Living with COVID-19 means accepting that it has become an endemic and that there is likely no way to eliminate the virus using current strategies without paying a tremendous price, said infectious diseases specialist and chairman of Singapore Democratic Party (SDP) Professor Paul Tambyah.
In an hour-long Facebook Live discussion, titled “Ask Paul Anything”, on Tuesday evening (17 Aug), Prof Tambyah spoke about living with COVID-19 as an endemic and addressed various concerns about the vaccines and vaccination programme in Singapore.
During the discussion, he said that he doesn’t think there is a chance of Singapore heading back to square one in terms of circuit breaker if the nation lives with COVID-19 in an endemic stage.
Prof Tambyah attributes this to vaccinations.
“So because of vaccination, it’s very hard to lock down an entire country if nobody is in [intensive care units],” he said.
“So once we reach a very high level of vaccination and the disease is mainly mild, then you can’t justify shutting down businesses, closing schools, and things like that,” Prof Tambyah explained, adding that this is the situation in the United Kingdom right now.
On the topic of vaccinations and possibly making them mandatory, he noted that in Singapore, only the measles and diphtheria vaccines are mandatory. He also pointed out that the COVID-19 vaccines haven’t been made mandatory in any country so far as there isn’t enough longitudinal data about them.
This is important because if the Government mandates that everyone has to be vaccinated, they would not only have to provide the vaccines, but they would also be on the hook financially if anything goes wrong, Prof Tambyah asserted.
Nonetheless, he stressed that it is important for people to get vaccinated so that life can go on as the number of cases will go down significantly as more people are vaccinated.
However, Prof Tambyah advised caution for certain aspect of the vaccination. Referring to the recent concerns about the adverse effects of the Pfizer/BioNTech vaccine among the youth, he said that more studies need to be done.
“While we shouldn’t stop vaccination of young people, we should do studies on whether we could reduce the dose or whether we could, you know, have some kind of other regimes for these young people,” he said, adding that the risks and benefits should be weighed.
Is it true that vaccines do not make people less infectious?
When asked this question, Prof Tambyah said that it is true that the COVID-19 vaccine does not necessarily make people less infectious.
One possible explanation for this, he said, is that some people just don’t take the vaccine well and are unable to mount a response against the virus even after being vaccinated.
Another possibility is that the mRNA vaccines, which are widely used in Singapore, could be good as a whole in protecting from severe disease but does not prevent transmission.
“The current regimes for Pfizer, they have been a little bit disappointing in terms of preventing infection as a whole, but at the same time, in terms of preventing serious illness, they still are pretty good.
“The effectiveness that we’ve seen, not just in the US but also in Singapore and even in Israel, the vast majority of the cases have been mild and asymptomatic,” he explained.
Prof Tambyah also noted that asymptomatic carriers of the virus are less infectious than those who are symptomatic.
Subsequently, he suggested that the Government could offer different types of vaccines instead of just the mRNA ones.
On the topic of effectiveness, Prof Tambyah said that new data suggests that a third jab might be necessary for those who have been vaccinated with the Pfizer vaccine.
He noted that in the UK where the first and second dose of Pfizer jabs were stretched out beyond the recommended time, the number of cases appears not to have gone up. As such, he thinks it might be necessary for those who followed the recommended spacing to get a third dose.
Should not aim for 100% vaccination rate?
When asked if Singapore should not aim for a 100 per cent vaccination rate, Prof Tambyah responded: “Yeah, and frankly I think it’s how you get there.”
“Scotland has got a 100% vaccination rate for the very elderly, and I don’t know how they’ve done it but I think it’s got to do with the fact that the primary healthcare system in Scotland is very strong,” he elaborated.
Prof Tambyah then opined that even 90 per cent vaccination rate could bring down the number of cases “quite significantly”.
“This is living with the virus,” he said, adding that Singapore cannot afford to shut down over a single case as New Zealand did recently.
Drawing a comparison to influenza, Prof Tambyah cited a Ministry of Health (MOH) study from 15 years ago which estimated that between 500 to 600 people a year die of influenza in Singapore. Most of them are elderly people with underlying heart and lung disease.
“We need to move to a state where we live with the virus, we concentrate on protecting the vulnerable, making sure the health care systems are intact and we get on with life,” he said.
Long-term effects of the vaccine are still a “big mystery”
During the discussion, Prof Tambyah also touched on the concerns people have about the long-term effects of the COVID-19 vaccines.
Describing it as a “big mystery” still, he noted that many studies are already looking into it. He added that there have been nothing in the medical literature so far to suggest that there are long-term adverse side effects from being vaccinated, which is a “cause for optimism”.
Prof Tambyah went on to say that this is something the Government will have to “mitigate”.
Using the dengue vaccine as an example, he recalled how the Singapore government was cautious about it when it was first licensed. When cases of antibody dependent enhancement surfaced, Singapore was mostly spared.
“The ‘kiasu’ nature of our regulatory authorities may protect us,” Prof Tambyah said in jest.
Antibody dependent enhancement occurs when a pre-existing antibody present in the body – such as from vaccination or a primary infection – causes a more severe infection when a person is infected with a different strain later on.
Watch the full discussion here:
