Vaccination

Infectious disease outbreaks were prevalent in Singapore since pre-independence. Then, infectious diseases, such as cholera, typhoid fever, tuberculosis, smallpox, polio and measles, were often associated with unsanitary and overcrowded living conditions.1 Today, globalisation and ease of air travel increase the risk of the spread of infectious diseases in Singapore.2 Apart from continued investments in public healthcare, immunisation programmes have been introduced by the government as a key disease prevention strategy to control the spread of vaccine-preventable infectious diseases in the country.3

Vaccines
Most vaccines use small amounts of antigens to trigger the immune system to help build immunity against serious infectious diseases and can be administered through the mouth or injection methods. More than one dose of the vaccine may be needed and administered over a period of time to strengthen the immune system. In Singapore, vaccines that are authorised for local use are registered with the Health Sciences Authority, which closely monitors and assesses the safety and usage of approved vaccines.4

Quarantine and Prevention of Disease Ordinance
The Vaccination Ordinance was enacted in Singapore in 1868 and came into force on 1 May 1869, making smallpox vaccination compulsory for newborns.5 The Quarantine and Prevention of Disease Ordinance, later enacted in 1886, empowered the government to deal with and prevent the spread of infectious diseases.6 In 1915, the Vaccination Ordinance was consolidated into the Quarantine and Prevention of Disease Ordinance, following a comprehensive report that examined the latter ordinance, its regulations, and the efficacy of the measures in preventing the spread of infectious diseases in Singapore.7 The amended bill stated that every infant was to be vaccinated against smallpox within six months after birth. Vaccination was also compulsory for students attending government schools, and parents or guardians who failed to vaccinate their child could face a hefty fine of $10. Additionally, immigrants were also required to be vaccinated before they were allowed entry into the colony.8 The Quarantine and Prevention of Disease Ordinance was eventually replaced with the Infectious Diseases Act in 1976.9

Infectious Diseases Act
The Infectious Diseases Act was enacted in 1976 and came into force on 1 August 1977. It deals with the prevention and control of infectious diseases in Singapore. Under the Act, diphtheria and measles vaccinations are mandatory for every child in Singapore. The Act also empowers the Health Minister to serve mandatory vaccination orders to any person should an infectious disease outbreak occur in Singapore, in order to secure public safety. Failing to comply with these requirements is an offence under the Infectious Diseases Act.10

Expert Committee on Immunisation
Singapore’s Expert Committee on Immunisation comprises “specialists from various disciplines such as infectious diseases, microbiology, paediatrics and public health as well as representatives from both the public and private healthcare institutions”.11  The committee regularly reviews and monitors the safety and efficacy data of vaccines, and analyses available vaccines for inclusion in the national immunisation schedules. The committee provides its expert advice to the Ministry of Health on vaccination policies.12

National Childhood Immunisation Programme
Based on recommendations from the Expert Committee on Immunisation, the National Childhood Immunisation Programme (NCIP) was developed to provide recommendations on vaccinations against childhood infectious diseases. The first NCIP was implemented in 1862 with the introduction of smallpox vaccination, which was made compulsory in 1869. With the global eradication of smallpox, the vaccination was no longer mandatory by law in 1981.13

Vaccination against diphtheria was included in the programme in 1938, followed by tuberculosis in 1957, poliomyelitis in 1958, pertussis and tetanus in 1959, measles and rubella in 1976 and hepatitis B in 1985. Diphtheria and measles vaccinations became mandatory in April 1962 and August 1985 respectively. The programme later expanded to include vaccination against pneumococcal disease in 2009, human papillomavirus in 2010 and varicella in 2020.14

Birth doses of vaccinations for newborns are administered by the neonatal immunisation services at public and private hospitals. Vaccination of infants and pre-school children is carried out at polyclinics, paediatric clinics in public hospitals, and private general practitioner and paediatric clinics.15

The immunisation programme has been effective. There have not been any reported cases of hepatitis B among children 15 and below since 1996. In 2018, there were no reported cases of diphtheria, poliomyelitis or neonatal tetanus. The number of reported cases of measles also declined from 1,413 in 1997 to 34 in 2018.16

National Childhood Immunisation Schedule
Part of the National Childhood Immunisation Programme, the National Childhood Immunisation Schedule presents the recommended vaccination schedule and doses for all children from birth up to 17 years old. The schedule aims to raise awareness of important vaccinations among parents and increase the uptake of these vaccines.17

National Adult Immunisation Schedule
Established in November 2017, the National Adult Immunisation Schedule (NAIS) provides guidance on vaccinations for persons 18 and above and highlights the importance of adult vaccination for personal protection.18 NAIS was developed based on international best practice and recommendations of the Expert Committee on Immunisation, taking into consideration local disease burden, and “vaccine safety, efficacy and cost effectiveness of the vaccines in preventing infections among susceptible individuals and reducing complications, morbidity and mortality”.19 The schedule comprises 8 types of vaccines to protect against 11 vaccine-preventable diseases: influenza, pneumococcal disease, tetanus, diphtheria, pertussis, human papillomavirus, hepatitis B, measles, mumps and rubella, and varicella (chickenpox).20

