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1. Shard Calculation

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Response:

Calculated Shard: 129 (from laksa182)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa129.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical, ml_categories_json AS ml_categories_json, ml_types_json AS ml_types_json, ml_intent_types_json AS ml_intent_types_json, meta_language AS meta_language, attrs_author AS attrs_author, ifNull(toUnixTimestamp(attrs_publish_time), 0) AS attrs_publish_time, ifNull(toUnixTimestamp(attrs_original_publish_time), 0) AS attrs_original_publish_time, ifNull(attrs_is_republished, 0) AS attrs_is_republished, ifNull(attrs_nr_words, 0) AS attrs_nr_words, ifNull(attrs_boilerpipe_nr_words, 0) AS attrs_boilerpipe_nr_words, ifNull(body_ext_links_number, 0) AS body_ext_links_number, ifNull(body_int_links_number, 0) AS body_int_links_number, ifNull(meta_nofollow, 0) AS meta_nofollow, ifNull(meta_noarchive, 0) AS meta_noarchive, ifNull(props_was_rendered, 0) AS props_was_rendered, ifNull(src_redirect, \'\') AS src_redirect, ifNull(download_time_msec, 0) AS download_time_msec, ifNull(download_ttfb_msec, 0) AS download_ttfb_msec, ifNull(download_size, 0) AS download_size FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/\')), getAhrefsUnparsedNoserviceFromURL(\'https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/","crawl_time":1771682139,"first_indexed_time":0,"http_code":200,"src_unparsed":"gov,nih!nlm,ncbi,pmc,\/articles\/PMC11698280\/ s443","src_root_hash":"7295144728021232729","history_drop_reason":null,"meta_title":"COVID-19 vaccination strategy in Singapore: perspectives and lessons from primary care - PMC","meta_descriptions":[],"attrs_boilerpipe_text":"INTRODUCTION\nWith more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from\nin vivo\ntesting to population-wide implementation occurred in just under one year, with the first doses given in December 2021.\nSingapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.[\n1\n] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.[\n2\n,\n3\n,\n4\n] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,[\n5\n] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide.\nAs one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series [\nFigure 1\n], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.[\n6\n] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,[\n7\n,\n8\n] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.[\n9\n] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.[\n10\n] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.[\n11\n] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era.\nFigure 1.\nGraph shows COVID-19 vaccination rates by country.[\n6\n]\nSINGAPORE’S COVID-19 VACCINATION STRATEGY\nAs the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.[\n12\n] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals.\nThe COVID-19 vaccination milestones are detailed in\nFigure 2\n. The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021.\nFigure 2.\nDiagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization\nWith such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy.\nLeadership and evidence-based decision-making\nThe strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.[\n13\n]\nAn Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,[\n14\n] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)[\n15\n] and premature abolishment of mask mandate by Israel,[\n16\n] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.[\n17\n]\nBy adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.[\n18\n,\n19\n] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.[\n20\n]\nThe MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy.\nCommunications\nIn addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media.\nPromotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation (\nhttps:\/\/www.moh.gov.sg\/covid-19\n) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate [\nFigure 3\n].\nFigure 3.\nScreengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination.\nPrompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.[\n21\n] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety.\nThis unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate.\nExisting logistics\nDrawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments (\nhttps:\/\/www.vaccine.gov.sg\/\n) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe.\nPrimary care\nPrimary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.[\n22\n] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.[\n23\n] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 [\nFigure 2\n], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.[\n22\n]\nAs the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues\nbefore\n(address misconceptions, patient education, referrals),\nduring\n(safety protocols, vaccine administration, update of registries) and\nafter\n(manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.[\n24\n]\nLOOKING AHEAD\nAs we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one,\nalbeit\nan important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.[\n24\n] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation.\nConflicts of interest\nThere are no conflicts of interest.\nFunding Statement\nNil\nREFERENCES\n1.\nMinistry of Health, Singapore. COVID-19 Statistics.  [Last accessed on 2022 Aug 29].  Available from:\nhttps:\/\/www.moh.gov.sg\/covid-19\/statistics\n.\n2.\nLiow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al.  COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809\/hkmj208764.\n[\nDOI\n] [\nPubMed\n] [\nGoogle Scholar\n]\n3.\nWong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001\/jama.2020.2467.\n[\nDOI\n] [\nPubMed\n] [\nGoogle Scholar\n]\n4.\nHsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622\/smedj.2020036.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n5.\nMoghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al.  The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093\/cid\/ciab079. doi:10.1101\/2020.11.27.20240051.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n6.\nMathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al.  A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038\/s41562-021-01122-8.\n[\nDOI\n] [\nPubMed\n] [\nGoogle Scholar\n]\n7.\nCameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al.  Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038\/s41586-021-04386-2.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n8.\nLu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al.  Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093\/cid\/ciab1041. doi:10.1093\/cid\/ciab1041.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n9.\nKoh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021.  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.researchsquare.com\/article\/rs-983138\/v1\n.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n]\n10.\nTan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016\/j.socscimed.2022.114767.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n11.\nGriva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al.  Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390\/vaccines9121415.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n12.\nWorld Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021.  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng\n.\n13.\nMinistry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus.  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/default-document-library\/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf\n.\n14.\nPfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.pfizer.com\/news\/press-release\/press-release-detail\/pfizer-and-biontech-announce-agreement-united-kingdom-30\n.\n15.\nJames W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.reuters.com\/world\/uk\/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18\/\n16.\nSlotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.nytimes.com\/2021\/06\/15\/world\/middleeast\/israel-indoor-mask-vaccine.html\n.\n17.\nMinistry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021\n.\n18.\nMinistry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines\n.\n19.\nMinistry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech\/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years\n.\n20.\nMinistry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines\n.\n21.\nMinistry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination\n.\n22.\nLiow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622\/smedj.2020162. doi:10.11622\/smedj. 2020162.\n[\nDOI\n] [\nPMC free article\n] [\nPubMed\n] [\nGoogle Scholar\n]\n23.\nCampbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.theguardian.com\/society\/2020\/dec\/11\/gp-practices-england-opt-out-covid-vaccine-rollout\n.\n24.\nMinistry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep,  [Last accessed on 2022 Feb 09].  Available from:\nhttps:\/\/www.moh.gov.sg\/news-highlights\/details\/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021\n.","attrs_markdown":"[Skip to main content](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#main-content)\n\n![](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/us_flag.svg)\n\nAn official website of the United States government\n\nHere's how you know\n\nHere's how you know\n\n![](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/icon-dot-gov.svg)\n\n**Official websites use .gov**   \n A **.gov** website belongs to an official government organization in the United States.\n\n![](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/icon-https.svg)\n\n**Secure .gov websites use HTTPS**   \n A **lock** ( Locked padlock icon) or **https:\/\/** means you've safely connected to the .gov website. 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Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health.  \n Learn more: [PMC Disclaimer](https:\/\/pmc.ncbi.nlm.nih.gov\/about\/disclaimer\/) \\|  [PMC Copyright Notice](https:\/\/pmc.ncbi.nlm.nih.gov\/about\/copyright\/)\n\n![Singapore Medical Journal logo](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/banners\/logo-singmedj.jpg)\n\nSingapore Med J\n\n. 2023 Mar 2;65(12):681–685. doi: [10\\.4103\/singaporemedj.SMJ-2021-405](https:\/\/doi.org\/10.4103\/singaporemedj.SMJ-2021-405)\n\n- [Search in PMC](https:\/\/pmc.ncbi.nlm.nih.gov\/search\/?term=\"Singapore%20Med%20J\"[jour])\n- [Search in PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Singapore%20Med%20J\"[jour])\n- [View in NLM Catalog](https:\/\/www.ncbi.nlm.nih.gov\/nlmcatalog?term=\"Singapore%20Med%20J\"[Title%20Abbreviation])\n- [Add to search](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/?term=\"Singapore%20Med%20J\"[jour])\n\n# COVID-19 vaccination strategy in Singapore: perspectives and lessons from primary care\n[Sky Wei Chee Koh](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Koh%20SWC\"[Author])\n\n### Sky Wei Chee Koh, MBChB, MMed\n1National University Polyclinics, National University Health System, Singapore\n\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\nFind articles by [Sky Wei Chee Koh](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Koh%20SWC\"[Author])\n\n1,2,✉, [Victor Loh](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Loh%20V\"[Author])\n\n### Victor Loh, MMed, MHPE\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\nFind articles by [Victor Loh](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Loh%20V\"[Author])\n\n2, [Yiyang Liow](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Liow%20Y\"[Author])\n\n### Yiyang Liow, MBBS, MMed\n1National University Polyclinics, National University Health System, Singapore\n\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\nFind articles by [Yiyang Liow](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Liow%20Y\"[Author])\n\n1,2, [Choon Kit Leong](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Leong%20CK\"[Author])\n\n### Choon Kit Leong, MMed, FCFP\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\nFind articles by [Choon Kit Leong](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Leong%20CK\"[Author])\n\n2, [Doris Young](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Young%20D\"[Author])\n\n### Doris Young, MBBS, MD\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\nFind articles by [Doris Young](https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=\"Young%20D\"[Author])\n\n2\n\n- Author information\n- Article notes\n- Copyright and License information\n\n1National University Polyclinics, National University Health System, Singapore\n\n2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore\n\n✉\n\n**Correspondence:** Dr. Sky Wei Chee Koh, Family Physician and Associate Consultant, Department of Family Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, 119228, Singapore. E-mail: sky\\_wc\\_koh@nuhs.edu.sg\n\nReceived 2021 Oct 12; Accepted 2022 Jul 26; Collection date 2024 Dec.\n\nCopyright: © 2023 Singapore Medical Journal\n\nThis is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.\n\n[PMC Copyright notice](https:\/\/pmc.ncbi.nlm.nih.gov\/about\/copyright\/)\n\nPMCID: PMC11698280 PMID: [36926742](https:\/\/pubmed.ncbi.nlm.nih.gov\/36926742\/)\n\nSee the article \"[Compliance with face mask use during the COVID-19 pandemic: a community observational study in Singapore](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698284\/)\" on page 674.