​Last updated on 27 February 2024


1. This Operations Instruction seeks to inform Vaccination Providers on the instructions to operationalise the COVID-19 vaccination for children aged 6 months to 4 years who are receiving the Pfizer-BioNTech/Comirnaty XBB.1.5 Monovalent vaccine.

Principal Considerations

2. The principal considerations are as follows:

a) Client Safety

    i. Minimum age of eligible client to receive the mRNA COVID-19 vaccination should be calculated based on the date of birth, not just the birth year. The authorised minimum age specified for each vaccine type can be found on the respective MOH Guidance document for Vaccination Providers.

    ii. For clients who are receiving the vaccines for the first time, the second dose of the primary series could be offered to be received at the same venue as the first dose, and the vaccine should be from the same manufacturer as the first dose. Vaccination Providers should pay attention to the interval between the doses.

b) Minimise Vaccine Supplies Wastage

    i. Due to the short shelf-life of the thawed vaccines, Vaccination Providers should avoid holding on to excess vaccine supplies and should trigger re-supply only when necessary.

    ii. Due to the short shelf-life of the vaccines after opening of vials, Vaccination Providers should plan and schedule the client's vaccination in batches to reduce vaccine wastage.

Concept of Operations

3. Vaccines will be administered to individuals aged 5 to 11 years at designated vaccination sites offering Paediatrics vaccination, such as. Joint Testing and Vaccination Centres (JTVCs), Public Health Preparedness Clinics (PHPCs), Polyclinics, etc.  

4. Leverage on Mobile Vaccination Teams (MVTs) and Home Vaccination Teams (HVTs)

Mobile Vaccination Teams (MVTs) and Home Vaccination Teams (HVTs) will be deployed to conduct onsite vaccinations at Special Education (SPED) schools and Early INtervention Programme for Infants and Children (EIPIC) Centres for individuals aged 5 to 11 years

Home Vaccination Teams (HVTs) may be deployed to conduct vaccinations at the individual's residential home upon request (if the child has mobility issues).

Operating Parameters

5. Vaccination Providers will continue to achieve throughput as per MOH's latest instructions.

Updates to Clinical Guidance

6.1  Individuals who have not been vaccinated against COVID-19 with effect from 1 March 2024 are now recommended to receive two initial vaccine doses. 


Eligible Age

Dose(s) and Recommended Intervals

Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent COVID-19 Vaccine1

5 to 11 years

Primary series vaccination

  • 2 doses of 10 mcg (0.3mL)
  • 8 weeks apart

2023/2024 additional dose

  • 1 dose of 10 mcg (0.3mL)
  • 1 year after the last dose

1 Vaccine dose of the Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent COVID-19 vaccine to be used for primary series vaccination in individual ages 5 to 11 years is 10 mcg (0.3mL), the same as that used for the booster dose.

6.2  The advice to avoid strenuous physical activity after vaccination is updated to apply to only male vaccinees aged 12-29 years, for a duration of 1 week.


6.3  COVID-19 vaccines can now be administered concurrently with other non-COVID-19 vaccines across all ages eligible for the vaccine.


6.4  There is no longer a stipulated period of observation after COVID-19 vaccination, other than for persons at increased risk of anaphylaxis who should be observed for 30 minutes. These individuals include those who had a past history of:

  1. Allergic reactions (that is, immediate hypersensitivity reactions) to other COVID-19 vaccines, OR,

  2. Any anaphylaxis


6.5  Emergency drugs/equipment requirements for COVID-19 vaccine providers is now aligned to that required under prevailing regulatory requirements relevant to the licensable healthcare service which the licensee is licensed for and is stipulated in the "Licence Conditions for Providing or Intending to Provide Emergency Life Saving Measures".


6.6  There is no more restriction of nonsteroidal anti-inflammatory drugs (NSAIDs) use after COVID-19 vaccine administration.

