Not vaccinated? In Singapore, you’ll pay for your own COVID-19 treatment

Singapore’s government has since last year paid the full treatment cost of almost all Covid-19 patients, as part of a pandemic-era policy to ensure that financial considerations will not add to public concern about the disease. On Wednesday, the government withdrew that support for those who opt to go without vaccination.

“We have to send this important signal to urge everyone to get vaccinated if you are eligible,” Health Minister Ong Ye Kung said last month.

Singapore is one of several countries that have adopted measures to celebrate vaccine holdouts. Some European governments are banning unvaccinated access to restaurants and offices. Austria will require all adults to be vaccinated from February. In Vienna, those who fail to appear for the vaccine could face fines of up to $4,050. Greece has made COVID-19 vaccines mandatory for people over 60 and will begin issuing fines in mid-January for those who haven’t received their first dose or made an appointment to get their first shot. In Germany, politicians are debating similar policies.

The US government is also pressing to promote vaccination. In November, the Labor Department said all companies with 100 or more employees must ensure that their employees are either vaccinated or test negative COVID-19 at least weekly and wear masks in the workplace. But the rules have been challenged in court, and several early rulings have gone against federal vaccine requirements in the workplace.

Although Singapore has already achieved one of the world’s highest vaccination rates, 96% of its eligible population – which does not include categories such as young children – have been fully vaccinated, according to the government. This has been achieved in part by restricting activities in which vaccinations cannot be carried out: they cannot dine in Singapore’s food courts or enter shopping malls. Still, it hasn’t reassured everyone.

Of particular concern are the approximately 44,000 non-vaccinated older citizens. In early November, the Singapore government said that nearly 95% of deaths in the past six months were in people 60 or older, with 72% of deaths in people who had not been fully vaccinated. Covid-19 cases declined sharply in Singapore since late October, with a seven-day rolling average peaking at around 4,000 cases a day. According to Our World in Data, the country of 5.5 million people now averages less than 1,000 new cases per day.

“Because of their choice, unaffiliated individuals are responsible for a large proportion of hospital isolation and [intensive care unit] beds, and contribute disproportionately to the strain on our health resources,” a health ministry spokesman said.

Epidemiologists say they believe Singapore is the first country to adopt a policy to withdraw coverage of COVID-19 medical costs specifically for those who choose to go without vaccination . Several public-health experts in Singapore and abroad say the government’s decision has merit.

“They tried everything. They provided information, they provided facts, they have seen people telling their personal stories, they have seen ministers leave, what else can we do?” Hsien-Sean Lei, chief executive officer of the American Chamber of Commerce in Singapore and an adjunct associate professor at the National University of Singapore’s Saw Swee Hock School of Public Health. “We can’t use every tool in our toolbox, even if it involves some level of wand.”

But some are opposing the policy in the tightly controlled city-state. Some residents say it is coercion or that it may increase transmission by discouraging unvaccinated people from seeking medical care.

“The basic public-health principle is to provide free treatment for highly communicable diseases,” said Paul Tambyah, chairman of a smaller opposition party in the Singapore Democratic Party. “It encourages people to come forward for diagnosis and treatment, rather than the community, where they can spread the disease to even more people.”

Singapore’s Sabrina Chiu, 47, said the new policy was unfair. She said she has not been vaccinated because she is allergic to several drugs, although doctors have told her not to take the pill. “It’s like you’re indirectly forcing people to get vaccinated,” she said of the government’s policy.

Ms Chiu said the new rules would not persuade her to get vaccinated, although she could see it as reassuring older people in less secure financial positions.

A medical doctor in Singapore, who has been vaccinated and asked not to be identified, said the policy sent the wrong message. “The healthcare system should be for everyone, not just those whose choices we support,” he said.

A health ministry spokesman said its new policy “reflects the civic and moral duty of each of us to ourselves and those around us, during extraordinary times such as the pandemic crisis.”

The spokesperson said people who fall ill will still receive government assistance for treatment, even though the government will not automatically cover their full COVID-19 treatment costs as it did earlier.

According to the spokesperson, hospital bills for COVID-19 patients in intensive care wards receiving COVID-19 therapeutics often run up to around $18,000. But the health ministry says government subsidies for health care and the country’s national health insurance program will significantly reduce costs, and could reduce the bill by about $1,500 to $3,000. The government says patients can withdraw funds from their national medical savings accounts to help with the balance. “They will be given the best possible medical care,” a health ministry spokesperson said.

Arthur Caplan, founding head of the department of medical ethics at New York University Grossman School of Medicine, said he thought it was ethical to threaten not to cover COVID-19 costs as a way to encourage vaccination. This is partly because he suspects that non-vaccinated Medicare in Singapore will face bankruptcy, given that it is a wealthy society and the prices of Medicare are steep. “Having said all this, this is not the policy I would choose,” he said, adding that it would still be difficult for people who fall seriously ill and have a huge bill to pay.

But some medical experts view Singapore with envy, wanting their governments to adopt a similar policy to boost vaccination campaigns. “It will really help many people and save many lives,” said Jin Dong-yan, professor of molecular virology at the University of Hong Kong.