By Zakir Hussain, Singapore Editor, The Straits Times, 18 April 2021
Early this month, a person claimed in a Facebook post that his cousin, a renowned doctor at a private hospital in Singapore, had suffered a stroke as a result of getting a Covid-19 vaccine.
That post went viral, including on WhatsApp and social media chats, prompting Mount Elizabeth Hospital to issue a clarification on April 4.
"We wish to clarify that the allegations in the post are untrue. The doctor's family has also confirmed that the writer is not related to them and has written to Facebook to have the post removed," the hospital said. "You can help us stem the circulation of false information by not sharing the post, and deleting it if you have already done so."
A few days later, another vaccine-related post went viral. This time, the death of an 81-year-old man in Singapore was attributed to his receiving the Covid-19 vaccine.
Again, the claim was circulated online and in chat groups.
A week later, the Ministry of Health (MOH) addressed both falsehoods in detail - and invoked Pofma, the Protection from Online Falsehoods and Manipulation Act, to require two Facebook pages and a website to publish correction notices.
The posts - on two Facebook pages managed by opposition People's Power Party chief Goh Meng Seng - and the article, on the Singapore Uncensored website, now carry a note saying that they contain false statements of fact. The note also states that for the correct facts, readers should click through to the clarification here: www.gov.sg/article/factually150421
MOH said, among other things, that as at April 14, "there is no credible evidence for an increased risk of heart attack or stroke with the Pfizer-BioNTech and Moderna Covid-19 vaccines which are currently approved and offered in Singapore".
In the case of the doctor, the medical team caring for her assessed that her current condition is highly unlikely to be related to the Covid-19 vaccination, said MOH.
As for the 81-year-old man, he died of ischaemic heart disease - lack of blood circulation to the heart muscles.
But sentiments aligned with those posts continue to be held - and aired - by a minority online and offline.
On Facebook and in chat groups, these sceptics decry the attempt to shut out "the truth" and alternative views, never mind the facts, let alone global scientific consensus.
And I fear they are not likely to be swayed any time soon, in Singapore or around the world.
The risk is that such views gain ground, and traction, at a time when the global vaccination drive is key to recover from the pandemic.
How best can such disinformation about the virus and vaccines be countered?
GOING TO THE GROUND
Ground engagement is critical, for starters.
Globally, more than 850 million shots of a Covid-19 vaccine have been administered. Singapore's vaccination programme is well under way, with more than one million people having received their first dose of either the Pfizer or Moderna vaccine, and over 500,000 having completed their full vaccination regimen.
As in every society, there remain a minority of individuals who are hesitant or have doubts about the vaccines, for a variety of reasons, and a host of efforts are ongoing to allay concerns that groups like seniors may have.
Some of their worries are fed by misinformation - which is generally purveyed through informal networks like chat groups and friends.
Researchers have noted that some of this false information is shared within closed networks out of genuine concern, or a lack of knowledge.
On-the-ground engagement, and campaigns to address doubts they may have, are necessary and helpful in assuaging these worries.
Public education on sifting out dubious information may also help people be more discerning of what they read.
As Professor Nicholas Gascoigne from the National University of Singapore's Yong Loo Lin School of Medicine told my colleagues for an article published earlier this month, vaccine hesitancy stems from some genuine issues, but also from a lot of misinformation or prejudice. Some have called vaccines experimental since they have been approved much faster than people are used to, but, in fact, they have been rigorously tested and found safe, he noted.
DISINFORMATION DOZEN
Raising public awareness of the agendas of those purveying falsehoods is also important.
There will be a number of individuals who subscribe to - and spread - disinformation on the vaccines.
While misinformation refers to information that is false or out of context, disinformation is a subset of misinformation that is deliberately created or spread with the intent to mislead.
Observers note that these anti-vaxxers spend a disproportionate amount of time online and on social media, where they imbibe material that reinforces their beliefs, generally along these lines: Covid-19 is not dangerous; Covid-19 vaccines are dangerous; scientists (and governments) cannot be trusted.
What is particularly disturbing is that most of this disinformation can be traced back to - and appears to be deliberately manufactured by - a small group of anti-vaccine activists, aided by social media platforms and their algorithms that amplify viral content.
Recent reports by the Centre for Countering Digital Hate (CCDH), a think-tank based in Britain and the United States focusing on disinformation efforts, shed some light on this industry that has enabled anti-vaccine activists on Facebook, YouTube, Instagram and Twitter to reach over 59 million followers.
While these platforms say they have policies to prevent the spread of vaccine misinformation, the centre found in its latest report last month that "all have been particularly ineffective at removing harmful and dangerous misinformation about coronavirus vaccines, though the scale of misinformation on Facebook, and thus the impact of their failure, is larger".
"Further, they have all failed to remove the accounts of prominent anti-vaxxers who have repeatedly violated their terms of service."