\n\n## INTRODUCTION\nWith more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from *in vivo* testing to population-wide implementation occurred in just under one year, with the first doses given in December 2021.\n\nSingapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.\\[[1](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R1)\\] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.\\[[2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R2),[3](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R3),[4](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R4)\\] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,\\[[5](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R5)\\] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide.\n\nAs one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series \\[[Figure 1](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f001)\\], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.\\[[6](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R6)\\] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,\\[[7](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R7),[8](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R8)\\] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.\\[[9](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R9)\\] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.\\[[10](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R10)\\] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.\\[[11](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R11)\\] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era.\n\n### Figure 1.\n[![Figure 1](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/345075cd6694\/SMJ-65-681-g001.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g001.jpg)\n\n[Open in a new tab](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/figure\/singaporemedj.SMJ-2021-405-f001\/)\n\nGraph shows COVID-19 vaccination rates by country.\\[[6](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R6)\\]\n\n## SINGAPORE’S COVID-19 VACCINATION STRATEGY\nAs the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.\\[[12](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R12)\\] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals.\n\nThe COVID-19 vaccination milestones are detailed in [Figure 2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f002). The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021.\n\n### Figure 2.\n[![Figure 2](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/88e963d76eda\/SMJ-65-681-g002.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g002.jpg)\n\n[Open in a new tab](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/figure\/singaporemedj.SMJ-2021-405-f002\/)\n\nDiagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization\n\nWith such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy.\n\n### Leadership and evidence-based decision-making\nThe strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.\\[[13](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R13)\\]\n\nAn Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,\\[[14](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R14)\\] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)\\[[15](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R15)\\] and premature abolishment of mask mandate by Israel,\\[[16](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R16)\\] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.\\[[17](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R17)\\]\n\nBy adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.\\[[18](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R18),[19](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R19)\\] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.\\[[20](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R20)\\]\n\nThe MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy.\n\n### Communications\nIn addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media.\n\nPromotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation (<https:\/\/www.moh.gov.sg\/covid-19>) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate \\[[Figure 3](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f003)\\].\n\n#### Figure 3.\n[![Figure 3](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/fbf3025e549c\/SMJ-65-681-g003.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g003.jpg)\n\n[Open in a new tab](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/figure\/singaporemedj.SMJ-2021-405-f003\/)\n\nScreengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination.\n\nPrompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.\\[[21](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R21)\\] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety.\n\nThis unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate.\n\n### Existing logistics\nDrawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments (<https:\/\/www.vaccine.gov.sg\/>) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe.\n\n### Primary care\nPrimary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.\\[[22](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R22)\\] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.\\[[23](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R23)\\] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 \\[[Figure 2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f002)\\], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.\\[[22](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R22)\\]\n\nAs the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues *before* (address misconceptions, patient education, referrals), *during* (safety protocols, vaccine administration, update of registries) and *after* (manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.\\[[24](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R24)\\]\n\n## LOOKING AHEAD\nAs we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one, *albeit* an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.\\[[24](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R24)\\] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation.\n\n### Conflicts of interest\nThere are no conflicts of interest.\n\n## Funding Statement\nNil\n\n## REFERENCES\n- 1\\.\n  Ministry of Health, Singapore. COVID-19 Statistics. \\[Last accessed on 2022 Aug 29\\]. Available from:<https:\/\/www.moh.gov.sg\/covid-19\/statistics> .\n- 2\\.\n  Liow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al. COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809\/hkmj208764.\n  \\[[DOI](https:\/\/doi.org\/10.12809\/hkmj208764)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33558446\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Hong%20Kong%20Med%20J&title=COVID-19%20primary%20care%20response%20and%20challenges%20in%20Singapore:%20A%20tale%20of%20two%20curves&author=Y%20Liow&author=VWK%20Loh&author=LH%20Goh&author=DHY%20Tan&author=TL%20Tan&volume=27&publication_year=2021&pages=70-2&pmid=33558446&doi=10.12809\/hkmj208764&)\\]\n- 3\\.\n  Wong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001\/jama.2020.2467.\n  \\[[DOI](https:\/\/doi.org\/10.1001\/jama.2020.2467)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/32077901\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=JAMA&title=COVID-19%20in%20Singapore%E2%80%94current%20experience:%20Critical%20global%20issues%20that%20require%20attention%20and%20action&author=JE%20Wong&author=YS%20Leo&author=CC%20Tan&volume=323&publication_year=2020&pages=1243-4&pmid=32077901&doi=10.1001\/jama.2020.2467&)\\]\n- 4\\.\n  Hsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622\/smedj.2020036.\n  \\[[DOI](https:\/\/doi.org\/10.11622\/smedj.2020036)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7926611\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/32211911\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Singapore%20Med%20J&title=A%20midpoint%20perspective%20on%20the%20COVID-19%20pandemic&author=LY%20Hsu&author=PY%20Chia&author=S%20Vasoo&volume=61&publication_year=2020&pages=381-3&pmid=32211911&doi=10.11622\/smedj.2020036&)\\]\n- 5\\.\n  Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093\/cid\/ciab079. doi:10.1101\/2020.11.27.20240051.\n  \\[[DOI](https:\/\/doi.org\/10.1093\/cid\/ciab079)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7929033\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33515252\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=medRxiv&title=The%20impact%20of%20vaccination%20on%20COVID-19%20outbreaks%20in%20the%20United%20States&author=SM%20Moghadas&author=TN%20Vilches&author=K%20Zhang&author=CR%20Wells&author=A%20Shoukat&publication_year=2021&pmid=33515252&doi=10.1093\/cid\/ciab079&)\\]\n- 6\\.\n  Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038\/s41562-021-01122-8.\n  \\[[DOI](https:\/\/doi.org\/10.1038\/s41562-021-01122-8)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33972767\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Nat%20Hum%20Behav&title=A%20global%20database%20of%20COVID-19%20vaccinations&author=E%20Mathieu&author=H%20Ritchie&author=E%20Ortiz-Ospina&author=M%20Roser&author=J%20Hasell&volume=5&publication_year=2021&pages=947-53&pmid=33972767&doi=10.1038\/s41562-021-01122-8&)\\]\n- 7\\.\n  Cameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al. Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038\/s41586-021-04386-2.\n  \\[[DOI](https:\/\/doi.org\/10.1038\/s41586-021-04386-2)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9531318\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35016195\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Nature&title=Broadly%20neutralizing%20antibodies%20overcome%20SARS-CoV-2%20Omicron%20antigenic%20shift&author=E%20Cameroni&author=JE%20Bowen&author=LE%20Rosen&author=C%20Saliba&author=SK%20Zepeda&volume=602&publication_year=2022&pages=664-70&pmid=35016195&doi=10.1038\/s41586-021-04386-2&)\\]\n- 8\\.\n  Lu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093\/cid\/ciab1041. doi:10.1093\/cid\/ciab1041.\n  \\[[DOI](https:\/\/doi.org\/10.1093\/cid\/ciab1041)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8754807\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/34915551\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Clin%20Infect%20Dis&title=Neutralization%20of%20SARS-CoV-2%20Omicron%20variant%20by%20sera%20from%20BNT162b2%20or%20Coronavac%20vaccine%20recipients&author=L%20Lu&author=BW-Y%20Mok&author=L-L%20Chen&author=JM-C%20Chan&author=OT-Y%20Tsang&publication_year=2021&pages=ciab1041&pmid=34915551&doi=10.1093\/cid\/ciab1041&)\\]\n- 9\\.\n  Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.researchsquare.com\/article\/rs-983138\/v1> .\n  \\[[DOI](https:\/\/doi.org\/10.1186\/s12875-022-01693-z)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9010198\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35421920\/)\\]\n- 10\\.\n  Tan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016\/j.socscimed.2022.114767.\n  \\[[DOI](https:\/\/doi.org\/10.1016\/j.socscimed.2022.114767)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8812088\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35144226\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Soc%20Sci%20Med&title=Information%20trust%20and%20COVID-19%20vaccine%20hesitancy%20amongst%20middle-aged%20and%20older%20adults%20in%20Singapore:%20A%20latent%20class%20analysis%20approach&author=M%20Tan&author=PT%20Straughan&author=G%20Cheong&volume=296&publication_year=2022&pages=114767&pmid=35144226&doi=10.1016\/j.socscimed.2022.114767&)\\]\n- 11\\.\n  Griva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al. Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390\/vaccines9121415.\n  \\[[DOI](https:\/\/doi.org\/10.3390\/vaccines9121415)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8705614\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/34960161\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Vaccines&title=Evaluating%20rates%20and%20determinants%20of%20covid-19%20vaccine%20hesitancy%20for%20adults%20and%20children%20in%20the%20Singapore%20population:%20Strengthening%20our%20community's%20resilience%20against%20threats%20from%20emerging%20infections%20\\(Socrates\\)%20cohort&author=K%20Griva&author=KYK%20Tan&author=FHF%20Chan&author=R%20Periakaruppan&author=BWL%20Ong&volume=9&publication_year=2021&pages=1415&pmid=34960161&doi=10.3390\/vaccines9121415&)\\]\n- 12\\.\n  World Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng> .\n- 13\\.\n  Ministry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/default-document-library\/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf> .\n- 14\\.\n  Pfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.pfizer.com\/news\/press-release\/press-release-detail\/pfizer-and-biontech-announce-agreement-united-kingdom-30> .\n- 15\\.\n  James W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.reuters.com\/world\/uk\/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18\/>\n- 16\\.\n  Slotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.nytimes.com\/2021\/06\/15\/world\/middleeast\/israel-indoor-mask-vaccine.html> .\n- 17\\.\n  Ministry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021> .