6.7  For ages 5 years to 11 years, the updated Pfizer-BioNTech/Comirnaty XBB.1.5 COVID-19 vaccine DOES NOT REQUIRE DILUTION, and the volume of each dose is 0.3mL (10mcg). This is different from the previous version of the Pfizer BioNTech/Comirnaty vaccine.

6.8  Information on dosage, administration, storage, and handling are included in the vaccine package insert. Vaccination Providers staff should ensure that they are familiar with the materials before carrying out vaccinations.

6.9  Vaccination centres should refer clients with conditions listed in Table 1 to the hospital for their COVID-19 vaccination.

Table 1: Exceptions for vaccination in hospital


Consider Vaccination in Hospital


  • Persistent fluid overload or pulmonary hypertension and/or in NYHA class 3 or 4 symptoms
  • Severe, symptomatic stenotic valvular heart disease (with angina, faints, shortness of breath)
  • Hypertrophic cardiomyopathy with outflow tract obstruction


  • Advanced neuromuscular conditions with chronic respiratory failure, especially those on prolonged BiPAP support
  • Chronic lung disease with need for respiratory support (i.e. on supplemental oxygen or requiring suctioning)


6.10  Table 2 provides a non-exhaustive list of conditions that can be vaccinated at community vaccination sites.

Table 2: Non-exhaustive list of conditions that can be vaccinated at community vaccination sites


Can be safely vaccinated in community vaccination sites


All patients with non-vaccine related allergies can be safely vaccinated in a community vaccination centre.


Except for conditions in Table 1, all other patients can be safely vaccinated in a community vaccination centre.


Haemodialysis and peritoneal dialysis patients

Transplant patients

Complex renal patients with comorbidities

Patients on immunosuppression

Neurology and Rehabilitation Medicine

Patients with neuroimmunological conditions (e.g. MS, NMOSD, autoimmune encephalitis etc) can be safely vaccinated in community vaccination centres

Patients on immunosuppression should discuss with their attending physician before COVID-19 vaccination


See paras 6.7 and 6.8.

Patients with stem cell transplants should discuss with their primary specialist before COVID-19 vaccination.


Except for conditions in Table 1, all other patients can be safely vaccinated in a community vaccination centre

Cystic fibrosis and other forms of severe bronchiectasis can be vaccinated.


Patients on Rituximab should discuss with their primary rheumatologist before COVID-19 vaccination.

Cardiothoracic and Vascular Surgery

Safe to vaccinate in a community vaccination centre.

Psychological Medicine

Safe to vaccinate in a community vaccination centre.


6.11  It is safe for clients currently on cancer treatment (chemotherapy/immunotherapy/ radiotherapy) to be vaccinated. However, they may be advised to consult their oncologist on the optimal timing, weighing better vaccine effectiveness against the risks of delay in view of their vulnerability to COVID-19 infection.


6.12  Clients with cancer who have not been on chemotherapy/immunotherapy/radiotherapy for the past 3 months can be vaccinated. This includes clients currently on hormonal therapy. Hormonal therapy is not considered chemotherapy or immunotherapy. There is no need for a memo from the oncologist.


6.13  There may be instances where Community Vaccination Centres may refer clients for vaccination at a hospital in-situ vaccination site for non-medical reasons, for example, unwillingness to be vaccinated at a Community Vaccination Centre due to heightened parental concerns over their clien's pre-existing medical condition, or clients who are uncooperative in a community vaccination centre setting. In such instances, it should be emphasised to parents that this referral is specifically for COVID-19 vaccination and there is no scheduled review with any paediatrician at the hospital's in-situ vaccination site on the day of the vaccination.

6.14  MOH has provided the following clinical guidance materials to support vaccination provider staff who are carrying out vaccinations. Personnel who are carrying out vaccinations should ensure that they are familiar with the materials before carrying out vaccinations.

COVID-19 Recovered Persons

6.15  Recovered persons who were unvaccinated, or partially vaccinated before their infection can proceed to complete the standard primary vaccination series. They are recommended to receive remaining vaccine doses from 3 months or more after the date of infection to reduce their risk of reinfection.

