Singapore Minister of Health Ong Ye Kung spoke in Parliament on Tuesday, revealing that about 15% of Singapore’s vaccine stock for the coronavirus that’s worth about $140 million, has expired.
Snippet of Ong Ye Kung’s speech in Parliament
During the early phase of the pandemic, we set up an inter-agency workgroup chaired by the Head of Civil Service, and comprising senior officials from agencies such as Prime Minister’s Office Singapore, MOH, A*STAR, Health Sciences Authority (HSA) and Economic Development Board (EDB), to develop our vaccine procurement approach.
The workgroup had to deal with two key immediate challenges.
First, COVID-19 was a new virus. Although several vaccines were concurrently being developed at that time, nobody knew which one will work and which one to buy.
Second, every country was clamouring for vaccines, and limited manufacturing capacity cannot meet world demand. As a small market we lack negotiating power, and this would normally push us down the queue for delivery. The situation was worsened by supply chain disruptions caused by the pandemic. But time was of essence. How to secure assured and early deliveries?
On the question of what to buy, the workgroup recommended a portfolio approach – don’t put all our bets on one vaccine but buy a selected number of vaccines across different technology platforms. This includes both mRNA and non-mRNA vaccines.
To identify the most promising candidates, the workgroup was advised by a panel of experts from the research institutes, hospitals and industry.
Since we did not know which vaccine candidate would work and had to buy several types, and if one does not work, we had to make sure the other one had enough volume to cover our population. Hence, we needed to over-procure, such that the combined volumes of all the vaccine candidates more than cover the population of Singapore.
On the question of how to secure assured and early delivery, we leveraged our relationships with the pharmaceutical companies and entered into advance purchase agreements, with fixed delivery schedules and quantities.
To ensure quality and safety, all selected vaccine candidates were reviewed by the HSA thoroughly, before being authorised for emergency use in Singapore.
The Expert Committee on COVID-19 Vaccination (EC19V) provided a second layer of independent review and gave recommendations on how to optimise use of the vaccines.
The first batch of Pfizer-BioNTech vaccines arrived in late 2020, Singapore being the first country in Asia to receive them. We rolled out the National Vaccination Programme shortly after, from December 2020 – again one of the first few countries in the world to do so.
The Moderna vaccine was added to the National Vaccination Programme in March 2021, and Sinovac and Novavax in October 2021 and February 2022 respectively.
While the mRNA vaccines were found to be highly effective in protecting against severe COVID-19 infection, around mid-2021, we faced two new concerns.
First, there were early indications that vaccine protection could wane over time, especially amongst the elderly. So boosters would be needed.
We therefore procured additional vaccine doses to administer boosters to the whole population.
Second, new COVID-19 variants were emerging. There was a real possibility that one or more might break through vaccine protection and cause major new infection waves with high number of severe cases and deaths.
Moderna and Pfizer-BioNTech therefore developed the new bivalent vaccines that provide better coverage against the newer virus strains. In September 2022, we took the decision to make a clean switch to these new bivalent vaccines.
Looking back, today, if we had gone back in time, given the uncertainties, the high stakes and challenges we faced, I think we would have done things the same way.
Because we secured safe and efficacious vaccines, delivered when we needed them most, Singaporeans took them with confidence, even with relief. We built up our population immunity and achieved DORSCON Green today.
But there is a price to be paid. Because we deliberately over-procured to mitigate the uncertainty of selected vaccine candidate not working, and the possibility of supply chains being disrupted, there would be spare vaccine stock, which will expire.
Some months ago, MOH was asked how much of our vaccines had expired. We could only reply that about 10% of our stock had expired, because of confidentiality agreements that we have entered into with vaccine suppliers.
I would have preferred to be more transparent and forthcoming with information. We have since discussed with the vaccine suppliers, and they have agreed we can reveal the total value of the expired vaccines, so long as we do not give further quantitative breakdowns that enable people to estimate the cost of each dose of vaccine.
