Singapore may have been hit hard by COVID-19 in the beginning, but with the government’s measurements to curb the pandemic and the responsible behaviour of many Singaporeans, we have fortunately been able to keep the numbers low, with around zero to one community cases daily. It’s fair to say the COVID-19 situation in Singapore has been dealt with pretty successfully, and with the ongoing vaccination, we might be able to return to our “normal” lives relatively soon.
Every so often I would turn on the television and I would hear the advertisement by the government encouraging us to take the COVID-19 vaccination, telling us, “You are not safe till everyone is safe”. Prime Minister Lee has echoed this message when talking about the need to take the vaccine:
When you get yourself vaccinated, you are not just protecting yourself. You are also doing your part to protect others, especially your loved ones.
As a young adult, I will probably be among the last few groups of people to get the vaccine, as Singapore’s rollout sees elderly people and frontline workers getting access to the vaccine first, before moving on to younger age groups in the population. Yet, despite constant encouragement from the government to take up the vaccine as soon as possible, many of us risk-averse young Singaporeans report hesitancy about getting the vaccine.
I wanted to understand what concerns the younger Singaporean demographic have regarding the vaccine, to see if it was possible to address some of these concerns. Recent reports have identified that many younger people said they were uncertain of the effectiveness of the vaccine and whether there would be any side effects after taking it.
Joyce Tan (not her real name), 22, told me: “When a vaccine is first released, there’s high hesitation in taking the vaccine because no one has tried it yet so there is a lot of uncertainty about whether the vaccine is safe for all.” Others have shared the same sentiments, too.
As would be expected as more people began to be vaccinated, stories began to emerge of people who had suffered some side effects after taking the vaccine, with headlines such as “3 people in Singapore in 20s and 30s had severe allergic reaction after Pfizer Covid-19 vaccination jab” and a Facebook post that a girl had complained after being hospitalized after taking the vaccine. The reporting of these stories often made it seem like the vaccines might cause some complications after taking them, which fed into some of the vaccine hesitancy I encountered – even if the chances of serious side effects are extremely rare, especially in patients who are otherwise healthy. Other concerns that emerged in my interviews included a lack of understanding as to how the vaccine is made, what phase of trial the vaccines were at, how the vaccine had been tested, what side effects could be reasonably expected, and the vaccine has been developed so quickly.
Here in Singapore, vaccination remains optional, and as such some of my friends are a little hesitant. Joyce explained: “I’m uncertain about whether the vaccine is safe for all, knowing that the vaccine has side effects, and with some people experiencing severe symptoms”.
One of the articles she alluded to was published by the BBC in January, which talks about how there are currently mRNA vaccines that do not follow traditional methods of production or testing and therefore have “no successful example [of them] being used in the population”, according to Associate Prof Luo Dahai of the Nanyang Technological University.
The same article also talks about CoronaVac only being “suitable for emergency use”, according to Zhu Fengcai, who published a paper in the Lancet about the vaccine. Professor Luo also told the BBC that “vaccines must go through three trials with various criteria and a large sample size consisting of thousands of participants for vaccines to be safe to use at the population level.”
From this, Joyce said she drew the conclusion that “we should have a higher level of concern and caution in the specific vaccine that is being used, because not all vaccines are equal in meeting safety standards.” While this isn’t necessarily true, as the vaccines have all been assessed to high safety standards, the BBC article made her hesitant to take the vaccine – though, she told me, she understood that it would be important for her to do so to protect those around her.
Another interviewee, Cherlyn Lim, 22, told me she had friends who had suffered from some side effects due to the vaccine, and she had also heard that her mother’s friend passed away shortly afterwards after taking the vaccine.
“It might be due to other reasons”, she admitted, “but because we don’t know the real cause, it makes me worry that the jab could be a factor”. She added that after hearing such an incident, she “didn’t have the confidence [to take the vaccine]”
Concerns such as these have led many young people in Singapore to take a “wait and see” approach before deciding for themselves whether they would like to take the vaccine or not. An online poll conducted by Milieu Insight in December 2020 showed that a majority of respondents would not get the COVID-19 vaccination as soon as it is available in Singapore. Instead, they indicated they would only want to get vaccinated after 6 to 12 months, in order to wait and see whether the vaccine proves safe and effective.
The concept of “wait and see” has been described as a “prisoner’s dilemma” by Dr Bauch – the idea in decision analysis whereby two individuals act only in their own self-interest, leading to an unfavourable outcome. When the number of people being infected by the virus is low, people can feel that they are less at risk and become less cautious, which in turn causes the infection level to increase again.
