Saturday, 4 September 2021

Singapore to offer COVID-19 vaccine booster shots for seniors aged 60 and above, immunocompromised people from September 2021

By Lim Min Zhang, The Straits Times, 3 Sep 2021

Singapore will give its first Covid-19 vaccine booster shots - to seniors aged 60 and above, residents of aged-care facilities, and those whose immune systems are compromised - from this month, said Health Minister Ong Ye Kung on Friday (Sept 3).

Seniors should receive a booster dose of mRNA vaccine six to nine months after completing their two-dose vaccination regimen, said his ministry.

This means the first batch of seniors aged 60 and above who completed their original vaccination regimen around March this year will be eligible for their third dose later this month, said the Ministry of Health (MOH).

Those who are moderately to severely immunocompromised should receive a third dose of the same mRNA vaccine two months after their second dose, as this ensures they start off with adequate protective immune response to the virus, added the ministry.

These recommendations were made by the Expert Committee on Covid-19 Vaccination, after it reviewed the available evidence, including on the safety and efficacy of booster doses administered around the world.

MOH has agreed with its recommendations to start the booster shot programme for these groups of people, it said in a statement on Friday.

The booster shots for seniors are to ensure continued high levels of protection against infection and severe disease from Covid-19, and to reduce the possibility of spikes in infection and more people falling severely ill.

Migrant and healthcare workers, if they are 60 and above, will also be prioritised for booster shots.

Seniors are at risk of severe Covid-19 infection and may develop a lower immune response from their two-dose vaccination regimen, it said. "This is coupled with the expected decline of their immunity over time, as many were vaccinated earlier."

Mr Ong noted that with the waning immunity provided by vaccines and increasing breakthrough infections, a number of countries have commenced vaccine booster programmes.

"This is to pre-empt a very sharp rise in breakthrough infections, which can still mean, in absolute terms, many people can fall very sick or die... This is especially relevant to the elderly and to other higher-risk groups," said Mr Ong, who co-chairs the multi-ministry task force tackling Covid-19.

He urged all seniors contacted by their healthcare providers to come forward for their third dose of vaccination.

MOH said that the additional dose recommendations for immunocompromised individuals, seniors aged 60 years and above, and residents of aged-care facilities are aligned to the vaccination measures adopted in countries such as Israel and Germany.

The United States Food and Drug Administration (FDA) has also approved a third dose for immunocompromised individuals and is considering its recommendation for seniors, it added.

Among those who will be at the front of the line for booster shots are immunocompromised people, as they have a blunted immune response to vaccination and are at a higher risk of severe illness from Covid-19.

People with weakened immune systems include those who are on cancer treatment, transplant patients, other patients on immunosuppressive therapy, and end-stage kidney disease patients on dialysis.

These individuals will be contacted by their healthcare providers, as they would likely have regular follow-up sessions with their doctors, said Mr Ong.

During the virtual press conference on Friday, he also said the expert committee will continue to review the evidence and data for other groups.

One area which it is studying is the rare, but more severe, adverse reaction to vaccines which occurs mostly in younger age groups.

Another area is the effectiveness of using a different vaccine as a booster from the vaccine used in the first two doses, he said.

Asked why front-line workers – who were the first group to be vaccinated in Singapore – are not the first to receive the booster shots, director of medical services Kenneth Mak said the expert committee had looked at which groups needed additional protection to mount an adequate immune response to the virus.

For immunocompromised patients, they may not have developed even after the first two doses are completed. “This third dose is considered an expanded primary course of vaccination for them,” he said.

As for prioritising those aged 60 and above, Associate Professor Mak said they are more likely to have bad outcomes if they do get infected, such as an increased risk of being admitted to the intensive care unit and needing oxygen support.

While vaccinated migrant workers will also experience waning antibody response, they are generally younger, he noted. But they may also get their booster shots earlier if they are above 60, he added.

Will I be considered 'unvaccinated' if I do not take booster shots?
By Lim Min Zhang, The Straits Times, 4 Sep 2021

With the roll-out of Covid-19 vaccine booster shots expected to start this month, The Straits Times tackles key questions about the programme, including whether someone will be considered "unvaccinated" if they do not get the booster shots.

Q: Why is there a need for booster shots?

A: Booster shots will increase vaccine effectiveness and help in maintaining a high level of protection against more severe infections, said Trade and Industry Minister Gan Kim Yong in a press conference on Friday (Sept 3).

The strength of vaccine protection will come down as antibodies wane several months after the vaccination, said Health Minister Ong Ye Kung. Despite this, vaccines continue to be very effective in protecting against severe illnesses and deaths, should one be infected.

