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

Singapore’s government has paid the full treatment costs of nearly all Covid-19 patients since last year, under a pandemic-era policy to ensure financial considerations wouldn’t add to public concern about the disease. On Wednesday, the government withdrew that support for those who choose to go unvaccinated.

“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 many countries that have adopted measures to convince vaccine holdouts. Some European governments are tightening restrictions on the unvaccinated for restaurants and offices. Starting in February, Austria will require all adults to get vaccinated. In Vienna, those who fail to show up for vaccine appointments could face fines of up to $4,050. Greece has made Covid-19 vaccines mandatory for those over 60 and will start issuing fines in mid-January to those who haven’t received a first dose or made appointments to get their first shot. In Germany, politicians are debating similar policies.

The U.S. government is also using pressure to boost vaccinations. In November, the Labor Department said all companies with 100 or more employees would have to ensure that their workers are either vaccinated or produce a negative Covid-19 test at least weekly and wear a mask in the workplace. But the rules have been challenged in court, and several early rulings have gone against federal vaccine requirements in the workplace.

Singapore, however, has already achieved one of the world’s highest vaccination rates, with 96% of its eligible population—which excludes categories such as young children—fully vaccinated, according to the government. It has achieved this in part by restricting activities that the unvaccinated may partake in: They can’t dine in at Singapore’s food courts or enter shopping malls. Still, that hasn’t convinced everybody.

Of particular concern are about 44,000 unvaccinated older citizens. In early November, the Singapore government said that about 95% of deaths over the past six months were of people 60 or older, with 72% of deaths occurring among those who hadn’t been fully vaccinated. Covid-19 cases dropped sharply in Singapore from late October, with a seven-day rolling average peaking at nearly 4,000 cases a day. The country of 5.5 million people is now averaging just under 1,000 new cases a day, according to Our World in Data.

“Because of their choice, unvaccinated individuals account for the bulk of hospital isolation and [intensive care unit] beds, and contribute disproportionately to the strain on our healthcare resources," a Health Ministry spokesman said.

Epidemiologists say they believe Singapore is the first country to adopt a policy of withdrawing coverage of Covid-19 medical costs specifically for those who choose to go unvaccinated. Many public-health experts in Singapore and abroad say the government’s decision has merit.

“They tried everything. They provided information, they provided facts, they’ve had people telling their personal stories, they’ve seen the ministers go and get their jabs, what else can we do?" said Hsien-Hsien 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 cannot afford to not use every tool in our toolbox, even if there is some level of stick involved in it."

But some are opposed to the policy in the tightly controlled city-state. Some residents say it is coercive or that it could 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 small opposition party, the Singapore Democratic Party. “This encourages people to come forward to be diagnosed and treated rather than remain in the community, where they may end up spreading the disease to even more people."

Sabrina Chiu, a 47-year-old unvaccinated Singaporean, said the new policy was unfair. She said she hasn’t gotten vaccinated because she has allergies to many medications, though doctors haven’t told her not to get the shot. “It’s kind of like you are indirectly forcing the people to get vaccinated," she said of the government’s policy.

Ms. Chiu said the new rules wouldn’t persuade her to get vaccinated, though she could see it convincing elderly people in a less secure financial position.

One medical doctor in Singapore, who is vaccinated and asked not to be identified, said the policy sent the wrong message. “The healthcare system needs to be there for everyone, not just for those whose choices we endorse," he said.

A Health Ministry spokesman said its new policy “reflects a civic and moral duty each of us have to ourselves and people around us, during exceptional times like a pandemic crisis."

The spokesman said that unvaccinated people who fall ill will still receive government support for treatment, even though the government won’t automatically cover their full Covid-19 treatment costs as it did before.

Hospital bills for Covid-19 patients in intensive care wards who receive Covid-19 therapeutics often run to about $18,000, according to the spokesman. But the Health Ministry says that means-tested government subsidies for healthcare and the country’s national health insurance program would significantly defray costs, and can reduce the bill to about $1,500 to $3,000 dollars. The government says patients can draw funds from their national medical savings accounts to help fund the rest. “They will be given the best possible medical care," the Health Ministry spokesman said.

Arthur Caplan, founding head of the Division of Medical Ethics at the 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. That is in part because he doubts the unvaccinated will face medical bankruptcies in Singapore, given that it is a wealthy society and medical prices tend to be contained. “Having said all that, it’s not the policy I would choose," he said, adding that it would still be difficult for those who fall seriously ill and have a large bill to pay.

But some medical experts elsewhere look at Singapore enviously, wishing their governments would adopt a similar policy to boost vaccination campaigns. “That would actually help many people and save many lives," said Jin Dong-Yan, a professor of molecular virology at the University of Hong Kong.