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The thing about life in Singapore is that there are rules, regulations and laws you have to follow if you have a pink IC or a six-digit postal code.

National service for men. Ban on flying a drone in certain areas. Returning your trays at the hawker centre, that sort of thing.

You may not think it's fair to be subjected to such rules, but it is genuinely not difficult to follow. Just follow law lah.

So I ask: Why do individuals opposed to the Covid-19 vaccine kick up such a fuss when subjected to Vaccine-differentiated Safe Management Measures?

Let's make this clear upfront, when I say anti-vaxxer, I am referring to a person aged 12 and above, who is medically eligible to take the vaccine, and yet for some inane reason, chooses not to.

And I don't care whether they are vehemently opposed to vaccines in general, or just want to "wait and see" (as if 2020 wasn't enough waiting and seeing), or just plain lazy to walk to a vaccine centre. In terms of the impact they have on society, and potentially on our healthcare system, they fall into the same camp.

How many anti-vaxxers are there?

First, let's look at some numbers.

Back on Sept. 13 this year, Health Minister Ong Ye Kung gave a written reply to PAP Member of Parliament Darryl David, who asked for the percentage of unvaccinated people in this country who are not children under 12, and are not medically ineligible for a vaccine.

In other words, thanks to David, we roughly know how many anti-vaxxers there are in Singapore.

Here's the answer:

"As of Sept. 5 2021, 17 per cent or about 930,000 of our population are yet to be vaccinated with any dose of the Covid-19 vaccine.

Of the unvaccinated, more than half are children below the age of 12 and are not yet eligible. The remaining 400,000 unvaccinated comprise about 100,000 seniors aged 60 and above, and an estimated 300,000 individuals aged 12 to 59 years.

A small group of about 1,000 individuals have a previous allergic reaction to other vaccines and may potentially not be able to receive Covid-19 vaccines. They are being referred to specialists for further assessment."

930,000 minus 400,000 leaves 530,000 children under the age of 12. The figure of 530,000 represents about 9.7 per cent of the total population of 5.45 million. (Don't worry, there's not much math left to go.)

Now as of Oct. 11 (according to the MOH report that arrives every night without fail in my email inbox), 83 per cent of the country are fully vaccinated.

Add that to the kids (whose numbers can't have changed much in less than a month), and this accounts for nearly 93 per cent of Singaporeans.

Which means that the remaining anti-vaxxers represent around just 7 per cent of the population.

How many people have had reactions?

What about those who are medically ineligible? Thanks to a question from Workers' Party MP Gerald Giam, we have the answer for that too:

"About 1,000 individuals had previous allergic reactions to other vaccines. These persons have been referred to allergists to assess their suitability for mRNA vaccines. The assessment is fully-subsidised for Singaporeans, Permanent Residents and long-term pass holders.

A separate group of about 7,100 individuals had allergic reactions after taking the first dose of a COVID-19 mRNA vaccine. They have been invited to complete their vaccination with two doses of Sinovac-CoronaVac under a dedicated public health programme. Of these persons, 3,900 have indicated interest to do so."

According to the Ministry of Health in an August update, from Aug. 10 onwards, individuals who are fully vaccinated with the WHO EUL vaccines such as Sinovac-CoronaVac, Sinopharm, and AstraZeneca will be eligible for the vaccination-differentiated safe management measures.

So an individual will be considered “fully-vaccinated” two weeks after they have received the full regimen of Pfizer-BioNTech/ Comirnaty, Moderna, or any WHO EUL vaccines.

And they will have more options, with the non-mRNA based Novavax vaccine coming to town in end-2021.

Vaccine Differentiated Measures help boost vaccinations

When the Multi-Ministry Task Force announced on Saturday (Oct. 9) the introduction of more Vaccine-differentiated Safe Management Measures (VDMs), I rejoiced.

Why? VDMs, which limit access to certain services for fully vaccinated individuals, have been proven to work.

According to Wired, back in Dec. 2020, 60 per cent of the French population said they didn't want a Covid vaccine.

President Emmanuel Macron then announced a "vaccine passport" in July 2021, which required proof of vaccination status for entering cinemas, museums, restaurants and bars, and for those using long-distance public transport.

What happened? In the week after Macron's announcement, 3.7 million people booked a vaccine appointment. By mid-September 2021, 63 per cent were fully vaccinated, with a higher number having received at least one dose.

According to NPR, Italy announced a vaccine "green pass" proof of at least one Covid vaccine, a negative test or recovery from the virus. It was first required for indoor dining, museums and gyms. It was then extended to high-speed trains, planes and ferries.

Immediately following the announcement, appointments for a first dose rose up to 40 per cent over the previous week. Italy is now hopeful of seeing 82 per cent of its population (aged 12 and above) fully vaccinated by mid-October.

Look, even "the land of the free" is taking vaccinations seriously.

U.S. President Joe Biden, who was initially reluctant to issue mandates, has announced a proposed vaccine mandate for private companies with 100 employees or more, or weekly testing. Federal workers could also face disciplinary measures if they refuse to be vaccinated.

Meanwhile closer to home, in Hong Kong, the local government has resisted implementing vaccine mandates (ostensibly because it is a "free society"). Its percentage of fully vaccinated people (aged 12 and above) is just 64 per cent, Straits Times reported on Oct. 12.

And while it's true that Hong Kong has very few cases on average as of Oct. 2021, it's worth keeping in mind that it is going for a zero-Covid strategy instead of an endemic one. Hong Kong has implemented very strict border controls, with no clarity on whether the border with mainland China could be opened anytime soon.

