OYK makes an announcement.
4d ·
Ministry of Health, Singapore has announced that we will start subsidising shingles vaccinations from September. As a result, the out of pocket cost of two doses of vaccination for seniors aged 60 and above will drop from about $900 now to around $75-300, depending on their household income.
This is old news, but I think it is worthwhile to explain what went behind the scenes that led to the change, MOH’s considerations and internal workings.
The public has been requesting that MOH subsidise this vaccination, which we heard and totally understand. But we had a problem.
Under the pharmaceutical industry’s differential pricing system, Singapore, as a small and higher income geography, pays a higher price for shingles vaccination.
I must reiterate that I am not against this industry practice. This is how the industry works, how it pays for the very high cost of R&D, and it is not unfair that poorer countries pay less than higher income countries so that their people have better access to drugs and vaccines.
But in this case, if we subsidise the vaccine at a high price, we will entrench the high price, with no more room to discuss with the vaccine supplier.
Further, in MOH, we have set up an internal mechanism to make sure that when we decide to subsidise a treatment or a drug, it passes a clinical and cost-effectiveness threshold. In plain speak, it means the additional spending of public monies must be worth it.
Most developed jurisdictions have such a mechanism. In Singapore, we have a team called the Agency for Care Effectiveness to do this, staffed by clinicians and economists. They assess the evidence for the drug or treatment, and provide their professional assessment on its clinical and cost-effectiveness. This is further assessed by a panel of senior clinicians who then make their recommendation.
This ensures that when we ever come under pressure to splurge on subsidies, including on expensive drugs and treatments where the benefits do not justify the very high cost, there is a robust process to focus on the evidence and the science. Internally, we must also have the discipline to heed their advice when we make our policies.
Under this system, the shingles vaccine was initially not assessed to be cost-effective. The supplier understood this. We had good discussions which led to price adjustments to meet our concerns on cost-effectiveness, and MOH came in to subsidise the vaccine.
More importantly, we now bring the shingles vaccine under our population health measures, and recommend it under our National Adult Immunisation Schedule, together with others like the influenza and pneumococcal vaccines.
Post COVID-19, Singapore’s population health strategy has received strong international attention, and our move on shingles vaccination can have a significant salutary effect.
I thought to take this opportunity to let people know how policy decisions are made in a complex and modern socio-political environment, squaring off the needs and considerations of the public, industry, clinicians, economists and policy decision-makers. It is really becoming a complex art.
