Hansard, Monday, 10 January 2022

Order. On 1 December 2021, I informed hon Members that I received a letter on 30 November 2021 at 2247 hours from the Member for Sengkang GRC Ms Raeesah Khan resigning her seat in Parliament. In accordance with clause (2)(c) of Article 46 of the Constitution, the seat of the Member became vacant with effect from 2247 hours on 30 November 2021.

I also wish to place on record that hon Members were informed on 10 November 2021 that pursuant to Standing Order No 102, I had nominated Mr Zaqy Mohamad to the Committee of Privileges, to take the place of Mr Masagos Zulkifli, on the matter of a complaint made against former Member for Sengkang GRC, Ms Raeesah Khan. Mr Zaqy Mohamad will serve as a Member of the Committee until the Committee has reported upon the matter referred to it.

Order. Questions for Oral Answer. Mr Yip Hon Weng.

1 Mr Yip Hon Weng asked the Minister for Health (a) whether children who are eligible for COVID-19 vaccination but whose parents do not approve of their vaccination, have their medical bills covered by the Government if they contract COVID-19; and (b) whether unvaccinated children have to be subjected to vaccination-differentiated safe management measures in schools and shared spaces in public.

2 Ms Foo Mee Har asked the Minister for Health whether the Ministry can provide an update on (i) Singapore’s ability to cope with increasing number of infections arising from the COVID-19 Omicron variant, (ii) the breakdown, by country of origin, for imported COVID-19 Omicron cases and (iii) the strategies to mitigate imported cases.

3 Miss Cheng Li Hui asked the Minister for Health with regard to containing the Omicron variant of COVID-19 (a) whether the Ministry has assessed a need for more vaccination doses after the booster jab; and (b) how does the Ministry plan to utilise the anti-viral pills as part of its strategy.

4 Mr Lim Biow Chuan asked the Minister for Health whether the Ministry is continuing with its efforts to engage Singaporeans and Permanent Residents who refuse to be vaccinated and to educate them on the benefits of vaccination.

5 Ms Jessica Tan Soon Neo asked the Minister for Health (a) whether he can provide an update on the COVID-19 vaccination rate of those eligible for vaccination aged 18 and below; and (b) whether COVID-19 vaccination will be made a requirement for participation in group activities in schools and educational institutions.

6 Mr Pritam Singh asked the Minister for Health (a) how many Singaporeans and Permanent Residents (PRs) respectively are deemed to be medically ineligible for COVID-19 vaccination; and (b) excluding these persons, how many Singaporeans and PRs respectively remain unvaccinated as of December 2021.

7 Mr Chua Kheng Wee Louis asked the Minister for Health in view of the emergence of the COVID-19 Omicron variant globally and subsequent tightening of border measures, what are the key quantitative or qualitative metrics and thresholds that the Government will consider before making a decision for domestic reopening plans to be rolled back and safe management measures tightened.

8 Mr Dennis Tan Lip Fong asked the Minister for Health (a) what is the Ministry’s strategy in containing the spread of the Omicron variant of COVID-19; (b) what measures should Singaporeans expect to be taken; and (c) how will these measures differ from previous measures implemented to contain the spread of the Delta variant or COVID-19 virus generally.

9 Mr Leon Perera asked the Minister for Health (a) what is the expected impact on ICU utilisation based on the Ministry’s modelling for the COVID-19 Omicron variant; (b) at what ICU utilisation rate will hospitals begin to defer non-urgent clinical services; (c) what is the number of healthcare workers working in ICUs currently as compared to December 2020; and (d) what permanent changes have been made to increase healthcare capacity and, in particular, ICU capacity and scalability since (i) the start of the pandemic and (ii) the start of 2021.

10 Ms He Ting Ru asked the Minister for Health (a) whether there are plans to offer non-mRNA COVID-19 vaccines to children in the age groups of five to 11, and 12 to 18; and (b) if so, when can these vaccines be expected.

11 Mr Gerald Giam Yean Song asked the Minister for Health what is the impact from the emergence of the COVID-19 Omicron variant on the plans for Singapore to live with COVID-19 as an endemic disease, in terms of the timelines for reopening the economy and permitting more social and cultural activities involving the gatherings of people.

12 Ms He Ting Ru asked the Minister for Health whether the Ministry has plans to apply vaccination-differentiated measures to children aged between five and 11.

Mr Speaker, Sir, as the first Member to speak in the first Parliamentary Sitting of the year, may I just wish all Members and Speaker a good 2022 ahead.

Mr Speaker, Sir, with your permission, may I address Question Nos 1 to 12 and also written Question Nos 34 to 38 in the Order Paper, please?

Yes, please.

Mr Speaker, Sir, Senior Minister of State Janil Puthucheary and Minister Chan Chun Sing will then address another set of questions on child vaccination. May I request that we deliver our replies and then all three of us take supplementary questions together, please?

Yes, please.

Thank you. Mr Speaker, Sir, Singapore just weathered a significant COVID-19 transmission wave caused by the Delta variant which is still active in many parts of the world. By working together, making collective sacrifices to restrain our social interactions, watching out for one another and implementing sound policies, we have overcomed perhaps the most difficult part of the pandemic.

As of now, our hospital situation is stable, with 11 COVID-19-related ICU cases. Most activities have resumed and we are meeting up with friends and loved ones. Our society has become much more resilient to COVID-19 than before. This is an important milestone.

But a new Omicron wave is upon us. If we work together, we can ride through the wave. Once we have done so, we will be even more resilient than now and even more prepared to live with COVID-19.

When Omicron first burst onto the global scene, we immediately introduced measures, such as restricting travel from affected countries in Africa, enhancing testing for all travellers, isolating cases in hospitals and reinstating stringent contact tracing and quarantine for Omicron infections. These measures will not stop Omicron from taking root and spreading in Singapore, given its high transmissibility. However, they have helped to delay its emergence, giving us precious time to understand it better and to prepare ourselves.

The characteristics of Omicron have now become clearer. This is what we know today. There are three key points.

First, local and overseas evidence shows that it is far more transmissible than the Delta variant. We must expect a wave that could be a few times larger than the Delta wave. So, if Delta infections reached a sustained incidence of about 3,000 cases a day, Omicron could perhaps reach 10,000 to 15,000 cases a day or even more. Cases are likely to double every two to three days. So, once cases start to rise steeply, within a couple of weeks, we may see 3,000 Omicron cases a day.

Second, there has been consistent international evidence showing that Omicron infections are less severe than Delta. The incidence of hospitalisation and severe illness is lower and there are also indications that any hospital stays are also shorter. Indeed, the clinical outcomes, particularly the number of people who become severely ill or die, are much more important than the top line number of infection cases.

Mr Speaker, Sir, may I show a couple of slides on screen, just to illustrate this clearly?

Yes, please. [A slide was shown to hon Members. Please refer to Annex 1.]

Thank you. This graph describes the situation in South Africa. The blue line shows number of infections. Members can see three humps, reflecting the three waves that they have gone through: the first is Beta, then Delta in the middle, and the latest, the tallest is Omicron. And it is plotted against the scale on the left axis. The grey part for the top graph shows hospitalisations, plotted against the scale on the right axis. And so, Members can see that in the latest wave, the number of hospitalisations is proportionately lower than the previous two waves.

The bottom graph is even more stark. The red area shows number of deaths, plotted against a separate scale on the right axis. Members can see that during the Omicron wave, the red area is actually very small; number of deaths is, proportionately, much lower than the previous two waves.

The next slide is a similar analysis but now, it is for the UK. Members can see a similar pattern, proportionately fewer hospitalisations and fewer deaths.

A study by health authorities in South Africa showed that 4.9% of cases were admitted to hospitals during the Omicron wave, compared to 13.7% during the Delta wave. Among the patients admitted to hospital during the Omicron wave, they were 73% less likely to have severe disease. In the UK, the risk of being admitted to hospital or emergency care with Omicron was about half that of Delta. Data from Denmark also showed that about 0.8% of Omicron cases were hospitalised, lower than the 1.2% rate of hospitalisation among cases infected with other variants.

This has also been borne out by our own local experience. In Singapore, we have recorded 4,322 Omicron infections so far, including 308 seniors aged 60 and above. Eight of the 4,322 needed oxygen supplementation, and all of them have been taken off oxygen after a short few days. None required ICU care as yet. In comparison, if these 4,322 infections had instead been caused by Delta, we would expect 50 to 60 patients needing oxygen supplementation, ICU care or to die.