Internationally and in Singapore, more breakthrough infections - where fully vaccinated individuals are infected with the Delta variant - have been observed, he said. Israel, among the countries in the world with the highest vaccination rates, began offering those aged 60 and above a third vaccine dose in late July. They are eligible five months after their second dose.

Other countries such as the United States, Britain, France and Germany have also announced booster campaigns.

Q: Why are healthcare workers not the first group to receive booster shots?

A: When it comes to booster shots, two groups of people were identified as priorities by the expert committee, said Singapore's director of medical services Kenneth Mak.

Immunocompromised patients may not have developed sufficient protection even after the first two doses are completed, said Associate Professor Mak. "This third dose is considered an expanded primary course of vaccination for them."

The second group comprises those aged 60 and above. Prof Mak said they are more likely to have worse outcomes if they do get infected, such as an increased risk of being admitted to the intensive care unit (ICU) and needing oxygen support.

Migrant workers will, like everyone else, have over time a waning antibody response, said Prof Mak. But because they are generally younger, they do not need to be prioritised as much as those aged 60 and above.

But any migrant worker aged 60 and above can get vaccinated earlier as they fall into that same higher-risk group, he said. The same goes for healthcare workers aged 60 and above.

Q: Will the rest of the population need to take booster shots?

A: Prof Mak said the rest of the population not aged 60 and above will be offered booster shots at a later point in time.

This would be in accordance with a subsequent set of expert committee recommendations, he said, after further study to determine the best time for them and what form of booster vaccination is the most appropriate.

Q: Will those who have taken two doses of the Covid-19 vaccines still be considered fully vaccinated if they do not take the booster shots?

A: They will still be considered fully vaccinated, said Mr Ong. Singapore is taking a pre-emptive move before antibodies wane further, even as ICU cases and the number of deaths still show that seniors are well protected against getting very ill should they be infected, he said.

Singapore to maintain current COVID-19 measures, will rely on vaccination and testing to move ahead
By Audrey Tan, Science and Environment Correspondent, The Straits Times, 3 Sep 2021

Singapore will stay in the current preparatory stage of its reopening, and will continue to rely on vaccination and testing to keep the Covid-19 situation under control, amid a recent spike in infections.

In an update on the Covid-19 situation on Friday (Sept 3), Finance Minister Lawrence Wong said there are no plans to loosen or tighten curbs at this stage as the country transitions to living with the disease.

The multi-ministry task force tackling Covid-19, which Mr Wong co-chairs, will tighten measures only as a "last resort", to keep the healthcare system from being overwhelmed.

It will also not loosen measures at this juncture, taking into account the time lag between the onset of infections and serious illness, said Mr Wong at a virtual press conference alongside his co-chairmen, Trade and Industry Minister Gan Kim Yong and Health Minister Ong Ye Kung.

Singapore reported 216 new cases of community infections on Friday, 3 Sep, with 109 unlinked ones.

Mr Wong said the recent increase in the number of cases is not unexpected, since more people have been going out following the loosening of restrictions earlier.

But Singapore is also in a new phase, with a high level of vaccine coverage, he added.

As the Government continues to monitor the situation, it will also expand the nation's vaccination and testing regime.

In view of the more transmissible Delta variant, the Ministry of Health (MOH) will start administering booster Covid-19 vaccination shots to two groups of people - those who are moderately to severely immunocompromised, as well as those aged 60 and above, and residents of aged care facilities.

As the first batch of seniors aged 60 and above completed their second doses around March, they will be eligible for the third dose within this month (September). More details on the implementation of the booster shot will be announced later, MOH said.

Mr Ong said about 85 per cent of the population would have been fully vaccinated against Covid-19 by this month.

Added Mr Wong: "We have already reached very high levels of vaccination - we are one of the foremost countries in terms of vaccination - we should now aspire to be a nation of testing, where testing becomes a way of life."

On the testing front, the 20 quick test centres already set up for workers to meet testing requirements will open up to the public from Oct 1, so that they can make an appointment for a self-paid test.

This will supplement regular self-testing, and will enable people to use such tests to fulfil employment requirements, or for an unvaccinated person to attend a mass event.

Mr Wong said the Government is looking into setting up more of such testing sites across the island, so that it will be easier for people to get themselves tested regularly.

He added that the Government has already mandated rostered routine testing for people in high-risk settings.

"But regular testing should not be confined to those working in such settings," he said. "We want to strongly encourage everyone, whether you're vaccinated or not, to self-test regularly as a matter of social responsibility."