\n- 18\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines> .\n- 19\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech\/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years> .\n- 20\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines> .\n- 21\\.\n  Ministry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination> .\n- 22\\.\n  Liow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622\/smedj.2020162. doi:10.11622\/smedj. 2020162.\n  \\[[DOI](https:\/\/doi.org\/10.11622\/smedj.2020162)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9678137\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33256350\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Singapore%20Med%20J&title=100%20days%20on:%20The%20primary%20care%20response%20to%20COVID-19%20in%20Singapore&author=Y%20Liow&author=VWK%20Loh&author=D%20Young&publication_year=2020&pmid=33256350&doi=10.11622\/smedj.2020162&)\\]\n- 23\\.\n  Campbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.theguardian.com\/society\/2020\/dec\/11\/gp-practices-england-opt-out-covid-vaccine-rollout> .\n- 24\\.\n  Ministry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021> .\n\n***\nArticles from Singapore Medical Journal are provided here courtesy of **Wolters Kluwer -- Medknow Publications**\n\n![Close](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/usa-icons\/close.svg)\n\n## ACTIONS\n- [![View on publisher site icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/launch.svg) View on publisher site](https:\/\/doi.org\/10.4103\/singaporemedj.SMJ-2021-405)\n- [![Download PDF icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/file_download.svg) PDF (380.7 KB)](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/pdf\/SMJ-65-681.pdf)\n- ![Cite icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/format_quote.svg) Cite\n- ![Collections icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/action-bookmark-full.svg) ![Collections icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/action-bookmark-empty.svg) Collections\n- ![Permalink icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/share.svg) Permalink\n  ## PERMALINK\n  ![Copy icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/content_copy.svg) Copy\n\n## RESOURCES\n### Similar articles\n### Cited by other articles\n### Links to NCBI Databases\n\n## Cite\n![Close icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/close.svg)\n\n- ![Copy icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/content_copy.svg) Copy\n- [![Download icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/file_download.svg) Download .nbib .nbib](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/ \"Download a file for external citation management software\")\n- Format:\n## Add to Collections\n\nFollow NCBI\n\n[NCBI on X (formerly known as Twitter)](https:\/\/twitter.com\/ncbi)\n\n[NCBI on Facebook](https:\/\/www.facebook.com\/ncbi.nlm)\n\n[NCBI on LinkedIn](https:\/\/www.linkedin.com\/company\/ncbinlm)\n\n[NCBI on GitHub](https:\/\/github.com\/ncbi)\n\n[NCBI RSS feed](https:\/\/ncbiinsights.ncbi.nlm.nih.gov\/)\n\nConnect with NLM\n\n[NLM on X (formerly known as Twitter)](https:\/\/twitter.com\/nlm_nih)\n\n[NLM on Facebook](https:\/\/www.facebook.com\/nationallibraryofmedicine)\n\n[NLM on YouTube](https:\/\/www.youtube.com\/user\/NLMNIH)\n\n[National Library of Medicine   8600 Rockville Pike  Bethesda, MD 20894](https:\/\/www.google.com\/maps\/place\/8600+Rockville+Pike,+Bethesda,+MD+20894\/%4038.9959508,%0A%20%20%20%20%20%20%20%20%20%20%20%20-77.101021,17z\/data%3D!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb%3A0x19156f88b27635b8!8m2!3d38.9959508!%0A%20%20%20%20%20%20%20%20%20%20%20%204d-77.0988323)\n\n- [Web Policies](https:\/\/www.nlm.nih.gov\/web_policies.html)\n- [FOIA](https:\/\/www.nih.gov\/institutes-nih\/nih-office-director\/office-communications-public-liaison\/freedom-information-act-office)\n- [HHS Vulnerability Disclosure](https:\/\/www.hhs.gov\/vulnerability-disclosure-policy\/index.html)\n\n- [Help](https:\/\/support.nlm.nih.gov\/)\n- [Accessibility](https:\/\/www.nlm.nih.gov\/accessibility.html)\n- [Careers](https:\/\/www.nlm.nih.gov\/careers\/careers.html)\n\n- [NLM](https:\/\/www.nlm.nih.gov\/)\n- [NIH](https:\/\/www.nih.gov\/)\n- [HHS](https:\/\/www.hhs.gov\/)\n- [USA.gov](https:\/\/www.usa.gov\/)\n\nBack to Top\n\n![back to top icon](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/pd-medc-pmc-cloudpmc-viewer\/production\/8a2a0396\/var\/data\/static\/img\/arrow_upward.svg)","attrs_readable_markdown":"## INTRODUCTION\nWith more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from *in vivo* testing to population-wide implementation occurred in just under one year, with the first doses given in December 2021.\n\nSingapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.\\[[1](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R1)\\] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.\\[[2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R2),[3](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R3),[4](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R4)\\] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,\\[[5](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R5)\\] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide.\n\nAs one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series \\[[Figure 1](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f001)\\], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.\\[[6](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R6)\\] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,\\[[7](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R7),[8](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R8)\\] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.\\[[9](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R9)\\] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.\\[[10](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R10)\\] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.\\[[11](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R11)\\] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era.\n\n### Figure 1.\n[![Figure 1](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/345075cd6694\/SMJ-65-681-g001.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g001.jpg)\n\nGraph shows COVID-19 vaccination rates by country.\\[[6](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R6)\\]\n\n## SINGAPORE’S COVID-19 VACCINATION STRATEGY\nAs the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.\\[[12](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R12)\\] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals.\n\nThe COVID-19 vaccination milestones are detailed in [Figure 2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f002). The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021.\n\n### Figure 2.\n[![Figure 2](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/88e963d76eda\/SMJ-65-681-g002.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g002.jpg)\n\nDiagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization\n\nWith such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy.\n\n### Leadership and evidence-based decision-making\nThe strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.\\[[13](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R13)\\]\n\nAn Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,\\[[14](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R14)\\] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)\\[[15](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R15)\\] and premature abolishment of mask mandate by Israel,\\[[16](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R16)\\] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.\\[[17](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R17)\\]\n\nBy adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.\\[[18](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R18),[19](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R19)\\] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.\\[[20](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R20)\\]\n\nThe MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy.\n\n### Communications\nIn addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media.\n\nPromotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation (<https:\/\/www.moh.gov.sg\/covid-19>) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate \\[[Figure 3](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f003)\\].\n\n#### Figure 3.\n[![Figure 3](https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/90b7\/11698280\/fbf3025e549c\/SMJ-65-681-g003.jpg)](https:\/\/www.ncbi.nlm.nih.gov\/core\/lw\/2.0\/html\/tileshop_pmc\/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g003.jpg)\n\nScreengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination.\n\nPrompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.\\[[21](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R21)\\] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety.\n\nThis unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate.\n\n### Existing logistics\nDrawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments (<https:\/\/www.vaccine.gov.sg\/>) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe.\n\n### Primary care\nPrimary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.\\[[22](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R22)\\] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.\\[[23](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R23)\\] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 \\[[Figure 2](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#singaporemedj.SMJ-2021-405-f002)\\], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.\\[[22](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R22)\\]\n\nAs the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues *before* (address misconceptions, patient education, referrals), *during* (safety protocols, vaccine administration, update of registries) and *after* (manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.\\[[24](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R24)\\]\n\n## LOOKING AHEAD\nAs we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one, *albeit* an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.\\[[24](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11698280\/#R24)\\] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation.\n\n### Conflicts of interest\nThere are no conflicts of interest.\n\n## Funding Statement\nNil\n\n## REFERENCES\n- 1\\.\n  Ministry of Health, Singapore. COVID-19 Statistics. \\[Last accessed on 2022 Aug 29\\]. Available from:<https:\/\/www.moh.gov.sg\/covid-19\/statistics> .\n- 2\\.\n  Liow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al. COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809\/hkmj208764.\n  \\[[DOI](https:\/\/doi.org\/10.12809\/hkmj208764)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33558446\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Hong%20Kong%20Med%20J&title=COVID-19%20primary%20care%20response%20and%20challenges%20in%20Singapore:%20A%20tale%20of%20two%20curves&author=Y%20Liow&author=VWK%20Loh&author=LH%20Goh&author=DHY%20Tan&author=TL%20Tan&volume=27&publication_year=2021&pages=70-2&pmid=33558446&doi=10.12809\/hkmj208764&)\\]\n- 3\\.\n  Wong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001\/jama.2020.2467.\n  \\[[DOI](https:\/\/doi.org\/10.1001\/jama.2020.2467)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/32077901\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=JAMA&title=COVID-19%20in%20Singapore%E2%80%94current%20experience:%20Critical%20global%20issues%20that%20require%20attention%20and%20action&author=JE%20Wong&author=YS%20Leo&author=CC%20Tan&volume=323&publication_year=2020&pages=1243-4&pmid=32077901&doi=10.1001\/jama.2020.2467&)\\]\n- 4\\.\n  Hsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622\/smedj.2020036.\n  \\[[DOI](https:\/\/doi.org\/10.11622\/smedj.2020036)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7926611\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/32211911\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Singapore%20Med%20J&title=A%20midpoint%20perspective%20on%20the%20COVID-19%20pandemic&author=LY%20Hsu&author=PY%20Chia&author=S%20Vasoo&volume=61&publication_year=2020&pages=381-3&pmid=32211911&doi=10.11622\/smedj.2020036&)\\]\n- 5\\.\n  Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093\/cid\/ciab079. doi:10.1101\/2020.11.27.20240051.\n  \\[[DOI](https:\/\/doi.org\/10.1093\/cid\/ciab079)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7929033\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33515252\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=medRxiv&title=The%20impact%20of%20vaccination%20on%20COVID-19%20outbreaks%20in%20the%20United%20States&author=SM%20Moghadas&author=TN%20Vilches&author=K%20Zhang&author=CR%20Wells&author=A%20Shoukat&publication_year=2021&pmid=33515252&doi=10.1093\/cid\/ciab079&)\\]\n- 6\\.\n  Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038\/s41562-021-01122-8.