However, we should be careful in interpreting these observations. It is early days and the circumstances of each country are different. South Africa, for example, has a young population and a high level of natural immunity, even though their vaccination coverage is low. The UK has both high levels of vaccination and natural immunity, and this current Omicron outbreak is riding on the back of a protracted Delta outbreak, which worsens clinical outcomes. Further, Omicron transmits much faster and infects more people. So, even if a small percentage of infected individuals falls very sick, because of the large base of infections, it can still lead to many people needing ICU care or die.

The third thing we have found out about Omicron is that vaccines, especially boosters, retain substantial protection against severe disease. Indeed, the most recent studies in the UK found that for vaccinated individuals, the risk of hospitalisation for Omicron is reduced by 72%, compared to the unvaccinated. With a booster shot, vaccine effectiveness against hospitalisation is estimated to be 88%.

Currently, Omicron has spread to over 130 countries and has become the dominant strain in many places. Hence, we lifted the suspension of flights from affected African countries and aligned the healthcare protocols between Omicron and other COVID-19 variants.

Members would like to know our strategy in responding to the Omicron wave.

Given that it is less severe than the Delta variant and vaccines still work against it, our key objective remains, which is, to live with COVID-19 as an endemic disease. Then, we can lead life as normally as possible and continue to build a bright future for Singapore and our children. That includes not locking down our borders, which will inflict tremendous pain on families, workers, businesses and also the mental well-being of many people. In any case, a severe lock-down strategy will likely delay but not prevent the inevitability of Omicron finding its way into our community.

There are two factors working in our favour. First, a high percentage of our population is vaccinated, and more are getting their boosters every day. Second, unlike many European countries which have to contend with a double whammy of a concurrent Delta and Omicron wave, we have only recently gone through a Delta wave. We are not likely to have to ride through two rapidly rising infection waves.

In recent days, our overall local infection number is creeping up, to a few hundred a day, with Omicron accounting for about 40% of all cases. Given the transmissibility of Omicron, we expect the numbers to rise steeply in the coming weeks and Omicron will become the dominant variant within a few weeks.

The responses that we have developed against Delta will continue to be relevant against Omicron, with some adjustments. And there are three responses, essentially.

First, vaccination and boosters remain key. In countries where Omicron has spread, the unvaccinated and under-vaccinated are still the most prone to falling seriously ill when infected.

Mr Dennis Tan asked for a breakdown of COVID-19 deaths. There were 802 such deaths in 2021, of whom 555 were not fully vaccinated. Although the unvaccinated is a small proportion of our population, they contributed to 70% of the deaths in 2021. The remaining 247 were vaccinated with a range of locally available vaccines.

I am going to read out some crude incidence rates but, be mindful we are calculating these based on quite a small sample of 247 deaths of individuals who are vaccinated. They are as follows: 79 deaths per 100,000 for non-fully vaccinated persons overall; 11 deaths per 100,000 for those vaccinated with Sinovac; 7.8 per 100,000 for Sinopharm; 6.2 per 100,000 for Pfizer-BioNTech and one per 100,000 for Moderna. These rates are only indicative. As I mentioned, the sample size is small and they also do not account for other factors which may affect mortality, such as the age and timing of vaccination.

Around 132,000 individuals aged 18 and above remain unvaccinated, while around 300 persons are medically ineligible. We will continue to try to convince those who are medically eligible to get vaccinated, through their primary care physicians, public messaging and the media. But, as Members would appreciate, as the number gets smaller, it is also harder and harder to convince them.

For those who are homebound, our Mobile Vaccination Teams can visit their homes to vaccinate them.

Over the past months, we have managed to vaccinate well over 90% of every eligible age group. It is quite an achievement. We are especially happy to see that among seniors aged 60 to 69, and 70 and above, 96% and 95% have been fully vaccinated respectively. As for those aged 12 to 19 years, 95% are fully vaccinated. For the even younger ones aged five to 11, we have just started vaccinating them. The response has been good and operations smooth.

At this time, only the Pfizer-BioNTech/Comirnaty vaccine is authorised for use in ages below 18 years. We will continue to closely monitor the availability of other non-mRNA vaccines that are approved for use in children.

At the same time, our vaccine booster programme is gathering pace. About 46% of our population has received their boosters. We have recently brought some 900,000 individuals aged 18 to 29 into the booster programme, of whom 700,000 are already eligible to receive their boosters today. Our booster coverage will continue to expand over the month of January. We have also set a validity period for full vaccination status of 270 days, as a strong signal to our population, "Please get your boosters promptly".

As to whether there is a need for further booster shots – fourth shot, fifth shot – it is too early to tell. Today, Israel is the only country that has authorised a fourth dose for non-immunocompromised individuals.

For an endemic infectious disease like influenza, we can draw some inference from there. This virus mutates frequently, so, people receive vaccinations every year to protect themselves against it, without many problems or the need for disruptive border closures and social restrictions each time there is an influenza infection wave. It is a possible future scenario when we live with COVID-19 as an endemic disease.

MOH and the Expert Committee on COVID-19 Vaccination (EC19V) will continue to monitor local and international data on the durability of protection from vaccine boosters and the evolution of the virus to assess the need for further vaccinations.

The second response: we continue to enhance our healthcare capacity. We have made preparations to ramp up capacity and manpower of the Home Recovery Programme, Community Treatment Facilities (CTFs) and public hospitals. We stand ready to provide up to 350 ICU beds, 2,000 isolation beds and 4,000 CTF beds for COVID-19 cases with a couple of weeks’ notice. Particularly, for hospital ICU capacity, existing single rooms and isolation rooms can be repurposed into additional ICU beds when required. Medical equipment and consumables are ready. Manpower is always a limiting factor, but ICU staff has increased by 12% over the past year to about 1,800 now and we have trained or are training about 500 more staff to assist with ICU operations.

Anti-viral medications for COVID-19 have been used to treat vulnerable patients who are at high risk of falling severely ill. When authorised for use and made available in Singapore, these oral anti-viral medications will be important additions to the range of COVID-19 therapeutic agents already in use locally. We have signed or are negotiating supply agreements for these medications but, unfortunately, I am not at liberty to release details due to confidentiality obligations in these contracts.

Outside of the hospitals, we will be enhancing our health protocols to right-site patients, so that hospital resources go to those who need them most. The MTF has recently announced our partnership with primary care doctors to care for patients who are recovering at home after being tested positive with Antigen Rapid Tests, under what we termed Protocol 2. This will help them safely recover and return to normal activities as soon as possible.

I should caution Members against thinking that coping with a transmission wave successfully is a matter of recruiting more healthcare workers and building more ICU facilities. Our objective is not to have more people falling very sick and admitted to ICU but, in fact, to avoid it.

Hence, we size our emergency healthcare capacity based on what is sustainable and practical. Bearing in mind this is a crisis of a generation, the capacity needed cannot be provided within our redundancy provision and ICU-trained staff do not just increase multi-fold overnight or even over a few months. Hence, we have tried to temper the infection numbers through safe management measures and exercising self-restraint in our social interactions.

So, vaccinations, expansion of healthcare capacity and safe management measures, the three must work in tandem and we must strike a balance among the three factors. We cannot, for example, over-liberalise, remove all social restrictions, let infections rise uncontrollably and leave the healthcare system to bear the consequences. Neither do we swing to the other extreme: protect the healthcare system at all costs, go for a zero-COVID-19 strategy and lock down our borders and society which will cause tremendous suffering to our people.

How the three factors balance off one another is a matter of judgement, depending on the pandemic situation. It will be too rigid to set metrics and parameters to trigger social restrictions, as we need to respond flexibly and appropriately to the twists and turns that the pandemic situation may take.

This brings us to the third response, which is safe management measures. In recent months, instead of imposing across-the-board social restrictions, we introduced more vaccination-differentiated safe management measures (VDS). This is because unvaccinated individuals are at far higher risk of falling severely ill. This group has consistently taken up two-thirds of our ICU beds, throughout the pandemic. By restricting their social interactions, we protect them against infections and serious illnesses and taking up hospital resources. The rest of society who have been vaccinated can also then live life more normally.

