Wednesday 23 December 2020

Singapore receives Asia's first batch of Pfizer's COVID-19 vaccine; details of vaccination programme in January 2021

First shipment of COVID-19 vaccine arrives in Singapore on SIA flight from Brussels
By Yuen Sin and Toh Ting Wei, The Straits Times, 22 Dec 2020

The first batch of the Pfizer-BioNTech Covid-19 vaccine has landed in Singapore, a crucial first step to vaccinate the population.

The vaccine - the first from Pfizer to arrive in Asia - was carried by a Singapore Airlines (SIA) Boeing 747-400 freighter, SQ7979.

The flight had departed from Brussels, Belgium, on Sunday (Dec 20) and landed at Changi Airport at about 7.30pm on Monday (Dec 21).

The shipment was prioritised for loading into the aircraft in Brussels, as well as during unloading in Singapore, SIA said.

Transport Minister Ong Ye Kung, Mr Kevin Shum, the director-general of the Civil Aviation Authority of Singapore and the chief executives of Changi Airport Group and SIA were among those who turned up at the airport to witness the arrival of the vaccine.

Ground handler SATS moved the vaccines to its cold chain facility SATS Coolport before they were loaded onto a refrigerated truck that will send them to an external storage facility.

SIA had conducted a successful trial to test its vaccine handling capability along the same freighter flight route on Dec 19, the airline said.

It carried out the trial with cool boxes used to pack the actual vaccine, and had tracked the internal temperature within these boxes throughout the flight. It also monitored the rate at which dry ice within the box turned into carbon dioxide.

SIA senior vice-president for cargo Chin Yau Seng said the airline was honoured to be able to play its part in an important milestone in the fight against Covid-19.

"It also served to demonstrate SIA's and the Singapore air hub's readiness for the very important job of transporting and distributing Covid-19 vaccines internationally," he said.

The Pfizer-BioNTech vaccine is the first Covid-19 vaccine approved by the Health Sciences Authority in Singapore. There are no details yet on how it will be rolled out.

The vaccine is already being administered in countries such as Britain, Canada and the United States.

Singapore is one of the first countries to obtain the vaccine, and other vaccines are expected to arrive in the coming months, Prime Minister Lee Hsien Loong announced last week.

Priority will be given to healthcare and front-line workers, as well as elderly and vulnerable patients.

If all goes according to plan, there will be enough vaccines for everyone in Singapore by the third quarter of 2021.

The Republic has also beefed up its capacity to store and transport Covid-19 vaccines, and is positioning itself to be a hub for the movement of Covid-19 vaccines to the region.

Shipments from Europe are expected to go through Singapore to South-east Asia and South-west Pacific when broader regulatory approval is secured.

The Civil Aviation Authority of Singapore and Changi Airport Group have set up a task force to work on the vaccine shipment process. The task force comprises 18 members in the air cargo sector, including SIA and ground handlers SATS and dnata.

Logistic firm DHL Global Forwarding, a division of German logistics giant DHL, said it had arranged for the collection of the vaccines from the manufacturing site in Puurs in Belgium. The vaccine cargo was accompanied by security escorts on the road to the airport in Brussels.

DHL will also handle the final delivery of the vaccine to the designated location in Singapore, it said.

Details on Singapore's COVID-19 vaccination programme could be released by January 2021: Lawrence Wong
Exact details will depend on multiple variables including vaccine supply and delivery schedule
By Yuen Sin, The Straits Times, 23 Dec 2020

More details of the effort to inoculate Singaporeans against Covid-19, including the different phases of the vaccination programme and who will go through them, will hopefully be released by as early as next month, said Education Minister Lawrence Wong yesterday.

The exact details on the roll-out of the vaccine will depend on multiple variables, including their supply and delivery schedule, and when other vaccines get authorised for use here, added Mr Wong, who co-chairs the multi-ministry task force on Covid-19.

These factors are still uncertain for now, he said.