Vaccination Campaigns
Various campaigns have been rolled out over the years to highlight the importance of vaccination and encourage people to get vaccinated against various infectious diseases. A Bacillus Calmette-Guérin (BCG) campaign was launched in 1951 by the United Nations to advocate vaccination against tuberculosis in Singapore.21 A year later in August 1952, a nation-wide vaccination campaign was launched by the Singapore Health Department to reiterate the importance of vaccination against smallpox and encourage people to get the free vaccination.22

Vaccination is also one of the components in the Health Promotion Board’s F.I.G.H.T campaign introduced in 2017 against influenza and other infectious diseases.23 In March 2021, Singapore launched the VacciNationSG campaign, to raise awareness of the national vaccination programme against COVID-19 and address misinformation and misconceptions.24



Author
Asrina Tanuri


References
1. Hsu Li Yang and Vincent Pang Junxiong, Infectious Diseases and Singapore: Past, Present and Future (Singapore: Society of Infectious Diseases (Singapore), 2015), 1. (Call no. RSING 362.1969095957 HSU)
2. Hsu and Pang, Infectious Diseases and Singapore, 39.
3. Hsu and Pang, Infectious Diseases and Singapore, 3; “Stay One Step Ahead with Vaccinations,” Health Hub, accessed on 12 April 2021.
4. “Stay One Step Ahead with Vaccinations”; “4 Reasons to Get Vaccinated – Adult Immunisation,” Health Hub, accessed on 12 April 2021; Catherine Tay Swee Kian, Infectious Diseases Law & SARS (Singapore: Times Editions, 2003), 107. (Call no. RSING 344.5957043 TAY)
5. Loke Tuck Whye, The Control of Contagious Diseases in Colonial Singapore (BA Honours dissertation) (National University of Singapore, 1990), 29. (Call no. RSING 362.19690095957 LOK); “Wednesday, 28th April,” Straits Times Overland Journal, 6 May 1869, 5. (From NewspaperSG)
6. An Ordinance to Make Provision for Preventing the Introduction and Spread of Infectious and Contagious Diseases, no. XXIX of 1886, Straits Settlements Government Gazette, 17 December 1886, 2139. (From BooKSG; call no. RRARE 959.51 SGG)
7. A Bill Intituled an Ordinance to Make Provision for Preventing the Introduction into and Spread in the Colony, and Transmission from the Colony, of Infectious Diseases, Straits Settlements. Government Gazette, 7 May 1915, xxv–xxxi. (From BookSG; call no.: RRARE 959.51 SGG); “Infectious Disease,” Straits Times, 6 July 1912, 10. (From NewspaperSG)
8. Straits Settlements. Government Gazette, xxv–xxxi.
9. “New Bill to Combat Infectious Diseases,” Straits Times, 10 September 1976, 11. (From NewspaperSG)
10. “Infectious Diseases Act,” Ministry of Health, accessed on 12 April 2021; Infectious Diseases Act, cap 137, Singapore Statutes Online, rev. ed., 2003, accessed on 12 April 2021.
11. Ministry of Health, “Stay One Step Ahead with Vaccinations.”
12. “Various Considerations for Vaccines in National Schedule,” Ministry of Health, 3 August 2019, accessed on 12 April 2021; Ministry of Health, “Stay One Step Ahead with Vaccinations.”
13. K. T. Goh, “The National Childhood Immunisation Programmes in Singapore,” Singapore Medical Journal, 26, no. 3 (June 1985) 225–242.
14. Goh, “The National Childhood Immunisation Programmes in Singapore,” 225–242; “Communicable Diseases Surveillance 2018,” Ministry of Health, 2019, 116, accessed on 12 April 2021; “Special Feature: Singapore’s Progress Towards Measles Elimination,” Ministry of Health, accessed on 12 April 2021
15. Ministry of Health, “Communicable Diseases Surveillance 2018,” 117.
16. Ministry of Health, “Communicable Diseases Surveillance 2018,” 122–126.
17. Ministry of Health, “Various Considerations for Vaccines in National Schedule.”
18. “Vaccinations and How They Protect You,” SingHealth Polyclinics, 27 October 2020, accessed on 12 April 2021.
19. “Nationally Recommended Vaccines,” Ministry of Health, accessed on 12 April 2021.
20. Ministry of Health, “Nationally Recommended Vaccines.”
21. “B.C.G. Team Starts S’pore Campaign,” Straits Times, 4 June 1951, 5. (From NewspaperSG)
22. “Vaccination Drive Starts Monday,” Sunday Standard, 17 August 1952, p. 1. (From NewspaperSG)
23. “FIGHT the Spread of Infectious Diseases,” Health Hub, accessed on 12 April 2021.
24. Linette Lai, “VacciNationSG Campaign Launched to Raise Awareness of Covid-19 Vaccine, Combat Misinformation,” Straits Times, 2 March 2021.



Further resources
Bonny Tan, “Cholera in 19th-century Singapore BiblioAsia 16, no. 2 (2020).

Kevin Y. L. Tan, “The Plague Fighter: Dr Wu Lien-Teh and His Work,” BiblioAsia 16, no. 2 (2020).

Ong Eng Chuan, “Vaccinating a Nation,” BiblioAsia 17, no. 2 (2021).



The information in this article is valid as at May 2021 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.


 

Subject
Communicable diseases--Singapore--Prevention--History
Public health
Immunization--Singapore--History
Vaccination--Singapore--History

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