KUALA LUMPUR: Malaysia's movement control order, known as MCO 3.0, will be extended for another two weeks from Jun 15 to Jun 28.
Senior Minister for Defence Ismail Sabri Yaakob announced in a statement on Friday (Jun 11) that the decision to extend the MCO 3.0 was made as daily case numbers still exceeded 5,000.
“The positive/negative list (permitted and prohibited activities) and standard operating procedures (SOPs) for every manufacturing, business and industrial activity still remains as announced before this,” he said after attending a National Security Council meeting.
In May, a nationwide MCO was re-imposed in Malaysia amid a third wave of COVID-19 cases.
Known as MCO 3.0, all economic sectors were allowed to operate during the period but cross-district and interstate travel as well as social, sports and educational activities were prohibited.
Stricter restrictions on the economic and social sectors were later announced on May 21 as community cases continued to rise. The emergence of new variants have also delayed efforts to flatten the infection curve, the Prime Minister's Office had said.
On May 28, Prime Minister Muhyiddin Yassin announced that the country would go into total lockdown for 14 days beginning Jun 1, with only essential economic and service sectors allowed to carry on with their operations.
Case number breached the 9,000-mark on May 29, before the lockdown measures brought daily infections down gradually. On Friday, a total of 6,846 cases were reported.
If the first phase of total lockdown could reduce the number of daily cases, then the country would ease into a four-week second phase, where more economic sectors would be allowed to reopen.
Phase 3 would be similar to the movement control order (MCO) that has been enforced in the country, where nearly all economic sectors are allowed to operate with strict SOPs.
The progression from one phase to another would be subject to the Ministry of Health's risk assessments.
As of Friday, Malaysia's national COVID-19 tally stood at 646,411.
KUALA LUMPUR: United Malays National Organisation (UMNO) has pleaded with the king to not extend Malaysia's state of emergency beyond Aug 1, its president Ahmad Zahid Hamidi said after an audience with the ruler on Friday (Jun 11).
The party also wanted the parliament to reconvene again to ensure that the country's "democratic system can be defended", Ahmad Zahid told journalists outside the palace.
UMNO's stance echoed that of Leader of the Opposition Anwar Ibrahim, who called for the state of emergency to end as scheduled in his meeting with King Al-Sultan Abdullah Ri’ayatuddin Al-Mustafa Billah Shah.
Al-Sultan Abdullah has been summoning political party leaders to the palace for meetings this week.
He first met with Prime Minister Muhyiddin Yassin for a pre-Cabinet meeting, and then granted audiences to Mr Anwar, Parti Amanah Negara president Mohamad Sabu and Democratic Action Party secretary-general Lim Guan Eng on Wednesday.
On Thursday, the king had audiences with leaders of Parti Islam Se-Malaysia, Malaysian Chinese Associatio, Parti Warisan Sabah, as well as former prime minister Mahathir Mohamad, who is heading the yet-to-be-registered Parti Pejuang Tanah Air.
Malaysian King Al-Sultan Abdullah Ri’ayatuddin Al-Mustafa Billah Shah (left) grants an audience to Prime Minister Muhyiddin Yassin on Jun 9, 2021. (Photo: Facebook/Istana Negara)
The king had earlier declared a nationwide state of emergency back in January to curb the spread of COVID-19. Parliament, state legislative assemblies and elections are suspended, while economic activities are allowed to continue.
Malaysia's COVID-19 numbers have continued to rise since January, and as of Thursday, total caseload stood at 639,562 cases, with 79,848 active cases and 3,684 deaths.
With the parliamentary suspension, the legitimacy of Mr Muhyiddin's Perikatan Nasional government - formed following a power tussle in February and March last year - cannot be challenged in the august house. Mr Muhyiddin had said he would advise the king to dissolve the parliament once the pandemic is under control.
Speaking to journalists on Friday, Ahmad Zahid said the damage of a prolonged state of emergency would be "too great for the country".
