Minister for Health Ong Ye Kung revealed that 15 per cent of Singapore's Covid-19 vaccine stock, worth S$140 million, has expired.
He said the government deliberately over-procured the vaccinations to mitigate the uncertainty of selected vaccines not working and the possibility of supply chain disruption, despite knowing that the vaccines would expire.
Ong explained that it was a price that the government was prepared to pay to protect Singaporeans.
How Singapore procured vaccinations
Speaking in Parliament on Mar. 21, 2023, Ong shared how the government managed to secure Singapore's stock of Covid-19 vaccinations, describing the act "as an art in itself, or at best, an inexact science".
An inter-agency workgroup was set up during the early phase of the pandemic to develop Singapore's vaccine procurement approach.
It was chaired by the Head of Civil Service and comprised senior officials from agencies such as Prime Minister’s Office Singapore, MOH, A*STAR, Health Sciences Authority (HSA) and Economic Development Board (EDB).
The inter-agency workgroup was faced with two challenges – the novelty of Covid-19, where no one knew which vaccine would work, and a shortage of vaccines due to the global demand, limited manufacturing capabilities, and supply chain disruptions at that time.
To secure assured and early delivery of the Covid-19 vaccines, the government needed to enter into advance purchase agreements with pharmaceutical companies, which entailed fixed delivery schedules and order quantities, Ong explained.
Why Singapore over-procured vaccinations
The workgroup decided to procure a variety of Covid-19 vaccines – mRNA and non-mRNA – that have been shortlisted by experts, hospitals, and those in the medical industry so as to not "bet" on a single vaccine.
"Since we did not know which vaccine candidate would work we had to buy several types, and if one didn't work, we must make sure the other one has enough volume to cover our population.
So we needed to over-procure such that the combined volumes of all the vaccine candidates more than cover the population of Singapore," he elaborated."
Singapore rolled out its National Vaccination Programme in December 2020, starting with the Pfizer-BioNTech vaccines and progressively added Moderna, Sinovac and Novavax into its portfolio of vaccines.
Boosters and bivalent vaccines
Booster shots, as well as a bivalent vaccine, became necessary as the pandemic progressed and various new Covid-19 variants started emerging.
The government procured additional vaccine doses to administer boosters to the whole population, before completely switching over to bivalent vaccines that will provide better coverage against the newer Covid-19 strains.
CNA reported in October 2022 that the existing stock of older vaccines back then could not be used as updated jabs with greater efficacy were being rolled out.
Initially reported that 10 per cent of vaccines have expired
Quoting a Ministry of Health (MOH) spokesperson, CNA also reported that the number of expired vaccines constituted about 10 per cent of Singapore's stock at that time.
The spokesperson did not provide any further details back then, citing contractual obligations.
Ong circled back to this in Parliament on Mar. 21, 2023, saying that he would have "preferred to be more transparent and forthcoming with the information" but MOH had entered confidentiality agreements with vaccine suppliers.
Since then, MOH has reached an agreement with vaccine suppliers.
The Health Ministry can reveal the total value of the expired vaccines, as long as it does not "give further breakdowns or quantities that enable people to estimate the cost of each dose of vaccine", Ong said.
15 per cent of vaccines expired to date
He revealed in Parliament on Mar. 21, 2023 that 15 per cent of Singapore's vaccines, worth S$140 million, have expired so far.
The government has tried to donate the spare vaccines, but to no avail.
"There has been an over-supply of vaccines in the world. Manufacturers have ramped up their production capacity and demand for vaccines has been declining as the pandemic stabilised."
The number of expired vaccines is likely to increase to 25 per cent, before it stabilises.
Citing other reports, Ong said the number expired vaccines globally are estimated to range up to 500 million doses or more.
A price that the government were prepared to pay
He said the government "deliberately over-procured" vaccinations to mitigate the uncertainty of a selected vaccine candidate not working and the possible disruption of supply chains.
The government knew that the spare vaccine stock will expire, but it was a price that they were prepared to pay.
"The expiry of unused vaccines was an insurance premium – the price we were prepared to pay to stave off the risk of catastrophic consequences."
