Singapore studying possibility of non-mRNA vaccines for COVID-19 booster shots: Janil Puthucheary

SINGAPORE: Singapore is studying the possibility of using non-mRNA vaccines as booster shots and is in talks with suppliers to obtain the vials, said Senior Minister of State for Health Janil Puthucheary in Parliament on Tuesday (Sep 14).

Dr Puthucheary was responding to several questions by Members of Parliament (MP) on Singapore's vaccination strategy and how it applies to the path towards eventually living with COVID-19.

The Ministry of Health's (MOH) Expert Committee on COVID-19 vaccination is “actively studying a heterologous strategy involving non-mRNA vaccines”, he said, adding that the ministry will continue to observe global and local data - particularly on the risk of adverse reactions - before recommending booster shots for additional population groups.

Currently, the committee has recommended that seniors aged 60 and above receive a booster jab six to nine months after their second dose, while immunocompromised individuals should get a booster two months after their second dose.

MOH had said on Sep 3 that immunocompromised people should get a third dose of the same mRNA vaccine to "ensure that they start off with an adequate protective immune response to vaccination".

It also said then that the expert committee would study whether a different brand of vaccine would be more effective as a booster shot. Some studies have shown that this could be the case.

"We are negotiating with suppliers to provide us non-mRNA booster shots, and a few are preparing their applications for PSAR (pandemic special access route)," Dr Puthucheary said on Tuesday.

The PSAR allows the Health Sciences Authority to grant interim authorisation for critical novel vaccines, medicines and medical devices during a pandemic. The only COVID-19 vaccines currently approved under PSAR are the mRNA vaccines Pfizer-BioNTech and Moderna.

China's Sinovac vaccine, an inactivated type, was in June approved for use in Singapore under a different Special Access Route after it was approved for emergency use by the World Health Organization (WHO).

Non-mRNA vaccines on WHO's emergency use list include viral vector vaccines such as Oxford-AstraZeneca and Johnson & Johnson, as well as another inactivated vaccine Sinopharm.

Singapore has also signed advance purchase agreements with American biotechnology company Novavax to secure its protein-based vaccine, with supplies possibly arriving before the end of the year.

"We have a deliberate strategy to procure a portfolio of vaccines that use different technologies, to improve our chances of securing vaccines that will continue to be safe and effective against COVID-19," Dr Puthucheary added.

As of Sep 9, 81 per cent of Singapore's population have completed their full vaccine regimen, while 85 per cent have received at least one dose as of the vaccine.

VACCINATION NOT THE BE ALL END ALL

Nevertheless, Dr Puthucheary reiterated that vaccination is not the only factor in Singapore's journey to living with COVID-19, with case numbers, transmission trajectory, adherence to safe management measures and status of testing regimes also critical.

"It needs to be complemented by pervasive testing and safe management measures to detect and ringfence infections in the community early, so as to control community transmission," he said.

Given the current spike in the number of COVID-19 cases, Dr Puthucheary said the Government has decided to put a pause on the transition plan.

“So while we have achieved our vaccination target of 80 per cent, taking all this into account we have decided to pause the transition plan, given the rising number of cases currently," he said.

"We are not reversing course, and neither are we charging ahead."

Still, he acknowledged the need to open up social and economic activities to avoid the risk of “permanently damaging our ability to earn a living”.

“But we have to do so safely, which means reducing the number of people falling very sick to a minimum. For this, vaccination continues to be key,” he stated.

MAKING VACCINES COMPULSORY?

In response to MP Alex Yam (PAP-Marsiling–Yew Tee), who asked if the Government would consider making vaccines and boosters compulsory, Dr Puthucheary said: "We will study the matter when it arises".

"As to making the vaccine compulsory, well, I think firstly we do need to wait for that process, if it happens at all. We also need to then look at our context," he said.

Dr Puthucheary said Mr Yam could be referring to the situation in the US, where President Joe Biden's administration has made it compulsory for employees of the federal government and large private sector companies to be vaccinated.

"Our context is different, our vaccine rates are much higher. The acceptance by our population of vaccinations, has also been very different," Dr Puthucheary added. "So, we will look at the matter, but I think at the moment, there is no full approval, anytime soon."

COULD SINGAPORE'S VACCINATION RATE HAVE BEEN FASTER?

MP Jamus Lim (WP-Sengkang) asked why the Government was not able to accelerate the roll-out of vaccines in the first three months of this year, given that it had secured advance agreements with vaccine manufacturers.

"I'm afraid I continue to disagree with the characterisation that our rate of vaccination roll-out was in fact as rapid as could be," said Associate Professor Lim although he acknowledged that Singapore's vaccination rate is one of the highest in the world.

Dr Puthucheary said the pace of Singapore's vaccine roll-out at the beginning was constrained by the supply from manufacturers, who were "under some strain" to produce as much as they could for the whole world.

"But I think our contractual agreements were honoured," he said, noting that vaccine doses were delivered to Singapore as part of its advance purchase agreement.

"If (Assoc Prof Lim) was suggesting that perhaps we should have renegotiated the agreements or not honoured the agreements in some way or changed it, he can hold on to that opinion."

Dr Puthucheary thanked Assoc Prof Lim for acknowledging that Singapore has now done "relatively well" compared to what the situation was in March.

"Ultimately it's that destination which is of importance and will protect us," he added.

TESTING SUBSIDIES FOR PEOPLE WHO CANNOT BE VACCINATED

Rounding off the supplementary questions, Leader of the Opposition Pritam Singh (WP-Aljunied) asked if members of the public who cannot get vaccinated for medical reasons could get subsidies for additional antigen rapid test (ART) kits.

From Oct 1, frontline workers in high-risk workplace settings, including healthcare, food and beverage, and public service, will need to be vaccinated or take an ART twice a week. These tests will be subsidised only if the worker is medically ineligible for the vaccine.

In response, Dr Puthucheary said people who cannot get vaccinated due to medical reasons only make up a "small number", and that this figure is "not an absolute cut and dry".

"Some of it is a continued assessment. You're waiting, for example, your chemotherapy to be completed, or to recover from your surgery and so forth. So, it's not a fixed number. We will play very close attention to it," he said.

Dr Puthucheary said these people have some degree of vulnerability to COVID-19 and need to be careful about their exposure to the wider community, adding that testing is not going to protect them from this vulnerability.

"So it's not quite the same as the circumstances where you have someone who for some reason is allergic to the vaccine, and then cannot complete the vaccination regimen, but would like to then go out and work and is otherwise healthy," he said.

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Editor's note: A previous version of this story stated that the Sinovac vaccine was approved for use in Singapore under the Pandemic Special Access Route. This is incorrect. It was approved under the Special Access Route. We apologise for the error.