"And it was obvious that even without the emergency, the government could previously handle matters related to fighting the COVID-19 pandemic," he said.
Ahmad Zahid, who is Bagan Datuk MP, added that parliament meetings would ensure that the government administration is held accountable through checks and balances.
"UMNO is of the opinion that the parliament is an important official platform to voice the people's grouses, such as moratorium, increasing price of goods, i-Sinar and i-Lestari 2.0 and other assistance for everyone," he said, referring to the retirement fund withdrawal programmes.
On Dr Mahathir's proposal to set up a National Operations Council to take over the country's administration, Ahmad Zahid said this was not discussed in his meeting with the king.
The council, better known by its Malay abbreviation Mageran, was an emergency administrative body established to restore the rule of law in Malaysia after the May 13 racial riots in 1969.
The opposition alliance Pakatan Harapan has rejected the proposal on Friday, and reiterated its stance that the state of emergency should end immediately and the parliament should reconvene.
Meanwhile, the palace said the king is due to meet with the other Malay rulers next Wednesday for a special discussion on the efforts to fight COVID-19 and their implementation during the state of emergency.
SINGAPORE: Students from Singapore could be given priority to travel to Australia to pursue or complete their studies when the infrastructure for safe travel is in place, said Australian Prime Minister Scott Morrison on Thursday (Jun 10).
Speaking at a joint press conference with Mr Morrison following the in-person leaders’ meeting that took place earlier on Thursday, Prime Minister Lee Hsien Loong said the two discussed how two-way travel between the countries can eventually resume in a safe and calibrated manner “when both sides are ready”.
This can “start small” with an air travel bubble “when ready”, said Mr Lee in his statement, which was broadcast live on his Facebook page.
“We need to prepare the infrastructure and processes to get ready to do this. It starts with mutual recognition of health and vaccination certificates, possibly in a digital form. When all the preparations are ready, we can start small with an air travel bubble to build confidence on both sides,” he added.
There is still some time before Singapore and Australia “reach that milestone”, but the two countries will be “getting on with the job” of putting systems in place that will enable such a bubble to emerge between Singapore and Australia, similar to the one between Australia and New Zealand, said Mr Morrison.
“But in addition to that ... giving priority to students from Singapore to be able to return to Australia to complete their studies and to engage in their studies,” he added.
“And for the students from Singapore ... a first opportunity to see increased travel between Australia and Singapore realised, and for that to occur sooner rather than later.”
This is the sixth Singapore-Australia Leaders’ Meeting. Mr Lee and Mr Morrison held their previous meeting in March last year by video conference because of the COVID-19 pandemic.
Mr Morrison's trip to Singapore is the first official visit by a foreign leader since the start of the pandemic.
The 6th Singapore-Australia Leaders' Meeting was held in Singapore on Jun 10, 2021. (Photo: Ministry of Communications and Information)
TRAVEL BUBBLE CONDITIONS
Responding to a question following the prime ministers' statements, Mr Morrison said Singapore is the first country outside of New Zealand that Australia wishes to engage in a travel bubble with.
Adding that Australia’s system for digital vaccination certificates had just gone live, he said: “And we get it right in Singapore, which we know we can do, because of the very sophisticated systems that Singapore has.”
“And with some encouragement from Prime Minister Lee, we really do want to focus on those students coming ... as part of the exercise piloting how these systems can work most effectively when we get to the next phase ... but the timing of that is still somewhere away.”
“Quite a number” of students from Singapore study in Australia and some students came home due to the COVID-19 pandemic, said Mr Lee.
These students in Singapore are unable to go back to Australia to resume their studies, and “there’s urgency for them”, he added.
“Especially for those of them who have got clinical attachments or postings, and to be unable to take them up, it's very, very disruptive to their studies.”
Mr Lee said he also suggested to Mr Morrison that these students could be one way to test the safe travel systems and “get a pilot going so that we can widen the project”, and later on implement a full travel bubble between Singapore and Australia.