6.16  Recovered persons who are recommended to receive a COVID-19 vaccine dose after their last vaccine dose should do so at the recommended interval thereafter, and at least 28 days after the infection although an interval of three months from the infection is recommended for better effectiveness.

Parent Consent for Vaccination 

7.1 Persons below 13 years old are required to have the consent of their parent or legal guardian in order to be administered with the vaccine. The parent or legal guardian must also be present on the vaccination day.

Requirements on Granting of Consent and Consent Verification (including in person parent/guardian presence) 

7.2 The Vaccination Providers will verify the following before administering the vaccine to the client: 

a) HAS Appointment. Verify the HAS appointment​ status of the client to ensure that he/she has a valid appointment booked when present. If there is a valid HAS appointment, consent was given at the point the appointment was made and there is no need for written consent. If the client does not have any valid appointments, Vaccination Providers shall facilitate the client's vaccination on site and ensure that consent has been obtained

b) Verify the identification document of the client to ensure that he/she is the correct person for whom the parent/legal guardian had booked the vaccination appointment. 

c) Clients who present the MOE EZ-link as their identification document will be recognised as MOE students. Vaccination Providers should record the accompanying adult's relationship with the client in GPConnect-lite​.

d) If the client presents other forms of identification documents (e.g. birth certificate or other valid identification cards), Vaccination Providers shall verify the parent/legal guardian's signed letter of consent​ either in hardcopy or softcopy format, provided by the client. If the client is unable to produce the signed letter of consent​ either in hardcopy or softcopy format, the Vaccination Providers will verbally verify consent with the parent/legal guardian, whose presence is required in-person, and record the consent in GPConnect-lite​. Consent for this group is sought at the point when the appointment was made.

For foreign clients with foreign identification documents or whose birth certificates indicate they were not Singaporean at birth, Vaccination Providers shall register the clients with their FIN number.

Vaccination Providers are not required to retain the hardcopy of the signed letter of consent​. However, the Vaccination Providers should document the parent's/legal guardian's consent in GPConnect-lite/PRPP or vaccination provider's IT system by capturing the following details for every client whose parent/legal guardian consent​ needs to be verified:

  1. ​Name of the parent/legal guardian 

  2. Contact number of the parent/legal guardian 

  3. Consent obtained from parent/legal guardian 

  4. <Mode of consent obtained> from parent/legal guardian 

  5. Relationship between parent/legal guardian and client 

e) For the second and additional dose appointments, the Vaccination Providers onsite will again verify that the client has the required parent/legal guardian consent and captured the same details in GPConnect-lite/PRPP​ or vaccination provider's IT system for each appointment, before administering subsequent doses. 

f) The Vaccination Providers will capture the required data under the “Clinical Notes" area and in accordance with the template shown below as a guide. 

Clinical Notes in GP Connect Lite.jpg

7.3  Hospitals and other healthcare institutions that provide vaccination services to their existing clients should obtain consent from a parent/legal guardian for their clients who are below 18 years old, using the hospital/institution's existing processes. Hospitals/institutions should document the parent/legal guardian's consent obtained in an appropriate EMR/IT system. 

Medical Screening for Clients

7.4  For medical screening questions which are not declared by the parent/legal guardian on behalf of the client, the Vaccination Providers onsite should ask the client these questions when the client presents himself/herself for vaccination with an authorised proxy. If the Vaccination Providers assesses that the client is unable to answer the screening questions, or seems unsure about the screening questions, or seems not to be taking the vaccination process seriously, the Vaccination Providers should for avoidance of doubt contact the parent/legal guardian to clarify the answers to the relevant questions before administering the vaccine to the client. 

7.5  If the parent of the client is present in-person during the vaccination, the Vaccination Providers should ask the parent/legal guardian the screening questions, for the parent/legal guardian to answer on behalf of the client. 

