People With Severe Allergies Can Now Take COVID-19 Vaccines in S’pore

The last we heard of COVID-19 vaccine restrictions, the Ministry of Health (MOH) had recommended those with severe medical conditions not to take the two mRNA-based vaccines that are approved in Singapore.

Specifically, those with a history of anaphylaxis, a severely weakened immune system and those with a very low blood platelet count.

As of Friday (4 Jun), the Expert Committee on COVID-19 Vaccination (EC19V) has further relaxed the restrictions once again, now approving the use of vaccines on individuals with a history of anaphylaxis.

mRNA Vaccines Extended to Those With Anaphylaxis

For those of us who have no clue what anaphylaxis is, it is a type of life-threatening allergic reaction which include:

• hives or swelling in the face, eyelids, lips or throat
• difficulty breathing
• dizziness

According to their news release, the committee had initially limited the administration of the vaccine to those individuals as a cautionary move—there were some overseas and local reports of anaphylaxis with the mRNA-based vaccines in individuals with a history of allergies when the mRNA vaccines were first introduced.

With more information available today, they felt that the data was “reassuring”. The incidence rate of anaphylaxis reported locally with these mRNA vaccines has stabilised at about 0.85 per 100,000 doses administered, similar to cases reported internationally.

Furthermore, there have been no safety issues detected with vaccinating individuals with a history of anaphylaxis to other triggers.

MOH noted that there are nearly 32,000 individuals in Singapore who are unable to take the vaccine due to severe allergies.

However, the EC19V cautioned that these restrictions are lifted only to those with a history of anaphylaxis or allergic reactions to other drugs, food, insect stings, or unknown triggers.

Individuals with a history of anaphylaxis to any component of the mRNA COVID-19 vaccine are still not recommended to receive the shot.

In addition, individuals with a history of allergies to other vaccines should first be referred to an allergist for further evaluation (fully subsidised by the government) as the mRNA vaccines may have similar components.

As such, there is a need for other types of vaccines to cater to the needs of the population.

Alternate Vaccines

MOH highlighted in another news release that some individuals had developed anaphylaxis or allergic reactions (hives, face/ eyelid/ lip/ throat swelling, generalised rash within 7 days after vaccination) due to the first dose of an mRNA COVID-19 vaccine.

“This group should not receive an mRNA-based vaccine again,” they wrote.

The ministry added that they will continue to evaluate vaccines and bring in non-mRNA vaccines for these individuals. They expect the non-mRNA vaccines to be approved by the Health Sciences Authority (HSA) for use in Singapore’s national vaccination programme by the end of this year.

And if you’ve been keeping up with the news, you’ll know that more alternative vaccines now have been approved for use in private healthcare clinics. These will be available to those who are still unable to take the mRNA vaccines.

For this group, the government will reimburse them the private vaccination charges if they decide to receive Sinovac-CoronaVac from private healthcare providers.

One thing to note is that these vaccines are not approved by HSA but are on the World Health Organisation’s (WHO) Emergency Use List (EUL).

These vaccines come under the “special access route” (SAR) and will not be subsidised by the government so individuals who are keen on taking them will have to do so at their own risk.

Currently, the WHO EUL comprises of vaccines by:

• Pfizer-BioNTech
• Moderna
• AstraZeneca
• Johnson & Johnson
• Sinopharm
• Sinovac-CoronaVac

Why Isn’t Sinovac Approved For Public Use in Singapore?

The health ministry also responded to public queries on why Sinovac has not been included in our national vaccination programme, emphasising that “the WHO EUL pathway focuses on the needs of low- and middle-income countries with limited access to COVID-19 vaccines.”

“It is a risk-based process that expedites the assessment of vaccines for use in a pandemic especially in these countries, where the benefits are deemed to outweigh the risks, despite uncertainties about the safety and efficacy of the vaccine,” they explained.

On the other hand, many healthcare regulators in developed areas like Singapore usually conduct more stringent tests beyond the WHO EUL approval before allowing a vaccine to come into general use.

HSA is still waiting for more outstanding data on Sinovac-CoronaVac from Sinovac for it to complete its independent and thorough evaluation of the quality, safety and efficacy of the vaccine.

Sinovac in Private Clinics

While you can’t get the Sinovac COVID-19 vaccine through the national programme, you can approach a private healthcare provider to have it administered to you.

Since WHO’s inclusion of Sinovac into the EUL, MOH has invited private healthcare institutions licensed under the Private Hospitals and Medical Clinics Act (PHMCA) to apply to be licensed providers for the Sinovac-CoronaVac vaccine under the SAR.

The ministry will select 20 private clinics and draw on their current stock of 200,000 Sinovac doses to provide them to all Singapore Citizens, Permanent Residents and persons holding Long-Term Visit Passes who wish to take the vaccine.

As mentioned earlier, vaccines not yet approved by HSA will not be subsidised by the government. Hence, private healthcare providers will be allowed to charge patients receiving the vaccine a fee to cover their costs.

It cannot be covered by the Vaccine Injury Financial Assistance Programme (VIFAP) either.

Though it is a private arrangement, MOH will still draw up guidelines on proper counselling, informed consent and safe management of patients. They urge patients who wish to take the alternative vaccines to discuss with their doctor in these appointed providers the risks and benefits of using these vaccines and jointly make an informed decision.

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