S’pore Has Made Deposits for COVID-19 Vaccines Even Before Trial Results Were Out

You know what people, including citizens like ourselves, say about Singaporeans: we’re all super kiasu about everything – but of course, it may not necessarily be a bad thing.

Enrolling your children in tuition classes even before they turn two? Check. 

Arriving two hours early to the start of the sale to queue? Check.

And in true Singaporean fashion, securing multiple vaccines before they were even proven to be valid, “just in case”? You bet.

Sealed The Deal For COVID-19 Vaccines Early

Back in June last year, during Singapore’s circuit breaker period that left everyone lamenting at the loss of bubble tea, healthcare experts were working harder than they ever had to secure vaccines for everyone against the virus.

Singapore had actually signed its first deal to procure some of these COVID-19 vaccines then, long before any of the more than 200 vaccine-producing companies in consideration held their phase three trials.

Despite having to pay a premium on the price and the uncertainty of it all, the panel behind this decision made the choice to go ahead, if only to secure vaccines for high-risk Singaporeans, such as healthcare workers and the elderly.

The deal they had signed was for the Moderna mRNA vaccine which has yet to be approved for use here.

Two more vaccine purchases were made in August with traditional vaccine producer Sinovac and Pfizer-BioNTech which also uses the mRNA technology. All of these should be sufficient for the entire adult population of Singapore, but our country’s not stopping there.

Call us kiasu, but hey, it never hurts to be too careful.

Dr Benjamin Seet, the chairman of the Therapeutics and Vaccines Expert Panel by the Economic Development Board, said that Singapore’s still engaging in late-stage discussions with several companies.

There might still be delivery delays, disruptions in the supply, and some may still need booster shots, he added. Some people may also not react well to existing vaccines that are being used, which calls for alternatives.

Such delays have actually happened with Pfizer and AstraZeneca. India’s largest vaccine facility, Serum Institute, also faced a fire last month, even though they’ve said the production of vaccines will still go on.

The Search For Vaccines

Dr Seet, 56, was appointed chairman of the panel after joining the National Healthcare Group (NHG) just slightly after Singapore saw a booming increase in COVID-19 cases among domestic workers here, a tally of more than 54,500.

“It was around that point that we realised that the impact on Singapore could be more serious,” Dr Seet said, sharing that they decided that Singapore should get access to an effective vaccine once made available.

“We were tasked to make sure that when Singapore needs it, we do have an effective vaccine in a timely manner,” he added.

The panel consists of 18 members, of whom were chosen due to their expertise and experiences in immunology and basic science, clinical as well as in drug development and manufacturing. Dr Seet was the executive director of the Biomedical Research Council at the Agency for Science, Technology and Research (A*Star) prior to him joining.

Selecting which vaccines were worth the money took a long time involving thousands of readings and cold calls to companies to enquire about their vaccines, taking both conventional as well as novel vaccine technology into consideration when there were eight or nine developing globally at the time.

The panel thought it would be challenging to review all their options, which is probably enough work to render anyone exhausted, so they narrowed it down to four platforms including vaccines using RNA (not yet used in other vaccines yet), viral vector (in Ebola vaccine), inactivated virus (in flu vaccines) and protein sub-units (whooping cough vaccine).

“We realised that we couldn’t put all our eggs in one basket. So we wanted some of the old and some of the new. We also looked at it in terms of timeliness; which ones could come faster,” Dr Seet explained.

Knowing that the first may not always be the best, they were still pleasantly surprised that the Moderna and Pfizer-BioNTech vaccines turned out to have the best efficacy rates of 95%, a truth they did not know yet when they made the downpayment for these two.

FYI, these two used the new technology (mRNA),

They managed to shortlist 40 companies, yet still needed more confidential information about the vaccines in order to make an informed choice.

And it’s not just “shut up and take my money”.

Many calls were made to “the right people” in these companies to express their interest in buying vaccines, connections that were leveraged on through the Economic Development Board and Temasek’s contacts as well as contacts from the scientific and medical community, thanks to Singapore’s global network.

Although it was a fairly new concept for these pharmaceutical companies to sell a vaccine that remained uncertain, most of them agreed, and non-disclosure agreements were signed. These usually took two weeks to finalise, but the fastest took only a day.

They were then able to access unpublished information amidst talks with chief medical officers and scientists, and colleagues from Health Sciences Authority were even able to visit their production plants.

New options were added and some were removed from the panel’s list as decisions were refined while more data became available, and there were more than 20 by July. By September, 12 to 14 remained on the list.

In the end, Singapore placed a deposit with Moderna in June and made the other two purchases as well, all before trials were complete.

It’s nice to be rich #justsaying

Considered The Science Behind The Vaccines Heavily

Dr Seet explained that the team went “deep into the science” of the vaccines before making any decisions, finding confidence in the pre-clinical studies of some but not others.

“We looked at the early data in mice, hamsters, ferrets, and for some, in primates. We looked at how strong the immune response was. We looked at different immune markers, antibody levels, T cell activity,” he shared, adding that they were “very keen on the challenge studies where they vaccinate the animals, then expose them to the live virus to see how many actually get infected.”

Another consideration was the delivery of the vaccines, for most vaccines needed to be reassembled, and the panel ruled out those that required three components.

Lest you didn’t know, Singapore’s been using the Pfizer vaccine currently, which requires storage under minus 70 degrees Celcius.

The vaccine, which comes in powder form, has to be put together again. 1.8ml of saline solution is injected through the rubber cap of each vial, which contains six doses and has to be shaken 10 times first.

It was a gamble for Singapore, as advanced payment agreements meant that they had to fork out more money gradually as various milestones were reached. Thankfully, it worked out well, or else all the money would have simply gone down the drain.

Purchasing more vaccines ensured that Singapore would receive an early first batch and a steady flow of vaccines as they are delivered throughout six months or so. As of late, more than 100,000 people have taken the Pfizer vaccine here which arrived at the end of last year.

You might have been complaining about the costs of ERP and COE, but now you know why our country saves so much money.

Featured Image: angellodeco / Shutterstock.com