Ong listed the potential consequences, which ranged from resulting in more Circuit Breakers, which in turn leads to substantial financial losses, to driving up the number of Covid-19 fatalities.
"Before vaccines were available, we had to resort to a Circuit Breaker in April 2020 to contain the pandemic. The two-month Circuit Breaker cost us about S$11 billion in terms of GDP loss. And we spent close to another S$60 billion over two financial years to cushion the hardship for businesses and workers.
Without vaccines, we would certainly have had to resort to further Circuit Breakers during the Delta and Omicron waves of late 2021 and throughout 2022. But we did not have to, because the vaccines, we got them early and protected us.
More importantly, our approach averted many deaths due to Covid-19 infections and protected Singaporeans against that catastrophic consequence."
MOH estimates an additional 2,000 deaths during Covid-19
As of Dec. 31, 2022, a total of 1,711 people in Singapore had passed away due to Covid-19.
Based on MOH's estimates, however, Ong said the number of deaths during the Covid-19 period may be over 3,700, which is above the expected number of deaths based on pre-pandemic trends.
He explained that the additional 2,000 deaths were not recorded in the official Covid-19 death toll as the individuals might have died because of undiagnosed Covid-19 infections.
Alternatively, these individuals may have other underlying conditions, which were made worse by Covid-19 and ultimately resulted in their deaths.
Ong said these individuals were the most affected by Covid-19 as most of them are unvaccinated, older, and/ or had underlying illnesses.
"We will never know the exact number, or all the names and faces of every victim of this pandemic crisis."
He expressed his condolences and said: "At MOH, and I’m sure in this house, we mourn their deaths and extend our deepest condolences to their families."
Defended government's vaccination procurement strategy
Ong attributed the government's decision and ability in procuring Covid-19 vaccines to Singapore's current Disease Outbreak Response System Condition (DORSCON) Green status.
The DORSCON framework gives an indication of the current disease situation.
Singapore's DORSCON level was raised to Orange on Feb. 7, 2020, during the start of the pandemic, before it was lowered to Yellow more than two years later on Apr. 26, 2022 and finally to Green on Feb. 13, 2023.
During the assessment of MOH's handling of the Covid-19 pandemic in Singapore, Ong defended how the government went about procuring vaccines, saying:
"Looking back, today, if we had gone back in time, given the uncertainties, the high stakes, what we knew and did not know, and challenges we faced, I think we would have done things the same way."
Vaccine procurement is one of the areas for improvement
Having gone through the "trials and tribulations of the pandemic", the government has identified six areas for improvement in Singapore's healthcare system to better prepare the country for the next pandemic, Ong said.
One of the areas is the need to ensure that Singapore has early access to efficacious vaccines for future pandemics.
The other five areas are boosting Singapore's preparedness and response to a pandemic, strengthening the capacity of local hospitals, restructuring MOH, updating legislation, and recognising the advances Singapore has made during the crisis.
With regard to Covid-19, MOH will maintain an adequate stock of Covid-19 vaccines, which will be periodically refreshed.
This allows continued protection of the elderly and vulnerable as needed and allows MOH to facilitate a rapid response should there be a major or more severe pandemic wave, Ong explained.
MOH will maintain "a baseline" of five to ten joint testing and vaccination centres, comprising primary care clinics and polyclinics, so that persons aded 50 and above and the medically vulnerable can receive their booster, if necessary.
On future pandemics
Ong said the government is negotiating agreements to secure early access to vaccines against other pathogens with pandemic potential in the future.
They will also be investing in vaccine research and development, where one of the objectives is to learn how to quickly develop a working vaccine based on either the mRNA or protein-subunit platform such that it can be brought to clinical trials locally.
The government will also be "anchoring" six vaccine manufacturing plants in Singapore and at the same time continue to engage other vaccine manufacturers to invest in Singapore, grow local biomedical sector capabilities, and cement the country's position as a pharmaceutical hub of Asia.
Lastly, Ong said MOH will continue to do its part to strengthen global health security and support fair and equitable access to vaccines.
Top image screenshot from Ministry of Communications and Information/YouTube and from MOH/Facebook