Mr Ong said personal responsibility and community resilience are "alternate lines of defence" to keeping the situation under control, now that the Government is refraining from tightening measures.

"I think most of us, all of us, don't want to turn back," said Mr Ong. "Then we must be able to fall back on alternate lines of defence."

This includes getting vaccinated, observing safe management measures, wearing masks properly, and not spreading misinformation, among others.

Mr Ong added: "This next phase of the journey depends critically on everyone's civic consciousness and social responsibility. So let's take care of ourselves and the people around us."

############### 6 Sep 2021

*  Singapore rolls out measures to slow down spread of COVID-19 community cases
By Audrey Tan, Science and Environment Correspondent, The Straits Times, 7 Sep 2021

Singapore will expand its testing regime more aggressively to keep the Covid-19 situation under control, as the number of new infections last week doubled to more than 1,200 - up from around 600 cases the week before.

Announcing a range of measures on Monday (Sept 6) to slow the spread, Finance Minister Lawrence Wong said workers in more sectors will now have to undergo mandatory fast and easy rostered routine testing, with the frequency of tests increased from every 14 days to once a week.

To ring-fence cases more quickly, the Government will also issue health risk warnings (HRW) to individuals identified as close contacts of Covid-19 cases or who have been near a patient for an extended period of time.

Individuals who receive a health risk warning will be required by law to get a polymerase chain reaction (PCR) test and self-isolate until they receive a negative result for their first test. They will also be required to do an antigen rapid test (ART) thereafter, and a PCR test on the 14th day.

Meanwhile, those whose SafeEntry records overlap with that of Covid-19 cases will get health risk alerts (HRA). They are not required to get tested, but are strongly encouraged to go for a PCR test as soon as possible, said the Ministry of Health (MOH).

HRW and HRA are not quarantine orders, MOH said, but individuals who get them should reduce their social interactions for 14 days.

Mr Wong, who co-chairs the multi-ministry task force handling Covid-19, said a rise in cases was expected as restrictions were eased and activities resumed.

"What is of concern to us is not just the absolute number of cases, but the rate at which the virus is spreading," he said, noting that the experience of other countries has shown that many more people will need intensive care or die when cases rise so sharply.

"It's not just the unvaccinated seniors, because even for vaccinated persons, there will be a small proportion of them falling severely ill."

MOH said Singapore's rate of severe illnesses and deaths among vaccinated individuals is low, thanks to the country's high vaccination coverage.

But unvaccinated individuals remain susceptible - over the past 28 days, 6.7 per cent of unvaccinated cases fell severely ill or died, it noted.

Meanwhile, the number of new infection cases in the community has almost doubled to more than 1,200 cases in the week ending Sept 5, up from around 600 cases in the week before.

"If the infection continues at this trajectory, we will see a doubling of cases every week. This means that we can expect to see more individuals suffer serious consequences," said MOH.

"Thus, we need to take quick action now to dampen the increasing likelihood of an exponential increase in cases. This will also buy us time to get more people, in particular seniors, vaccinated as soon as possible, and also to roll out our booster programme to those aged 60 and above."

To detect cases early, mandatory rostered testing will be extended to retail mall workers, supermarket staff, last-mile delivery personnel - including parcel and food delivery workers - as well as public and private transport workers such as taxi drivers, private-hire car drivers and all public transport front-line staff.

Previously, only workers in higher-risk settings such as food and beverage outlets, personal care services, and gym and fitness studios needed to undergo such tests.

These tests will continue to be administered primarily through the Employer Supervised Self-Swab scheme. The Government will pay for the cost of all tests under this enhanced surveillance regime, for both vaccinated and unvaccinated individuals, until the end of this year, MOH said.

More details on the enhanced surveillance regime will be released at a later date, MOH said.

The Government will also distribute ART kits to companies in sectors which are not subject to mandatory testing. Each firm will get eight ART kits per employee to facilitate weekly testing of their staff over a two-month period.

"With these kits, we expect all companies to initiate weekly testing for their onsite staff," said MOH.

While these tests can be administered by individuals at home or at the work premises, MOH said employers should put in place a process to ensure that the tests are done properly, and report the results to respective government agencies.

More details on this will also be made available at a later date.

"With all these measures, we hope that we can help to slow down transmission without having to go back to (a state of) heightened alert, or a circuit breaker," Mr Wong told reporters in an interview at The Treasury.

"These are last-resort measures and we will try our best to refrain from using them. But we should not rule them out entirely," he added, urging people to get tested regularly and scale back their non-essential social activities during this period.


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