The centre analysed a sample of anti-vaccine content that was shared or posted on Facebook and Twitter a total of 812,000 times between Feb 1 and March 16 this year, and found that 65 per cent of anti-vaccine content is attributable to just 12 people, or so-called influencers.
Dubbed the Disinformation Dozen, these 12 anti-vaxxers - some of whom are entrepreneurs peddling alternative medical treatments - play leading roles in spreading digital misinformation about Covid-19 vaccines, aided by their large following, high volumes of anti-vaccine content and rapid growth of their social media accounts. Among their more extreme claims: that Bill Gates plans to inject everyone with microchips as part of the vaccination programme.
The CCDH says the best way to stop such content is to deny it a platform. Users should also be given warnings when attempting to follow links to sites known to host vaccine misinformation, and those viewing misinformation should be shown corrections - not unlike under Pofma.
In an article in Nature Medicine published last month, CCDH chief executive Imran Ahmed noted that anti-vaxxers have been training one another in identifying potential targets online.
"They discuss their tactics for deepening people's fears, sowing doubt as to whether people should take a vaccine, deepening vaccine hesitancy, and converting the chosen few into fully fledged anti-vaxxers - the people who further propagate the lies," he wrote. "Anti-vaxxers distribute themselves across social media, finding new and varied ways to inject misinformation into users' news feeds."
SHARE POSITIVE VACCINE STORIES
While this was taking place even before Covid-19, the pandemic and the swift global roll-out of vaccines were seen as an opportunity to grow their reach.
A conundrum for observers is whether to actively engage such misinformation online, given the tendency to spread the misinformation further.
It is far more helpful and effective for people to instead share good information about vaccines from trusted sources, Mr Ahmed suggests. They could also post their photos and clips of their vaccinations, to encourage their circles and show that there is nothing to fear, he adds.
While doctors and governments need to convince the vaccine-hesitant to take a specific course of action, anti-vaxxers need only to persuade them to do nothing, he notes. "All they need to do is raise doubt."
Observers have also called on tech companies to do more to act on such falsehoods, but the nature of the beast may be that such disinformation is more likely to keep popping up, including on new and alternative platforms.
Complicating the situation is geopolitical rivalry feeding into state-sponsored disinformation campaigns.
In a note this month, National University of Singapore business school visiting senior fellow Alex Capri pointed out that Russia allegedly engaged in digital disinformation operations to undermine confidence in Pfizer's and other vaccines produced in the US and Europe.
This was done not only to promote its own vaccine, the Sputnik V, but to sow confusion and mistrust among citizens of its chief protagonists.
At the same time, China's "wolf warriors" have painted American and European pharmaceutical companies as greedy opportunists, while depicting their governments as self-serving and callous. This narrative has resonated on both social media and traditional media in many of the world's poorer countries, as Beijing seeks to promote its own vaccines.
Ultimately, being aware of disinformation attempts and what drives those who propagate it is only one part of the battle.
Falling back on the facts must be key. They are:
One, Covid-19 continues to pose a significant threat to Singapore and the world, as recent surges in infections in the region show.
Two, vaccines have contributed significantly to human health outcomes over the past two centuries, and continue to be among the most effective methods of saving lives from disease - and for protecting our loved ones, colleagues and the wider community from the virus.
Three, scientists and other public health professionals have played a key role in helping humanity through the years, and their decisions, from developing vaccines to ensuring they are safe to administer, aim to maximise the well-being of the general public.
And this is why scientists and public health officials the world over have worked together to ensure vaccines are safe and that there is enough to go round for everyone so that the world can emerge from the shadow of one of its worst health crises.
Opposition politician Goh Meng Seng, Singapore Uncensored website issued POFMA correction directions over COVID-19 vaccination falsehoods
Posts implied that jabs led to doc's stroke, senior's death
By Shabana Begum, The Straits Times, 16 Apr 2021
Singapore's fake news law was invoked after unsubstantiated claims about vaccine-related adverse reactions were posted on Facebook and published online by an alternative news website.
In a statement yesterday, the Ministry of Health (MOH) said the Health Minister had instructed the Protection from Online Falsehoods and Manipulation Act (Pofma) Office to issue the correction directions.
Posts published on April 2 on the Facebook pages of Goh Meng Seng People's Power Party and Goh Meng Seng (Satu Singapura) implied that Covid-19 vaccination had caused or substantially contributed to a doctor in Singapore suffering a stroke.
Mr Goh is the secretary-general of the People's Power Party.
The same Facebook accounts also published posts on April 7 implying that Covid-19 vaccination had caused or substantially contributed to the death of an 81-year-old man here.
MOH said that on that same day, Singapore Uncensored published an article on its website stating that an 81-year-old man had died from alleged vaccination complications. The article was also shared on the site's Facebook page on April 7.
