SINGAPORE: The rapid pace at which the COVID-19 vaccine went from development to approval is unprecedented, but no corners were cut, said Associate Professor Lim Poh Lian, member of the Expert Committee for COVID-19 Vaccination.
“A lot of things that slow down vaccine development, including political will and regulatory processes, was sped up, because the need was so great," Assoc Prof Lim said, speaking on CNA’s weekly podcast Heart of the Matter published on Thursday (Jan 7).
COMPRESSED TIMELINE FOR VACCINE DEVELOPMENT
Assoc Prof Lim said the process of developing a vaccine could have taken years, yet was compressed for the following reasons.
First, the vaccine builds on decades worth of messenger RNA (mRNA) technology, which has been used in existing treatments such as cancer therapy.
Second, the pandemic created conditions for rapid vaccine development.
Normally, pharmaceutical companies would develop a vaccine in three phases: Phase one and phase two might take two years each, while phase three might take three to four years, she said.
After approval, manufacturing the vaccine could take another year or two.
But in the face of economic and social disruption caused by the pandemic, governments stepped up and provided funding for pharmaceutical companies to mitigate commercial risks.
Many people were also willing to volunteer for vaccine trials, after witnessing the impact of the pandemic, she added. Combined with increased transmission, confirmed cases accrued very quickly, which helped in demonstrating the vaccine’s effectiveness.
When asked how safety assessments were not compromised for speed, Assoc Prof Lim said the US Food and Drug Administration (FDA) has an “extremely rigorous process”, requiring manufacturers to wait for two months after the vaccine is fully administered before submitting requests for approval.
That provided enough time to observe for side effects, which usually develop within four to six weeks, she said.
The Health Sciences Authority (HSA) had access to vaccine manufacturers’ data and presented it to the Expert Committee for independent review, she added.
READ: COVID-19 vaccine allowed for use only if HSA assesses it to be ‘sufficiently efficacious and safe’: Gan Kim Yong
CONCERNS ABOUT SAFETY OF VACCINE
Assoc Prof Lim said “media attention is always on the dramatic, bad side effects of the vaccine”.
“It’s the one case of anaphylaxis that gets on to the headlines,” she said. “The 15,000 people that got vaccinated without anaphylaxis don’t get featured.”
Prof Teo Yik Ying, Dean of Saw Swee Hock School of Public Health, who was also on the Heart of the Matter podcast, said the widely covered case of a US doctor who went into anaphylactic shock had a history of allergies – a point that may have been missing from headlines.
“One important fact is we know what kind of people are medically suited to take the vaccine, and those that aren’t,” he said.
The period of observation immediately after one receives the vaccine is important for clinicians to monitor whether they develop any rare side effects. “In Singapore, we’re already putting an extra margin of safety and caution by requiring 30 minutes,” added Assoc Prof Lim.
When asked why the Government had indicated it would take a “slow and careful” approach to rolling out the vaccines, Assoc Prof Lim said “vaccine hesitancy is a real problem”.
“A lot of people hesitate about vaccines for various reasons, some of which are unscientific claims, and some of them valid concerns,” she said.
“We want to make sure it's done carefully. And we respect the fact that people are concerned about how quickly all of this is happening.”
READ: Commentary: A vaccine is on the horizon. But most Singaporeans are adopting a wait-and-see attitude
Assoc Prof Lim acknowledged that many people worry about the long-term effects of vaccines. But “we’ve had vaccine technology for the last 70, 80 years,” she said.
“If you think about it, every vaccine was new in the beginning.”
It’s very “sobering” to think about yourself, your family or colleague getting it, she said. Yet as Senior Consultant at the National Centre for Infectious Diseases (NCID), Assoc Prof Lim was one of the first 40 healthcare workers who received the COVID-19 vaccines on Dec 30.
“I get to eat my cooking, in the sense that we’ve been making these recommendations for vaccines,” said Assoc Prof Lim.
LOGISTICAL CHALLENGES AHEAD
When asked about Health Minister Gan Kim Yong’s comments as part of a Ministerial Statement delivered in Parliament on Monday (Jan 4) that offering people choice of vaccine would complicate the rollout, Prof Teo said it’s a “simple demand and supply problem”.
“Right now, the world is actually in vast shortages of vaccine supply. So for Singapore to even be able to come forward to say that we are able to guarantee a supply of vaccine for everyone who wishes to take it, that is a really quite a huge accomplishment.
“But in order for people to have a choice, we are going to need perhaps 5 million doses of the Moderna, 5 million doses of Pfizer and 5 million doses of Sinovac, just in case people wish to choose one or the other. And that is impossible,” he said.
READ: Commentary: Can Singapore be a major COVID-19 vaccine transshipment hub and save its aviation industry?
Administering the vaccine will be an uphill task, as Assoc Prof Lim explained. The Government’s goal to provide free vaccines for all citizens and long-term residents would mean vaccinating 5 million people by the end of 2021.
In fact, since the COVID-19 vaccine is a two-dose series, 10 million doses of vaccine are required.
“If you do the math of trying to do 10 million divided by 365 days of the year, vaccinating every single day (…) we’re talking 27,000 doses of vaccine a day.
“When you think about vaccinating the entire birth cohort in Singapore, that's 35,000 to 50,000 babies a year. We’re trying to vaccinate 5 million people in a year, and to do that successfully and safely,” she said.
There’s also the issue of storing the vaccines and administering them before they expire. It will require at least 10 million syringes, needles, plasters, and doctors and nurses, not to mention managing the data, entering it into the National Immunisation Registry, and generating cards and vaccination certificates, she said.
“It’s a huge undertaking. But if anyone can do it, Singapore can,” Assoc Prof Lim said.
Listen to the full podcast episode to hear the behind-the-scenes considerations and discussions going into what might be Singapore’s biggest vaccination programme ever: