Intended for healthcare professionals


Covid-19: Singaporeans who remain “unvaccinated by choice” must fund own treatment, says government

BMJ 2021; 375 doi: (Published 10 November 2021) Cite this as: BMJ 2021;375:n2748

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  1. Owen Dyer
  1. Montreal

Singapore’s government will no longer fund covid treatment after 8 December for citizens and residents who choose to remain unvaccinated, its government has said.

Until now all of Singapore’s citizens and residents, except those who have recently arrived from abroad, have had their covid treatment fully funded by the government. Under the new plan unvaccinated people will lose this privilege from 8 December, and those who are partially vaccinated will lose it from 31 December. Those ineligible for vaccination, such as children and medically exempt people, will continue to have their covid treatment costs publicly covered.

The city state of six million people is one of the world’s most vaccinated countries, with 85% of its population fully vaccinated and 18% having already received a third, booster dose. Its mix of strong border controls and early lockdowns kept the pandemic largely at bay for 18 months: until the end of September 2021 the most covid deaths it had recorded in a single day was three.

It then saw a surge in cases that led to abandonment of its “zero covid” approach in favour of a “living with covid” policy of slow reopening, at least for vaccinated people. But with almost no herd immunity, the unvaccinated population is still highly susceptible. Singapore’s health ministry said that fully vaccinated people were admitted to hospital over the past week at a rate of 0.5 per 100 000 and that deaths in this group were 0.1 per 100 000. But unvaccinated people were admitted at a rate of 5.2 per 100 000, and deaths were 0.9 per 100 000.

About 1725 people are currently admitted to hospital with covid, of whom 67 are critically ill and intubated. Singapore’s intensive care facilities are at 68.5% occupancy.

The ministry said in a statement announcing the new policy, “Currently, unvaccinated persons make up a sizeable majority of those who require intensive inpatient care, and disproportionately contribute to the strain on our healthcare resources.”1

A vaccination drive beginning in early August brought the number of unvaccinated people over 65 down from 175 000 to below 64 000. “If not for this reduction, our hospitals and ICUs today would have been already overwhelmed,” said Ong Ye Kung, health minister.

In practice, he noted, few Singaporeans would have to pay for covid treatment out of their own pockets, as strong legal incentives encourage most citizens to have extensive private health coverage.

“Our hospitals really much prefer not to have to bill these patients at all, but we have to send this important signal, to urge everyone to get vaccinated if you are eligible,” the minister said.

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