"When we have greater certainty of when, what sort of supply (and) delivery schedule we can expect in Singapore, that will be matched with the vaccination programme, the different phases of vaccination," said Mr Wong, a day after Singapore received its first shipment of the Pfizer-BioNTech vaccine.

The minister was speaking to reporters at the Ministry of Education headquarters about tighter border measures for travellers from Britain, where a highly contagious strain of the coronavirus has been circulating.

When asked for an estimate on the frequency of vaccines coming in, Mr Wong said it is premature to do so, given that other vaccines which Singapore has advance purchase agreements for have not yet been authorised for use here.

These include vaccines by Moderna in the United States and Sinovac in China.

But the Government does have a rough sense of when further shipments of the Pfizer-BioNTech vaccine as well as those from Moderna and Sinovac are going to arrive, said the minister. "Assuming all three are authorised for pandemic use... we do have some rough indication," he said. "But it's still early days, it's still very preliminary, and it can change."

The Pfizer-BioNTech vaccine has been approved by the Health Sciences Authority in Singapore for individuals aged 16 and above.

Mr Wong said that as previously announced by the task force, priority for the vaccines will be given to groups such as healthcare and front-line workers.

The first of the vaccines will be administered to these workers some time between the end of this month and January or February, he said. "I think it will be some time before we can talk about opening up and offering the vaccine to the broader population."

The roll-out to the Singapore population will take place over several months, and if all goes to plan, Singapore will have enough vaccines to vaccinate everyone by the third quarter of next year.

But if other factors arise, the vaccination programme could be pushed back to the end of next year or beyond. Or if some vaccines arrive earlier, this could be brought forward, said Mr Wong.

When asked about the spread of the new and seemingly more infectious virus strain that has emerged in Britain, Mr Wong said the new strain has not yet been detected in Singapore.

On whether the Government is concerned that the vaccines that have arrived would not be effective against that latest strain, he said: "That is uncertain; this is part of the question that I think scientists everywhere are asking."

He added: "And I am sure our scientists and experts, together with experts everywhere in the world, will be asking these questions and seeking answers."

As for what Singapore would do differently if the new strain is detected here, Mr Wong said the country will have to be extra cautious in implementing existing safeguards against the virus, including stepping in quickly to isolate close contacts each time an infected person is identified, so as to contain and ring-fence a possible cluster.

"But before we even get there, we try our best to keep our borders secure," said Mr Wong.

This is why Singapore announced yesterday that it will deny entry as well as transit to all long-term pass holders and short-term visitors with recent travel history to Britain, he noted.

Still, no measure is 100 per cent foolproof, and the strain could still come through another country, he said. "Again, we are in a new situation, we have to stay vigilant. We have to monitor how the virus is spreading, how the new strain is spreading everywhere in the world, and then we have to constantly adjust our measures at the borders and within the community accordingly."

Identify, investigate, negotiate: How Singapore took steps to ensure access to COVID-19 vaccines
By Audrey Tan, Science and Environment Correspondent, The Straits Times, 23 Dec 2020

Many things about the coronavirus were still unknown in the first half of the year, but Singapore knew it had to act fast to secure Covid-19 vaccine doses for its people.

This was even though some solutions were as novel as the pathogen itself - a number of vaccine candidates were being developed with new technologies that had not been used in any other vaccines on the market.

The data was limited, so risks had to be taken and bets made, after careful analysis of the available information.

They all paid off on Monday night, when Singapore became the first nation in Asia to receive doses of the Pfizer-BioNTech Covid-19 vaccine. This, just weeks after Britain and the United States received theirs.

Professor Benjamin Seet, who oversees the expert panel that provides the Singapore Government with advice on Covid-19 therapeutics and vaccines, said during a press conference on Monday that advance purchase agreements hinged on many factors, including safety and availability.

"If we want to buy it, will it be available? Because the doses could actually be bought up by bigger jurisdictions - for example we have seen from the global media, the United States, European Union, many of the larger economies have bought huge chunks," said Prof Seet, who is deputy group chief executive for education and research at the National Healthcare Group.

"So essentially, to even put ourselves in the early order book, we need to make decisions as early as possible. And that's why we have advance purchase agreements."