So these are the numbers.
To date, expired vaccines are about 15% of the doses we ordered, with a total value of S$140 million. In the coming months, this is likely to rise to close to 25%, as more vaccines expire. After that, it should stabilise.
We had tried to donate our spare vaccines. But there have been no takers, because there has been an over-supply of vaccines in the world. Manufacturers have ramped up their production capacity and demand for vaccines has been declining as the pandemic stabilised.
There are reports estimating that expired vaccines globally could range up to 500 million doses or more.
The expiry of unused vaccines was an insurance premium – the price we were prepared to pay to stave off the risk of catastrophic consequences.
What are these consequences?
To illustrate, before vaccines were available, we had to resort to a Circuit Breaker in April 2020 to contain the pandemic. The two-month Circuit Breaker cost us around $11 billion in terms of GDP loss. And we spent close to another $60 billion over two financial years to cushion the hardship for businesses and workers, not to mention the heartaches and difficulties families had to go through.
Without vaccines, we would certainly have had to resort to further Circuit Breakers during the Delta and Omicron waves in late 2021 and throughout 2022. But we did not have to, because we got the vaccines early and they protected us.
More importantly, our approach averted many deaths due to COVID-19 infections and protected Singaporeans against catastrophic consequences.
Let me now address a few questions regarding vaccines posed by members.
Ms Hazel Poa thought that MOH favoured mRNA over other vaccines in our regulatory approval. She has misunderstood. Several non-mRNA vaccines could not secure HSA’s approval because of insufficient data on safety and efficacy, and we cannot compromise on our standards.
Ms Hazel Poa and Mr Yip Hon Weng also asked if VDS measures were too harsh on the unvaccinated.
In a pandemic, measures can be harsh. The Circuit Breaker is harsh on everyone. The relevant question is whether from a public health perspective, the measures are necessary and justified.
We need to be mindful that while everyone should make their own medical choices, but in a pandemic, individual action affects not just yourself but also others around you.
When the vast majority chose to take the vaccine, they not only protected themselves but also their loved ones, and they raised our collective resilience. Those who did not take the vaccine, put themselves and others including their colleagues at workplaces at risk. Hence, VDS was needed as a public health measure. But we understand the hardship some of them had to go through, some of them were allergic to the vaccine. Therefore the moment we could step down VDS, we did so.
More importantly, we must continue to be prepared in case a dangerous variant of concern emerges. So this is our vaccine strategy going into the future:
First, MOH will maintain and periodically refresh an adequate stock of COVID-19 vaccines, to allow continued protection of the elderly and vulnerable as needed, and to facilitate a rapid response should there be a major or more severe pandemic wave.
Second, we will maintain a network of vaccination centres – primary care clinics, polyclinics and a baseline footprint of five to ten Joint Testing and Vaccination Centres even during DORSCON Green. With this, we will be able to administer a booster to all persons aged 50 and above and the medically vulnerable, within three weeks, if necessary.
Third, we are negotiating agreements to secure early access to vaccines against other pathogens with pandemic potential; these might include new influenza and other respiratory viruses.
Fourth, we will invest in vaccine research and development, like PREPARE I spoke about earlier. One of our objectives is to establish how to quickly develop a working vaccine based on either the mRNA or protein-subunit platform, and bring it to clinical trials locally.
Fifth, through the EDB’s efforts, we will be anchoring six vaccine manufacturing plants in Singapore. In response to Dr Tan Wu Meng, EDB will continue to engage other vaccine manufacturers to invest in Singapore, grow our biomedical sector capabilities, and cement our position as a pharmaceutical hub in Asia.
Finally, we will continue to do our part to strengthen global health security and support fair and equitable access to vaccines. There is now a global effort to develop safe and effective vaccines within 100 days of a Public Health Emergency of International Concern being declared. MOH is actively contributing to that effort.