Hi, my name is Tina, I am 47, and I am asthmatic. The impact of COVID-19 on a respiratory system like mine is almost guaranteed to be huge.
So you can imagine the tsunami of relief that washed over me when the government announced that the COVID-19 vaccine would be made available to all Singaporeans and long-term residents in Singapore by the end of this year.
I registered my interest in a hurry, and I was not alone.
Following Prime Minister Lee Hsien Loong’s announcement that the vaccines would arrive in Singapore from late December 2020, the rollout began in late February this year with an inoculation programme for seniors aged 70 and up in late February this year.
For Gen Xers, pre-registration for vaccination timeslots began in late March. Where we stand as a nation now, most of the Gen Xers—over 900,000 of us aged between 41 and 56—should have completed or received at least the first of their two shots. Vaccinations are now open to the youngest of Gen X, the 40-to-44 year olds. As of June 1, registration for students aged 12 to 18 has also opened, and from mid-June, the final demographic, those 39 and under, will be able to register for vaccination.
Judging from the number of posts on social media of Gen Xers showing off their red #Igotmyshot packs of masks having completed their second jab, the take-up rate has been reasonably good. And most don’t even care if they receive the Pfizer-BioNTech or Moderna vaccine as long as the holy trinity of a convenient location, date and time is met.
The last few weeks have lit a fire under many who were still hemming and hawing over taking the jab, thanks to new clusters forming and a new COVID variant that has proved to be highly infectious. On May 31, Prime Minister Lee Hsien Loong made a national announcement that, while things appear to be under control, the “new normal” in Singapore will involve much more regular routine testing, tracing and vaccination.
GOTTA GET IT!
Way before this current wave of new infections and revived urgency to get vaccinated, Andy Yap, 54, manager was an early adopter. He registered for a timeslot in late March, “as soon as details for my age group were out”.
“Why? To get back pre-COVID days where we can throw parties—such a dirty word now—travel, and even receive Holy Communion in church. I have been playing my part by observing safe distancing and wearing my mask. And while I know there are also other ways to stop the spread such as staying home more, maintaining personal hygiene and avoiding fake news (cow dung bath, seriously?), a more logical way is to get vaccinated.” he says.
Andy, who is now fully vaccinated, adds that taking the shots is his way of helping achieve herd immunity. He explains: “Vaccination will help mitigate the terrible effects of COVID, and as more do the same, the ripple effect increases. The sore arm and throat infection I endured after my jabs are a small inconvenience.”
Whether it’s the longing for life (and travel) to resume, or the hope of protecting self and loved ones from the virus, many Gen Xers have received or at least registered for and await their jabs.
The process is twofold: first, register your interest at vaccine.gov.sg. You should receive an SMS the next day informing you that you are or are not eligible for vaccination. Second, check your SMS regularly for a message from the Ministry of Health that you are now able to choose a timeslot and location for vaccination.
Sounds simple, but as the months passed, some Gen Xers found they had to wait a long time to receive that second SMS.
“As soon as I knew my age group was eligible, I tried applying several times, unsuccessfully. I guess the server was not ready to keep up to the influx of responses,” laughs freelance designer KS Lim, 50. “I was not anxious, such programmes take time.”
His main reason for wanting the jab? To protect his health. He says: “I know the great importance of getting a vaccination, and understand the urgency for the government to get as many citizens as possible to be vaccinated. I wanted to protect myself, I wasn’t thinking so much about travelling since most countries are still grappling with the pandemic.”
KS, who has since been fully vaccinated, says the side effects he read about were a minor concern for him, and that the importance of the jab “far outweighed” them.
The rate of vaccination in Singapore has been affected by the supply, as PM Lee explained. But it should gain speed soon, seeing that delivery of vaccines has been confirmed for the next two months.
“PLEASE, I JUST WANT TO DUST OFF AND USE MY PASSPORT”
For most, the reasons for getting vaccinated run the gamut of “for greater immunity”, “for peace of mind” and “I believe the sooner I get protection, the better”.
Also high on the list: “I need to travel, pronto.”
Says Desmond Williams, a management consultant: “I want to get my jab so that I can see my family in Ireland sooner. Hopefully by the end of July.”
The 48-year-old signed up for his jabs immediately, and has since been fully vaccinated. Like many, he assumes proof of full inoculation instantly grants a vaccine passport.
However, that is not necessarily the case.
In an article in The Straits Times on May 18, newly-minted Minister for Health Ong Ye Kung called the concept of a vaccine passport “a misnomer” and said countries will have to come to an agreement to recognise the vaccine certificates issued by their counterparts before travel will be allowed.
This was in response to a question about whether Singapore has plans to introduce vaccine passports as a condition for travelling in or out of the country. Leisure travel remains prohibited as travel bubbles continue to burst.