"These allegations are false. As of April 14, there is no credible evidence for an increased risk of heart attack or stroke with the Pfizer-BioNTech and Moderna Covid-19 vaccines which are currently approved and offered in Singapore," said MOH.
It added that the medical team caring for the doctor has assessed that the doctor's current condition is highly unlikely to be related to the Covid-19 vaccination, and Mount Elizabeth Hospital had issued a clarification on April 4.
As for the 81-year-old man, MOH said the cause of death was ischaemic heart disease, which refers to the lack of blood circulation to the heart muscles.
Both Mr Goh and Singapore Uncensored have complied with the correction directions to carry a correction notice alongside their posts. These are the first Pofma correction directions issued since last July.
In its statement, MOH said it is aware of falsehoods circulating that Covid-19 vaccination has clear and causal links with stroke and heart attack.
"There are also third parties who have exploited the sharing of personal experiences by individuals by reposting these personal accounts and making unsubstantiated claims about vaccine-related adverse reactions," it said.
"They often continue to do so despite the original posts being removed or made private."
MOH said Covid-19 vaccines that are used in Singapore have been assessed to be safe and efficacious by both the Health Sciences Authority (HSA) and the Expert Committee on Covid-19 Vaccination.
"Medical teams are well equipped and measures are in place at all vaccination sites to ensure the safety of vaccine recipients pre-, during, and post-vaccination."
The ministry said all vaccine-related incidents are taken seriously, and healthcare professionals are required to report these incidents expeditiously to the MOH and HSA.
Facts about the two cases
By Shabana Begum, The Straits Times, 16 Apr 2021
DOCTOR WHO HAD A STROKE
The medical team caring for the doctor has assessed that the doctor's current condition is highly unlikely to be related to Covid-19 vaccination.
The writer of the original Facebook post, Bun Ngok Fong, alleged that the doctor had a stroke a week after receiving the vaccine. The post also stated that the doctor is the writer's cousin.
In a Facebook post on April 4, Mount Elizabeth Hospital clarified that the allegations in the post are untrue.
The hospital added that the doctor's family has confirmed that the writer is not related to them. The family has also written to Facebook to have the post removed.
"You can help us stem the circulation of false information by not sharing the post and deleting it if you have already done so," added the hospital.
81-YEAR-OLD MAN WHO DIED
The cause of death of the 81-year-old man was ischaemic heart disease, which refers to the lack of blood circulation to the heart muscles.
The Health Sciences Authority's Forensic Medicine Division has reported that based on a post-mortem, there was no evidence of acute anaphylaxis or an allergic reaction at the injection site of the Covid-19 vaccine.
The three main blood vessels supplying blood to the muscles of the heart were extensively narrowed due to the build-up of plaque over time in the vessels, obstructing blood flow.
As at April 14, there is no credible evidence for an increased risk of heart attack or stroke with the Pfizer-BioNTech and Moderna Covid-19 vaccines that are currently approved and offered in Singapore.
*********************
** Health Sciences Authority safety update (30 December 2020 – 18 April 2021)
Serious reactions to COVID-19 vaccinations rare, affecting four in 100,000 out of 2.2 million vaccine doses administered in Singapore
By Joyce Teo, The Straits Times, 7 May 2021
There were 95 serious cases suspected to be reactions to Covid-19 vaccination here over a period of less than four months, and 20 of these involved a potentially life-threatening allergic reaction known as anaphylaxis, the Health Sciences Authority (HSA) said yesterday.
But the 95 cases represent just 0.004 per cent of the more than 2.2 million doses administered from Dec 30 to April 18, the HSA said in its first update on the safety of the mRNA Covid-19 vaccines used here.
About 0.13 per cent of the doses administered resulted in suspected adverse reactions.
About 70 per cent of these cases involved people who were younger than 60 years old, although they made up about half of the people who have taken the vaccines.
There were no deaths associated with taking the vaccine.
There were also no reports of unusual blood clots associated with low platelets that have been reported with other types of Covid-19 vaccines overseas, said the HSA.
It defines an adverse effect as serious when it results in hospitalisation, a significant reduction in functional capacity, a life-threatening event like anaphylaxis, or death.
Most of the adverse events were associated with the Pfizer-BioNTech vaccine because this has been available since Dec 30. The Moderna vaccine was rolled out only on March 12.
Nearly 850,000 people have completed the vaccination regimen by taking two doses as at April 18, according to the Ministry of Health (MOH).
Anaphylaxis, which typically happens very quickly, remained the greatest concern because it is life-threatening, said the HSA.
Within minutes of getting the vaccine, a person who has it may experience swelling of the face, eyes and lips. Their airway can be constricted, and there may be nausea, vomiting and diarrhoea.