\n  \\[[DOI](https:\/\/doi.org\/10.1038\/s41562-021-01122-8)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33972767\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Nat%20Hum%20Behav&title=A%20global%20database%20of%20COVID-19%20vaccinations&author=E%20Mathieu&author=H%20Ritchie&author=E%20Ortiz-Ospina&author=M%20Roser&author=J%20Hasell&volume=5&publication_year=2021&pages=947-53&pmid=33972767&doi=10.1038\/s41562-021-01122-8&)\\]\n- 7\\.\n  Cameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al. Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038\/s41586-021-04386-2.\n  \\[[DOI](https:\/\/doi.org\/10.1038\/s41586-021-04386-2)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9531318\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35016195\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Nature&title=Broadly%20neutralizing%20antibodies%20overcome%20SARS-CoV-2%20Omicron%20antigenic%20shift&author=E%20Cameroni&author=JE%20Bowen&author=LE%20Rosen&author=C%20Saliba&author=SK%20Zepeda&volume=602&publication_year=2022&pages=664-70&pmid=35016195&doi=10.1038\/s41586-021-04386-2&)\\]\n- 8\\.\n  Lu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093\/cid\/ciab1041. doi:10.1093\/cid\/ciab1041.\n  \\[[DOI](https:\/\/doi.org\/10.1093\/cid\/ciab1041)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8754807\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/34915551\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Clin%20Infect%20Dis&title=Neutralization%20of%20SARS-CoV-2%20Omicron%20variant%20by%20sera%20from%20BNT162b2%20or%20Coronavac%20vaccine%20recipients&author=L%20Lu&author=BW-Y%20Mok&author=L-L%20Chen&author=JM-C%20Chan&author=OT-Y%20Tsang&publication_year=2021&pages=ciab1041&pmid=34915551&doi=10.1093\/cid\/ciab1041&)\\]\n- 9\\.\n  Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.researchsquare.com\/article\/rs-983138\/v1> .\n  \\[[DOI](https:\/\/doi.org\/10.1186\/s12875-022-01693-z)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9010198\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35421920\/)\\]\n- 10\\.\n  Tan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016\/j.socscimed.2022.114767.\n  \\[[DOI](https:\/\/doi.org\/10.1016\/j.socscimed.2022.114767)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8812088\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/35144226\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Soc%20Sci%20Med&title=Information%20trust%20and%20COVID-19%20vaccine%20hesitancy%20amongst%20middle-aged%20and%20older%20adults%20in%20Singapore:%20A%20latent%20class%20analysis%20approach&author=M%20Tan&author=PT%20Straughan&author=G%20Cheong&volume=296&publication_year=2022&pages=114767&pmid=35144226&doi=10.1016\/j.socscimed.2022.114767&)\\]\n- 11\\.\n  Griva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al. Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390\/vaccines9121415.\n  \\[[DOI](https:\/\/doi.org\/10.3390\/vaccines9121415)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8705614\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/34960161\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Vaccines&title=Evaluating%20rates%20and%20determinants%20of%20covid-19%20vaccine%20hesitancy%20for%20adults%20and%20children%20in%20the%20Singapore%20population:%20Strengthening%20our%20community's%20resilience%20against%20threats%20from%20emerging%20infections%20\\(Socrates\\)%20cohort&author=K%20Griva&author=KYK%20Tan&author=FHF%20Chan&author=R%20Periakaruppan&author=BWL%20Ong&volume=9&publication_year=2021&pages=1415&pmid=34960161&doi=10.3390\/vaccines9121415&)\\]\n- 12\\.\n  World Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng> .\n- 13\\.\n  Ministry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus. \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/default-document-library\/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf> .\n- 14\\.\n  Pfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.pfizer.com\/news\/press-release\/press-release-detail\/pfizer-and-biontech-announce-agreement-united-kingdom-30> .\n- 15\\.\n  James W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.reuters.com\/world\/uk\/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18\/>\n- 16\\.\n  Slotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.nytimes.com\/2021\/06\/15\/world\/middleeast\/israel-indoor-mask-vaccine.html> .\n- 17\\.\n  Ministry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021> .\n- 18\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines> .\n- 19\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech\/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years> .\n- 20\\.\n  Ministry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines> .\n- 21\\.\n  Ministry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination> .\n- 22\\.\n  Liow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622\/smedj.2020162. doi:10.11622\/smedj. 2020162.\n  \\[[DOI](https:\/\/doi.org\/10.11622\/smedj.2020162)\\] \\[[PMC free article](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9678137\/)\\] \\[[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/33256350\/)\\] \\[[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?journal=Singapore%20Med%20J&title=100%20days%20on:%20The%20primary%20care%20response%20to%20COVID-19%20in%20Singapore&author=Y%20Liow&author=VWK%20Loh&author=D%20Young&publication_year=2020&pmid=33256350&doi=10.11622\/smedj.2020162&)\\]\n- 23\\.\n  Campbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.theguardian.com\/society\/2020\/dec\/11\/gp-practices-england-opt-out-covid-vaccine-rollout> .\n- 24\\.\n  Ministry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep, \\[Last accessed on 2022 Feb 09\\]. Available from:<https:\/\/www.moh.gov.sg\/news-highlights\/details\/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021> .","meta_canonical":null,"ml_categories_json":"{\"\/Health\":971,\"\/Health\/Public_Health\":931,\"\/Health\/Public_Health\/Health_Policy\":927}","ml_types_json":"{\"\/Article\":869,\"\/Article\/Study_or_Research_Findings\":446}","ml_intent_types_json":"{\"Informational\":999}","meta_language":"en","attrs_author":null,"attrs_publish_time":0,"attrs_original_publish_time":0,"attrs_is_republished":0,"attrs_nr_words":"3588","attrs_boilerpipe_nr_words":"2894","body_ext_links_number":69,"body_int_links_number":58,"meta_nofollow":1,"meta_noarchive":1,"props_was_rendered":0,"src_redirect":"","download_time_msec":109,"download_ttfb_msec":107,"download_size":35500}

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COVID-19 vaccination strategy in Singapore: perspectives and lessons from primary care - PMC

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INTRODUCTION With more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from in vivo testing to population-wide implementation occurred in just under one year, with the first doses given in December 2021. Singapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.[ 1 ] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.[ 2 , 3 , 4 ] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,[ 5 ] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide. As one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series [ Figure 1 ], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.[ 6 ] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,[ 7 , 8 ] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.[ 9 ] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.[ 10 ] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.[ 11 ] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era. Figure 1. Graph shows COVID-19 vaccination rates by country.[ 6 ] SINGAPORE’S COVID-19 VACCINATION STRATEGY As the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.[ 12 ] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals. The COVID-19 vaccination milestones are detailed in Figure 2 . The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021. Figure 2. Diagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization With such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy. Leadership and evidence-based decision-making The strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.[ 13 ] An Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,[ 14 ] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)[ 15 ] and premature abolishment of mask mandate by Israel,[ 16 ] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.[ 17 ] By adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.[ 18 , 19 ] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.[ 20 ] The MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy. Communications In addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media. Promotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation ( https://www.moh.gov.sg/covid-19 ) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate [ Figure 3 ]. Figure 3. Screengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination. Prompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.[ 21 ] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety. This unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate. Existing logistics Drawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments ( https://www.vaccine.gov.sg/ ) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe. Primary care Primary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.[ 22 ] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.[ 23 ] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 [ Figure 2 ], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.[ 22 ] As the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues before (address misconceptions, patient education, referrals), during (safety protocols, vaccine administration, update of registries) and after (manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.[ 24 ] LOOKING AHEAD As we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one, albeit an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.[ 24 ] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation. Conflicts of interest There are no conflicts of interest. Funding Statement Nil REFERENCES 1. Ministry of Health, Singapore. COVID-19 Statistics. [Last accessed on 2022 Aug 29]. Available from: https://www.moh.gov.sg/covid-19/statistics . 2. Liow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al. COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809/hkmj208764. [ DOI ] [ PubMed ] [ Google Scholar ] 3. Wong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001/jama.2020.2467. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Hsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622/smedj.2020036. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 5. Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093/cid/ciab079. doi:10.1101/2020.11.27.20240051. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038/s41562-021-01122-8. [ DOI ] [ PubMed ] [ Google Scholar ] 7. Cameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al. Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038/s41586-021-04386-2. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Lu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093/cid/ciab1041. doi:10.1093/cid/ciab1041. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021. [Last accessed on 2022 Feb 09]. Available from: https://www.researchsquare.com/article/rs-983138/v1 . [ DOI ] [ PMC free article ] [ PubMed ] 10. Tan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016/j.socscimed.2022.114767. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. Griva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al. Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390/vaccines9121415. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. World Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021. [Last accessed on 2022 Feb 09]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng . 13. Ministry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus. [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf . 14. Pfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul, [Last accessed on 2022 Feb 09]. Available from: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-agreement-united-kingdom-30 . 15. James W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul, [Last accessed on 2022 Feb 09]. Available from: https://www.reuters.com/world/uk/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18/ 16. Slotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun, [Last accessed on 2022 Feb 09]. Available from: https://www.nytimes.com/2021/06/15/world/middleeast/israel-indoor-mask-vaccine.html . 17. Ministry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021 . 18. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines . 19. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years . 20. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines . 21. Ministry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination . 22. Liow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622/smedj.2020162. doi:10.11622/smedj. 2020162. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Campbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec, [Last accessed on 2022 Feb 09]. Available from: https://www.theguardian.com/society/2020/dec/11/gp-practices-england-opt-out-covid-vaccine-rollout . 24. Ministry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep, [Last accessed on 2022 Feb 09]. Available from: https://www.moh.gov.sg/news-highlights/details/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021 .