Singapore signed its first advance purchase agreement in June with Moderna - the American biotechnology firm behind one of the early Covid-19 vaccine front runners - to buy its vaccine.

A down payment was made to secure the agreement.

At least two other agreements with vaccine developers Pfizer-BioNTech and Sinovac were inked later, and efforts are still ongoing to shortlist and procure other vaccine candidates as part of Singapore's plan to ensure a diverse portfolio of Covid-19 vaccines.

Mr Leo Yip, head of the Civil Service and chair of the planning group on vaccines and therapeutics, said the 11 months it took from Covid-19 arriving on Singapore's shores to when it received its first shipment of vaccines was no fluke.

He said: "This was due to the significant advances in vaccine technology. But it was also due to the dozens of public officers who worked tirelessly and quietly behind the scenes over this period, to ensure that Singapore had early access to vaccines."

Step 1: Identify

Knowledge is power, especially when it comes to a novel pathogen never before seen by the world.

So in April, Singapore took steps to ensure that it had access to all available information on the vaccine front.

The nation's first move was to form the therapeutics and vaccines expert panel, which is led by Prof Seet. The panel comprises 18 scientists and clinicians from the public and private sector, who went through data on potential drugs to treat the disease, as well as more than 35 vaccine candidates.

Their aim was to identify the most promising ones and assess which were safe and efficacious for Singapore to procure.

There are currently 56 Covid-19 vaccine candidates in clinical trials, and many of them are based on different technologies, such as inactivated viruses, viral vectors, and DNA/RNA. All of them work in different ways.

Traditional vaccines, such as inactivated virus vaccines and live attenuated vaccines, work by injecting whole but inactive viruses into patients to stimulate an immune reaction.

"But we eventually looked at RNA vaccines with a lot more interest, particularly because they were easier to manufacture. And therefore, they could go into clinical trials earlier, and be made available globally in the large quantities needed," Prof Seet said.​

"So it was interesting from the point that you can get it fast. And you could get it in a timely manner. And you could get more data about it, very early," he added.

The Pfizer-BioNTech vaccine approved for use in Singapore, for instance, is an RNA vaccine.

So is the Moderna shot, which was recently approved for use in the United States, as well as the Lunar-Cov19 vaccine being co-developed by scientists at the Duke-NUS Medical School.

RNA vaccines work by injecting snippets of the viral genetic code so a patient's body mounts a protective response without being actually exposed to the whole virus.

Data from late-stage clinical trials released last month by Pfizer-BioNTech and Moderna showed high success rates of more than 90 per cent effectiveness at preventing Covid-19.

But to make the right decisions, Singapore had to find other ways in the earlier months of getting the information it needed on which vaccines to buy.

Step 2: Investigate

Singapore's next step in late April was to form another group to make "strategic bets" on vaccines that looked promising, said Mr Yip, who chaired the planning group.

Its mission was to procure and support the development of promising therapeutics as well as to secure early access to vaccines for Singapore.

This group relied on the assessments made by the scientific panel.

"We relied on EDB officers to establish contact with a wide range of vaccine makers," said Mr Yip, referring to the Economic Development Board.

"We leveraged the strong relationships built up between EDB Singapore and pharmaceutical companies like Pfizer, as well as biotech companies like Moderna and BioNTech."

Non-disclosure agreements were also signed with a number of the companies, he added, which gave Singapore access to confidential data on the progress of the vaccines.

Typically, data from clinical studies is made public when they are published in scientific journals. But the process of peer review may take some time.

Prof Seet said Singapore signed about 40 non-disclosure agreements. "This allows us to get access to data that is not available in the published literature - to get it early and to be able to find out more from the teams that actually developed the drugs," he said.

None of these agreements was contractual, he clarified. This means that Singapore was not obliged to purchase any vaccines from the firm with whom it had signed the non-disclosure agreements.

Singapore's approach to securing vaccines was not dissimilar to how the country secures access to other vital resources like food and energy, which is to diversify its sources.

