Mandating Covid-19 vaccination in Singapore nursing homes could better protect seniors: Experts

Professor Teo Yik Ying said the vaccination mandate should be placed more on nursing home staff, vendors and visitors.
Professor Teo Yik Ying said the vaccination mandate should be placed more on nursing home staff, vendors and visitors.PHOTO: ST FILE

SINGAPORE - As nursing homes continue to grapple with large Covid-19 clusters, making vaccination mandatory for all eligible staff and residents as well as vendors and visitors might be the most effective intervention to protect seniors, experts said.

Infectious disease expert Leong Hoe Nam said a vaccination mandate for visitors would be a better alternative to the suspension of visitations at nursing homes.

"Vaccination, including booster shot administration, should be compulsory for all eligible staff, vendors, residents and visitors at nursing homes. Preventing the transmission of Covid-19 should now be seen as an individual's responsibility, instead of the sole responsibility of healthcare workers," Dr Leong said.

He added that all residents, except those who are allergic to the vaccines, ought to get vaccinated, stressing that even those with underlying conditions are eligible in most cases.

The suspension on visitations, which began on Sept 13, has been extended for a second time till Nov 21, the Ministry of Health (MOH) announced last Thursday (Oct 21).

MOH said the suspension is to protect healthcare capacity and vulnerable seniors as Covid-19 cases in the community continue to rise.

Given the high likelihood of transmission from the community to nursing homes, experts have said that putting in place a vaccination mandate will "dramatically reduce the risk of disease and deaths in the nursing homes".

Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore, said that while there was a strong case for making vaccination mandatory for staff and vendors, extending this to residents may be more challenging.

"Some of the residents may be particularly frail, and their family members should still have the right to decide whether their family members are vaccinated or not. Besides, the main purpose is for the residents to be protected from being exposed - this means the vaccination mandate should be placed more on the staff, vendors and also the visitors," he said.

However, Prof Teo still strongly encouraged residents to be vaccinated even if it is not mandatory.

"Nursing homes should put in place an advocacy programme to advise their unvaccinated residents and their family members to accept the vaccination," he added.

Vendors include external workers such as security employees and kitchen staff who enter nursing homes. The Straits Times understand that these workers do not generally interact with residents or access wards.

From Jan 1 next year, only employees who are vaccinated, or have recovered from Covid-19 within 270 days, can return to the workplace.

All unvaccinated employees will not be allowed at the workplace unless they have a negative pre-event test result.

For unvaccinated employees whose work cannot be done from home, the Ministry of Manpower has said that employers can redeploy them to available jobs which can be done from home, place them on no-pay leave, or consider terminating their employment with notice as a last resort.

Special considerations will be given to employees who are medically ineligible for vaccines or pregnant employees who may have specific needs and concerns.

A nursing home manager who did not want to be named told ST that homes here have stepped up their capabilities to ring-fence Covid-19 cases in their wards compared with last year.

He said that corralling staff who are living in the community in designated hostels would be too expensive for nursing homes and could even lead to a manpower crisis if a Covid-19 cluster emerges within staff accommodation. It could also have a negative effect on the morale of healthcare workers, he said.

Since last year, the manager said many homes have cut down on the number of staff living in on-site dormitories in order to adhere to safe management measures.

The manager added that his nursing home receives a government allowance of roughly $400 a month per employee to house staff.

The Agency for Integrated Care (AIC) said nursing homes continue to practise vigilance, detecting positive cases early and containing them to prevent clusters. Since 2020, homes here have been operating in split zones to prevent cross transmission of infections among residents and staff.

"Nursing homes have also stepped up the frequency of Covid-19 testing of staff to twice a week, to detect and manage any infections at its earliest. Homes also test residents and staff in affected wards promptly if Covid-19 cases surface," AIC said.

Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital, said that while mandating vaccination of staff would be helpful in protecting residents, mandating vaccination of residents would be the most effective.

"The value of having all staff and residents vaccinated means that as a cluster appears in a nursing home that by and large we can have business as usual as it will be a mild condition for those vaccinated," he said.