However, there are, presently, no plans to introduce VDS for children aged 12 and below in community, public, preschool and school settings. This is due to a combination of reasons, namely, children are less likely to develop severe illnesses when infected and we want to preserve as much as possible universal access to holistic education for children. Minister Chan will explain further.

For now, children aged 12 and below who are Singapore Citizens, Permanent Residents or Long-Term Pass Holders and did not travel recently will continue to have their COVID-19 medical bills fully covered by the Government. This is regardless of their vaccination status.

So, in general, while we have a strict VDS system in place, to enable society to carry on normal lives as much as possible while protecting the unvaccinated, the rules are much less strict on children, based on the reasons I have explained earlier.

Members asked if we are likely to tighten up social activities because of the Omicron wave. When the Delta wave subsided late last year, we refrained from being too jubilant and over relaxing restrictions. That would have been a mistake. We kept our masking requirements, we did not allow night entertainment to restart, we kept group sizes at five. So, it is the MTF’s hope that we can ride through the Omicron wave with the current safe management measures posture. If we have to tighten the restrictions, it will be as a last resort and when our healthcare system is under severe pressure.

In conclusion, Mr Speaker, Sir, I believe that just as we have ridden through the Delta wave with unity and resolve, we will be able to do so again with the Omicron wave. Omicron is a different enemy, but we are much better prepared and much more resilient than before. And after the Omicron wave passes, which it will, we would have taken another huge step towards living with COVID-19. Singapore will be one of the best and safest places to live in on Earth.

13 Dr Lim Wee Kiak asked the Minister for Health with the US Food and Drug Administration granting emergency authorisation to the COVID-19 vaccine by Pfizer-BioNTech for children aged five to 11 years (a) whether the Ministry will bring forward its proposed vaccination for children below 12 years of age; and (b) in the past one year, how many children below 12 years of age (i) were infected (ii) have recovered and (iii) are still hospitalised, respectively.

14 Mr Yip Hon Weng asked the Minister for Health (a) whether any local research is being done on possible side effects of mRNA COVID-19 vaccinations for children aged five to 11; (b) what are the protocols in place to manage any potential short- and long-term post-vaccination side effects in children, especially that of heart inflammation; and (c) whether children are covered under the Vaccine Injury Financial Assistance Programme for COVID-19 Vaccination (VIFAP).

15 Mr Dennis Tan Lip Fong asked the Minister for Health (a) what are the potential risks or side effects of taking COVID-19 vaccination for persons (i) between ages 12 and 18 and (ii) ages below 12; (b) whether the Government will consider not mandating vaccination for these groups of persons until more is known about the possible risks or side effects of the vaccination on them; and (c) whether there are plans to offer Sinovac or Sinopharm vaccines for children.

Mr Speaker, may I have your permission to take Question Nos 13 through to 15, please?

Yes, please.

Sir, my response will also be addressing questions on similar topics filed by Ms Hany Soh, Dr Wan Rizal1 and Mr Sharael Taha for 11 January 2022.

The Ministry of Health (MOH) commenced COVID-19 vaccinations using the paediatric formulation of Pfizer-BioNTech/Comirnaty vaccine on 27 December 2021, starting with older children and with a plan to progressively expand the programme to include younger children, which has now happened. The take-up so far has been encouraging. As of 7 January, about 123,000 children aged five to 11 have received at least one dose of the vaccine or booked their vaccination appointments.

In 2021, there were 15,540 children below the age of 12 who were infected with COVID-19, of which 3,145 had ever been in a hospital or a COVID-19 facility. Fortunately, as of 8 January 2022, none of these children remained hospitalised. Although fewer children have been seriously ill with COVID-19 compared to adults, there is still a risk of them becoming seriously ill or developing severe COVID-19 complications, such as Multisystem Inflammatory Syndrome in Children (MIS-C). Since mid-October 2021, we have observed several serious cases of COVID-19 in children, with some requiring intensive care.

This is why it is important for children aged five to 11 to take up the COVID-19 vaccination. The Pfizer/BioNTech COVID-19 vaccination for children has been assessed by HSA and our own Expert Committee on COVID-19 Vaccination (EC19V) to be safe. The assessment is corroborated by international data.

In the United States of America, where about 8.7 million doses had been administered to children as of 19 December 2021, most of the adverse events reported were not serious and no safety concerns have been raised; 2.4% of the children experienced serious adverse events, such as fever, vomiting, myocarditis and seizures. The incidence of myocarditis, which is what many parents are most concerned about, is about one in a million doses. The children reported with myocarditis following vaccination had either recovered or were recovering at the time of the report. Vaccination will allow our children to be protected against the disease and reduce the likelihood of infecting others, including vulnerable or elderly family members. On the other hand, the incidence of myocarditis among individuals aged 12 to 17 infected with COVID-19, is about 45 per 100,000 infections. [Please refer to “Clarification by Minister for Health”, Official Report, 10 January 2022, Vol 95, Issue 44, Clarification section.]

So, Members can see that the risk is much lower with the immunisation and, hence, the benefits are much greater.

To facilitate the vaccination of younger children, 15 designated paediatric vaccination centres (VCs) located island-wide are being progressively stood up. All 15 VCs will be manned by medical personnel trained in paediatric care and staff experienced in administering vaccinations for children.

To provide greater convenience for parents or guardians with more than one child or ward, from 10 January 2022, all accompanying siblings of a child with an appointment from Mondays to Thursdays can walk in for their vaccination without a prior appointment. MOH has also worked closely with MOE and the Early Childhood Development Agency (ECDA) to organise webinars with parents to address common concerns on the safety and efficacy of the COVID-19 vaccine.

Currently, there are no recommendations for children to receive booster shots. If introduced, MOH will continue to ensure that families with children are able to access vaccination services in a convenient manner.

As of 7 January 2022, MOH has not received any report of serious adverse events or myocarditis from vaccination in children in Singapore since the rollout of the national vaccination programme to children aged five to 11. We will continue to monitor this closely.

We assure parents that all our designated paediatric VCs are equipped with paediatric monitoring and resuscitation equipment, and the medical personnel are trained to manage any on-site emergencies arising from allergic reactions. Most side effects experienced by children after vaccination have been mild, such as injection site pain, fatigue and fever, which typically resolve in a few days. Members have asked if children are covered by VIFAP, and the answer is yes, as long as they are Singapore Citizens, Permanent Residents or long-term pass holders.

At present, only the Pfizer-BioNTech/Comirnaty COVID-19 vaccine is authorised for use in children aged below 18. Special exemptions are made for those aged 12 to 17 who are not medically eligible for the Pfizer-BioNTech/Comirnaty COVID-19 vaccine to receive the Sinovac-CoronaVac vaccine under a dedicated public health programme. MOH will work with the EC19V to review if the dedicated public health programme should be extended to children aged five to 11 who are medically ineligible to complete the Pfizer-BioNTech/Comirnaty COVID-19 vaccine based on further studies on the safety and effectiveness of Sinovac-CoronaVac vaccine.

Among those aged 12 to 19, less than 4% remain unvaccinated. As of 6 January 2022, there are 14,097 individuals between the ages of 12 to 19 who are unvaccinated, of which, only 14 are medically ineligible for the Pfizer-BioNTech/Comirnaty COVID-19 vaccine.

COVID-19 vaccination is an important national effort in our fight against the pandemic. Vaccination for children aged five to 11 will help to protect more members of our society from the risk of developing severe illness from COVID-19 infections and further minimise the risk of community spread. We strongly encourage all parents, all guardians, to allow their children who are medically eligible to please take up the vaccine when offered to them.

16 Mr Patrick Tay Teck Guan asked the Minister for Education what are the Ministry’s plans to seamlessly execute COVID-19 vaccination for Primary school children without disrupting national examinations, school examinations, co-curricular activities and other classroom time and attendance.

17 Mr Darryl David asked the Minister for Education (a) whether vaccination-differentiation measures will be adopted in preschools and schools with regard to children aged five to 11 who have not undergone COVID-19 vaccination; and (b) what support will be given to those young children (and their families) who have to miss school should they develop any adverse reaction to the vaccination.

18 Ms Foo Mee Har asked the Minister for Education whether vaccination will be made a requirement for eligible children in order for them to attend school in person.

Mr Speaker, Sir, may I have your permission to take Question Nos 16, 17 and 18 together, please?