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Learn more: [PMC Disclaimer](https://pmc.ncbi.nlm.nih.gov/about/disclaimer/) \| [PMC Copyright Notice](https://pmc.ncbi.nlm.nih.gov/about/copyright/) ![Singapore Medical Journal logo](https://cdn.ncbi.nlm.nih.gov/pmc/banners/logo-singmedj.jpg) Singapore Med J . 2023 Mar 2;65(12):681–685. doi: [10\.4103/singaporemedj.SMJ-2021-405](https://doi.org/10.4103/singaporemedj.SMJ-2021-405) - [Search in PMC](https://pmc.ncbi.nlm.nih.gov/search/?term="Singapore%20Med%20J"[jour]) - [Search in PubMed](https://pubmed.ncbi.nlm.nih.gov/?term="Singapore%20Med%20J"[jour]) - [View in NLM Catalog](https://www.ncbi.nlm.nih.gov/nlmcatalog?term="Singapore%20Med%20J"[Title%20Abbreviation]) - [Add to search](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/?term="Singapore%20Med%20J"[jour]) # COVID-19 vaccination strategy in Singapore: perspectives and lessons from primary care [Sky Wei Chee Koh](https://pubmed.ncbi.nlm.nih.gov/?term="Koh%20SWC"[Author]) ### Sky Wei Chee Koh, MBChB, MMed 1National University Polyclinics, National University Health System, Singapore 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Find articles by [Sky Wei Chee Koh](https://pubmed.ncbi.nlm.nih.gov/?term="Koh%20SWC"[Author]) 1,2,✉, [Victor Loh](https://pubmed.ncbi.nlm.nih.gov/?term="Loh%20V"[Author]) ### Victor Loh, MMed, MHPE 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Find articles by [Victor Loh](https://pubmed.ncbi.nlm.nih.gov/?term="Loh%20V"[Author]) 2, [Yiyang Liow](https://pubmed.ncbi.nlm.nih.gov/?term="Liow%20Y"[Author]) ### Yiyang Liow, MBBS, MMed 1National University Polyclinics, National University Health System, Singapore 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Find articles by [Yiyang Liow](https://pubmed.ncbi.nlm.nih.gov/?term="Liow%20Y"[Author]) 1,2, [Choon Kit Leong](https://pubmed.ncbi.nlm.nih.gov/?term="Leong%20CK"[Author]) ### Choon Kit Leong, MMed, FCFP 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Find articles by [Choon Kit Leong](https://pubmed.ncbi.nlm.nih.gov/?term="Leong%20CK"[Author]) 2, [Doris Young](https://pubmed.ncbi.nlm.nih.gov/?term="Young%20D"[Author]) ### Doris Young, MBBS, MD 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Find articles by [Doris Young](https://pubmed.ncbi.nlm.nih.gov/?term="Young%20D"[Author]) 2 - Author information - Article notes - Copyright and License information 1National University Polyclinics, National University Health System, Singapore 2Department of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore ✉ **Correspondence:** Dr. Sky Wei Chee Koh, Family Physician and Associate Consultant, Department of Family Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, 119228, Singapore. E-mail: sky\_wc\_koh@nuhs.edu.sg Received 2021 Oct 12; Accepted 2022 Jul 26; Collection date 2024 Dec. Copyright: © 2023 Singapore Medical Journal This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. [PMC Copyright notice](https://pmc.ncbi.nlm.nih.gov/about/copyright/) PMCID: PMC11698280 PMID: [36926742](https://pubmed.ncbi.nlm.nih.gov/36926742/) See the article "[Compliance with face mask use during the COVID-19 pandemic: a community observational study in Singapore](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698284/)" on page 674. ## INTRODUCTION With more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from *in vivo* testing to population-wide implementation occurred in just under one year, with the first doses given in December 2021. Singapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.\[[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R1)\] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.\[[2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R2),[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R3),[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R4)\] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,\[[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R5)\] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide. As one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series \[[Figure 1](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f001)\], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.\[[6](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R6)\] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,\[[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R7),[8](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R8)\] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.\[[9](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R9)\] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.\[[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R10)\] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.\[[11](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R11)\] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era. ### Figure 1. [![Figure 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/345075cd6694/SMJ-65-681-g001.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g001.jpg) [Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/figure/singaporemedj.SMJ-2021-405-f001/) Graph shows COVID-19 vaccination rates by country.\[[6](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R6)\] ## SINGAPORE’S COVID-19 VACCINATION STRATEGY As the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.\[[12](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R12)\] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals. The COVID-19 vaccination milestones are detailed in [Figure 2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f002). The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021. ### Figure 2. [![Figure 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/88e963d76eda/SMJ-65-681-g002.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g002.jpg) [Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/figure/singaporemedj.SMJ-2021-405-f002/) Diagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization With such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy. ### Leadership and evidence-based decision-making The strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.\[[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R13)\] An Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,\[[14](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R14)\] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)\[[15](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R15)\] and premature abolishment of mask mandate by Israel,\[[16](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R16)\] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.\[[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R17)\] By adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.\[[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R18),[19](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R19)\] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.\[[20](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R20)\] The MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy. ### Communications In addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media. Promotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation (<https://www.moh.gov.sg/covid-19>) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate \[[Figure 3](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f003)\]. #### Figure 3. [![Figure 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/fbf3025e549c/SMJ-65-681-g003.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g003.jpg) [Open in a new tab](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/figure/singaporemedj.SMJ-2021-405-f003/) Screengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination. Prompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.\[[21](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R21)\] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety. This unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate. ### Existing logistics Drawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments (<https://www.vaccine.gov.sg/>) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe. ### Primary care Primary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.\[[22](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R22)\] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.\[[23](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R23)\] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 \[[Figure 2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f002)\], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.\[[22](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R22)\] As the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues *before* (address misconceptions, patient education, referrals), *during* (safety protocols, vaccine administration, update of registries) and *after* (manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.\[[24](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R24)\] ## LOOKING AHEAD As we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one, *albeit* an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.\[[24](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R24)\] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation. ### Conflicts of interest There are no conflicts of interest. ## Funding Statement Nil ## REFERENCES - 1\. Ministry of Health, Singapore. COVID-19 Statistics. \[Last accessed on 2022 Aug 29\]. Available from:<https://www.moh.gov.sg/covid-19/statistics> . - 2\. Liow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al. COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809/hkmj208764. \[[DOI](https://doi.org/10.12809/hkmj208764)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33558446/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Hong%20Kong%20Med%20J&title=COVID-19%20primary%20care%20response%20and%20challenges%20in%20Singapore:%20A%20tale%20of%20two%20curves&author=Y%20Liow&author=VWK%20Loh&author=LH%20Goh&author=DHY%20Tan&author=TL%20Tan&volume=27&publication_year=2021&pages=70-2&pmid=33558446&doi=10.12809/hkmj208764&)\] - 3\. Wong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001/jama.2020.2467. \[[DOI](https://doi.org/10.1001/jama.2020.2467)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/32077901/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=JAMA&title=COVID-19%20in%20Singapore%E2%80%94current%20experience:%20Critical%20global%20issues%20that%20require%20attention%20and%20action&author=JE%20Wong&author=YS%20Leo&author=CC%20Tan&volume=323&publication_year=2020&pages=1243-4&pmid=32077901&doi=10.1001/jama.2020.2467&)\] - 4\. Hsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622/smedj.2020036. \[[DOI](https://doi.org/10.11622/smedj.2020036)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC7926611/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/32211911/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Singapore%20Med%20J&title=A%20midpoint%20perspective%20on%20the%20COVID-19%20pandemic&author=LY%20Hsu&author=PY%20Chia&author=S%20Vasoo&volume=61&publication_year=2020&pages=381-3&pmid=32211911&doi=10.11622/smedj.2020036&)\] - 5\. Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093/cid/ciab079. doi:10.1101/2020.11.27.20240051. \[[DOI](https://doi.org/10.1093/cid/ciab079)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC7929033/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33515252/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=medRxiv&title=The%20impact%20of%20vaccination%20on%20COVID-19%20outbreaks%20in%20the%20United%20States&author=SM%20Moghadas&author=TN%20Vilches&author=K%20Zhang&author=CR%20Wells&author=A%20Shoukat&publication_year=2021&pmid=33515252&doi=10.1093/cid/ciab079&)\] - 6\. Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038/s41562-021-01122-8. \[[DOI](https://doi.org/10.1038/s41562-021-01122-8)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33972767/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Nat%20Hum%20Behav&title=A%20global%20database%20of%20COVID-19%20vaccinations&author=E%20Mathieu&author=H%20Ritchie&author=E%20Ortiz-Ospina&author=M%20Roser&author=J%20Hasell&volume=5&publication_year=2021&pages=947-53&pmid=33972767&doi=10.1038/s41562-021-01122-8&)\] - 7\. Cameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al. Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038/s41586-021-04386-2. \[[DOI](https://doi.org/10.1038/s41586-021-04386-2)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9531318/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35016195/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Nature&title=Broadly%20neutralizing%20antibodies%20overcome%20SARS-CoV-2%20Omicron%20antigenic%20shift&author=E%20Cameroni&author=JE%20Bowen&author=LE%20Rosen&author=C%20Saliba&author=SK%20Zepeda&volume=602&publication_year=2022&pages=664-70&pmid=35016195&doi=10.1038/s41586-021-04386-2&)\] - 8\. Lu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093/cid/ciab1041. doi:10.1093/cid/ciab1041. \[[DOI](https://doi.org/10.1093/cid/ciab1041)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8754807/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/34915551/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Clin%20Infect%20Dis&title=Neutralization%20of%20SARS-CoV-2%20Omicron%20variant%20by%20sera%20from%20BNT162b2%20or%20Coronavac%20vaccine%20recipients&author=L%20Lu&author=BW-Y%20Mok&author=L-L%20Chen&author=JM-C%20Chan&author=OT-Y%20Tsang&publication_year=2021&pages=ciab1041&pmid=34915551&doi=10.1093/cid/ciab1041&)\] - 9\. Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.researchsquare.com/article/rs-983138/v1> . \[[DOI](https://doi.org/10.1186/s12875-022-01693-z)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9010198/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35421920/)\] - 10\. Tan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016/j.socscimed.2022.114767. \[[DOI](https://doi.org/10.1016/j.socscimed.2022.114767)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8812088/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35144226/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Soc%20Sci%20Med&title=Information%20trust%20and%20COVID-19%20vaccine%20hesitancy%20amongst%20middle-aged%20and%20older%20adults%20in%20Singapore:%20A%20latent%20class%20analysis%20approach&author=M%20Tan&author=PT%20Straughan&author=G%20Cheong&volume=296&publication_year=2022&pages=114767&pmid=35144226&doi=10.1016/j.socscimed.2022.114767&)\] - 11\. Griva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al. Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390/vaccines9121415. \[[DOI](https://doi.org/10.3390/vaccines9121415)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8705614/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/34960161/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Vaccines&title=Evaluating%20rates%20and%20determinants%20of%20covid-19%20vaccine%20hesitancy%20for%20adults%20and%20children%20in%20the%20Singapore%20population:%20Strengthening%20our%20community's%20resilience%20against%20threats%20from%20emerging%20infections%20\(Socrates\)%20cohort&author=K%20Griva&author=KYK%20Tan&author=FHF%20Chan&author=R%20Periakaruppan&author=BWL%20Ong&volume=9&publication_year=2021&pages=1415&pmid=34960161&doi=10.3390/vaccines9121415&)\] - 12\. World Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng> . - 13\. Ministry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf> . - 14\. Pfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-agreement-united-kingdom-30> . - 15\. James W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.reuters.com/world/uk/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18/> - 16\. Slotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.nytimes.com/2021/06/15/world/middleeast/israel-indoor-mask-vaccine.html> . - 17\. Ministry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021> . - 18\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines> . - 19\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years> . - 20\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines> . - 21\. Ministry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination> . - 22\. Liow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622/smedj.2020162. doi:10.11622/smedj. 2020162. \[[DOI](https://doi.org/10.11622/smedj.2020162)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9678137/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33256350/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Singapore%20Med%20J&title=100%20days%20on:%20The%20primary%20care%20response%20to%20COVID-19%20in%20Singapore&author=Y%20Liow&author=VWK%20Loh&author=D%20Young&publication_year=2020&pmid=33256350&doi=10.11622/smedj.2020162&)\] - 23\. Campbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.theguardian.com/society/2020/dec/11/gp-practices-england-opt-out-covid-vaccine-rollout> . - 24\. Ministry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021> . *** Articles from Singapore Medical Journal are provided here courtesy of **Wolters Kluwer -- Medknow Publications** ![Close](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/usa-icons/close.svg) ## ACTIONS - [![View on publisher site icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/launch.svg) View on publisher site](https://doi.org/10.4103/singaporemedj.SMJ-2021-405) - [![Download PDF icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/file_download.svg) PDF (380.7 KB)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/pdf/SMJ-65-681.pdf) - ![Cite icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/format_quote.svg) Cite - ![Collections icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/action-bookmark-full.svg) ![Collections icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/action-bookmark-empty.svg) Collections - ![Permalink icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/share.svg) Permalink ## PERMALINK ![Copy icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/content_copy.svg) Copy ## RESOURCES ### Similar articles ### Cited by other articles ### Links to NCBI Databases ## Cite ![Close icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/close.svg) - ![Copy icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/content_copy.svg) Copy - [![Download icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/file_download.svg) Download .nbib .nbib](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/ "Download a file for external citation management software") - Format: ## Add to Collections Follow NCBI [NCBI on X (formerly known as Twitter)](https://twitter.com/ncbi) [NCBI on Facebook](https://www.facebook.com/ncbi.nlm) [NCBI on LinkedIn](https://www.linkedin.com/company/ncbinlm) [NCBI on GitHub](https://github.com/ncbi) [NCBI RSS feed](https://ncbiinsights.ncbi.nlm.nih.gov/) Connect with NLM [NLM on X (formerly known as Twitter)](https://twitter.com/nlm_nih) [NLM on Facebook](https://www.facebook.com/nationallibraryofmedicine) [NLM on YouTube](https://www.youtube.com/user/NLMNIH) [National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894](https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/%4038.9959508,%0A%20%20%20%20%20%20%20%20%20%20%20%20-77.101021,17z/data%3D!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb%3A0x19156f88b27635b8!8m2!3d38.9959508!%0A%20%20%20%20%20%20%20%20%20%20%20%204d-77.0988323) - [Web Policies](https://www.nlm.nih.gov/web_policies.html) - [FOIA](https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office) - [HHS Vulnerability Disclosure](https://www.hhs.gov/vulnerability-disclosure-policy/index.html) - [Help](https://support.nlm.nih.gov/) - [Accessibility](https://www.nlm.nih.gov/accessibility.html) - [Careers](https://www.nlm.nih.gov/careers/careers.html) - [NLM](https://www.nlm.nih.gov/) - [NIH](https://www.nih.gov/) - [HHS](https://www.hhs.gov/) - [USA.gov](https://www.usa.gov/) Back to Top ![back to top icon](https://cdn.ncbi.nlm.nih.gov/pmc/pd-medc-pmc-cloudpmc-viewer/production/8a2a0396/var/data/static/img/arrow_upward.svg)

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## INTRODUCTION With more than 600 million infections and 6.4 million deaths worldwide, the disruptions wrought by coronavirus disease 2019 (COVID-19) spurred the development of vaccines at a pace unprecedented in global history. We have witnessed how the process of vaccine development from *in vivo* testing to population-wide implementation occurred in just under one year, with the first doses given in December 2021. Singapore encountered its first case of COVID-19 in January 2020 and to date has recorded close to 1.8 million cases and 1,590 deaths.\[[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R1)\] Like other countries, the pandemic has kept Singapore’s healthcare practice, economic resilience and community well-being at constant knife’s edge.\[[2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R2),[3](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R3),[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R4)\] With established evidence of their efficacy in reducing symptoms, severity and particularly hospitalisations and death,\[[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R5)\] COVID-19 vaccines are, and have been, a key enabler of a much-awaited reopening strategy. COVID-19 vaccines have played a significant role in the reopening strategy for countries worldwide. As one of the most vaccinated countries in the world with 92% of the population having completed the primary vaccination series \[[Figure 1](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f001)\], Singapore’s low death rates were a testament to the nation’s success in becoming a COVID-19-resilient nation.\[[6](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R6)\] Plans to gear shift from a ‘zero transmission’ to an endemic, ‘living with COVID-19’, approach was cautiously deliberated and implemented after achieving high vaccination rates to protect those who were at higher risk of developing severe complications of COVID-19. With proven booster effectiveness against new COVID-19 variants such as the Delta and Omicron variants for fully vaccinated individuals,\[[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R7),[8](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R8)\] vaccination continues to be the key public health strategy in our war against COVID-19 in 2022 and beyond. Despite this, vaccine hesitancy still existed within the Singapore population; healthcare workers still deliberated before accepting vaccination in the initial phase of the pandemic.\[[9](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R9)\] Informal sources such as social networks can be tapped upon to increase vaccine acceptance among middle-aged and older adults.\[[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R10)\] Among adults, the hesitancy rates were higher for children’s vaccination, in male gender and in those with lower perceived benefits and concerns with vaccinations.\[[11](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R11)\] With the possible threat of emerging vaccine resistant strains, the fight against hesitancy seemed far from over. Therefore, it would be crucial to outline the lessons learnt in Singapore’s initial COVID-19 vaccination strategy to combat future challenges as we progress towards a post COVID-19 era. ### Figure 1. [![Figure 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/345075cd6694/SMJ-65-681-g001.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g001.jpg) Graph shows COVID-19 vaccination rates by country.