While some are already resuming business travel work and abiding by the general rule to serve a Stay Home Notice upon their return, the question on everyone’s lips is: so if more and more people get vaccinated, will leisure travel open up?
Prior to the spate of new cases in May, Minister Ong had, in a Apr 28 report in The Straits Times, Minister Ong had painted a possible future where travel restrictions would be eased. Citing how countries such as Britain, Denmark, France, Germany and the United States have already exempted travellers from Singapore from quarantine, he said Singapore can consider allowing residents who are vaccinated to travel to countries with low numbers of COVID-19 cases without having to be quarantined on their return.
The caveat: “If they can keep the number of cases quite low—and it doesn’t have to go down to zero or one, two cases—we can consider allowing vaccinated Singaporeans to travel to these places. And when they return, they can just get tested instead of being quarantined. It won’t be considered a travel bubble, but it will be an important avenue to open up some more.”
While this has been superceded by recent events, there is still the possibility this could be the case in time to come. On Monday, PM Lee also ended his speech on an encouraging note: “[In the new normal, COVID-19 will not dominate our lives…] We will reopen our borders safely. Visitors will again come to Singapore. Singaporeans will travel again to countries where the disease is well under control, especially if we have been vaccinated.”
“LET’S WAIT AND SEE…”
Prior to getting his shots, Desmond did significant research to understand the risks, the resistance to various strains and so on.
He says: “Would I recommend others get vaccinated? I think this is a personal choice. Certainly, if you have a strong need to travel like I do, yes, it would make life easier. That being said, if I did not need to travel, I would wait to see what longer term side effects might happen, if any.”
This view is shared by a smaller minority who are resisting the government’s clarion call. Some choose to adopt a “wait and see” stance despite the widely publicised efficacy of Pfizer-BioNTech and Moderna vaccines.
Newspaper reports of vaccination-related deaths add paint to this no-so-pretty picture. A doctor in the United States was said to have developed a severe blood disorder after receiving the Pfizer-BioNTech vaccine, while other reports have linked the jabs to side effects such as facial paralysis and cardiac arrest.
“I’ve heard and read the horror stories of the after-effects,” says Jim Low, 44, a sales manager. “High fevers, complications leading to hospitalisation, extreme fatigue, to name a few. So, I do not have any intention to sign up till more information is available about how well the vaccines are being received.”
To date, he remains unconvinced—and unvaccinated.
Germaine Lim, 47, held a similar view initially. Despite working in a hospital and being exposed to coming-and-going patients on a daily basis, the marketing communications manager had refused the vaccine when it was offered to her in January in the early rollout for frontliners.
She explains, “I’m no medical expert, but I know the efficacy of vaccines can only be determined after a long period of testing. The thought of being a lab rat of sorts did not sit well with me. I was highly sceptical.
“I also considered the side effects. Dizziness, fever and muscle pain? Fine, no problem. But I had also read of people who experienced temporary facial paralysis, blood clots, and even anaphylaxis. Also since I am allergic to shellfish and antibiotics, I did not want to risk dealing with a bad allergic reaction so I adopted a wait-and-see attitude.”
But Germaine, who lives with aged parents and enjoys weekend family get-togethers with her siblings and their families, has now changed her mind.
She says: “I realise that by being vaccinated, I am helping protect my family as well. Working in a hospital, I potentially carry germs home every single day. What if I caught COVID and passed it on to my parents? With their age and the fact that they are already on multiple medications, they would be at high risk.”
She has since registered for her shots, and is now waiting to get her first jab on June 16.
Like Germaine, manager Jessica Yap*, 47, was planning to hold off getting the vaccine for as long as she could. “We don’t know what the vaccine does to which parts of our complex bodies, and there’s no luxury of time to test. So I thought let’s wait six or seven months and see what the after effects and effectiveness of the vaccines are.
“Community cases were low, I had been working from home since before the Circuit Breaker, and my 86-year-old father is already vaccinated, so I figured I’m at a super low risk of catching anything.”
Jessica admits that she is not convinced of the efficacy of the available vaccines, and is waiting to see what other options there might be, namely China’s SinoVac. “It uses inactivated virus, a traditional and proven method for vaccine development,” she points out. “As I understand it, there is no standardised method of testing and measuring.”
SinoVac showed a much lower efficacy rate in January when the vaccine was rolled out across Brazil. Compared to Pfizer-BioNTech (95 per cent effective) and Moderna (94 per cent), SinoVac reportedly has a 50.4 per cent rate of preventing COVID-19.
However, Indonesia has reported a 98 per cent rate of effectiveness among 120,000 healthcare workers vaccinated with SinoVac between January and March this year.
“There has been another factor that’s not widely tested: ethnicity,” Jessica reasons. “Maybe the China vaccine works better for Asians?”
