The World Health Organization (WHO) declared on Friday (May 5) that COVID-19 is no longer a global health emergency.
For three years, Singapore, along with the rest of the world, battled a disease that has killed 6.9 million people worldwide. That’s more than the total population of Singapore.
The lifting of the emergency alert by the WHO is a sign of the progress nations have made in containing COVID-19. Some countries, including Singapore in February, had previously withdrawn their own COVID-19 measures.
However, with each new wave of cases expected in endemic life and fewer people keeping up with their COVID-19 vaccinations, the question arises: are Singaporeans developing a false sense of security about COVID-19? -19?
“There is a common thought among older people and among the public, that ‘I rarely leave my house and therefore I don’t need to get vaccinated anymore.’ This is not recommended,” Health Minister Ong Ye Kung said in Parliament on Tuesday, while providing an update on the current wave of COVID-19.
Results of a recent survey conducted by Moderna Biotech Singapore and the Asia Pacific Immunization Coalition (APIC) reflect a similar attitude, raising some concern among clinicians about a sense of complacency among residents.
The survey showed that only a minority (13 per cent) of respondents in Singapore believe that COVID-19 currently poses a “high or very high risk” to their health.
Not surprisingly, most survey participants do not currently consider COVID-19 to pose a significantly high risk to health. His response is quite expected given that the COVID-19 restriction rules have been relaxed and business and leisure activities have almost returned to pre-pandemic levels.
What is alarming, however, is the statement by 38 percent of people age 60 and older and 31 percent of people with medical conditions of diabetes, chronic heart or lung disease (so-called medically vulnerable groups) that they do not they plan to take more booster shots in the future.
While no firm conclusions can be drawn from this survey, it nonetheless represents leading research in assessing current attitudes and behavior towards booster vaccination against COVID-19 among people living in Singapore.
SCIENTIFIC KNOWLEDGE VERSUS PRACTICAL WISDOM
In trying to elucidate the reasons behind people’s beliefs and behavior, I begin by referring to Aristotle, the ancient Greek philosopher, who distinguished between scientific knowledge and practical wisdom.
Scientific knowledge deals with questions of necessity, while practical wisdom (involving practical reasoning) deals with human concerns that are open to deliberation.
At the beginning and peak of the current pandemic, the necessary priority was to reduce the number of susceptible people by immunizing them against the virus, thus reducing the rate of contagion to reduce mortality and conserve health resources.
Yet today, with COVID-19 appearing to be becoming endemic, people must exercise practical reason in deciding how best to live with the looming presence of the virus, just as we do with the virus. dengue and influenza.
In the aforementioned survey, 56 percent of respondents expressed the belief that vaccination is “the best way” to protect themselves from COVID-19. By contrast, nearly the equivalent of 52 percent and 54 percent said they are concerned about the health complications of COVID-19 vaccines and fear potential side effects from the vaccines more than contracting the virus, respectively.
Therefore, it appears that many people are in a quandary when considering whether to receive a COVID-19 booster shot.
The recommended direct answer to anyone who asks how someone can reasonably act when faced with the seeming impossibility of antithetical explanations of what is correct is that the answer “will depend on who you are and how you understand yourself.”
In other words, there are no neutral, impersonal, and independent standards of rational judgment when trying to exercise practical reason.
“CAN ALL THIS BE PREVENTED?”
The undeniable fact is that medically susceptible groups are at higher risk of developing severe COVID-19 infections and complications requiring hospitalization and intensive care.
For example, a 2021 study showed that people with chronic obstructive pulmonary disease (COPD), a common chronic lung disorder, face a four times higher risk of hospitalization, a 35% higher chance of admission to the intensive care unit (ICU) and a 2.5 times higher mortality rate if they contract COVID-19 compared to people without COPD.
Even before COVID-19, health professionals knew that the risk of pneumonia caused by bacteria or viruses is much higher in older people with pre-existing chronic conditions. Using COPD as an example once again, the risk of developing bacterial pneumonia is 7.7 times higher.
Having been a respiratory specialist and intensivist for nearly three decades, I can attest to the reliability of the truism “prevention is better than cure” as well as the reliability of risk-benefit analysis while doing medicine.
In the course of my work, I treat patients with severe pneumonia in the ICU and know that once the infection becomes established in the lungs and other organs are affected, effective therapy is limited and the prognosis guarded.
Most of the patients I treated in the ICU did not receive the recommended vaccinations, even though they were in the high-risk medically vulnerable category. As these patients became progressively worse despite maximal support, the question, “Can all of this be prevented?” it arises quite naturally.
Risk-benefit considerations remain the norm in medicine over the decades; there are no absolutes in the discipline of medicine. It may seem surprising to the public that despite rapid advances, treatments and outcomes in medicine are still largely based on probability.
The overall odds of someone requiring hospitalization for a bout of flu are minuscule, but that’s for the “general” person. For the elderly patient with one or more medical conditions, the odds are substantial.
The reported average death rate from pneumonia caused by influenza is 20 percent; for a medically vulnerable person, that risk of death is multiplied.
Just as I try to discuss the risks and benefits of available treatments for each of my patients’ respiratory conditions, I would approach the issue of continuing immunization against COVID-19 in the same way, with a greater emphasis on those with a greater probability of acquiring and succumbing to the disease.
That is my practical rationale for doing the right and true thing on this issue. But this only reflects who I am and who I think I am, since according to the philosopher Alasdair MacIntyre, how one reasons cannot be abstracted from the reasoner.
VACCINE COMPLACENCY OR VACCINE FATIGUE?
From the main findings of the Moderna-APIC survey, it might seem likely that Singaporeans are on the verge of complacency with vaccinations.
During an expert panel discussion on April 25, APIC Co-Chair Professor Tikki Pang proposed vaccine fatigue as another plausible cause to explain the survey findings.
We certainly hope that pharmaceuticals will develop combination vaccines (for example, combined flu and COVID-19 shots) in the future to reduce the number of injections and reduce vaccine fatigue.
Furthermore, Professor Pang sounded a timely reminder that anyone who encourages the use of vaccines must do so with empathy and compassion.
Not everyone responds in the same way to scientific reason and human logic. In fact, some may view expert opinions and recommendations as hegemonic knowledge that leans toward coercion. Others from different traditions and cultures may focus more on affective than cognitive factors.
Understanding the basic attitudes of Singaporeans towards the continuation of COVID-19 vaccinations should foster an empathetic and sensitive promotion of active immunity against infection by the virus, which is likely to be around for some time.