In order to understand more about where this vaccine hesitancy stems from, I asked whether my friends had any bad experiences with medicines or vaccines in the past.
Joyce recalled how when she was younger, she observed doctors gave her antibiotics to take when she had a fever or cough, both common illnesses.
“However, I understand that antibiotics have the potential of causing adverse side effects without being able to cure the sickness itself due to it being for a different strain of illness”, she told me. “This to me felt like I was being given medication that could make my condition worse based on medication given seemingly out of trial and error.
“So, the uncertainty of vaccines does remind me of that and may or may not have influenced my current cautious behaviour around vaccines and stronger medication.”
This uncertainty might have made her hesitant in taking the vaccine, given that it is relatively new and in its early stages of being rolled out to the public.
Addressing the concerns
After talking to young people about their vaccine concerns, I decided to find out whether there were any answers to the questions I’d heard.
“How is the vaccine made?” – There are different vaccines and various methods of production. Traditional vaccines are made using a weakened or inactivated virus. While the newly developed Pfizer-BioNTech and Moderna vaccines, known as mRNA, are not made using any cells. Instead, they help our immune system generate antibodies that prevents us from getting infected by COVID-19. This is done through the training of our cells to produce copies of the “spike protein” in our body.
“At what phase of the trial is the vaccine at?” – According to the Coronavirus Vaccine Tracker, the vaccines that have been approved by Singapore such as Pfizer-BioNTech and Moderna have completed Phase 3 trials, which are extensive enough to reveal proof of relatively rare side effects.
“How many people has the vaccine been tested on?” – The sample size for the different vaccines varies, for Moderna, it is 27,817 participants in the U.S. and for Pfizer, it is 36,523 participants in Argentina, Brazil, Germany, South Africa, Turkey and the U.S.
“What are some side effects of the vaccine?” – It is common to have some side effects after taking the vaccine and the majority of the effects are mild or moderate which typically improves over the next few days. Some of the more common effects are: Pain, redness, swelling at the injection site, fever, chills, headache, muscle pain, joint pain, tiredness and lymph node swelling at neck or arms.
In some very rare cases, the vaccine may cause a severe allergic reaction. These include signs of: difficulty breathing, swelling of your face, throat, eyes or lips, a fast heartbeat, dizziness and weakness, a bad rash all over your body.
“How effective is the vaccine?” – It is important to note that efficacy is not the same as effectiveness and there is a difference between the two. This is a common misconception. When they state that the efficacy of the vaccine is 95%, it does not indicate that 5% of the people who get the vaccine will get COVID-19.
The efficacy that is often stated in the vaccine’s information is actually “a measurement of how much a vaccine lowers the risk of an outcome”. This means that people who are vaccinated are at a lower risk of contracting the virus.
“How long will vaccine immunity last?” – It is not yet fully known how long vaccine-conferred immunity lasts, but evidence put forward by Moderna shows 94% effectiveness six months following the second dose. As more vaccine are deployed, and as time passes since people have been vaccinated, we will get a better understanding of how long vaccine immunity will last.
Protecting our loved ones
Having spoken to many vaccine hesitant young Singaporeans, I came to the conclusion that it is natural to be a little cautious when it comes to the vaccines, but that many of the questions people have can actually be addressed by the evidence that’s currently available. At the end of the day, if it’s to protect our loved ones and for the greater good of society, even risk averse young people should be willing to do get vaccinated, especially given how incredibly small the risk involved actually is.
When I asked when she might think it would be safe enough to take the vaccine, Joyce told me: “Taking into account that it’s the same vaccine issued to the elderly, the generations above me, and my peers, I would deem it safe enough if there is little to no news of cases of side effects leading to further complications. If there are such cases, they must be ruled as anomalies.”
Cherlyn told me: “I would give it a few months or maybe a year.”
Joyce also added that despite this hesitancy, she would still consider taking the vaccine. “I would highly consider taking the vaccine for my family’s sake and I personally see it as my responsibility to keep my own health in check and take the necessary precautions despite my own reservations. I live with elderly relatives and in a larger family, so I see this as all the more urgent to consider seriously.”
Each of us has a part to play in keeping the virus at bay so that we can ensure the safety of our loved ones and family. With a little more research, we can all learn to be a little less hesitant in taking the vaccine.
For COVID-19 vaccines to be effective, there is a need to build trust and address vaccine concerns in a clear and comprehensive manner that will not be misunderstood. On our end, we can do our part by checking our sources before sharing any news and stories relating to the vaccine.