A Nuanced Analysis Of Vaccination-Differentiated Safe Management Measure

05/11/2021

Tuesday, 2 November 2021 

Dear Fellow Singaporeans, 

Dear Policy-Makers, 

Introduction 

1. I am writing as a citizen of Singapore. Nothing in this letter should be taken to represent the position or views of any organisation or groups that I am in or may be associated with. 

2. I am pro-vaccine. I believe there are strong grounds to be vaccinated. Indeed, I am myself fully vaccinated. I would strongly encourage those who are yet to be vaccinated (especially those in the high-risk categories if they contract COVID-19) to consider doing so after independently weighing the benefits and risks. 

3. Yet, at the same time, I am deeply concerned about what are euphemistically called vaccination-differentiated safe management measures ("VDS"), which are effectively vaccine passports. I would very respectfully suggest that VDS, in its current form, is too broad and inconsistent, and it must be carefully recalibrated and specifically targeted, and certain public assurances must be given by policy makers to the unvaccinated. Importantly, VDS is creating a divided Singapore, and very sadly, turning the majority against the minority. 

4. This letter will examine VDS, and the rationale(s) offered in support of it. In the final analysis, only one rationale holds water, that of reducing the strain on the healthcare system, but even for such purpose, VDS in its current form needs to be substantially reduced / limited in terms of scope and duration. In offering this analysis, which is predominantly grounded on legal and philosophical principles, it is hoped that: 

(1) policy makers will do what is necessary to recalibrate VDS to the least intrusive version possible; and 

(2) Singaporeans will look empathetically at the unvaccinated, and to kindly refrain from divisive comments or opinions which may have a tendency to cause others to alienate or marginalize the unvaccinated. 

5. Executive Summary: This is an executive summary of this letter: 

(1) Freedom of Movement: As citizens of Singapore, as a starting point, everyone is entitled, without distinction, to freedom of movement throughout Singapore (and by extension, the goods, services, events and activities provided at various places in Singapore). These are fundamental liberties, who must not be lightly taken away by the State. See [14]. 

(2) Public Health Exception, Reasonableness and Necessity: Any restrictions to the freedom of movement, on account of public health reasons, are subject to the requirements of reasonableness and necessity. A balance must be found between the right to freedom of movement and the interest of public health. See [15]. 

(3) Rationale No. 1: The first rationale cited in support of VDS, i.e. protecting the unvaccinated, is unable to support VDS: 

(a) A Deeply Personal Decision, and Equal Respect: The decision whether to vaccinate is, and must remain, a deeply personal one, and as such, is subject to unique and multi-factorial considerations for each and every citizen. Equal respect must be accorded to each individual's decision whether to vaccinate or not to vaccinate. VDS, by taking away fundamental liberties from the unvaccinated, makes this respect illusory. See [18]. 

(b) Balance of Probability vs Reasonable Doubt: When it comes to the deeply personal decision whether to vaccinate, some or many are satisfied that, on a balance of probability, there are more reasons to vaccinate than to not vaccinate. However, some others assess benefits and risks in a different way, and they would like to be persuaded beyond reasonable doubt. As a matter of principle and values, should we not, as a society, respect the decisions of Singaporeans who entertain a reasonable doubt? See [20]. 

(c) Natural Consequences v Forced Protection: Having given every Singaporean ample time and opportunity to choose whether to vaccinate, the natural consequences of that choice must be something for those individuals to bear, rather than forcefully and disproportionately "prevented" by the State. It is highly arguable that the Government's public duty towards Singaporeans is already fulfilled by making vaccines freely available and accessible, and there is no need for the Government to play "nanny State" or "helicopter parent" to protect the unvaccinated from the consequences of choosing not to vaccinate. See [26]. 

(d) Underlying the issue of VDS is a question which lies beyond the realm of expertise of health experts, namely, whether we as a society should be forcefully protecting people against their own will by way of restricting their movement. This is a question of principle and of values, and is not a question of science. See [29]. 

(e) Even if, for argument's sake, our society may engage in the forceful protection of the unvaccinated despite their choice (which is denied), VDS in its current form is overinclusive in scope, by including those with low or lower risks of contracting serious Covid or dying, and is therefore unreasonable and/or unnecessary. See [31]. 

(4) Rationale No. 2: The second rationale cited in support of VDS, i.e. protecting others from the unvaccinated, likewise is unable to support VDS: 

(a) Rationale Probably No Longer Applicable: This rationale, which was initially cited when VDS was first introduced, is  conspicuously missing as a rationale for the subsequent expansion of VDS. See [32]. 

