drivers, have recently been offered the chance to get their first dose of the vaccine.

Those aged 60 and above are expected to be vaccinated from the end of this month. The forecast is for 1.25 million to be vaccinated by the end of next month.

Prof Toole said: “If 1.25 million people are vaccinated in Singapore by April, that will be a 22 per cent coverage, which is not enough for herd immunity as that is expected to be 70 to 75 per cent.

“Keep in mind that migrant workers in Singapore already have herd immunity because more than 70 per cent were infected.”

Singapore’s Covid-19 vaccination program is under way at 14 centers, including one in Raffles City Convention Centre, one in Changi Airport Terminal 4, one at an unused school in Hong Kah and 11 at community clubs.

Vaccination is also taking place at 20 polyclinics and 22 Public Health Preparedness Clinics.

By the middle of this month, more than 30 vaccination centers will be in operation, and by the end of next month, 40 centers will be up, with each planned for an estimated capacity of 2,000 jabs a day.

A global snapshot More than 236 million doses have been administered across 103 countries, including 72.8 million in the United States, according to data collected by Bloomberg as at yesterday.

Last week, African countries Ghana and Cote d’Ivoire became the first two countries outside of India to receive Covid-19 vaccines through the Covax program, which aims to enable global equitable access to the vaccine.

Globally, the latest vaccination rate is 6.67 million doses per day, on average, according to Bloomberg data.

At this rate, it will take an estimated 4.6 years to cover 75 percent of the world’s population with a two-dose vaccine, according to yesterday’s projection.
Nevertheless, some good news has surfaced.

Israel, which has been the quickest in the world to vaccinate its people, appears to have benefited.

To date, it has administered the most Covid-19 vaccine doses per capita in the world.

Slightly more than half of its 9.3 million population have received one dose of the Pfizer-BioNTech jab since vaccinations started on Dec 20.

Early reports show that the number of cases has fallen significantly among those who were vaccinated. The vaccine has helped to reduce infections by around 85 per cent, said Prof Toole.

Professor Teo Yik Ying, dean of the National University of Singapore Saw Swee Hock School of Public Health, said that as more people are vaccinated around the world, a better understanding will emerge of whether the present vaccines are able to prevent or at least significantly minimize the risk of infections and transmissions, on top of preventing severe disease.

More vaccines, but more variants too Singapore has approved the Pfizer-BioNTech and Moderna vaccines, and taken delivery of the CoronaVac vaccine by China’s Sinovac, though it has yet to approve Sinovac’s.

Prof Teo noted that public data on the effectiveness of the Sinovac vaccine is actually higher than the target efficacy of at least 50 per cent required by the World Health Organization and a number of regulators, including the European Medicines Agency.

But the effectiveness of Sinovac varies according to the clinical trials in different countries, and ranges from 50.4 per cent to 91.3 per cent. “So there is a need for a proper assessment of the clinical trial data,” Prof Teo said.

This is what the Health Sciences Authority will be reviewing, before it decides on whether to approve for use.

At present, all the data suggests that the vaccine’s effectiveness meets the minimum requirement for population roll-out, Prof Teo noted.

To put this in perspective, the influenza vaccine, which has been used globally across many countries, has an effective rate of between 40 per cent and 60 per cent, depending on the season and specific population segment, he said.

But even as vaccinations continue, new variants of Sars-CoV-2 are circulating around the globe; some more transmissible than others. RNA viruses like Sars-CoV-2 mutate over time, so newer variants can surface and cause trouble.

Prof Seet said: “At this point, Singapore’s vaccine portfolio remains effective against the prevailing variants, but there is a need to continue to monitor efficacy of the vaccines against new variants that have yet to emerge.”

Easing of restrictions

There are no clear answers on whether restrictions can be eased because of two unknowns.

First, we do not know how well the vaccines will prevent asymptomatic infection, said Prof Toole.

Second, “we don’t know how long the vaccines will induce immunity. So far, the Pfizer and Moderna vaccines induce immunity for at least four months”, he added.
This means that resuming travel to pre-Covid levels, for example, is not yet on the horizon.

More business or leisure travel will resume with minimal quarantine requirements for entry or re-entry, only when Singapore and other countries have successfully vaccinated a large segment of the population, said Prof Teo.

This is also dependent on whether governments are able to establish a platform to mutually access, recognize and accredit Covid-19 vaccination records.

Singapore’s Ministry of Health has said it is actively engaging its international counterparts, and monitoring global developments on the development and recognition of vaccination certificates.

It will be crucial for any two countries to mutually recognize that travelers have been vaccinated by an accredited provider using an approved vaccine, said Prof Teo.

“I expect this will first start off with a series of bilateral agreements between pairs of countries or jurisdictions, very much like a travel bubble agreement, but one that is based on vaccination status and records,” he added.

“However, there will still be the challenge of addressing the inequity faced by people who are not vaccinated, either because of medical reasons or out of personal choice, who may now be penalized and barred from a range of activities (including travel) because of their vaccination status.”

Prof Toole noted that to travel safely, there needs to be a high vaccine coverage in Singapore as well as the countries of destination, though the latter may take a longer time.

“What I predict is that Singapore, Australia and New Zealand will create travel bubbles to countries that have zero community transmission and/or high vaccination rates,” he said.

This could start with small Pacific countries, Taiwan, Vietnam, Laos, Cambodia, Mauritius and maybe Thailand.

The bubbles could then be gradually expanded, Prof Toole said.

More than a year after the first case was reported, Covid-19 has spread to more than 200 countries. There are around 113 million cases worldwide and 2.5 million people have died of the disease.

Singapore has recorded nearly 60,000 Covid-19 infections and 29 deaths.

In Parliament late last week, Senior Minister of State for Health Janil Puthucheary said Singapore is not expected to move out of phase three of its reopening any time soon.

Singapore entered phase three of its reopening on Dec 28, but subsequently tightened some measures after an increase in the number of unlinked and community cases.

Dr Janil reiterated that phase three is a “new normal”, which will last until there is evidence on vaccine effectiveness in preventing future outbreaks, a substantial proportion of the population is vaccinated, and the rest of the world also has the virus under control.

Experts stressed that as vaccination continues here and around the world, more answers are still needed.

Prof Teo said a considerable shift in outbreak control policies, including border control measures and community restrictions, will happen when the science clearly indicates that vaccination prevents or reduces the risk of infection and transmission.