Mr Yip said it was important for Singapore to select a portfolio of vaccine candidates as there was no certainty which, even among the more promising ones, would eventually succeed.

Step 3: Negotiate

More than $1 billion has been set aside to support Singapore's search for vaccines.

Dr Lisa Ooi, vice-president for healthcare and wellness at EDB, said other than procurement, the budget funds related needs.

This includes Singapore's participation in the multilateral Covax initiative meant to ensure equitable vaccine access worldwide, as well as support for local development of therapeutics and vaccines, and support for companies that manufacture vaccines here in the longer term.

EDB declined to comment on how much each of the vaccines cost.

When asked whether Singapore's relatively small order affected its bargaining power with pharmaceutical companies, EDB's senior vice-president and head for healthcare and wellness Goh Wan Yee said many pharmaceutical firms recognise Singapore's status as a leading biomedical hub in Asia.

"So I think that position, plus the fact that many companies actually have a base in Singapore, put us on good footing to negotiate and work with them on vaccine access," said Ms Goh.

"So despite our small market size I think companies are still keen to have their products launched and used in Singapore."

$1 billion kitty for Singapore's vaccine push
The Straits Times, 23 Dec 2020

More than $1 billion has been set aside to support Singapore's search for vaccines.

Dr Lisa Ooi, vice-president for healthcare and wellness at the Economic Development Board, said the funding covers a range of vaccine-related purposes. This includes funds for:

• Procurement of vaccine doses;

• Singapore's participation in the multilateral Covax facility initiative meant to ensure equitable vaccine access worldwide;

• Support for local development efforts in therapeutics and vaccines, in partnership with research institutes; and

• Support for companies that would manufacture vaccines here in the longer term.

Singapore ensuring multiple safety checks in place before COVID-19 vaccine roll-out: Experts
By Audrey Tan, Science and Environment Correspondent, The Straits Times, 23 Dec 2020

The urgency in tackling the Covid-19 pandemic has seen a quickened process in developing and approving a vaccine, but experts say multiple steps have been taken to ensure that any vaccine rolled out in Singapore is safe.

The first shipment of Covid-19 vaccines arrived in Singapore on Monday night, marking the first time the country is buying in large quantities drugs that have been approved for use in a pandemic.

The vaccine developed by Pfizer and its German partner BioNTech was granted authorisation for use here by the Health Sciences Authority (HSA) under the Pandemic Special Access Route.

It is so far the only vaccine approved by the HSA, although others are being studied.

But even during these unprecedented times, steps have been taken to ensure the safety of vaccines that will be used here, said two experts at a press conference on Monday.

Associate Professor Tan Say Beng and Professor Benjamin Seet, both on an expert panel that advises the Government on therapeutics and vaccines, pointed to numerous safety checks along the vaccine development process.

First, the data must show safety in animal studies before the vaccine is tested on humans.

Data from the clinical trials is also reviewed by the HSA when it assesses whether to approve a vaccine for use here.

Prof Tan, who is executive director of the Ministry of Health's National Medical Research Council, said: "During the whole process, there are many vaccine candidates, and many may drop out along the way.

"Some animal studies show that (a vaccine) may not be safe enough, for example, while others make it to human studies but they don't make it through all the different phases of clinical trials."

He added: "So you can think of it as there being multiple safety checks all along the way."

The first two phases of clinical trials, known as early-phase trials, are mainly carried out among smaller groups of up to hundreds of volunteers to test the safety and efficacy of a vaccine.

In these stages, researchers look out for dangerous side effects and analyse patient samples to see how the human immune system is responding to the vaccine.

Phase three trials are much larger, usually involving thousands to tens of thousands of people. These are often held across multiple jurisdictions or countries.

Prof Tan said: "Many agencies in many countries are confident that the clinical trial process was abided by, even though things were quickened in terms of urgency. It was not at risk of compromising the integrity of the study."

For instance, phase three trials must be sized correctly so that the results are representative of a larger group, he said.

The phase three trial of the Pfizer-BioNTech vaccine involved over 43,000 people.