7.6  The vaccination will generally follow the processes below: 

a) Pre-vaccination – Clients will make an appointment or walk-in for vaccination. 

b) On-Site Registration and Triaging – Upon the client's arrival at the vaccination site, the client will be triaged and screened based on the client's updated information and age. For organisations with access to National Electronic Health Record (NEHR), the Doctor/Nurse should also access the client's NEHR via GPConnect Lite/Staff Surveillance System (S3)/Electronic Medical Record (EMR)/Patient Risk Profile Portal (PRPP) or vaccination provider's IT system to verify the client's medical history. COVID-19 vaccines can now be administered concurrently with other non-COVID-19 vaccines across all ages eligible for the vaccine. The Doctor/Nurse should also check the client's COVID-19 vaccination records, if any, via GPConnect Lite/S3/EMR/PRPP or vaccination provider's IT system. 

c) Vaccination - Vaccination and data capture. 

d) Post-vaccination – Monitoring of the client and reporting of adverse effects, if necessary. 

Referral to Public Healthcare Institutions (KKH/NUH) for In-Situ Vaccination 

7.7  The default posture is for vaccination to take place in the community. Most clients can and should be safely vaccinated in the Vaccination Centres. There are rare exceptions who may require vaccination in a hospital setting. The workflow for such referrals and documents required for the vaccination process are as follows:

7.8  The following documents are required during the vaccination process:

  • Vaccination Information Sheet: Vaccine information and post-vaccination advice for client, if necessary.

  • Vaccination Screening FormReference of the minimum dataset for various uses, including registration, declaration of contraindications, indication of consent, medical record documentation, and vaccination procedure medical record documentation.

  • Vaccination Card​:  To be issued to client's parent/legal guardian after the vaccination is administered, if required. Vaccination Card is not meant to be used for travel purposes/proof of vaccination. Client's parent/legal guardian may request for a digital vaccination certificate from the Notarise website.​

Vaccination Screening Form

7.9  If a client has been assessed to be ineligible or has to be deferred for vaccination, the screening Doctor/Nurse should reflect the associated reason/medical conditions on the GPConnect Lite/S3/EMR/PRPP or vaccination provider's IT system as follows:

a) The reasons/medical conditions2 should be aligned to the latest recommendations indicated in the definition of medical ineligibility for all COVID-19 vaccines under NVP in MOH circulars, last updated in circular no. 183/2021​.

b)  The screening Doctor/Nurse should clearly communicate the said reasons to the client.

7.10  Clients undergoing the second/additional dose do not need to complete a new Vaccination Screening Form. Vaccination Providers should continue to exercise due diligence to assess clients during screening/triaging. This includes questioning the parent(s)/legal guardian as to whether the client experienced anaphylaxis after previous doses. The Vaccination Batch Number should continue to be recorded, as new batches would be distributed to institutions in future.

2The reasons/medical conditions are codified in GPC as: fever, acute respiratory infections, general unwell, immunosuppression, platelet count abnormality, allergy to vaccine product, history of drug-induced anaphylaxis, others, cancer treatment.

​Daily Reporting Requirements

7.11  Vaccination Providers are required to submit daily reports  to MOH. The reporting requirements are as follows:

  • ​Data reporting is to be submitted through PRPP, the cut-off time for data submission each day is 2359 hrs each day.

  • PRPP Reporting Module: Clinics are only required to key in the information below under the reporting module. Other necessary information will be auto-populated by PRPP for reporting to MOH:

    • Doses administered/ Number of persons vaccinated

    • Number of Vials used

    • Efficiency Ratio (Total doses administered/ Number of vials used)

    • Inventory at the end of the day (In vials)

    • Wastage (In doses) 

    • Wastage reason (if any)

Please refer to the PRPP COVID-19 Vaccination Module Quick Start Guide here​.

Vaccine Handling and Storage

8.1  Vaccination Providers should adhere to the following vaccine storage guidelines.

a) Undiluted vaccine vials should be stored in a refrigerator with the temperature maintained between 2°C and 8°C and must be monitored. For refrigerators that do not have a temperature data logger, the internal temperature of the refrigerator where vaccine vials are stored should be recorded twice daily, e.g. in the morning and evening.

b) Care should be taken to protect the vaccine vials from light if the refrigerator door/window panel is transparent.

c) Adopt a first-expire-first-out system when retrieving vaccine vials from the refrigerator.