Yes, please.

Mr Speaker, Sir, there are, currently, no plans to make COVID-19 vaccination a requirement for physical attendance in our preschools or primary schools. The focus at this point in time is to ensure our students are well-protected against COVID-19 as we begin vaccination for those aged five to 11. We have seen an encouraging start to the vaccination exercise for our children. We will continue to work with our parents to achieve a high vaccination rate so that it would be possible to resume as many school activities as possible in the coming months. The pace, extent and approach towards resuming these school activities would depend on various factors, including vaccination rates as well as the overall national posture.

Students whose vaccination appointments are during school hours, as well as those feeling unwell from vaccination, will be excused from school. Schools will help students catch up on missed lessons and work. We strongly encourage parents to get their child vaccinated as early as possible to keep our children, families and the wider community safe and resilient against COVID-19.

Mr Pritam Singh.

Thank you, Mr Speaker. Sir, I have two supplementary questions.

The first pertains to a subject I believe that was covered both by the Minister for Health and the Minister for Education. This concerns the apprehension some parents have over the administration of mRNA vaccines for their children. These parents anecdotally are not anti-vax per se. Some of them may have taken the mRNA vaccine on their own, but the concern is really a visceral one, that is, about the long-term effects, the fact that this vaccine is referred for emergency approvals and so forth, even though I think some have been granted FDA approval, Pfizer-BioNTech specifically.

To that extent, will the Ministry of Health (MOH) allow such parents to wait until non-mRNA traditional protein-based vaccines are approved for their children's inoculation, so as to give them more choices and to assuage their concerns?

The second question follows. I understand that one such non-mRNA vaccine company, Novavax, submitted data for approval under Singapore's Pandemic Special Access Route (PSAR) on 22 November. The Director of Medical Services confirmed a few days ago, on 5 January, that he was very optimistic Novavax would be authorised as a non-mRNA booster. My question is, if Novavax or any other non-mRNA vaccine maker has submitted data for the authorisation for use for children above the age of 12, and, if so, when can these vaccines be expected to be introduced in the National Vaccination Programme?

Just a very short follow-through on that: with regard to the point made by the Minister for Health on the 270 days that are required, the limit before you take a booster and then to be recognised still as being vaccinated, would there be some flexibility to allow Novavax at least to get on this programme and to allow more individuals to then be considered fully vaccinated?

Thank you. I can fully appreciate parents' concern about mRNA vaccines for children. They will be concerned about the long-term effects and whatever side effects there may be. Just a few facts. The children's vaccine, Pfizer-BioNTech/Comirnaty, has gone through extensive clinical trials. And during the clinical trials, it was proven and shown to be safe and effective.

Specifically, myocarditis, which is what most parents are concerned about in children, it occurred. Currently, there are about 8.5 million already vaccinated in the US and the incidence rate is about one in a million. And as Senior Minister of State Janil Puthucheary mentioned, we have to balance this against the downside of getting infection. If you are infected, the chances of myocarditis are 45 in a million and also other effects, such as MIS-C, which can make the child really sick. [Please refer to “Clarification by Minister for Health”, Official Report, 10 January 2022, Vol 95, Issue 44, Clarification section.] And we have seen a handful, one or two a week, when Delta was at its peak and they are admitted to ICU. Thankfully, all of them recovered.

So, there is a good track record of safety and efficacy for the children's vaccine. On the other hand, for children who are infected with COVID-19, while, generally, children are more resilient, we have seen cases of myocarditis and MIS-C. So, it is a pandemic crisis. We do have to weigh those costs and benefits.

I do have to add one more fact, which is that, for the children's vaccine, it is a diluted form. They are not taking the same adult vaccine. Pfizer-BioNTech, for example, is one-third the dose of an adult's.

So, these are the facts and parents will have to make the right decision. As of now, we are quite encouraged that many parents are coming forward and the paediatric vaccination exercise is actually gathering pace, and many parents are coming forward to protect their children.

On the question of Novavax, it is being assessed by the Health Sciences Authority (HSA). We need to let the scientists do their work. I think we should consider putting it into our National Vaccination Programme. We have always wanted a good portfolio of mRNA and non-mRNA vaccines. But, as for the timing, I think it may take a while more, including for delivery, plus another process for assessing whether it is suitable for children, there is another set of data, another set of trials. So, I do not know how long it would take.

In the meantime, Omicron is upon us, highly transmissible, and we do not want to rule out that even a small percentage of children can get very sick; we might be looking at a significant absolute number. So, I would suggest, as Senior Minister of State Janil Puthucheary has advised, get your child vaccinated with mRNA, given the circumstances. It is not perfect, but I think, given the circumstances, cause and benefits, the right thing to do now is to get your child vaccinated as quickly as possible.

Likewise, for the 270 days, I can understand what the Leader of the Opposition is suggesting – whether we should wait for Novavax. But again, Omicron is upon us. While I hope we have the luxury of time to wait for a non-mRNA vaccine to be available, but, with the impending Omicron wave, I think we should act quickly and, therefore, we set the validity period of 270 days.

Mr Yip Hon Weng.

Mr Speaker, I thank the Ministers and the Senior Minister of State for their replies. My supplementary question is for Senior Minister of State Janil Puthucheary. Some young children may have undetected medical conditions and, especially allergies, if their parents do not send them for non-mandatory medical reviews. As such, I wish to ask whether MOH would advise all young children to undergo a medical review before going ahead with the COVID-19 vaccination. This is similar to how some adults with underlying medical conditions are advised to get clearance from the doctor in the early stages of the vaccination drive.

Sir, I thank the Member for his question. The answer is partly in the last line that he stated, which is, that we took that approach in the early stages of the adult vaccination drive because, at that time, the amount of data that we had was less and the amount of experience that we had was less. Now we know a lot more about both the disease as well as the vaccination, including in children.

So, the approach for children is not so different from adults. If they have an underlying condition – and there is a list that the doctor will know about it – then some review needs to happen. But if the child is otherwise healthy, then the recommendation is to proceed with the COVID-19 vaccination.

The issue of allergies is slightly different in that, for any drug, you cannot necessarily tell whether an allergy will happen or not happen on the basis of prior underlying conditions. Hence, the team at the site of the vaccination is trained to then detect and deal with the rare allergies that do happen. And again, our experience with COVID-19 is, it does not happen any differently from other vaccinations that we are giving to children on a regular basis.

So, the short answer to the Member's question whether all children should go for medical review prior to COVID-19 is "no".

Mr Gerald Giam.

Thank you, Sir. I have got two supplementary questions. The Government has been encouraging the use of ART swabbing to prevent the spread of viruses. However, in many situations, self-reporting of ART results is not allowed. Instead, people are required to conduct the test only at approved testing centres, which not only costs more but is more inconvenient. Can we move to a regime where people are trusted to accurately report the ART results, just like how it is done in schools and, indeed, here in Parliament? This will reduce the cost for many people and make administrative procedures at events more efficient.

Second question: there is a tendency for some activities to be prohibited, even though the transmission risk is low. Can the lead agencies issue more specific advisories to organisations based on the actual prevailing risk of viral spread, so that we move closer on the path towards normalcy?

Thank you for those suggestions. Relying on individuals to self-report ART results, this, as Mr Gerald Giam has acknowledged, is actually in place. It is not quite in Parliament because you do get informed by an SMS that you are negative. But there are many settings where we do rely on self-reporting. Workplace, for example, a lot of meetings, events you go to, you do a self-test.

We have an entire protocol, what we call a protocol tool, that is based on self-testing – that you self-test and, if you are positive, you stay home for 72 hours. After that, daily tests and only when you are negative, you come out. It is totally an honesty-based system. If you are negative, you come out; and if you are positive, you stay at home.

So, the answer is, yes, we very much support what Mr Gerald Giam has said, and it is already in place. Can we do more? We are doing more. You will notice that, recently, MOH announced that we are now working with general practitioners (GPs) and primary care-providers. Previously, we could see a primary care-provider or a GP and when you say you are sick, he can only prescribe you a PCR test, which will be taken to a lab and reported by the lab. But now, he can also prescribe you an ART test. Essentially, he can trigger Protocol 2.

So, we are moving in that direction. And I must say that, to overcome this crisis, it is really not just the Government, but it requires the cooperation, civic-mindedness and sense of self-responsibility of every individual in our population.