“There's no timetable, but we hope it can be done as soon as possible.”
Vaccination rates and COVID-19 transmission rates will be considered when setting up the travel bubble, said Mr Lee during the press conference.
“I would say that in Singapore, we are making good progress with our vaccination program. In Australia, they're also steadily vaccinating the population. And I think once the majority of the population is vaccinated, it becomes much easier for us to contemplate these openings,” he added.
The prevailing transmission rates will “certainly be a factor”, said Mr Lee.
“What we want to do is to get the preconditions infrastructure ready, the vaccine recognition, what are the standards, what are the conditions. Then the actual decision to do it, that is a political decision. But let's get everything teed up, so that we are in the position to make the political decision when we want to do so,” he added.
Neither Singapore nor Australia has identified a benchmark vaccination rate that would influence the decision on an air travel bubble, said Mr Morrison, adding that this would be dependent on the advice of the medical community.
Australia's Prime Minister Scott Morrison (left) with Singapore's Prime Minister Lee Hsien Loong at the 6th Singapore-Australia Leaders' Meeting in Singapore on Jun 10, 2021. (Photo: Ministry of Communications and Information)
DEFENCE AND FINTECH PARTNERSHIPS
Addressing other areas of partnership between Singapore and Australia, Mr Lee noted that the two countries’ treaty on military training and training area development came into force in December 2020.
“This was a milestone in our longstanding defence partnership,” he added.
“Singapore greatly appreciates Australia’s generous and sustained support for SAF’s training. Over many years, in many air bases and camps all over Australia.”
The bilateral digital economy agreement between the two countries also came into force in 2020, said Mr Lee.
“This was the fruit of our forward looking, open and progressive attitudes towards trade and the future economy,” he added.
Building on the agreement, the two leaders will commence discussions to develop a fintech bridge between the two countries, said Mr Lee in his opening remarks.
Singapore and Australia are also exploring collaborations on low-emissions solutions to support climate change efforts, said Mr Lee.
“This is another key domestic priority for both of us, and it includes a public-private partnership on low emissions fuels and technologies for shipping and port operations, based at Nanyang Technological University’s Eco Labs.
“We are also exploring a broader partnership on a green economy agreement. This will facilitate trade and investment in environmentally sustainable goods and services, and strengthen environmental governance and our capacity to address climate change.”
JAKARTA: Indonesia reported 8,892 new daily coronavirus infections on Thursday (Jun 10), the highest number since Feb 23. The country has reported nearly 1.9 million cases in total.
Data from Indonesia's COVID-19 taskforce also showed 211 deaths reported on Thursday, taking total fatalities to 52,373.
A jump in coronavirus cases on Indonesia's two most populous islands has health experts worried that the worst could be yet to come, with few curbs on movement at a time when dangerous variants drive record fatalities elsewhere in Southeast Asia.
Case numbers have risen sharply in Java and Sumatra three weeks after holidays that followed the Islamic fasting month of Ramadan, when millions ventured across the archipelago, ignoring a temporary travel ban.
In Kudus, central Java, where healthcare reinforcements have been brought in, cases skyrocketed 7,594 per cent according to Wiku Adisasmito of Indonesia's COVID-19 task force. Hospital capacity had hit 90 per cent there, local media reported.
Defriman Djafri, an epidemiologist from Andalas University in Pandang, said fatalities in West Sumatra in May were the most on record.
In Riau on Sumatra, daily cases more than doubled from early April to more than 800 by mid-May, while the positivity rate was at 35.8 per cent last week, said Wildan Asfan Hasibuan, an epidemiologist and provincial task force adviser.
Wildan attributed the spike to increased mobility and possible spread of coronavirus variants, which have driven big spikes in many countries.
The impact of variants of concern is hard to determine in Indonesia, which has limited genomic sequencing capacity.
It also has testing and tracing shortfalls and its immunisation drive has progressed slowly, with one in 18 people targeted for inoculations fully vaccinated so far.