8.2 Vaccination Providers should adhere to the following vaccine handling guidelines.

a) Vaccine vials should always be protected from light when not being handled. Handling refers to the process of preparation (when diluting or pre-filling the syringe) and administration of the vaccine.

b) Vaccine vials should be visually inspected for discolouration, or particulates before dilution, after dilution and before each syringe is filled during preparation.

c) When filling the syringe, the dose in each syringe should be visually inspected by lifting up each syringe to check for (I) the correct final dosing volume, (ii) no discolouration and no particulates, and (iii) no air bubbles.

Disposal of Used/Empty Vaccine Vials, Syringes and Needles​

8.3  Used/empty vaccines vials are considered pharmaceutical waste. They should be collected in containers that are non-reactive, tamper-proof and designed to resist impact rupture and labelled with the proper colour code and symbol before disposal by a licensed biohazard waste collector.

8.4  As COVID-19 vaccines delivered to vaccination sites are considered controlled consumables, used/empty vials should be properly accounted for and stored in a controlled environment before disposal to prevent unauthorised possession.


8.5  Vaccination Providers should adhere to the following guidelines to prevent needle-stick injuries.

a) Used needles and syringes should be disposed as one single unit into a Sharps Disposal Container immediately after they have been used.

b) Used needles should not be removed from the syringe, bent or broken by hand manipulation/removal device/port to prevent accidental needle sticks which may cause serious infections.

c) Used needles and syringes should not be left protruding from Sharps Disposal Containers, and Sharps Disposal Containers should not be more than two-thirds full.

d) Sharps Disposal Containers should be located in a safe and secure position such that they cannot be easily tipped over. Sharps Disposal Containers should not be stored on the floor or above shoulder level.

e) There should not be any form of crossing over of hands/clients when disposing used needles and syringes into Sharps Disposal Containers.

f) When Sharps Disposal Containers are not in use, the temporary closure mechanism must be used.

g) If recapping of needles is necessary or required as part of the vaccine preparation workflow, the needle should be recapped with the aid of a pair of forceps, using a cap-holding device, or using a “one-handed scoop" technique to scoop the cap.

8.6  Vaccination Providers should ensure that Sharps Disposal Containers used are properly, securely, and safely stored in a controlled area that is not accessible by any unauthorised personnel. Proper storage and handling of Sharps Disposal Containers before disposal must be adhered to as part of workplace safety management (i.e., Sharps Disposal Containers must not be stacked hazardously.)

8.7  Please refer to the National Infection Prevention and Control Guidelines​ for more information.

Inventory Management​​

8.8  Vaccination Providers should account for the vaccines issued. Proper recording of vaccine inventory and stock movement (e.g. stock balance/usage/received/transferred/wastage/disposed) should be maintained. Vaccination service providers are recommended to adopt the good practice of counting empty/used/damaged vaccine vials before disposal, to ensure that the quantity discarded tallies with that taken out of the fridge.

8.9  Vaccination Providers must have a system to monitor the stock expiry and transfer any excess stock to fellow Vaccination Providers at the first instance, to reduce wastage. If necessary, Vaccination Providers may seek assistance from your operations lead (PHPCs should contact their AIC Account Manager​)
 at least 2 weeks before expiry for MOH redistribution of the excess stock, subject to availability of vaccination sites that are able to consume before expiry.

8.10  Vaccination Providers are recommended to hold sufficient supply for 5 to 7 days to keep the vaccine fresh, and to manage the supply and re-supply properly to keep wastage to a minimum.


Pfizer-BioNTech/Comirnaty XBB.1.5 Monovalent (6 months to 4 years)

8.11  The Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent (6 months to 4 years) vaccine will be thawed by MOH's vaccine distributors and delivered to Vaccination Providers at the temperature range of 2°C and 8°C. The shelf-life of the vaccine is 10 weeks once removed from the freezer at the central warehouse. The expiry date of the vaccine at 2°C and 8°C will be labelled on the vaccine vial.