The 20 cases were in people aged 23 to 68, and most of them were women. About 55 per cent of them had a history of allergies, to food or drugs. And, 60 per cent of them had onset of symptoms within 30 minutes. All have recovered after medical treatment, said the HSA.
The incidence rate of this reaction here is about 1.4 per 100,000 doses administered, which is similar to the incidence rates reported overseas, of around 0.5 to two per 100,000 doses administered.
Anaphylaxis incidence rate in Singapore similar to those reported overseas
Anaphylaxis is a reaction that has been reported with the use of other vaccines too, as is Bell's Palsy, which the HSA is also monitoring closely.
There have been 25 cases of Bell's Palsy, which is a temporary paralysis of a part of the facial muscles, and most are not serious, it said. Most patients recover completely, even without treatment.
The 25 works out to a rate of 3.45 per 100,000 people per month, which is within the background incidences of 1.1 to 4.4 per 100,000 people per month prior to the introduction of vaccination, said the HSA.
Among the 95 with serious adverse events, 20 involved anaphylaxis, while another 20 had severe allergic reactions, including severe rashes, possible shortness of breath and rapid heartbeat.
Other serious adverse effects include breathing difficulty, fast heart rate, an increase or decrease in blood pressure, chest discomfort, fainting, limb numbness or pain for a few days, changes in vision and an increase in liver enzymes, said the HSA update.
Most of the 95 people have recovered or are recovering.
They are among a bigger group of 2,796 people who experienced adverse effects associated with the vaccine, according to the HSA data.
The most commonly reported adverse effects of getting the vaccine shot are rashes, hives, dizziness, swelling of eyelids, face and lips, fever, shortness of breath, muscle aches, headache and itchy skin, said the HSA.
These effects are in line with the ones described in clinical trials and Covid-19 vaccine product information.
"Based on available data, the benefits of the Pfizer-BioNTech and Moderna Covid-19 vaccines continue to outweigh the known risks in a pandemic," the HSA said.
It will continue to monitor the safety of the vaccines, and release vaccine safety updates on a monthly basis from now on.
No rise in heart attack, stroke cases among vaccinated people: HSA
Also no evidence that vaccines used here can directly cause such medical events, says Health Sciences Authority
By Joyce Teo, The Straits Times, 7 May 2021
There has been no uptick in heart attacks or strokes among vaccinated people, and no evidence that the Covid-19 vaccines used here can directly cause them, the Health Sciences Authority (HSA) said yesterday.
"A greater frequency of heart attacks and strokes has not been observed in vaccinated persons locally and to date, there is also no evidence that the vaccines can directly cause these events," HSA said in its first update on the safety of the mRNA vaccines used here.
Only the Pfizer-BioNTech and Moderna vaccines are used here.
"No deaths from heart attacks, strokes or any other causes suspected to be associated with the vaccines have been reported locally," HSA said. It had looked at the cases of adverse events - there were 2,796 - that arose from the more than 2.2 million doses administered between Dec 30 and April 18.
Due to the large number of people being vaccinated, some may, by chance, experience medical events such as heart attacks and strokes in the days or weeks after vaccination. And this may not be related to the vaccination, said HSA.
At a Ministry of Health (MOH) media briefing yesterday, an HSA spokesman said it is hard to ascribe causality to heart attacks or strokes as they can happen spontaneously and generally these patients do have underlying medical conditions.
Professor Teo Yik Ying, dean of the National University of Singapore's Saw Swee Hock School of Public Health, said at the briefing that typically, in a three-month period, there would be some 2,000 stroke cases and slightly fewer than 3,000 heart attack cases. People can experience these, whether they are vaccinated or not.
"There have not been any established links between cases of stroke or heart attack with either the Pfizer or Moderna vaccines in the United States, which has seen at least 240 million doses delivered as at May 5," he said.
He said vaccination remains key to the battle against Covid-19 as new variants spread and form clusters here. "The signal from the Tan Tock Seng Hospital (TTSH) cluster is that vaccination helps because it provides much better protection against serious outcomes of infection," he said.
MOH's director of medical services Kenneth Mak had earlier said that eight patients in the TTSH cluster who had been vaccinated were either asymptomatic or exhibited very mild symptoms, and none required oxygen therapy.
"Of those not protected by vaccination, seven of the 20 had need of oxygen therapy," he had said at a May 4 Covid-19 press conference.
Yesterday, MOH said it had received and was processing applications for the Vaccine Injury Financial Assistance Programme for Covid-19 vaccination (VIFAP).
Under Vifap, which was launched on March 17, those who need inpatient treatment and medical intervention, and who subsequently recover, will get $2,000.
Those who require admission to high dependency or intensive care wards, and subsequently recover, will get $10,000.
Those who die or suffer permanent severe disability as a result of the vaccination will get $225,000.
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