Recent studies have also indicated cases could be far higher than the nearly 1.9 million known infections, among Asia's highest caseloads.
Dicky Budiman, an epidemiologist from Australia's Griffith University, said Indonesia should take COVID-19 variants more seriously, particularly the Delta variant, which he said was in its early stage of spreading.
"If we don't change our strategy, we will face an explosion of cases in the community, mortality will increase," he said.
"It means sooner or later it will reach the more vulnerable ... we will face an explosion of cases which we cannot contain or respond to in our health facilities."
KUALA LUMPUR: More leaders of key Malaysian political parties met King Al-Sultan Abdullah Ri’ayatuddin Al-Mustafa Billah Shah on Thursday (Jun 10), the second day of a series of meetings called by the ruler.
Thursday's meetings began with an audience granted by the king to the deputy chief of Parti Islam Se-Malaysia (PAS), Tuan Ibrahim Tuan Man, who represented party president Hadi Awang, currently receiving treatment at the National Heart Institute.
Shortly after, Malaysian Chinese Association president Wee Ka Siong followed suit with his meeting with the king around noon.
Mr Tuan Ibrahim and Dr Wee are Cabinet members of Prime Minister Muhyiddin Yassin’s Perikatan Nasional government.
Both left the palace without speaking to reporters waiting outside the gate.
Former prime minister Mahathir Mohamad, chairman of the yet to be registered Parti Pejuang Tanah Air (Pejuang), met the king in the afternoon.
Speaking in an online media conference, Dr Mahathir said that he has suggested the formation of a National Operations Council during his audience with the king, according to Malay Mail.
The council, better known by its Malay abbreviation Mageran, could potentially steer the country towards the right direction and help solve the health, economic, and social issues currently plaguing the country, said Dr Mahathir.
He said the king did not dismiss his suggestion outright, but pointed out that such a decision must be made by the government.
Malaysia's former Prime Minister Mahathir Mohamad, right, wearing a face mask, waves as he leaves National Palace after meeting with the king in Kuala Lumpur, Malaysia, Thursday, June 10, 2021. (AP Photo/Vincent Thian)
The last political leader given an audience with the king on Thursday was Warisan president Mohd Shafie Apdal.
The Sabah-based party president left the palace without speaking to reporters.
The king’s meetings with leaders of major political leaders will continue on Friday with United Malays National Organisation president Ahmad Zahid Hamidi expected to be granted an audience in the afternoon.
Opposition leader Anwar Ibrahim, Democratic Action Party secretary-general Lim Guan Eng and Parti Amanah Negara president Mohamad Sabu were present at the palace on Wednesday, after the king had a pre-Cabinet meeting with Prime Minister Muhyiddin Yassin in the morning.
It was widely speculated that the political landscape would be among the meeting agenda, but the politicians told the media that the discussions revolved around COVID-19 and parliament sitting which is currently suspended due to the state of emergency.
Mr Anwar said he pleaded for the king to not extend the state of emergency, while Mr Mohamad said he requested for parliament to reconvene.
In a statement, the palace said the king’s meeting with Mr Muhyiddin was a routine discussion on government affairs and issues.
In January, the king had declared a state of emergency across the nation to curb the spread of COVID-19. It is set to end on Aug 1 or earlier depending on the state of the pandemic.
Opposition MPs and activists set up a Committee for Ending the Emergency Declaration in March and launched a petition to appeal for an end to the state of emergency.
Mr Muhyiddin, who is under pressure from the opposition parties as well as coalition partners to prove the parliamentary support he commands, has reiterated that he would advise the king to dissolve parliament once the COVID-19 pandemic is under control.
Malaysia is currently under renewed movement restrictions as record high daily new infections and deaths were recorded.
SINGAPORE: Eighteen months into the pandemic, we have multiple COVID-19 vaccines available. This is cause for great optimism.