Minister Ong announced on May 31 that such alternative vaccines, which are still being evaluated, can be made available under MOH’s Special Access Route, through the private healthcare sector. Those that choose these alternatives, such as SinoVac and Astra-Zeneca will not have their vaccination subsidised by the government. They will also not be eligible for financial assistance should they have any vaccine injuries.
Despite her scepticism, Jessica went for her first Pfizer-BioNTech jab in the last week of May. “Now with the variants coming into Singapore, I don’t have a choice,” she says. “What we do know is about the original COVID-19 strain, but with this development, it’s safer to have some sort of protection—it’s spreading very fast.”
“NO THANKS, NO VACCINATION FOR ME”
There are yet those who are against any sort of vaccination, never mind ones with a short history like the COVID vaccines.
Wendy Choo*, a 50-year-old private educator, has no plans to be vaccinated against COVID. The mother of three had a life-changing scare when her firstborn became catatonic following a routine MMR vaccine shot at the age of 1.
“She had diarrhoea, very high fever for a few days, shivering,” she recalls of her daughter’s adverse reaction. “She just lay down on the bed lifeless. We thought we were going to lose her.”
The doctor who had administered the jab admitted it was a reaction to the vaccine, and wrote a letter to exempt her daughter from the booster six months later. This has scarred Wendy for life: her second and third children have had their first year vaccinations, but for herself, the COVID vaccine is a no-no.
“I have a strong belief that the COVID virus is manmade,” she says, adding that she knows it’s not a popular viewpoint and that some of her friends now shun her. “I personally believe that the body can heal on its own in many ways, so I’m not overly afraid of this COVID.”
She fails to see the benefits of getting the jab, she says. “After being vaccinated you can still carry and pass the virus around. Not everyone will get severely ill if they catch COVID—in fact, they could possibly develop antibodies—but if one gets serious side effects from being vaccinated, like getting a stroke and dying, that’s irreversible. I think we just need to be careful during an outbreak, that’s all.”
“I WANT IT, BUT I CAN’T HAVE IT”
Recently, Chris Henson, 50, a financial services professional and podcast host, felt “abandoned. Anxious. Angry.”
He was rejected in late April when he turned up for his first jab at a vaccination centre. “When the newspapers announced that those in my age group could get the vaccine already, I went into the MOH site to register. A couple of days later I received the link to book the two vaccination dates, and there, I had to answer a questionnaire.
One question regarding allergies popped up and I had to state honestly that I am allergic to penicillin and Synflex. I also had to disclose that for Synflex, I reacted with swollen eyes and face; also felt a tightening of the throat but this was also highlighted in the template answer in their questionnaire as breathlessness.”
Chris’ application for vaccination was rejected then. “So I called their hotline and they told me to see my attending physician to get a memo and then apply again; without having to state that I have any allergies. I went to see my doctor who wrote a memo describing my allergy symptoms to these drugs. I re-booked my vaccination appointment dates again and got them.”
Chris’ doctor explained that while he believed his allergy to Synflex—a one-time reaction a few decades ago—would not impact his taking the vaccine as they are unrelated, there was a chance that the doctors in-attendance at the vaccination centre might still reject him.
Armed with this information, Chris showed up for his first jab. “At registration, I had to answer the same questions regarding my allergies. I was already advised at that stage that I may have an issue but to go to the vaccination point anyway and see what the nurses had to say.
“The nurse who read my declaration said that I answered positively to two out of the three questions relating to allergies and that was a red flag. I insisted with respect, to speak with a doctor instead.”
The doctor at the centre informed Chris that there was an erratum from MOH stipulating that if any patient answered “Yes” to two out of the three reactions—dizziness, swelling of the face, eyes or lips, and breathlessness—they were not to proceed with the vaccination. “I had dizziness and breathlessness from my last reaction to Synflex,” says Chris.
Unable to get his jab, Chris asked the doctor what his next steps were. “He gave me a deferment notice and said that in the event there is a new vaccine that I can take, I’ll be notified. Or in the event that the ministry lightens its rule over this.”
“I know for a fact where herd immunity is concerned, there will be that pariah minority who want to be vaccinated but cannot be vaccinated,” he explains his frustration. “Herd immunity doesn’t mean that those who have been vaccinated will not carry and spread the virus to someone like me. I will always be at risk regardless.”
Unhappy but not ready to give up following his rejection, Chris wrote to Health Minister Ong. “He replied and said he read about my position and he asked one of his people to be in touch with me. Someone did call me, but it was more or less a templated answer that the vaccination centre doctor already gave me.”
However, since the May 31 announcement by the Multi-Ministry Task Force (MTF), Chris feels that at least his concerns have been heard and are being seriously considered, even though it will be another two weeks before he can get any clarity on his eligibility for vaccination.
