SINGAPORE - Since the roll-out of the national vaccination programme, traditional Chinese medicine (TCM) physician Ren Xiao Ling has been dispensing free advice on Covid-19 safe management measures and vaccinations.

Most of the patients at the Xi Jing TCM Clinic in Bedok North Avenue 2 are seniors, said Ms Ren, who estimated that about 50 per cent of them are not fully vaccinated.

She said: "Some children are concerned that if their elderly parents take the vaccine and have serious side effects, then who is going to be responsible?

"As a result, the seniors become resistant to the idea of being vaccinated because they have the mentality that if they have any side effects, then they are going to become a burden to their children and give them more stress."

A survey by Singapore Management University's Centre for Research on Successful Ageing found that the most common reason offered by seniors not wanting to get vaccinated was fear of negative side effects from the vaccine. This was followed by not believing in any form of vaccination at all.

The study, released in July, also found that those who did not wish to get vaccinated were the least trusting of all sources of information on Covid-19. However, they were more likely to trust family members over the Government or media sources.

But Mr Andy Lee, divisional director of Thye Hua Kwan Moral Charities (THKMC) elderly services division, pointed out that some seniors refuse vaccinations because their family members do not insist they take the jab.

He added: "Some single elderly are concerned that no one would be able to take care of them should anything happen to them post-vaccination."

To date, about 20 per cent of seniors at THKMC's 17 senior activity centres are not vaccinated, said Mr Lee. The centres' staff have been reaching out to the unvaccinated monthly, to encourage them to get their shots.

Unvaccinated seniors - who make up about 1.5 per cent of the total population - accounted for close to 70 per cent of Covid-19 deaths and intensive care unit cases in the past month.

Around 237,000 people aged between 12 and 59 remain unvaccinated, while the figure for those 60 and older is about 68,000.

Over the past three weeks, The Straits Times visited different housing estates to explore how residents in each estate reach out to unvaccinated seniors.

For example, in Bedok, a volunteer group that distributes basic necessities has taken on Covid-19 education as part of its mandate.

In Bukit Merah, a Residents' Committee staff makes it a point to inform elderly residents about the daily Covid-19 cases and deaths by updating a chart written in all four languages.

Harming loved ones

Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said family members who are actively advising their elderly relatives against vaccination - especially for those seniors who are not frail or ill - are doing harm to their loved ones.

"As the world moves towards treating Covid-19 as an endemic disease, and restrictions in public spaces are gradually lifted, it is almost certain that everyone will be infected in the coming few years.

"By continuing to discourage their elders from getting vaccinated, they may inadvertently be jeopardising the lives of these seniors, which I'm sure is not (their) intent," added Prof Teo.

But he also noted it is unrealistic to aim for a 100 per cent vaccination rate.

Fake news and misinformation are also strong factors deterring some seniors from getting vaccinated.

Edgedale Medical Clinic director Yan Shi Yuan said: "Most unvaccinated elderly are concerned with the unknown effects of the mRNA (messenger ribonucleic acid) vaccines. They hear stories from WhatsApp messages or friends that many people have died suddenly after vaccination."

At his clinic in Punggol, more than 90 per cent of his patients are fully vaccinated. The unvaccinated includes seniors and pregnant women.

Neighbourhood general practitioners (GPs) like Dr Yan have been relying on the long-term doctor-patient relationship with their older patients to help them navigate through the misinformation.

Dr Tan Teck Jack, chief executive of Northeast Medical Group, said: "I would persuade my patients by first sharing my genuine concern for their health, then allowing them to vent their frustrations and finally, gently debunking myths without appearing dismissive."

At the group's Bedok branch, Dr Tan sees about one or two patients with vaccine hesitancy each day.

Dr Eric Wee from Nobel Gastroenterology Centre added: "As a doctor, I meet them one on one, and can help them at an individual level. In contrast, policymakers don't have that opportunity."

Through this, Dr Wee managed to convince half of his unvaccinated patients to get their jabs. Last month, he also persuaded a woman in her 30s or 40s to get vaccinated the same day she consulted him for a digestive problem.

"The lady was delaying her vaccine. Wanted to wait till her digestive problems were sorted, and I told her to get vaccinated before I would do anything to investigate her problem."

But some patients remain resistant.

Despite nagging the few unvaccinated patients he has, Dr Lee Joon Loong, medical director of Paddington Medical Clinic, has been unsuccessful.

"Some of them even have elderly and children at home, unvaccinated. One can try, but frankly, it doesn't end up well usually if doctors push too hard," said Dr Lee.

Sinovac will raise inoculation rate

Some GPs are positive that including the Sinovac vaccine in the national drive would raise the inoculation rate here.

Dr Lee Yik Voon from Lee & Tan Family Clinic and Surgery said: "Any World Health Organisation-approved vaccine will help patients combat Covid-19 than not vaccinating at all."

The Sinovac Covid-19 vaccine will be included in the national vaccination programme to cater to those unable or unwilling to be vaccinated with mRNA vaccines.

Three doses of the Sinovac vaccine will be required for a person to be considered fully vaccinated with the second dose taken 28 days after the first dose, and the third 90 days after the second dose.

At the community level, befrienders under NTUC Health also visit seniors regularly and encourage them to get vaccinated, said Dr Goh Siew Hor, its head of clinical services.

Communicating with seniors at an interpersonal level is more powerful, said Associate Professor Edson Tandoc Jr, director of Nanyang Technological University's Centre for Information Integrity and the Internet.

"Evidence itself is insufficient to convince them; they attend to messages that resonate with their own experiences and pre-existing beliefs."

He added: "It is always tempting and easier to ignore the questionable messages they forward to our group chats, but when we keep quiet, they may mistakenly take that as indicating that what they shared is correct."