The next question is more specific: rules on different settings. That is what we have been doing, too. If the Member has any specific suggestion on specific settings, we would be happy to hear them and we are constantly tweaking them. But just one word of caution. Sometimes, when you tweak more, it becomes more complicated and people do compare: "Why is it for this setting I am allowed to do this? Why is it for that setting I am not allowed?" And you start to have invidious comparisons and people start to get confused. So, we are also very mindful to keep rules as simple as possible because simplicity is an essential ingredient for people to exercise self-responsibility. What they do not understand, they cannot self-enforce.

Ms Foo Mee Har.

Thank you, Mr Speaker. Let me start by wishing Speaker "Happy Birthday!"

Thank you.

Mr Speaker, I have two questions for the Minister for Health. One is regarding a question that I raised in my Parliamentary Question (PQ), which is yet to be answered. With quite a significant proportion of Omicron coming from imported cases, I had asked the Minister for a breakdown by country of origin of imported COVID-19 Omicron cases. So, if the Minister for Health could shed some light on that.

My second question relates to his answer that boosters have shown to increase protection against infection and severe illness, including Omicron, substantially; whether MOH will contemplate imposition of booster jab as a requirement for VTL travellers, beyond the current requirement of two jabs only and that would be deemed as vaccinated. So, whether we will bump up the requirement to a booster jab.

I must apologise to the Member. I did not mean to drop her question but it will be addressed by Minister Iswaran later in the next set of questions, especially on the specific breakdown on the number of imported cases.

As for booster jabs, it is a serious issue that the Member has raised because we do know that two doses do not last forever. The European Union (EU) has already implemented a guideline which is similar to ours: nine months' validity or 270 days. So, I think the world will converge towards some form of validity, I believe, and, naturally, this will become a requirement in due course. That is my conjecture.

Mr Darryl David.

Thank you, Mr Speaker. I just have one supplementary question for the Minister for Education. I thank the Minister for confirming earlier that there will be no vaccination-differentiated measures for children in schools who do not get vaccinated.

My question, however, is whether there should be activities beyond school, perhaps, say, if and when the National School Games should commence or if there are national-level sporting or athletic activities that will involve children aged five to 11, would there be possibly vaccination-differentiated measures implemented then. For example, would there be a position that might say if young children are not vaccinated or not fully vaccinated, they would not be allowed to participate in these events?

I ask also primarily because, sometimes, the results of these events for the children – the timings, their performances and so on, especially for those in Primary 6 this year – could be relevant and important in the application for secondary schools under Direct School Admission (DSA).

Mr Speaker, Sir, if I may, let me explain our thinking at this point in time. Of course, I caveat that by saying that whatever our considerations current at this point in time will, subsequently, have to take into account the prevailing national posture and also the development of the virus and its mutation.

At this point in time, we would very much like to have all our children be able to attend school and participate in as many of the core activities as much as possible. Having said that, of course, there are also activities beyond the core curriculum that may pose a higher risk to our students. And for those higher-risk activities, we will then have to consider if differentiated measures will be required.

For example, at this point in time, we have already put in place some additional measures for some of these activities that the students are participating in, and these apply to our secondary, Junior College (JC) and Millenia Institute (MI) students. Just to give an example. Today, if they do team sports under the pilot, only the fully vaccinated students who have taken an onsite ART will be allowed to participate in team sports in groups of up to 10. For some other students who are participating in the band or the choir, they would also have to take some other additional measures to safeguard themselves and their fellow participants.

So, this is how we will go about considering the participation of our students in some of these particularly higher-risk activities in the sense that they have a higher-risk of transmission. But as far as possible, we would like to have our students participate in the core curriculum all together because this adds to their overall social emotional development beyond their academic development.

Mr Louis Chua.

Thank you, Mr Speaker. I just have one supplementary question which is, essentially, the PQ that I asked. Given what we know about COVID-19 today over the last one, two years of experience, may I ask if the Government would consider publishing the key quantitative and qualitative matrix and thresholds before decisions are made to change the safe management measures?

I do understand the need to be nimble. But, basically, having that decision-making framework and matrix published would actually help businesses and consumers to have greater confidence and clarity and, certainly, better than the situation where some people feel a certain sense of nervousness whenever the Multi-Ministry Task Force (MTF) holds a press conference, especially those in F&B businesses which are most affected by the dine-in rules.

The Member reiterated his question, but I may have to reiterate my answer. As alluded to in the Member's supplementary question as well, we also do not want to be too rigid in setting the parameters or trigger points, for example, if we cross this, therefore, it will shut down from five to two and so on and so forth.

I think there are so many twists and turns in this pandemic, we would rather be a bit more nimble and to be able to adapt.

But we take the Member's point, and we have always adopted this position that we do not go for "Freedom Day", neither do we go for zero COVID-19. We want to strike a balance, preserve the healthcare capacity; at the same time, allow people to live life as normally as possible, businesses to be able to operate and survive. Each time we make a decision, we do explain why. We do show all the data – hospitalisation, ICU and so on and so forth – to give the full rationale, with numbers, why we decide that way. So, I also hope that, over time, people will begin to understand what our key considerations are, even though we may not be able to pinpoint trigger points.

I should say that, ultimately, it is not about the numbers that cause all this uncertainty. It is a fact that we are in the middle of a pandemic and our society, for two years, we were not entirely ready in the first year in terms of our resilience. Last year, we were much better, and I do believe that, in 2022, we will be even better and that is most important. Remember, in 2020, when we faced a wave – it was hardly a wave, it was just clusters – we went into circuit breaker. Last year, in 2021, when we faced a wave, we went into what we called "Phase Two (Heightened Alert)". Group size was down to two. Restaurants did not close towards the end of the year, but they operated with dine-in group size of two. Hopefully, this year, we can ride through waves with a much more liberal posture and that is how we keep on improving. And that is most important to our businesses.

Mr Xie Yao Quan.

Thank you, Mr Speaker. I have two questions for the Minister for Health, and this is with regard to averting a testing crunch that we see around the world amidst an Omicron-driven wave.

My first question is, in the event of such a wave, how do we plan to avoid a run on testing facilities in our healthcare system for people who are keen to get a test – either PCR or ART – and this includes, of course, primary care providers that the Minister has mentioned in his answer, but also, importantly, emergency departments? How do we avoid a run on healthcare facilities for people who are keen to get a test ordered?

The second question is about self-testing. How do we plan to ensure an adequate supply of ART kits to keep prices of these kits steady?

On the second question first, to keep prices steady and affordable, I think competition helps, choices help. So, we are constantly on the lookout for kits that are effective as well as lower priced. In that way, we bring them in and, recently, we have done so – FlowFlex, for example, is below $5 – and we will continue to be on the lookout. There have been many kits out there that claim to be cheaper but are not as effective. So, HSA does not approve all of them just unquestioningly. And we will continue to do that.

As to the Member's question on how to prevent a run on testing facilities, number one, is to try as much as possible to plan ahead, have supply agreements signed, stock up. This is what we have been doing. And we will continue to monitor the situation, bearing in mind that we have seen in other countries where there has been a run.

Second, a run happens when people panic. So, to prevent a run, do not make people panic. Omicron can be scary, it can go up a few times, it can be 10,000 cases, 15,000 cases a day. That is why we are telling the people now that it can reach that level. That is why we started what we called "Protocols 1, 2, 3", specifically Protocol 2, which sensitises people to self-test, self-report and self-discipline. And we have extended this now to GPs to also trigger Protocol 2. That way, I think people are sensitised to "when I need a test, what do I do after a test?" And when people know what they need to do, they do not panic, there is much less chance of a run on any testing facility.

Mr Leong Mun Wai.

Thank you, Mr Speaker. I would like to ask the Minister for Education to confirm again, although I think he might have said so just now, that the VDS measures will not be applied to children below 12 years old for as long as it is and maybe at least until the non-mRNA vaccines are available for the kids. Because there is a strong request from the parents that, at least, there should be more choices for vaccines and the VDS measures will not be applied to the children. I also received feedback from residents that some teachers have already practised VDS measures in schools. So, can the Minister confirm whether the teachers are practising that or if any officers in the schools are practising that, that it is against the Government's policy at the moment?