Scientific trials have shown that several have efficacies well above the minimum 50 per cent required by the World Health Organization (WHO). Some, like the mRNA vaccines used in Singapore, have efficacies above 90 per cent.
The amount of information on these vaccines, however, is also a source of confusion. Studies show that, given the choice, people prefer vaccines with a higher vaccine efficacy number and fewer side effects. Media reports interpreting the latest findings from vaccine studies have understandably led the public to compare which vaccines are safer and which offer better protection.
Unfortunately, the scientific community has not communicated clearly what vaccine efficacy means. Therefore, there is misunderstanding about how much protection different vaccines provide and their implications for people deciding whether to get vaccinated.
To get an insight on how the public interprets vaccine efficacy, we polled Facebook users in Singapore to see what they thought vaccine efficacy meant.
Results from a poll of Facebook users asked the question: “If a vaccine has 95% efficacy, what does this mean to you?” (Graphic: Authors)
Only a quarter of users identified the accurate interpretation – if vaccine efficacy is 95 per cent, your chances of getting COVID-19 will be 95 per cent lower if you are vaccinated than if you are not.
Instead, most people are under the impression that if you get vaccinated, you still have a 5 per cent chance of getting COVID-19.
This suggests that many people have an inflated sense of their risk of COVID-19 if they get vaccinated, and this could undermine confidence in how much benefit these vaccines provide.
This misinterpretation is understandable – what most people want to know is how likely they are to get COVID-19 if they get vaccinated.
But this is not exactly what vaccine efficacy measures. Your chances of getting COVID-19 depend not just on how good the vaccine is, but also on how much virus is circulating in the population and other factors that affect your risk of COVID-19.
These factors include your age, if you have underlying medical conditions, if you work in a high-risk job, how much social interaction you have and your mask-wearing and hand hygiene practices.
Vaccine trials do not generally account for all of these social and lifestyle factors, so they provide limited information about your individual risk of contracting COVID-19.
We can illustrate the idea of vaccine efficacy with an example from a scientific trial of the Pfizer-BioNTech vaccine, currently used in Singapore.
In that trial, around 36,000 people were randomly split into two groups. Half received two doses of the vaccine, while the other half got two doses of an identical-looking but inactive placebo injection. Everyone was then observed for about six weeks to see who developed COVID-19.
In the 18,000-strong control group who received the placebo injection, there were 169 symptomatic COVID-19 cases over the six weeks. This equates to a risk of getting COVID-19 of about 90 cases for every 10,000 unvaccinated people for this period.
In contrast, in the 18,000 vaccinated individuals, there were only eight symptomatic COVID-19 cases, or about four cases for every 10,000 vaccinated people.
This means that among vaccinated people, the chances of getting symptomatic COVID-19 were about 20 times lower, or 5 per cent of the risk compared to people who got the placebo injection.
Consequently, the vaccine has an efficacy of 95 per cent, because in vaccinated people it reduces the risk of getting symptomatic COVID-19 by 95 per cent compared to unvaccinated people. But it does not mean that 5 per cent of those who got the vaccine went on to get COVID-19.
To date, the risk of getting COVID-19 in Singapore has been very low. Over 2020, before vaccination began, there were about 2,400 community cases in a population of around 5.4 million people living in the community. So for a resident in Singapore, the chances of getting COVID-19 in 2020 were about 1 in 2,250.
A medical worker prepares a syringe at a coronavirus disease (COVID-19) vaccination center in Singapore. (FILE PHOTO: REUTERS/Edgar Su)
Had the Pfizer-BioNTech or Moderna vaccines been available then, getting vaccinated would have reduced this risk by about 20 times, to around one in every 50,000 vaccinated individuals.
Recent increases in community cases mean your risk of getting COVID-19 is currently somewhat higher, but getting vaccinated will still drastically reduce your chances of getting COVID-19.
COMPARING EFFICACIES ACROSS VACCINES CHALLENGING
There has been much interest in which vaccines have better efficacy. Yet, comparing efficacy numbers for different vaccines is not straightforward.