8.12  Each Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent (6 months to 4 years) vaccine vial is a multi-dose vial sufficient for 10 clients to be vaccinated. Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent (6 months to 4 years) vaccine requires dilution and must be used within 12 (twelve) hours from the time of dilution.

8.13  Vaccination Providers are required to submit vaccine orders via
Zuellig Pharma's Online Ordering Portal.
(Note: If the portal is temporarily not available or experiencing issues, vaccination providers may email Zuellig Pharma at SGZPSCSOrdersMailbox@zuelligpharma.com​ their COVID-19 Vaccine order form​ and cc MOH at MOH_SRMD_Supply@moh.gov.sg.)

8.14  Vaccination Providers should note the order cut-off time, and the expected delivery when requesting for top-up of vaccines.

Order Placed on Working Day Vaccine Delivery
Day 1; Before 10am By Day 4; Within 3 working days

Day 1; After 10am

(Processed as Next Working Day; Day 2)

By Day 5; Within 4 working days

Orders placed on Friday and Eve of Public Holiday (By 10am)

Next 3 working days
​Note: No order processing on​ weekends and public holidays.


8.15  Please refer to the detailed work instructions for the requisition of vaccine and medical supplies.

8.16  Medical supplies such as needles and syringes may also be ordered from MOH via ST Logistics, if the medical service provider is unable to obtain the supplies from their usual sources.


Low Dead Volume (LDV) Needles & Syringes

8.17  Vaccination sites can order the MICSAFE NIPRO Slip Tip 1cc LDS syringe and NIPRO Hypodermic 25G needle (as a set). Users should attempt to extract 10 doses from the Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent (6 months to 4 years) vial.​

9.1  The broad approach for IT systems is to provide a unified and integrated system to complement the appointed Vaccination Providers with the administrative and clinical functions to handle the operations' requirements.

Health Appointment Booking System (HAS)

9.2  The COVID-19 vaccination appointment booking function had been incorporated into the HAS​ to enable MOPs to schedule their COVID-19 vaccination appointments at the respective vaccination sites. This system will enable notifications and reminder functions to facilitate appointment attendance.


Vaccination Operations EMR System

9.3  GP Connect Lite (GPC Lite) has been identified to be the EMR System to manage the Vaccination Providers operations.

Mobile Vaccination Team (MVT) Deployments

9.4  MVTs would be deployed to vaccinate those with special needs (i.e., EIPIC Centres) OR for specific purposes (i.e., Temp VCs). Such setups would not be connected to HAS.

Updating of COVID-19 Vaccination Records in the National Immunisation Registry (NIR)

9.5  Updating of Vaccination Records into NIR will be done via GPC Lite automatically. Vaccination Providers and MVTs are to ensure that all clients' Vaccination Records accumulated within each operational day are entered into GPC Lite by 2200H on the same day.

Manual Updating of Vaccination Records into National Immunisation Registry (NIR)

9.6  There are currently 2 main methods to manually update Vaccination Records into NIR Web Portal. Vaccination Providers performing the updating of Vaccination Records via this route are to login using their Corp Pass account using this internet link​.

9.7  Data Entry Method: Vaccination Providers may choose one of the following relevant modes to perform the data entry function on NIR Web Portal. 'Individual Record Entry (18 Years Old and Above)', 'Individual Record Entry (Below 18 Years Old)' and “Multiple Record Entry".

9.8  Batch (Excel) Upload Method: Vaccination Providers may choose to batch Vaccination Records and pre-populate them into the .xls excel template provided on NIR Web Portal. The completed templates should be uploaded into NIR Web Portal within the daily stipulated timing. Vaccination Providers should not develop the template on their own.

9.9  To perform the operations specified in this section efficiently, Vaccination Providers are advised to apply for an appropriate number of NIR “User" accounts within their respective organisations to assist with the updating requirements.

9.10  The collective instructions for manual updating of Vaccination Records into NIR are prescribed in this document​.