Mr Speaker, Sir, can I seek a clarification from Mr Leong Mun Wai and further information on which schools and what VDS measures have which teachers been practising, please?

Mr Speaker, the residents who have given feedback to me are on my WhatsApp messages. Can I refer to the messages and then I give a reply later?

Mr Speaker, Sir, I would really appreciate if Mr Leong Mun Wai could give me the information on which teacher in which school has practised what VDS measures so that we can take the feedback seriously and then, look into the necessary follow-up, if possible.

Mr Speaker, Sir, if I may just repeat my answer in case Mr Leong Mun Wai was not around when I answered this just now. My specific answer was that, at this point in time, we have no plans on applying any VDS in our schools and that is because of the reasons that I have mentioned. We want, as far as possible, for our students to be able to participate in the core curriculum, in the school activities. For certain selected activities that may be deemed of higher risk, we may consider applying specific measures for them.

And I have raised two very specific examples. One, for example, of students participating in the playing of wind instruments or the choir; and two, students participating in sports activities that may require physical contact or close physical contact. I also caveated my explanation by saying that, of course, we will have to look at the overall national posture and how the virus will continue to evolve for us to adjust our policies accordingly.

Ms Sylvia Lim.

Thank you, Speaker. I have a clarification for the Minister for Health regarding the COVID-19 statistics that he cited earlier and also, in general, statistics reported by the Government. I have come across cases of individuals who did self-testing by ART and, they were positive. But they did not report themselves to the authorities or to any clinics.

With home recovery now as the default response to any positive COVID-19 test, does Minister agree that the risk of unreported cases is, actually, quite high? And to that extent, we need to be quite careful when we look at the official statistics recorded by the Ministry.

I take the Member's point. In every country, they also have a concept of what they call "ascertainment rate", which is, of the underlying cases, how many are uncovered and reported. And every country knows that it cannot be 80%, 90% or 100%. Especially when you have a Delta wave or Omicron wave that is highly transmissible, you do want people to take self-responsibility, take care of themselves, isolate themselves and, in these cases, they may not be reported. So, they do happen in every country.

To think about it, when we face an endemic disease, whether it is chicken pox or influenza, we cannot report every case and that is what endemicity means, which is, many people get it, many people are able to recover without it being officially reported. That is part and parcel of endemicity.

But notwithstanding that, testing remains important for us, first, to exercise self-responsibility; second, to have a sense of what is the prevalence of the virus in the community. And we continue to do quite a fair number of tests: over 20,000 PCR tests a day; over 150,000 ART tests a day. Some self-monitored, not reported, but many are. That will always give us a consistent measure of the prevalence of the virus in the community. And we will continue to do so in a practical way.

19 Mr Saktiandi Supaat asked the Minister for Transport (a) what are the risks of airflow-related COVID-19 transmissibility at Changi Airport buildings given what we know about the Omicron variant transmission capabilities; and (b) what other enhanced measures can be taken to protect all our airport workers, both frontline and non-frontline.

20 Mr Saktiandi Supaat asked the Minister for Transport in relation to the COVID-19 Omicron variant virus, what key global and domestic indicators are being monitored to assess the need to change our border measures and adjustments to both the Vaccinated Travel Lanes, their land capacity, flight sales caps and allocated quotas; and (b) what is the 2022 outlook for our regional air and maritime hubs.

21 Ms Poh Li San asked the Minister for Transport whether additional polymerase chain reaction (PCR) tests will be required several days after arrival into Singapore for Vaccinated Travel Lane (VTL) travellers, especially for those arriving from countries with high incidence of COVID-19 Omicron cases, in case the first PCR test upon arrival into Singapore does not pick up the infection.

22 Mr Lim Biow Chuan asked the Minister for Transport whether the freeze on new bus and flight ticket sales for the Vaccinated Travel Lane (VTL) is necessary as Singapore moves towards treating the COVID-19 disease as endemic.

23 Dr Tan Wu Meng asked the Minister for Transport (a) how often does Changi Airport undergo studies of the presence, viability and infectivity of COVID-19 virus in its built environment, including in the air and on surfaces which members of the public or staff may come into contact with; (b) whether these studies are revisited when COVID-19 novel variants arise around the world with higher transmissibility, such as Delta and Omicron; and (c) when was this last studied.

24 Mr Dennis Tan Lip Fong asked the Minister for Transport in light of the spread of the Omicron variant of COVID-19 (a) how does the Ministry review its border control measures for air travel with all countries as well as Vaccinated Travel Lane (VTL) and non-VTL travel with Malaysia, with the view to striking a meaningful balance between allowing travel to continue while minimising the risk of COVID-19 spread during travel; and (b) what measures can be expected from the Ministry in the coming weeks.

25 Mr Leon Perera asked the Minister for Transport (a) what are the reasons for limiting Vaccinated Travel Lane (VTL) flights to only specific airlines; and (b) whether the Ministry will consider including more airlines, especially low-cost carriers, as well as more flights during festive periods like Chinese New Year and Hari Raya, to ensure that lower-cost options are available to those who need to travel.

26 Mr Shawn Huang Wei Zhong asked the Minister for Transport with regard to the effort to jumpstart the Singapore economy in 2022 and to gain momentum in the aviation sector (a) whether the Ministry is taking any steps to ensure the continued growth and success of Singapore’s aviation industry; (b) if so, what are these steps; and (c) what are the additional efforts undertaken to ensure the success of the Singapore AirShow in 2022.

Mr Speaker, Sir, may I have your permission to take Question Nos 19 to 26 together, please?

Mr Speaker: Yes, please.

I will also address questions raised by Mr Seah Kian Peng1 and Mr Gan Thiam Poh for the Sittings on 11 and 12 January.

Sir, over the past two years, the Ministry of Transport MOT) and the Civil Aviation Authority of Singapore (CAAS) have worked closely with the Ministry of Health (MOH) and other Government agencies to reopen our borders in a careful and calibrated manner.

Mr Saktiandi Supaat and Mr Dennis Tan have asked how we have reviewed our border measures in light of the Omicron variant, including what global and domestic indicators we monitor to inform our measures. Essentially, it is a composite of both domestic and external factors. Let me elaborate in the context of what we have done over the past several months.

In September last year, with a substantial proportion of the Singapore population vaccinated, we launched the Vaccinated Travel Lanes (VTLs). Two months later, on 26 November, the World Health Organization (WHO) designated Omicron as a "Variant of Concern". Then, scientists around the world were still trying to ascertain Omicron's transmissibility and virulence relative to Delta and the efficacy of existing vaccines against this new variant. As a precautionary move, based on reports of the spread of Omicron in Sub-saharan Africa, we restricted the entry and transit of non-residents from Botswana, Eswatini, Lesotho, Mozambique, Namibia, South Africa and Zimbabwe from 28 November; and from Ghana, Malawi and Nigeria from 5 December. Residents returning from these countries were subjected to a 10-day Stay-Home Notice (SHN) at dedicated facilities. We halted the expansion of the VTL scheme and deferred the launch of the already-announced VTLs to Qatar, Saudi Arabia and the United Arab Emirates. We also decided to maintain the daily quota for VTL (Air) travellers at 10,000, rather than increase it to 15,000, as we had earlier intended.

On 22 December, given the rapid and global spread of the Omicron variant, we froze the sale of new VTL flight and bus tickets for entry into Singapore from 23 December 2021 to 20 January 2022. We also imposed a 50% limit on the daily number of VTL travellers from 21 January this year.

Mr Lim Biow Chuan has asked whether this freeze was necessary, given our approach of living with COVID-19. As I have outlined, the freeze was part of a series of calibrated moves informed by the latest public health risk assessment as well as developments around the world. It was essential to balance the need to manage the risk of imported Omicron cases while minimising disruption to travellers who had already made VTL bookings to enter Singapore.

Ms Foo Mee Har had asked earlier about the breakdown of imported cases for Omicron. In summary, about 2,600 cases were imported. The key sources were the United States at 16%, United Kingdom at 16% and India at 11%. This broadly corresponds to the VTL traveller volume and, as most Members will appreciate, it is also influenced by the incidence of Omicron in these countries. I would add that, of the composition of this figure, less than 10% were actually short-term visitors. So, the bulk is actually Singapore Citizens (SCs), Permanent Residents (PRs) and long-term visit pass (LTVP) holders who are returning to Singapore from overseas.