Trials of different vaccines were done in different countries with varying levels of virus transmission, at different time points in the epidemic and with different virus variants circulating.
The trials were also done with different groups of volunteers – some included older adults, while others included mostly younger people who tend to have milder illness. And different trials diagnosed COVID-19 in slightly different ways.
All these influence the estimated efficacy. It is also important to note that headline vaccine efficacy numbers indicate the level of protection against any symptomatic COVID-19 disease.
For the majority of individuals, COVID-19 is relatively mild, so it is more important to know how well these vaccines protect against severe disease.
The evidence so far is that most of the vaccines available are highly effective for preventing COVID-19 hospitalisation and death, even if some vaccines provide better protection against milder disease.
UNDERSTANDING THE USE OF ALTERNATIVE VACCINES
It is important to interpret vaccine efficacy figures in relation to how much virus transmission is currently happening. The current low levels of transmission put Singapore in an advantageous position.
With rapid scaling up of vaccination, we can drastically reduce the COVID-19 risk in the population and maintain it at a low level even as we ease other social distancing measures.
But for this to work, we need a very high uptake of vaccination in the population.
Recent surveys in March suggest that a third of adults are unwilling or still unsure about whether to get vaccinated. So there is still work to do to communicate the benefits of vaccination, address public concerns and reduce hesitation.
A student receives a shot at a COVID-19 vaccination centre for students on Jun 3, 2021. (Photo: Facebook/Ministry of Education)
The Singapore Government is also taking other steps to improve the vaccination take-up rates.
They recently announced that the second dose of the Pfizer-BioNTech and Moderna vaccines, usually given within three to four weeks, would be delayed to six to eight weeks. This will allow more people to receive their first dose earlier.
Alternatives to mRNA vaccines will also be made available through the special access route. This will provide vaccination options for people who cannot receive the mRNA vaccines, including those with severe allergies.
With more options available, people may wonder if it is prudent to mix and match vaccines, for example, because of a belief that taking two different vaccines gives better protection, or because of an unpleasant reaction to the first dose of a mRNA vaccine.
It is not recommended to mix and match vaccines unless medically advised, because we currently do not have any information on how much protection this would provide. Different vaccines are designed and tested using specific dosing schedules and regimens.
Doses of alternative vaccines, such as Sinovac, will be limited and it is important that we reserve these for those who need them for medical reasons.
(Are COVID-19 vaccines still effective against new variants? And could these increase the risk of reinfection? Experts explain why COVID-19 could become a “chronic problem" on CNA's Heart of the Matter podcast.)
QUESTIONS REGARDING VACCINATION TO BE TACKLED
The science of COVID-19 vaccines is indeed evolving constantly as we accumulate more information from large-scale vaccination programmes and the emergence of new variants.
For example, it is too early to know how much protection these vaccines will provide against more recent variants, such as the Delta (B16172) variant currently causing global concern, or how long vaccine protection will last.
But vaccination remains overwhelmingly the best way to reduce your individual risk of COVID-19. It is also currently the only viable way to navigate a safe relaxation of control measures while minimising the risk of large epidemics.
This is not to say that vaccination will drive out the virus completely. As we open up our borders and ease restrictions, we need to accept that the risk of introducing the virus into the community will increase and cases will continue to occur.
Having a large fraction of the population vaccinated will vastly improve our chances of managing these clusters without spiralling epidemics overrunning our healthcare facilities, and without having to implement repeated lockdowns.
Dr Clarence Tam is an Assistant Professor at the Saw Swee Hock School of Public Health under the National University of Singapore.
Dr Hannah Clapham is an assistant professor at the same school.
Dr Yung Chee Fu is a senior infectious disease consultant at KK Women’s and Children’s Hospital and an assistant professor at the Duke-NUS Medical School.
SINGAPORE: Eighteen months into the pandemic, we have multiple COVID-19 vaccines available. This is cause for great optimism.