Another Covid-19 vaccine front runner, developed by Moderna, had a phase three trial involving more than 30,000 people.

But responding to a question on why other reactions to the Pfizer-BioNTech vaccine - such as severe allergic reactions reported in the United States, for instance - were picked up only after those trials, Prof Seet, who oversees the expert panel, said some reactions were very rare.

Such reactions are not unique to Covid-19 vaccines, but apply to all types of drugs or shots, he added.

"Because some side effects are very rare, you may need to involve hundreds of thousands, or sometimes even a million or two million people, before you actually see these very, very rare events, and the only way you can pick that up is actually through post-implementation (monitoring)," he said.

That is why the Government will continue to monitor the situation as the vaccine is rolled out here.

But Prof Seet, who is deputy group chief executive for education and research at the National Healthcare Group, noted that not all side effects were dangerous.

Safety is about whether a vaccine or drug will cause actual harm to an individual, he said.

Tolerability, on the other hand, refers to effects like a fever or headache after a shot.

"So that is quite different from safety. Some people will experience some of these side effects - but that doesn't affect overall safety," he said.

Singapore aims to be hub for COVID-19 vaccine transport, says Ong Ye Kung
It has the capabilities to do so, says Ong Ye Kung, with support of logistical, pharmaceutical firms
By Toh Ting Wei and Yuen Sin, The Straits Times, 22 Dec 2020

Singapore wants to become a Covid-19 vaccine distribution hub for the region, Transport Minister Ong Ye Kung said yesterday.

He said the Republic has the capabilities to make sure the process is secure and there is adequate capacity.

"Some countries, of course, would prefer direct delivery because they will think that it's faster, so point-to-point delivery, but I think there's also a case to say that a place like Singapore, with our Changi family, we can also play a role as a hub for distribution and transportation to the region," he said.

"I don't think they are mutually exclusive."

Mr Ong was speaking to the media at a cold chain management facility run by cargo handler SATS, after welcoming the arrival of the first batch of Covid-19 vaccines in Singapore.

"Our staff, our logistics companies, they all have been trained up to the World Health Organisation standards to be able to handle all this cargo safely," said Mr Ong.

"In terms of capacity, we have quite a huge capacity... more than adequate to handle temperature-controlled cargo."

Mr Ong said the estimated cargo movement for vaccines is about 65,000 tonnes worldwide but local handler SATS dealt with more than 300,000 tonnes of temperature-controlled shipment in the last year alone.

The Republic also has the support of firms including logistics giants DHL, UPS and FedEx, as well as pharmaceutical companies.

"Everything must come together," said Mr Ong. "We have worked on it for several months and we'll continue to work on it."

There has been hope that positioning Singapore as a hub for vaccine transportation could give the battered aviation sector another boost as it seeks to continue its gradual recovery.

In the last few months, the air cargo industry in Singapore has been intensifying preparations to safely transport Covid-19 vaccines in a constant temperature-controlled environment.

In October, the Civil Aviation Authority of Singapore and Changi Airport Group (CAG) set up a task force comprising 18 members to look into improving the process.

Mr Ong said they had been identifying possible challenges and seeking to address them even before a vaccine was produced.

"One example was when they got to know that the Pfizer vaccine requires minus 70 deg C of storage, they started to look at dry ice production," said Mr Ong.

"So today SATS can produce four tonnes of dry ice every day in its... own facilities."

This work, which also involved trial runs, has helped to ensure that the first shipment of Covid-19 vaccines arrived in Singapore safely, said Mr Ong.

He said the shipment of the vaccine was a joint effort involving several organisations, including the Economic Development Board and the Ministry of Health.

Singapore Airlines (SIA), which flew in the vaccine from Brussels on its cargo plane, said yesterday that it was honoured to be able to play its part in an important milestone in the fight against Covid-19.

SIA senior vice-president for cargo Chin Yau Seng said: "It also served to demonstrate SIA's and the Singapore air hub's readiness for the very important job of transporting and distributing Covid-19 vaccines internationally."


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