Ms Poh Li San, Mr Gan Thiam Poh and Mr Seah Kian Peng asked about the additional enhanced measures for VTL travellers. In the first week of December 2021, in consultation with MOH, we introduced additional supervised self-administered antigen rapid tests (ARTs) for VTL travellers on Day Three and Day Seven after arrival. This is on top of the pre-departure and on-arrival test requirements. VTL travellers were also required to undergo self-administered ARTs on Days Two, Four, Five and Six of their arrival before going about their daily activities. Those who test positive are required to undergo a confirmatory PCR test. So, basically, pre-departure, on arrival and then from Day Two to Day Seven, there is daily ART self-administered, but on Days Three and Seven, they have to do it under supervision. And these have to be reported and, if there is a positive ART result, then they go for a PCR test.

Collectively, these adjustments to our border and other measures have allowed us time to study and better understand the Omicron variant, to strengthen our defences, including our healthcare capacity, and to get more people vaccinated and boosted, as we have heard. We will continue to work closely with MOH to regularly review our border measures. As part of learning to live with the virus and its variants, we must press on with our efforts to restore our connectivity with the world while safeguarding public health. Our goal is to restore quarantine-free travel with more countries and regions, as allowed for by the public health assessment.

Mr Saktiandi Supaat asked about the additional measures to protect airport workers from Omicron. Since 2 December 2021, we have enhanced the personal protective equipment (PPE) and testing protocols. All frontline airport workers are now placed on a seven-day PCR Rostered Routine Testing (RRT) regime. For higher-risk frontline airport workers, an employer-supervised ART was introduced on the third day in addition to their seven-day PCR RRT. Further, all Singapore aircrew arriving from affected regions are required to undergo an on-arrival PCR test and post-arrival PCR tests on Days Three and Seven. These protocols will be adjusted, as they have in the past, in accordance with the latest public health risk assessments.

Mr Saktiandi Supaat and Dr Tan Wu Meng asked about airflow and COVID-19 transmissibility at the airport. Since the onset of the pandemic, Changi Airport Group (CAG) has progressively upgraded the air ventilation system at the airport. For instance, CAG has upgraded the filters in the air-conditioning and mechanical ventilation (ACMV) system to Merv-14 filters, which are able to remove about 85% of particles of 0.3 to 1.0 micron in size. In other words, they can filter out particles smaller than the size of a respiratory particle containing the COVID-19 virus. With the emergence of the more transmissible Delta variant in May last year, CAAS, CAG, MOH, the National Environment Agency (NEA) and the Building and Construction Authority (BCA) conducted an airflow study to identify spaces at the airport where ventilation and filtration could be further stepped up. Since then, 350 High Efficiency Particulate Absorbing (HEPA) portable air purifiers have been installed throughout the airport terminals at locations, such as staff canteens, rest areas and health screening stations. These HEPA air purifiers are also used in hospitals, and they help to reduce the risk of airborne transmission of COVID-19. Since September last year, CAG has also installed ultraviolet-C (UV-C) sanitation equipment in the airport terminal air-conditioning systems to provide an additional layer of defence.

Mr Dennis Tan, Mr Leon Perera, Mr Saktiandi Supaat and Mr Shawn Huang asked about upcoming VTL moves and the outlook for our air and maritime hubs in 2022.

Our maritime hub has weathered the COVID-19 crisis relatively well, with container throughput at our port likely to reach an all-time high in 2021. Maritime businesses also continued to establish and expand operations here. We expect the favourable outlook for trade and shipping to continue in 2022. According to industry projections, global seaborne trade is expected to grow 3.5% in 2022, slightly below the estimate of 3.6% last year. We are working with our tripartite partners to seize these opportunities, continue growing our maritime sector and create more good jobs for Singaporeans.

On the other hand, air travel is expected to take several years to recover to pre-pandemic levels. Notwithstanding this, we remain confident of the long-term potential of air travel and are resolutely committed to working with Changi Airport Group and airline partners to rebuild and reclaim Singapore's status as an international air hub. Compared to 3% at the start of 2021, passenger traffic at Changi increased to about 15% of pre-COVID-19 levels by the end of December 2021, largely aided by our VTL schemes. A study by the International Air Transport Association (IATA) and Oxford Economics has projected international passenger volume at the end of 2022 to recover to about 55% of 2019 levels, which is up from about 20% at the end of last year. Therefore, barring unexpected setbacks like Omicron, we anticipate further recovery in 2022.

To Mr Leon Perera’s question, we do not restrict any airline from applying to operate VTL flights; the overall quota of inbound VTL travellers is allocated to airlines based on the plans they submit to CAAS. Low-cost carriers, such as Scoot, AirAsia and Jetstar Asia, already operate VTL flights from Malaysia. Scoot also operates VTL flights from Thailand and the Republic of Korea, Australia and Germany. Mr Perera also asked if we would allow more VTL flights during festive periods. You have heard from the MTF and also in today's session in Parliament, we closely monitor the demand for VTL flights and will regularly review the VTL quotas, always taking into consideration the prevailing public health assessment.

Mr Shawn Huang asked about our plans for the Singapore Airshow in 2022. The Singapore Airshow is one of the world’s leading airshows that bring together aerospace and defence leaders and key decision makers to conduct business and forge partnerships. The event organiser, Experia Events Pte Ltd, has announced that Singapore Airshow 2022 will go ahead from 15 to 18 February, for trade visitors only. To ensure the success of Singapore Airshow 2022, our Government agencies are working closely with the organiser on the public health protocols to facilitate its safe and smooth execution, including ensuring the safe entry of international trade attendees and safe management measures at the event.

As part of living with COVID-19, we must shift to a new setting that will enable us to stay connected to the world. It is essential that we press on with our mission to reopen our borders. The VTL scheme is a useful pathfinder for us to establish, test and build confidence in safe reopening to vaccinated travellers. Ultimately, we want to work towards quarantine-free travel for all vaccinated travellers.

Singapore’s global connectivity is critical to our economic competitiveness and the livelihoods of our people. It underpins our status as an international business centre and global trading hub. Over the past two years, the Government has provided significant support to preserve core capabilities in this strategic sector and to help them tide over this crisis. We will continue to work closely with our aviation stakeholders to rebuild a safe and sustainable Changi aviation hub.

Mr Saktiandi Supaat.

Mr Speaker, I would like to thank the Minister for his comprehensive answers. I have two supplementary questions.

First, in relation to a Nikkei article on 4 December, I quote Indonesia's Deputy Minister of State-owned Enterprises, Mr Kartika Wirjoatmodjo, mentioning in parliament about Kualanamu Airport, which they are actually looking to operate in Indonesia's North Sumatra region. He said, "Kualanamu can be a base to reduce dominance of Changi and KLIA" and that GMR Airports group has committed 56 trillion rupiahs or $3.8 billion to support the expansion. My first supplementary question (SQ) is in relation to that. And the Minister mentioned and elaborated on the aviation hub outlook. Can the Minister share what are the risks of our regional partners trying to gain a foothold in our aviation sector in terms of its growth and hub status as well? That is the first question.

Second, I am heartened to hear that CAAS is working to improve the airport ventilation rates, especially in a built environment. But the airport phase is key and I hope we can continue to enhance the airport phase's cleanliness, filters and airflows. My question is in relation to transport passenger volume. If we are going to grow it further forward, what measures can we take to enhance it even more because, definitely, with Changi Airport, we want to enhance the transit passenger volume even further as well.

Mr Speaker, I thank the Member for his questions. First, on the reports that he has cited, I do not think I can speak with authority on the specific plans that the Indonesian government or, for that matter, any other government or regional players have. But let me start by saying that Changi is no stranger to competition. We have always had to compete with a whole variety of regional hubs. And there will continue to be new hubs that will emerge. Therefore, it is critical that we work at the system level with all the partners – whether it is Changi Airport Group, airline partners, SATS and other ground handlers, the unions and, certainly, the Government agencies, including CAAS. It is important that we mount a systemic response to preserve our competitiveness as an international aviation hub.

Central to that, in terms of looking ahead, I think that it will be underpinned by two key factors. The first is to emerge from the COVID-19 pandemic in a manner that is safe and robust so that travellers, airlines and, indeed, the general population, have the confidence that air travel can, in fact, continue in a safe manner and that Changi is one of the places that they can travel through with utmost confidence. That is key.

