SINGAPORE: The take-up rate of COVID-19 vaccination among seniors is acceptable, or even good, but more can be done to boost numbers, infectious diseases experts said.
Senior Minister of State for Health Janil Puthucheary said earlier this month that about 60 per cent of eligible seniors aged 70 and above have received the COVID-19 vaccination or booked their vaccination appointments, while the corresponding proportion for eligible seniors aged 60 to 69 is close to 70 per cent.
Infectious diseases experts said that the proportion is good, especially in comparison to the take-up rate of the influenza vaccination, which they said is the most comparable to the COVID-19 vaccination.
“I think it’s an acceptable figure. If you look at the influenza vaccination, which has been promoted annually, we don’t even achieve 15 to 20 per cent, so this is actually very good,” said infectious diseases specialist at Mount Elizabeth Novena Hospital Dr Leong Hoe Nam.
When asked if the better take-up for the COVID-19 vaccination is because it is potentially fatal, he said that the flu can also be fatal, taking the lives of 200 out of every 100,000 people aged 70 and above annually in Singapore.
Influenza can trigger heart attack and stroke, he explained.
Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the take-up rate among seniors is “really good”.
“Flu is also known to be fatal in elderly people. In fact, it's probably comparable fatality rate (with COVID-19), especially among the very old,” he said.
However, experts said there is a need for more seniors to be vaccinated.
"We want vaccine uptake to be as high as possible," said Dr Hannah Clapham, Assistant Professor at the Saw Swee Hock School of Public Health.
There are two reasons for wanting a high level of vaccination - so that people are protected from COVID-19 and to boost population immunity.
“For the senior group, the first reason is very important as if people in this group become infected, they have a high risk of severe disease,” she said.
READ: COVID-19 vaccination for people aged 60 to 69 brought forward, invitations to go out in 'next few days': MOH
People should get vaccinated so that “as a whole, as a country, we can boost our population-based immunity and as a result of that, we may be able to inch towards normalcy”, said Dr Ling Li Min, an infectious diseases physician at Rophi Clinic.
WHAT IS BEING DONE TO ENCOURAGE SENIORS
Such health and community benefits are among the explanations Silver Generation Office (SGO) volunteer Vesuvasam Perianar gives to seniors when he goes door to door to engage them.
SGO, the outreach arm of the Agency for Integrated Care, has been engaging seniors since February this year with the help of about 3,000 volunteers.
“Our main job is to ask them if they have received the letters. If they have and have not made the appointment we will ask them why they have not made the appointment,” the 68-year-old told CNA.
If seniors indicate that they need help in booking a slot, Mr Perianar will help them on the spot.
“In most cases, they will say ‘my children will help, but they haven’t had time, they will do it in a short while, maybe a few days later’,” he said.
Others may be waiting for their next medical appointment in a month or two with their regular doctors to make sure that the vaccination is safe for them, he added.
Information on their plans to register for a slot goes into a report he has to create at the end of these sessions, Mr Perianar said. Based on the report, a volunteer - not necessarily him - will then go back to the home to get an update on the status of the booking.
Mr Perianar does these engagements with a partner four times a week for about two hours each time.
READ: Government plans to invite people below the age of 45 to book COVID-19 vaccination slots from June
SGO also arranges transport for seniors who are not able to get to a vaccination centre on their own, he said.
Mr Perianar said that while the majority of the seniors he approaches would say that they would be booking an appointment, or need help doing so, about 20 per cent of them would be sceptical or distrustful of the vaccination regime.
To convince seniors, he tells them that they may not be able to travel overseas, even for religious pilgrimage, without the vaccination. He also uses himself as an example of someone who has had the vaccination.
He said: “Sometimes after we speak for a while … they will be more open. They will say ‘ok lah, I’ll consider lah’.”
Still, some of them are “very adverse”, calling the regime a “government gimmick” and refusing to accept a leaflet containing more information, he said.
He said that some of them bring up negative news about vaccination and have fears of overdosing, or deaths that they misunderstand that have happened because of the vaccination.
BARRIERS TO VACCINATION
Dr Leong said individuals have different reasons for not wanting to get the vaccination.
“There are many elderly people whom I have spoken to who say: ‘I’m not afraid of COVID-19. In fact if I die, so be it. I’m not afraid of dying’,” he said.
Barriers to seniors getting vaccinated could include mobility, logistics and understanding of the vaccination, said Dr Ling.
“They (seniors) may at times listen to their friends more than what is on the mainstream media. Sometimes, older folks, they could have more inertia to get themselves vaccinated,” she said.
Some of them may not feel the need to get the vaccination especially if community numbers are low and they don’t go out so much, she added.
Dr Clarence Tam, Assistant Professor at the Saw Swee Hock School of Public Health, said that findings from a survey he recently conducted with his team suggest that many people are taking a wait-and-see approach.
“They are unsure if the benefits of vaccination outweigh the potential risks of side effects, particularly given that the risk of contracting COVID-19 is currently low,” said Dr Tam.
The survey, which has not been published, was conducted online earlier this month among 1,000 Singapore residents aged 21 and above. Findings were similar among seniors and other groups, he added.
WHAT CAN BE DONE TO IMPROVE TAKE-UP AMONG SENIORS
When asked what would make them more willing to get vaccinated, respondents commonly mentioned personal recommendations from healthcare professionals, family, employers, friends and the Government, said Dr Tam.
For a third of respondents, a strong motivator would be the relaxation of social distancing rules if many people are vaccinated, he added.
Seeing positive stories on social media from people who had been vaccinated would also make them willing, Dr Tam said.
In contrast, people would be put off vaccination if a family member had a bad reaction to the vaccine, if friends or family advised against vaccination or if they saw content on social media advising against vaccination, he said.
“Positive reinforcement and prompts from a broad range of trusted sources will be needed to encourage undecided individuals to get vaccinated,” he said, adding that healthcare professionals have an important role to play, particularly in allaying worries about side effects.
Dr Leong, who said that Singapore should increase the proportion of vaccinated seniors by 10 per cent, said that videos of elderly public figures getting vaccinated could help.
The narrative used to convince the elderly should revolve around helping their families, he said.
“It could be someone saying ‘I am a grandmother, I am 70 years old, I am getting myself vaccinated because of my grandchildren’,” he said.
Another way is to regularly organise trips to vaccination centres for seniors, ferrying five seniors at a go.
“What we have to do is literally take the mountain to Muhammad,” he said.
However, Dr Leong said that he expects many seniors who have not been vaccinated to be immobile and that they may not account for much in overall herd immunity.
“Individuals who are mobile, interacting in public areas are more important in the calculation of herd immunity. These individuals tend to be more well-informed, a bit on the younger side of 70 and they would be interacting with their peers,” he said.