Scientific trials have shown that several have efficacies well above the minimum 50 per cent required by the World Health Organization (WHO). Some, like the mRNA vaccines used in Singapore, have efficacies above 90 per cent.
The amount of information on these vaccines, however, is also a source of confusion. Studies show that, given the choice, people prefer vaccines with a higher vaccine efficacy number and fewer side effects. Media reports interpreting the latest findings from vaccine studies have understandably led the public to compare which vaccines are safer and which offer better protection.
Unfortunately, the scientific community has not communicated clearly what vaccine efficacy means. Therefore, there is misunderstanding about how much protection different vaccines provide and their implications for people deciding whether to get vaccinated.
To get an insight on how the public interprets vaccine efficacy, we polled Facebook users in Singapore to see what they thought vaccine efficacy meant.
Results from a poll of Facebook users asked the question: “If a vaccine has 95% efficacy, what does this mean to you?” (Graphic: Authors)
Only a quarter of users identified the accurate interpretation – if vaccine efficacy is 95 per cent, your chances of getting COVID-19 will be 95 per cent lower if you are vaccinated than if you are not.
Instead, most people are under the impression that if you get vaccinated, you still have a 5 per cent chance of getting COVID-19.
This suggests that many people have an inflated sense of their risk of COVID-19 if they get vaccinated, and this could undermine confidence in how much benefit these vaccines provide.
This misinterpretation is understandable – what most people want to know is how likely they are to get COVID-19 if they get vaccinated.
But this is not exactly what vaccine efficacy measures. Your chances of getting COVID-19 depend not just on how good the vaccine is, but also on how much virus is circulating in the population and other factors that affect your risk of COVID-19.
These factors include your age, if you have underlying medical conditions, if you work in a high-risk job, how much social interaction you have and your mask-wearing and hand hygiene practices.
Vaccine trials do not generally account for all of these social and lifestyle factors, so they provide limited information about your individual risk of contracting COVID-19.
We can illustrate the idea of vaccine efficacy with an example from a scientific trial of the Pfizer-BioNTech vaccine, currently used in Singapore.
In that trial, around 36,000 people were randomly split into two groups. Half received two doses of the vaccine, while the other half got two doses of an identical-looking but inactive placebo injection. Everyone was then observed for about six weeks to see who developed COVID-19.
In the 18,000-strong control group who received the placebo injection, there were 169 symptomatic COVID-19 cases over the six weeks. This equates to a risk of getting COVID-19 of about 90 cases for every 10,000 unvaccinated people for this period.
In contrast, in the 18,000 vaccinated individuals, there were only eight symptomatic COVID-19 cases, or about four cases for every 10,000 vaccinated people.
This means that among vaccinated people, the chances of getting symptomatic COVID-19 were about 20 times lower, or 5 per cent of the risk compared to people who got the placebo injection.
Consequently, the vaccine has an efficacy of 95 per cent, because in vaccinated people it reduces the risk of getting symptomatic COVID-19 by 95 per cent compared to unvaccinated people. But it does not mean that 5 per cent of those who got the vaccine went on to get COVID-19.
To date, the risk of getting COVID-19 in Singapore has been very low. Over 2020, before vaccination began, there were about 2,400 community cases in a population of around 5.4 million people living in the community. So for a resident in Singapore, the chances of getting COVID-19 in 2020 were about 1 in 2,250.
A medical worker prepares a syringe at a coronavirus disease (COVID-19) vaccination center in Singapore. (FILE PHOTO: REUTERS/Edgar Su)
Had the Pfizer-BioNTech or Moderna vaccines been available then, getting vaccinated would have reduced this risk by about 20 times, to around one in every 50,000 vaccinated individuals.
Recent increases in community cases mean your risk of getting COVID-19 is currently somewhat higher, but getting vaccinated will still drastically reduce your chances of getting COVID-19.
COMPARING EFFICACIES ACROSS VACCINES CHALLENGING
There has been much interest in which vaccines have better efficacy. Yet, comparing efficacy numbers for different vaccines is not straightforward.
Trials of different vaccines were done in different countries with varying levels of virus transmission, at different time points in the epidemic and with different virus variants circulating.
The trials were also done with different groups of volunteers – some included older adults, while others included mostly younger people who tend to have milder illness. And different trials diagnosed COVID-19 in slightly different ways.
All these influence the estimated efficacy. It is also important to note that headline vaccine efficacy numbers indicate the level of protection against any symptomatic COVID-19 disease.
For the majority of individuals, COVID-19 is relatively mild, so it is more important to know how well these vaccines protect against severe disease.
The evidence so far is that most of the vaccines available are highly effective for preventing COVID-19 hospitalisation and death, even if some vaccines provide better protection against milder disease.
UNDERSTANDING THE USE OF ALTERNATIVE VACCINES
It is important to interpret vaccine efficacy figures in relation to how much virus transmission is currently happening. The current low levels of transmission put Singapore in an advantageous position.
With rapid scaling up of vaccination, we can drastically reduce the COVID-19 risk in the population and maintain it at a low level even as we ease other social distancing measures.
But for this to work, we need a very high uptake of vaccination in the population.
Recent surveys in March suggest that a third of adults are unwilling or still unsure about whether to get vaccinated. So there is still work to do to communicate the benefits of vaccination, address public concerns and reduce hesitation.
A student receives a shot at a COVID-19 vaccination centre for students on Jun 3, 2021. (Photo: Facebook/Ministry of Education)
The Singapore Government is also taking other steps to improve the vaccination take-up rates.
They recently announced that the second dose of the Pfizer-BioNTech and Moderna vaccines, usually given within three to four weeks, would be delayed to six to eight weeks. This will allow more people to receive their first dose earlier.
Alternatives to mRNA vaccines will also be made available through the special access route. This will provide vaccination options for people who cannot receive the mRNA vaccines, including those with severe allergies.
With more options available, people may wonder if it is prudent to mix and match vaccines, for example, because of a belief that taking two different vaccines gives better protection, or because of an unpleasant reaction to the first dose of a mRNA vaccine.
It is not recommended to mix and match vaccines unless medically advised, because we currently do not have any information on how much protection this would provide. Different vaccines are designed and tested using specific dosing schedules and regimens.
Doses of alternative vaccines, such as Sinovac, will be limited and it is important that we reserve these for those who need them for medical reasons.
(Are COVID-19 vaccines still effective against new variants? And could these increase the risk of reinfection? Experts explain why COVID-19 could become a “chronic problem" on CNA's Heart of the Matter podcast.)
QUESTIONS REGARDING VACCINATION TO BE TACKLED
The science of COVID-19 vaccines is indeed evolving constantly as we accumulate more information from large-scale vaccination programmes and the emergence of new variants.
For example, it is too early to know how much protection these vaccines will provide against more recent variants, such as the Delta (B16172) variant currently causing global concern, or how long vaccine protection will last.
But vaccination remains overwhelmingly the best way to reduce your individual risk of COVID-19. It is also currently the only viable way to navigate a safe relaxation of control measures while minimising the risk of large epidemics.
This is not to say that vaccination will drive out the virus completely. As we open up our borders and ease restrictions, we need to accept that the risk of introducing the virus into the community will increase and cases will continue to occur.
Having a large fraction of the population vaccinated will vastly improve our chances of managing these clusters without spiralling epidemics overrunning our healthcare facilities, and without having to implement repeated lockdowns.
Dr Clarence Tam is an Assistant Professor at the Saw Swee Hock School of Public Health under the National University of Singapore.
Dr Hannah Clapham is an assistant professor at the same school.
Dr Yung Chee Fu is a senior infectious disease consultant at KK Women’s and Children’s Hospital and an assistant professor at the Duke-NUS Medical School.