That is what we are working towards. So, throughout the last 12 to 18 months, for all the airport players here in the aviation cluster, basically, it has been a Herculean effort because we have had to invert the operating model in Changi. A civilian airport, in general, is designed for an experience, for passengers to interact and we have had to reverse that logic and start to look at segmentation, testing and all kinds of other necessary protocols to protect health, but it means the travel experience is diminished.

But we are committed, as I have said earlier, to reclaiming and rebuilding our status as an international aviation hub. And our VTLs have helped us to raise volumes to about 15% or so of pre-COVID-19 levels by the end of last year and, based on both global projections and our own anticipation, we should be able to do better this year. But how much and how fast are really a function of the environment. And we need to always prioritise the public health assessment.

I would add that, beyond safe recovery, the longer-term competitive proposition of Changi will also rest on sustainability. And that is something that CAAS is working on with all the partners. That will also be an important competitive differentiator for us going forward.

The Member's second point was on passenger volumes and, if we want to increase passenger volumes, what would it entail. I think it is fair to say that the current protocols, whilst necessary, do impose a limit on how much we can grow within the current set of formulations. So, we will have to work with our health authorities and the aviation partners to ascertain how much flexibility we have, going forward, and what are the possible rate-limiting steps or aspects that we need to reconfigure so that we can go for the next bound of growth in terms of passenger volumes in Changi. And that is an effort that is currently being undertaken by MOT with CAAS and all our partners.

Dr Tan Wu Meng.

I thank the Minister for his answer. I would like to draw reference to a Parliamentary Question (PQ) I filed early in July 2021 about detection of COVID-19 in the built environment because better sensing of virus in the air and on surfaces may help us to find new vulnerabilities ahead of new clusters. I have an SQ for the Minister for Transport.

The Minister has spoken about what has been done to clean the air filtration better, to try and sterilise surfaces better with UVC. But can I ask the Minister how are we evaluating the effectiveness of these measures? Are we checking whether there is viral detectability in the ambient air? Are we checking for detectable virus on surfaces that members of the public or members of staff may come into contact with?

And if I may put a second SQ to MOT, can the Minister confirm that there is ongoing attention to making sure that existing security protocols in the airport also interlink safely with safe management measures? So, for example, where staff are required to have their faces validated against photo IDs, that this is done in a way that does not undermine the safe management processes against COVID-19.

Mr Speaker, if I may take the second question first and thanking the Member for raising these matters. Our highest priority is protecting the health and welfare of our frontline airport workers because, without them, the airport will not be able to function. So, we have undertaken a whole series of steps to ensure that our workers are protected to the best of our ability. And that is why I mentioned, specifically, the moves we have made with respect to personal protective equipment, or PPEs, and we have heightened them. In almost all the settings, they now wear N95 masks, for example, apart from the usual garb.

I would add that we have also the testing protocols that we have enhanced. All of these, on the one hand, ensure a higher level of safety for our workers. But I must also emphasise that it also means additional inconveniences and challenges. So, it is a constant recalibration, taking into account the risks, whilst we also focus on the welfare of the workers. So, the short answer to the Member's question is, of course, SMMs are our top priority and, when it comes to aspects like facial IDs and so on, all the necessary protocols are put in place and, if there is evidence that we need to do more, we will do more. But I just wanted to highlight to Members – and I have been engaged in conversations with the union leaders and so on – that every one of these moves does impose a real human burden, which we have to take into account.

On the first point on detection and how we continue to monitor, CAAS and Changi Airport are not the specialists in this area. But they are fully committed to protecting the environment to the best of their ability. In some ways, I think Changi Airport or its surrounding facilities are not too different from many commercial building settings and so on. This flow of people is from different sources and there are all kinds of activities and convergences.

First, we will be informed by the general settings and requirements and make sure that these are observed rigorously. Second, we are also working with, as I have said, MOH, NEA and BCA. These are specialised agencies that have important perspectives that then informs the measures that we can take in Changi Airport, as necessary. So, let me assure Members that it is something that we are watching and monitoring closely and we will continue to take all necessary steps to protect the health and safety of our workers.

Mr Ong Ye Kung.

Mr Speaker, Sir, just now, in reply to a question delivered by Senior Minister of State Janil Puthucheary, he mentioned that the incidence of myocarditis amongst young people is 45 per million and, during the supplementary questions, I referred to the same number. [Please refer to "Assessment of Effects of COVID-19 Vaccines on Younger Children and Singapore's Decision to Extend Vaccination to Younger Children" and "Vaccination for Primary School Students and Possibility of Vaccination-differentiated Measures for Preschools and Primary Schools", Official Report, 10 January 2022, Vol 95, Issue 44, Oral Answers to Questions section.]

We now realise the number is inaccurate. It is actually 10 times less. What we said was 10 times less. It is actually 450 cases of myocarditis per million infections of COVID-19 on young people. This is in the preprint and the number is actually disproportionately weighted towards males. And the age group is actually 12 to 17, to be specific, and not below 12. I thought I would make that clarification.

27 Mr Leon Perera asked the Minister for Education whether the Government plans to (i) look into the survey findings of the Academic Freedom Survey 2021 published by AcademiaSG, notably that faculty who said they work on "politically sensitive" topics are more likely to feel constrained in their ability to research or engage the public, compared to those whose work are not "politically sensitive" and (ii) take steps to improve the state of academic freedom, especially in respect of Singapore studies and women academics, whom the survey reported as being more likely to feel constrained.

Mr Speaker, our Autonomous Universities (AUs) are committed to safeguarding academic freedom for their faculty and students. Doing so has allowed them to attract top talent as well as to create new knowledge, innovate and contribute to Singapore's development over the past decades. The quality of education and research done by AUs is also well-regarded internationally.

With regard to the Academic Freedom Survey by AcademiaSG, the authors of the survey have noted that the response rate was only about 10%, that is, about 198 out of 2,061 contacted academics in the social sciences, humanities, business and law schools at the National University of Singapore (NUS), the Nanyang Technological University (NTU), the Singapore Management University (SMU), the Singapore University of Technology and Design (SUTD) and the Singapore University of Social Sciences (SUSS) replied to the survey. Among the 10% who responded, only a minority reported significant concerns about academic freedom in Singapore. I would, therefore, advise some caution in generalising the findings from the survey as representative of how all academics in Singapore feel. Academics in AUs have been able to teach, engage in discourse, research and publish on a wide range of topics, including domestic politics, race, religion and gender issues. It would be unfair to our academics to assume that they self-censor or feel inhibited.

The AUs' work on Singapore studies is evidence that academics do not shy away from "politically sensitive" topics. The NUS' Faculty of Arts and Social Sciences has a public listing of more than 8,000 Singapore-related publications, with more being added over time. This includes titles, such as "Is the People's Action Party Here to Stay?" by Singh, 2019, and "Super-diversity and the Bio-politics of Migrant Worker Exclusion in Singapore" by Goh, 2019. Such works contribute to public discourse on governance and public policy and also inform the teaching curriculum.

MOE has also funded projects on topics that may be considered sensitive, under the competitive grants. Many researchers in AUs also work with Government agencies to study complex issues. Examples include integration of bi-national families in Singapore, coping strategies among low-income households and the development of racial attitudes during early childhood. These projects, in turn, can be used or adapted as teaching materials for the students.

Many of these projects are led by female researchers. So, it would be unfair to our academics, including female academics, to assume that they self-censor or feel inhibited.

Order. End of Question Time. Introduction of Government Bills. Minister for Trade and Industry.

[Pursuant to Standing Order No 22(3), Written Answers to Question Nos 33-34, 36-43, 45-50, 53-55, 57-58, 61, 64-65, 67-69, 71-72, 77, 80, 82-83, 85-88, 90, 92-93, 96-100, 102-109, 111, 114-122 and 124-128 on the Order Paper are reproduced in the Appendix. The remaining Questions have been postponed to a later Sitting of Parliament or withdrawn.]

[(proc text) "to amend the Economic Expansion Incentives (Relief from Income Tax) Act 1967", (proc text)]

[(proc text) recommendation of President signified; presented by the Minister for Trade and Industry (Mr Gan Kim Yong); read the First time; to be read a Second time on the next available Sitting of Parliament, and to be printed. (proc text)]