Currently, MOH states on its website that three categories of persons cannot be vaccinated: those with a history of anaphylaxis, those with a severely weakened immune system, and those with a very low platelet count. These categories are broad enough to exclude individuals like Chris, and cancer patients like Alexis Tan*, a 47-year-old civil servant.
Alexis received a diagnosis of Stage 1 breast cancer one day before she showed up for her first jab in late March—she had not had surgery or treatment yet. Although her doctor had given her the all-clear for vaccination, and the media had reported that cancer patients not receiving chemotherapy, radiotherapy or immunotherapy could be vaccinated, she was not allowed to receive the vaccine when she went to the centre.
“I was still dealing with being diagnosed, so when the nurse came out with a memo stating that I could not be vaccinated, I was a little disappointed. I thought those with cancer or illnesses could be vaccinated. Why was I discriminated against?” Alexis remembers.
“If they had cleared me, I would have completed both jabs before my cancer operation. Maybe I should have asked to talk to the doctor at the vaccination centre but honestly I was too shocked.”
When contacted about these situations, Dr Loh Jiashen, an Infectious Disease Physician from Infectious Disease Clinic at Farrer Park Hospital, shared two perspectives on this matter.
“The lifting of exclusions in people with severe allergies is encouraging,” he noted following the May 31 announcement. “But people with previous anaphylaxis seem to still be disallowed. We need to wait for the exact guidelines to be released before we can be clear.”
Dr Loh feels that people should not be excluded from receiving the vaccine when the aim should be to protect as many people as possible from COVID-19. He adds that his colleague, a rheumatologist, has written hundreds of memos for those deemed ineligible.
“There are mitigation measures in place onsite to catch the exceedingly few people who will have reactions,” he explains. “The vaccines have proven to be spectacularly effective; the danger of dying from COVID is much more real than dying from a vaccine reaction.”
He adds that “there is misunderstood and misapplied information out there now that has resulted in mistaken rejections”. International recommendations have shown that mRNA is exceedingly safe, even for people with allergies, no matter what these are.
Dr Loh adds that US studies have shown that the general rate of developing anaphylaxis is 4.7 and 2.5 cases per million cases for Pfizer-BioNTech and Moderna respectively. Of these cases, no one has died.
On the other hand, there are significant factors to consider in holding off vaccinations for cases like Chris’ and Alexis’, Dr Loh notes.
“Singapore currently does not have an abundant supply of vaccines, which will slowly ramp up over the next few months to cover the entire local population. At the same time, bad press from vaccine reactions may potentially undermine the population’s enthusiasm to get vaccinated.
“The restrictive local guidelines could possibly be a way to divert the safer population for vaccination first, since the prospective effect on the country is the same whoever gets the vaccine—as long as we are vaccinating as fast as we possibly can,” he says.
“For example, if we have enough for 30 percent of the population, it would be reasonable to vaccinate the safest 30 percent in the first wave, so that supremely good feedback will encourage the marginally higher-risk population to get vaccinated, such as people with previous anaphylaxis.”
Hopefully, things will change soon for the 30,000 individuals in the same conundrum as Chris. At the MTF press conference on May 31, Minister Ong said, “The expert committee is also examining the data and reviewing the current policy where we restrict individuals with known anaphylaxis, to take the vaccine. Specifically, the committee is reviewing the restriction for those who are not allergic to the mRNA vaccine or its components, but other substances like seafood, painkillers, antibiotics.”
The committee expects to come to a conclusion in two weeks. Meanwhile, those in this group that wish to be inoculated can apply for the Special Access Route to receive alternative vaccines.
A WHOLE NEW WORLD?
In Singapore and most first world countries, the take-up rate for vaccinations has been on the rise.
Global media, including Singapore’s, have reported a rise in vaccination confidence levels now that more have been inoculated. According to the vaccination tracker by The New York Times, more than 1.74 billion vaccine doses have been administered worldwide. Data is compiled from government sources by the Our World in Data project at the University of Oxford.
Meanwhile, gov.sg states that in Singapore, 2,112,450 have received their first dose while 1,616,419 are fully vaccinated. It is estimated that come end of July, 4.3m people in Singapore would have received their first dose. And with the recent spate of infections among schoolchildren, preregistration for vaccinations for those aged 12 to 18 has begun.
By the time you read this article, those figures would have grown. As Singapore and the rest of the world comes to terms with COVID being endemic, and not just a pandemic, life as we know it will have to adapt. Our new normal will likely include not just vaccination but yearly booster shots. Rapid and frequent testing at religious services, concerts, conferences will likely become as de rigueur as scanning an e-ticket. What else will happen next as the world continues to fight this invisible, shape-shifting beast? For now, it seems reasonable to make PM Lee’s courageous and hope-filled vision—of Singapore returning to a level of normalcy with the “Test, Trace, Vaccinate” strategy—a dream we can hold on to.
~ Additional reporting by Theresa Tan
*Not their real name