\[[6](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R6)\] ## SINGAPORE’S COVID-19 VACCINATION STRATEGY As the first country in Asia to start COVID-19 vaccination, Singapore was in line with the World Health Organization’s (WHO) guidance on developing a national deployment and vaccination plan for COVID-19 vaccines, 2021.\[[12](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R12)\] This included prioritising higher risk individuals such as frontline workers, the elderly and immunocompromised individuals. The COVID-19 vaccination milestones are detailed in [Figure 2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f002). The timeline maps key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites and measures implemented to encourage vaccine uptake; these are cross-referenced with Singapore’s vaccination rate from December 2020 to early December 2021. ### Figure 2. [![Figure 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/88e963d76eda/SMJ-65-681-g002.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g002.jpg) Diagram shows the timeline of COVID-19 vaccination in Singapore from December 2020 to December 2021. COVID-19: coronavirus disease 2019, EC-19V: Expert Committee on COVID-19 Vaccination, MOH: Ministry of Health, MTF: multi-ministry taskforce, WHO: World Health Organization With such a massive and complex undertaking that required an all-of-government and an all-of-society effort, we outline some of the factors that have worked in favour of our vaccine strategy. ### Leadership and evidence-based decision-making The strategy, led by a multi-ministry taskforce (MTF), has been a key component in orchestrating Singapore’s overall COVID-19 response. This taskforce included members from the Ministries of Health, National Development, Communications and Information, Trade and Industry, Environment and water resources, Education, Manpower, Social and Family Development, and Transport, as well as the National Trades Union Congress, which provided prompt legislative adjustments and frequent updates throughout Singapore’s fight against COVID-19, allowing for inter-ministerial planning, prioritisation and coordination of the vaccination strategy, while integrating with disease containment.\[[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R13)\] An Expert Committee on COVID-19 Vaccination (EC-19V) was appointed in October 2020 to advice the taskforce on vaccine recommendations and policies, based on scientific evidence and observations from other countries. Unlike UK which signed several vaccine contracts with manufacturers during ongoing efficacy trials,\[[14](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R14)\] Singapore waited for firm evidence and accepted a slower start. Singapore’s vaccination campaign is largely similar to Israel’s rollout in December 2020 — both countries are small, densely populated, have good infrastructure and primary health care and effective governance. By analysing the success of other vaccination campaigns, Singapore is able to cautiously adopt, reconfigure and successfully deliver. By drawing from lessons learnt from UK’s early reopening (‘Freedom Day’)\[[15](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R15)\] and premature abolishment of mask mandate by Israel,\[[16](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R16)\] Singapore persisted with a carrot-and-stick approach by only easing restrictions in fully vaccinated individuals when achieving 80% full vaccination rate, while using non-traditional and novel strategies to reach priority target populations and change the behaviours of late vaccine adopters. These included the implementation of vaccination-differentiated safe-management measures, by allowing fully vaccinated individuals to partake in social events like attending conferences, weddings and large group gatherings and even eating in outdoor venues when cases surged in September 2021.\[[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R17)\] By adopting an evidence-based approach and a prompt review of the available literature, the EC-19V and the Ministry of Health were able to make timely reviews to vaccination guidelines to increase vaccination uptake. This was evident in allowing vaccination for pregnant and breastfeeding mothers and subsequently for children aged 5–11 in May 2021 and December 2021, respectively.\[[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R18),[19](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R19)\] Following a few local cases of post-vaccination myocarditis, prompt review led to guideline change, with recommendation in June 2021 to avoid strenuous exercise post-vaccination.\[[20](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R20)\] The MTF’s positive track record since the start of COVID-19 has garnered the confidence of the population, and this has been an important factor in the success of the vaccination strategy. ### Communications In addition to regular press conferences in the mainstream media updating residents on the state of Singapore’s COVID-19 campaign, public broadcasts of COVID-19 vaccines being administered to ministers and members of parliament were also shown to the public. What stood out in the communications strategy was the creative use of print, non-print media and even social media. Promotion videos by local celebrities dubbed in local languages and dialects helped to persuade hard-to-reach seniors about the merits of vaccination. The set up of a transparent website on the nation’s COVID-19 situation (<https://www.moh.gov.sg/covid-19>) with updated health advisory and frequently asked questions regarding COVID-19 vaccination provided early public access to credible information. Use of social media such as Facebook, Instagram and TikTok helped to relay messages effectively to the intended target audience. Daily updates via social media communication apps such as Telegram and WhatsApp kept the general public informed in real time. The Prime Minister highlighted the merits of vaccination during his scheduled address to the population across multiple timepoints. At other times, political leaders were seen being interviewed by celebrities in local dialects to encourage the elderly population to vaccinate \[[Figure 3](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f003)\]. #### Figure 3. [![Figure 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/90b7/11698280/fbf3025e549c/SMJ-65-681-g003.jpg)](https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=11698280_SMJ-65-681-g003.jpg) Screengrabs from Youtube show a video series by Gov.sg featuring politicians partnering celebrities to encourage seniors to go for COVID-19 vaccination. Prompt actions were taken by the taskforce and vaccine committee to correct misinformation. In June 2021, sporadic pockets of errant opinions by medical professionals and online petitions started by concerned parents surfaced, highlighting the safety concerns of COVID-19 mRNA vaccines in children.\[[21](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R21)\] These views were swiftly countered with available existing evidence, public address and amendments of circulars, thereby curbing the spread of fake news and anxiety. This unified system of mass media communication with prompt curation of misinformation allowed for a watertight and appropriate system for good COVID-19 vaccination delivery and increased uptake rate. ### Existing logistics Drawing from experience when handling the severe acute respiratory syndrome (SARS) epidemic in 2003, the foresight of pandemic preparedness led to the development of a National Centre for Infectious Diseases and a robust system for vaccine research and delivery. Singapore was able to leverage on this existing infrastructure and reconfigure and redeploy resources to fight the COVID-19 pandemic. Being a major transport and logistics hub, Singapore could support the demands of vaccine transport, storage, cold chain management and distribution; this propelled Singapore to become a regional vaccine transport hub with Southeast Asia, Australia and New Zealand. This has also attracted pharmaceutical companies to set up vaccine manufacturing capabilities in Singapore. IT infrastructure that allowed for unified booking of vaccination appointments (<https://www.vaccine.gov.sg/>) and syncing of data between the National Health Records and the National Immunisation Registry was developed to ease documentation and record keeping. The IT infrastructure also ensured adequate vaccine availability based on appointment bookings, handled back-end reimbursements, streamlined administration documentation with preset templates and checked for vaccination eligibility by accessing the Critical Medical Information System for documented drug and vaccine allergies. This made the system usable and safe. ### Primary care Primary care has played an important role in COVID-19 mitigation. At its height, primary care physicians operated over 900 Public Health Preparedness Clinics (PHPCs) nationwide for early detection and management of symptomatic patients. They also volunteered to oversee the operations of community isolation facilities early in the pandemic.\[[22](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R22)\] These had arguably contributed in preventing tertiary care from being overwhelmed by patients with acute respiratory infections. The MTF knew that by tasking primary care to deliver a peak of 80,000 vaccinations per day would compromise on existing primary care services, as evidenced in the UK, where complete reliance on primary care networks and existing infrastructure resulted in vaccine delivery and logistic challenges, organisation gaps and insufficient resources.\[[23](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R23)\] Therefore, the rollout of vaccination in the community started in January 2021 with the setup of four community vaccination centres and 21 PHPCs helmed largely by primary care and supported by private–public partnerships. This was quickly ramped up, so that by the end of April 2021 \[[Figure 2](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#singaporemedj.SMJ-2021-405-f002)\], there were as many as 40 community vaccination centres, 20 polyclinics and 21 PHPCs that provided vaccinations to the community.\[[22](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R22)\] As the gatekeepers of healthcare practice, primary care providers are key to translating vaccine research into population delivery. Their commitment to their patients ensured that issues *before* (address misconceptions, patient education, referrals), *during* (safety protocols, vaccine administration, update of registries) and *after* (manage concerns, side effects, allergy reporting, continuing care) any COVID-19 vaccination were managed holistically. Because of their role as trusted care providers in the community, they were activated to promote and provide same day opportunistic vaccinations to patients who presented for chronic disease management. Some had provided non-mRNA vaccinations where indicated, and a number had been recruited to run mobile vaccination services for home-based vaccinations to reach home-bound seniors. These measures contributed to increasing vaccination rates among seniors.