(b) The Vaccinated are Protected by Virtue of Being Vaccinated: The vaccinated are protected by virtue of being vaccinated. As such, the question of whether the unvaccinated are more infectious than the vaccinated, is a red herring. See [35]. 

(c) It is Debatable whether the Unvaccinated are More Infectious: In any event, given that it is at least debatable (or arguably even inaccurate that) the unvaccinated are more likely to infect the vaccinated, VDS cannot be grounded on the rationale of protecting others from the unvaccinated. See [38]. 

(d) Protecting the Unvaccinated from the Unvaccinated: In relation to protecting the unvaccinated from the unvaccinated, insofar as the former are unvaccinated by choice, the natural consequences of that choice must be something for those individuals to bear. See [41]. 

(e) Protecting the Unvaccinated (not by Choice) from the Unvaccinated by Choice: The unvaccinated not by choice may contract Covid-19 from either the vaccinated or the unvaccinated. It is therefore overinclusive to restrict only the unvaccinated by way of VDS. In any event, a calibrated and proportionate strategy must be specifically designed for the purposes of protecting those in this relatively small group who are at higher risks. See [42]. 

(5) Rationale No. 3: The third rationale cited in support of VDS, i.e. reducing the strain on the healthcare system, has merits. However: 

(a) Policy makers should clearly and publicly affirm that VDS is being used solely for the limited purposes of preserving and protecting the healthcare system, and that the moment it is no longer strained (as defined below), VDS will be lifted as a matter of principle for all of the unvaccinated (including the lifting of WFVM for unvaccinated workers). See [46]. 

(b) Young People, and Mental Health Needs: VDS applies to restrict the movement of unvaccinated young people (from age 13 onwards), despite such restriction having little link or impact towards reducing the strain on the healthcare system. VDS is overinclusive in this regard, and is unreasonable and/or unnecessary, and/or lacks a rational relation to the object of reducing the strain. In addition, the mental health needs of young people who are restricted in their movement is a critical counterfactor which requires that VDS be lifted against young people. See [49]. 

(c) 12-49 Years Old: The risk of severe illnesses for unvaccinated persons aged 49 years old and below (12-49) is low (as recognised by policy makers), and they should be excluded from VDS as a general rule. VDS is overinclusive in this regard, and is unreasonable and/or unnecessary, and/or lacks a rational relation to the object of reducing the strain. See [56]. There is room to consider whether those aged 50-59 should be excluded from VDS as well (provided that they do not fall into the same risk profile as those who are 60-61 years old). See [59]. 

(d) 60-61 Years Old and Above: The supermajority of those who require oxygen supplementation and are in ICU are 60-61 years old and above (both vaccinated and unvaccinated). For the limited purposes of reducing strain (as defined below) on the healthcare system, VDS should be recalibrated to only include those who are 60-61 years old and above who are unvaccinated (and only if absolutely necessary, the elderly vaccinated who are assessed to be at very high risk despite being vaccinated), but even then, their mental health needs must be carefully looked into, and the VDS should be lifted immediately upon the strain (as defined below) on the healthcare system being sufficiently reduced. See [60]. 

(e) Percentage of Vaccinated vs Unvaccinated: From the perspective and for the purposes of reducing the strain (as defined below) on the healthcare system, VDS is being underinclusive in failing to include the vaccinated as well, and for only applying to the unvaccinated, since both groups each contribute roughly the same numbers in terms of the strain (as defined below). In this regard, VDS is unreasonable and/or lacks a rational relation to the object of reducing the strain. See [65]. 

(f) Summary for Rationale No. 3: VDS should be recalibrated to include only persons in the high-risk categories of serious Covid illness or death, namely, to those who are 60-61 years old and above who are unvaccinated (and only if absolutely necessary, the elderly vaccinated who are assessed to be at very high risk despite being vaccinated). See [70].

(6) "Rationale" No. 4: The fourth "rationale" (suggested by a member of the media) as a justification for VDS, i.e. that the inconvenience is meant to nudge some of the unvaccinated into taking the vaccine jabs, must be rejected outright. VDS cannot be used as a tool of compulsion. See [71]. 

(7) Recommendations: Various recommendations to policy makers and the vaccinated majority are made below. See [75]. 

(8) Conclusion: See [77]. 

6. Table of Contents: The table of contents below will help you to navigate the various points / sections. 

Yours faithfully, 

Dominic Chan 

A pro-vaccine, fully vaccinated, concerned citizen of Singapore 

* This letter should be read holistically, and nothing in it should be read or cited out of context.