Here in Singapore, we have appeared to reach the limits of what encouragement can do. And at around 85 per cent, it's genuinely impressive. That's an "A" or distinction in all kinds of examinations, from GCE 'O' levels, to getting a first class honours in university.

But maybe it's time to get even tougher.

Carrot and the stick

Any policymaker knows there are two broad categories of tools at their disposal. The carrot and the stick. Either incentivise people to do something with rewards, or discourage certain actions with punishments ranging from mild discomfort to death itself.

There are very few carrots in Singapore society. But there are a hell of a lot of sticks.

If I threw litter on the ground, I'd get slapped with a fine. But there are no rewards if I stopped myself from littering. We are very much a stick-based society. It's just who we are.

But a harsh punishment like jail isn't a consequence of the latest VDMs. Just malls, coffee shops, attractions, hawker centres and other food and beverage outlets will require proof of vaccination status.

Anti-vaxxers will risk jail if they forge documents to appear vaccinated when they are not. But otherwise, all they are missing out on is what appears to be some shopping.

And even so, there are many, many exceptions:

• Anti-vaxxers can enter malls for medical appointments at clinics.
• Anti-vaxxers can enter malls to send their children to childcare centres.
• Anti-vaxxers can enter hawker centres and coffeeshops to dapao food orders.
• Anti-vaxxers can go for staycations at hotels (!), although they might not be able to dine at a restaurant in said hotel.
• Anti-vaxxers can visit large standalone supermarkets to get groceries.

And there's even an extended grace period for the mall restrictions, up to Oct. 19.

Given all these exceptions and sensitivities, did the anti-vaxxers respond with good grace?

Backlash

Nope.

(Published before Ministers Lawrence Wong and Ong Ye Kung did their FAQ)

There was at least one petition.

A quick glance at the usual Telegram groups to which anti-vaxxers flocked reveal even more unbridled fury.

Words like "discrimination" get used a lot. So was "oppression". Comparisons to racism were made, with some opining that VDMs are worse.

I just have one question for these people -- which country did they think they were living in?

Time to take off the kid gloves

The government is treating these people with kid gloves, in my view. They are showing care, kindness, empathy and compassion on a level which I believe is unprecedented. Maybe they have done so before, and I've just never noticed. But it is remarkable how patient they are being with a group that poses a risk to our healthcare capacity.

Because make no mistake about it, choosing to remain an anti-vaxxer if you are medically eligible is dangerous during a global pandemic. As Prime Minister Lee Hsien Loong said on Saturday (Oct. 9):

"Our data, as well as data from around the world, clearly show that vaccination sharply reduces the risk of serious illness. The vast majority of local cases (more than 98 per cent) have mild or no symptoms. Only 2 per cent or less developed more serious illness.

Of these, 0.2 per cent died or needed ICU treatment – just two out of every thousand cases. The rest of the serious cases have needed oxygen supplementation for a few days.

In other words, with vaccination, Covid-19 is no longer a dangerous disease for most of us."

The science is overwhelming at this point. Yes, there have been cases of bad reactions to vaccines. It happens. But such numbers are extremely low compared to those who got the vaccine and experienced no issues.

And if you're worried about possible side-effects of the vaccine...what about the side-effects of Covid-19? Even for those who recover, Long Covid -- or post Covid-19 condition -- is no joke. The list of post-Covid symptoms on the CDC website makes for terrifying reading.

Fortunately, according to a study in Lancet and reported by the New York Times, the likely risk of "breakthrough" infections in fully vaccinated people, resulting in Long Covid symptoms, is cut in half.

Rules are in place to protect lives

Anti-vaxxers are risking their lives and putting others around them at risk too. And while they may argue that it's their own lives at stake, the government clearly does not want to take such risks. As Ong and Wong said in their FAQ session:

Wong explained that the government is looking out for the unvaccinated in Singapore as "the risks are higher".

He added that the measures have been put in place to "safeguard the health and well-being" of these unvaccinated persons.

Wong said: "Imagine we have just 1.5 per cent of people who are unvaccinated seniors, but they make up two-thirds of the people in ICU (intensive care units), or who have passed away."

Ong then added: "Even if you are young but unvaccinated, don’t take for granted that you are safe.""

Some anti-vaxxers like to point out that there are more "breakthrough" infections in fully vaccinated people than unvaccinated ones, and somehow this proves their superiority.

No, darling, it proves the superiority of mathematics.

If a population is 83 per cent vaccinated, then of course there will be more infections among this larger group of people. Especially with the insanely high transmissibility of the Delta variant.

It's abundantly clear that the measures are in place to save lives, particularly among the elderly, who are at higher risk.

The Nanny State

The really surprising thing about it all is that I never expected anti-vaxxers to be quite so prominent in Singapore. You know, the country where almost all of us received BCG and MMR jabs before we even knew how to sing the national anthem.

Of all the things that you could have stood up for, THIS is the hill on which you choose to plant your flag? You choose to defend the hill of...dying painfully of a preventable disease while needlessly burdening the healthcare system?

This is Singapore, the country that once banned chewing gum, ponytails, and Playboy magazine. This is the country that mandated flushing after using a public toilet. This is the country that has a rule about not bringing durians on public transport, and another one against being naked in your own house.

Singapore has shown zero qualms about banning some things and mandating certain others for what it believes is the greater good. Anti-vaxxers should feel relieved the government hasn't implemented a vaccine mandate as seen in other countries, with the vast array of horrific punishments it has at its disposal.

It's time for anti-vaxxers to stop pretending that they live in a different country, where people can be exempt from rules like VDMs because they don't like said rules.

This isn't that kind of country. This is the one with a lot of sticks, she just hasn't fully utilised them.

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Top image by Sandy Huffaker via Getty Images and a Mothership contributor.