\[[24](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R24)\] ## LOOKING AHEAD As we transit into our third year of combating COVID-19, emerging variants, spread despite vaccination and the contesting voice of anti-vaxxers pose new challenges. Vaccine-generated immunity is only one, *albeit* an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support and strengthened social responsibility. With the closure of community vaccination centres starting in September 2021, the rollout of boosters falls back on the shoulders of primary care; primary care providers are in the community, and so they know the community and are able to link translational research to the community. As last mile providers of vaccination and translators of upstream evidence and policy decisions in the community, they do well to be involved early in decision-making regarding interventions in the community and can foresee challenges on the ground. With new focus on home quarantine for positive cases with teleconsultation support to reduce strain on hospital resources, primary care can be called upon to take up greater responsibilities and provide new insights to improving care.\[[24](https://pmc.ncbi.nlm.nih.gov/articles/PMC11698280/#R24)\] Let us put our continued trust in primary care to contribute in making Singapore a COVID-19–resilient nation. ### Conflicts of interest There are no conflicts of interest. ## Funding Statement Nil ## REFERENCES - 1\. Ministry of Health, Singapore. COVID-19 Statistics. \[Last accessed on 2022 Aug 29\]. Available from:<https://www.moh.gov.sg/covid-19/statistics> . - 2\. Liow Y, Loh VWK, Goh LH, Tan DHY, Tan TL, Leong CK, et al. COVID-19 primary care response and challenges in Singapore: A tale of two curves. Hong Kong Med J. 2021;27:70–2. doi: 10.12809/hkmj208764. \[[DOI](https://doi.org/10.12809/hkmj208764)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33558446/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Hong%20Kong%20Med%20J&title=COVID-19%20primary%20care%20response%20and%20challenges%20in%20Singapore:%20A%20tale%20of%20two%20curves&author=Y%20Liow&author=VWK%20Loh&author=LH%20Goh&author=DHY%20Tan&author=TL%20Tan&volume=27&publication_year=2021&pages=70-2&pmid=33558446&doi=10.12809/hkmj208764&)\] - 3\. Wong JE, Leo YS, Tan CC. COVID-19 in Singapore—current experience: Critical global issues that require attention and action. JAMA. 2020;323:1243–4. doi: 10.1001/jama.2020.2467. \[[DOI](https://doi.org/10.1001/jama.2020.2467)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/32077901/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=JAMA&title=COVID-19%20in%20Singapore%E2%80%94current%20experience:%20Critical%20global%20issues%20that%20require%20attention%20and%20action&author=JE%20Wong&author=YS%20Leo&author=CC%20Tan&volume=323&publication_year=2020&pages=1243-4&pmid=32077901&doi=10.1001/jama.2020.2467&)\] - 4\. Hsu LY, Chia PY, Vasoo S. A midpoint perspective on the COVID-19 pandemic. Singapore Med J. 2020;61:381–3. doi: 10.11622/smedj.2020036. \[[DOI](https://doi.org/10.11622/smedj.2020036)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC7926611/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/32211911/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Singapore%20Med%20J&title=A%20midpoint%20perspective%20on%20the%20COVID-19%20pandemic&author=LY%20Hsu&author=PY%20Chia&author=S%20Vasoo&volume=61&publication_year=2020&pages=381-3&pmid=32211911&doi=10.11622/smedj.2020036&)\] - 5\. Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021 doi: 10.1093/cid/ciab079. doi:10.1101/2020.11.27.20240051. \[[DOI](https://doi.org/10.1093/cid/ciab079)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC7929033/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33515252/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=medRxiv&title=The%20impact%20of%20vaccination%20on%20COVID-19%20outbreaks%20in%20the%20United%20States&author=SM%20Moghadas&author=TN%20Vilches&author=K%20Zhang&author=CR%20Wells&author=A%20Shoukat&publication_year=2021&pmid=33515252&doi=10.1093/cid/ciab079&)\] - 6\. Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hasell J, Appel C, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947–53. doi: 10.1038/s41562-021-01122-8. \[[DOI](https://doi.org/10.1038/s41562-021-01122-8)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33972767/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Nat%20Hum%20Behav&title=A%20global%20database%20of%20COVID-19%20vaccinations&author=E%20Mathieu&author=H%20Ritchie&author=E%20Ortiz-Ospina&author=M%20Roser&author=J%20Hasell&volume=5&publication_year=2021&pages=947-53&pmid=33972767&doi=10.1038/s41562-021-01122-8&)\] - 7\. Cameroni E, Bowen JE, Rosen LE, Saliba C, Zepeda SK, Culap K, et al. Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift. Nature. 2022;602:664–70. doi: 10.1038/s41586-021-04386-2. \[[DOI](https://doi.org/10.1038/s41586-021-04386-2)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9531318/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35016195/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Nature&title=Broadly%20neutralizing%20antibodies%20overcome%20SARS-CoV-2%20Omicron%20antigenic%20shift&author=E%20Cameroni&author=JE%20Bowen&author=LE%20Rosen&author=C%20Saliba&author=SK%20Zepeda&volume=602&publication_year=2022&pages=664-70&pmid=35016195&doi=10.1038/s41586-021-04386-2&)\] - 8\. Lu L, Mok BW-Y, Chen L-L, Chan JM-C, Tsang OT-Y, Lam BH-S, et al. Neutralization of SARS-CoV-2 Omicron variant by sera from BNT162b2 or Coronavac vaccine recipients. Clin Infect Dis. 2021:ciab1041. doi: 10.1093/cid/ciab1041. doi:10.1093/cid/ciab1041. \[[DOI](https://doi.org/10.1093/cid/ciab1041)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8754807/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/34915551/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Clin%20Infect%20Dis&title=Neutralization%20of%20SARS-CoV-2%20Omicron%20variant%20by%20sera%20from%20BNT162b2%20or%20Coronavac%20vaccine%20recipients&author=L%20Lu&author=BW-Y%20Mok&author=L-L%20Chen&author=JM-C%20Chan&author=OT-Y%20Tsang&publication_year=2021&pages=ciab1041&pmid=34915551&doi=10.1093/cid/ciab1041&)\] - 9\. Koh SWC, Liow Y, Loh VWK, Liew SJ, Chan Y-H, Young D. Covid-19 vaccine acceptance and hesitancy among singaporean primary healthcare workers. In Review. 2021. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.researchsquare.com/article/rs-983138/v1> . \[[DOI](https://doi.org/10.1186/s12875-022-01693-z)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9010198/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35421920/)\] - 10\. Tan M, Straughan PT, Cheong G. Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis approach. Soc Sci Med. 2022;296:114767. doi: 10.1016/j.socscimed.2022.114767. \[[DOI](https://doi.org/10.1016/j.socscimed.2022.114767)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8812088/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/35144226/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Soc%20Sci%20Med&title=Information%20trust%20and%20COVID-19%20vaccine%20hesitancy%20amongst%20middle-aged%20and%20older%20adults%20in%20Singapore:%20A%20latent%20class%20analysis%20approach&author=M%20Tan&author=PT%20Straughan&author=G%20Cheong&volume=296&publication_year=2022&pages=114767&pmid=35144226&doi=10.1016/j.socscimed.2022.114767&)\] - 11\. Griva K, Tan KYK, Chan FHF, Periakaruppan R, Ong BWL, Soh ASE, et al. Evaluating rates and determinants of covid-19 vaccine hesitancy for adults and children in the Singapore population: Strengthening our community's resilience against threats from emerging infections (Socrates) cohort. Vaccines. 2021;9:1415. doi: 10.3390/vaccines9121415. \[[DOI](https://doi.org/10.3390/vaccines9121415)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC8705614/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/34960161/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Vaccines&title=Evaluating%20rates%20and%20determinants%20of%20covid-19%20vaccine%20hesitancy%20for%20adults%20and%20children%20in%20the%20Singapore%20population:%20Strengthening%20our%20community's%20resilience%20against%20threats%20from%20emerging%20infections%20\(Socrates\)%20cohort&author=K%20Griva&author=KYK%20Tan&author=FHF%20Chan&author=R%20Periakaruppan&author=BWL%20Ong&volume=9&publication_year=2021&pages=1415&pmid=34960161&doi=10.3390/vaccines9121415&)\] - 12\. World Health Organisation. Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organisation. 2021. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccine-deployment-2021.1-eng> . - 13\. Ministry of Health, Singapore. Multi-Ministry Taskforce on Wuhan Coronavirus. \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/multi-ministry-taskforce-on-wuhan-coronavirus-and-tor---final.pdf> . - 14\. Pfizer Inc. Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-Based Vaccine Candidate Against SARS-CoV-2. Pfizer Inc. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-agreement-united-kingdom-30> . - 15\. James W. England's 'freedom day'marred by soaring cases and isolation chaos. Reuters. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.reuters.com/world/uk/pm-johnson-pleads-caution-freedom-day-arrives-england-2021-07-18/> - 16\. Slotnik DE, Minder R, Cave D. Israel ends its indoor mask mandate after a robust vaccination campaign. The New York Times. 2021. Jun, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.nytimes.com/2021/06/15/world/middleeast/israel-indoor-mask-vaccine.html> . - 17\. Ministry of Health, Singapore. Stabilising our COVID-19 situation and protecting our overall healthcare capacity. 2021. Sep, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/stabilising-our-covid-19-situation-and-protecting-our-overall-healthcare-capacity_24September2021> . - 18\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination expands medical eligibility for mRNA vaccines. 2021. May, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-expands-medical-eligibility-for-mrna-vaccines> . - 19\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination recommends using the paediatric dose Pfizer-BioNTech/Comirnaty vaccine for children aged 5-11 years and extending booster vaccination to persons aged under 30 years. 2021. Dec, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-recommends-using-the-paediatric-dose-pfizer-biontech-comirnaty-vaccine-for-children-aged-5-11-years-and-extending-booster-vaccination-to-persons-aged-under-30-years> . - 20\. Ministry of Health, Singapore. Expert committee on COVID-19 vaccination: Updates of assessment on myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines. 2021. Jul, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/expert-committee-on-covid-19-vaccination-updates-of-assessment-on-myocarditis-and-pericarditis-following-vaccination-with-mrna-covid-19-vaccines> . - 21\. Ministry of Health, Singapore. Benefits of mRNA COVID-19 vaccines continue to outweigh the risk of vaccination. 2021. Jun, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/benefits-of-mrna-covid-19-vaccines-continue-to-outweigh-the-risk-of-vaccination> . - 22\. Liow Y, Loh VWK, Young D. 100 days on: The primary care response to COVID-19 in Singapore. Singapore Med J. 2020 doi: 10.11622/smedj.2020162. doi:10.11622/smedj. 2020162. \[[DOI](https://doi.org/10.11622/smedj.2020162)\] \[[PMC free article](https://pmc.ncbi.nlm.nih.gov/articles/PMC9678137/)\] \[[PubMed](https://pubmed.ncbi.nlm.nih.gov/33256350/)\] \[[Google Scholar](https://scholar.google.com/scholar_lookup?journal=Singapore%20Med%20J&title=100%20days%20on:%20The%20primary%20care%20response%20to%20COVID-19%20in%20Singapore&author=Y%20Liow&author=VWK%20Loh&author=D%20Young&publication_year=2020&pmid=33256350&doi=10.11622/smedj.2020162&)\] - 23\. Campbell D. Dozens of GP practices in England opt out of Covid vaccine rollout. The Guardian. 2020. Dec, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.theguardian.com/society/2020/dec/11/gp-practices-england-opt-out-covid-vaccine-rollout> . - 24\. Ministry of Health, Singapore. Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit. 2021. Sep, \[Last accessed on 2022 Feb 09\]. Available from:<https://www.moh.gov.sg/news-highlights/details/speech-by-mr-ong-ye-kung-minister-for-health-at-the-asean-eu-health-summit-15-september-2021> .

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