Speech by A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health, at the Opening of the 2nd International Symposium on Respiratory Research and Launch of The Academic Respiratory Initiative on Pulmonary Health (TARIPH), 19 March 2018

Professor Lionel Lee, Executive Vice Dean, Lee Kong Chian School of Medicine, 

Professor Darryl Knight, University of Newcastle, Australia 

Assistant Professor Sanjay Chotirmall, Lee Kong Chian School of Medicine, 

Associate Professor Fabian Lim, Lee Kong Chian School of Medicine, 

Distinguished guests, 

Ladies and gentlemen, 

            Good morning.  It gives me great pleasure to join you at the 2^nd International Symposium on Respiratory Research.  Chronic respiratory diseases are a significant contributor to the global burden of disease.  According to WHO estimates, globally, about 235 million people have asthma, 64 million people have chronic obstructive pulmonary disease (COPD), while millions have allergic rhinitis and other often underdiagnosed chronic respiratory diseases.

2           In Singapore, chronic respiratory diseases account for 4.4% of our total disease burden^[1].  COPD is the largest contributor of this burden, and is the 11^th leading cause of death in Singapore^[2].  About 5.9% of adults in Singapore above 40 years of age has COPD, although this is likely an underestimate as many patients remain undiagnosed.

3           The second largest contributor of chronic respiratory disease burden in Singapore is asthma.  About one in five children and one in 20 adults in Singapore^[3] have asthma.  In addition, lung cancer is the second and third leading cancer occurring in local men and women, respectively, from 2011 to 2015^[4].  Lung cancer remains the most common cause of cancer deaths for local men and the second most common cause for women. 

Reducing Healthcare Burden: Importance of Upstream Interventions

4           Given the high burden of lung diseases, the importance of upstream interventions in reducing healthcare burden should be emphasised. Smoking, for example, has been identified as a key risk factor for chronic respiratory diseases.  Since the 1970s, Singapore has introduced many approaches to control tobacco sales and advertising as well as public education initiatives on the harms of tobacco use.  As a result, smoking rates in Singapore fell from 23% in 1977 to 19% in 1984, and further to about 12.6% in 2004^[5].

5           However, the rate of decline in smoking rates has been harder to sustain in recent years as smoking rates have been fluctuating between 12% and 14% in the last decade.  There remains a sizable proportion of men (more than one in five) who smoke daily.  Singapore’s male smoking rate is higher than the rates in 13 OECD countries, including Australia, New Zealand, the United Kingdom and the United States.

6           More needs to be done to achieve sustained improvements in the decline in the smoking rates, so as to attain lower male smoking rates, and to reduce the overall smoking rate as much as possible.  Therefore, we have recently introduced measures such as the point-of-sale display ban for tobacco products, which came into effect in August last year.  The minimum legal age for smoking will also be progressively raised from the current 18 to 21 by the year 2021.  These measures aim to prevent youths from picking up smoking.

7           To support and encourage current smokers to break their habit, the Health Promotion Board has also implemented smoking cessation programmes such as the “I QUIT” campaign, as well as tailored cessation programmes for youths.  Quitting smoking brings immense benefits, beyond health, to the person, and smoking cessation continues to be the most important intervention for the management of respiratory conditions such as COPD.

8           Apart from prevention, we also aim to provide good care to those affected with lung diseases. Since 2001, the Ministry of Health has  put in place the Singapore National Asthma Programme, or SNAP, in all our public hospitals and has progressively introduced the programme in our primary care settings^[6]. SNAP aims to reduce asthma care burden and has helped raise the standard of asthma care. This is evidenced by the reduced number of asthma deaths, which have been kept below 1 per 100,000 population since 2010.

9           In line with the Ministry’s shift to strengthen care beyond hospitals to the community, we are working with healthcare professionals from primary care to address barriers to the provision of optimal asthma care in the community, as well as to develop and streamline shared care workflows among GPs and community partners.  The Ministry is also developing Appropriate Care Guides focusing on COPD case-finding, the value of spirometry and appropriate drug use and management, to better inform clinicians and facilitate diagnosing and managing COPD patients.  The guides should be available in the second half of the year.

Importance of Collaboration in Driving Respiratory Research

10           Beyond prevention and upstream interventions, we will continue to invest in research and innovation for better health outcomes for our patients.  Research and innovation can potentially discover better ways to maintain healthy lungs and prevent disease.  It helps us to understand the pathophysiology of the disease itself, evaluate existing treatments in different patient groups, and optimise service delivery.  This will require close collaborations beyond academic, healthcare and research institutions. 

Launch of TARIPH

11           Today, I am pleased to launch The Academic Respiratory Initiative for Pulmonary Health, or TARIPH.  This new initiative, led by the Lee Kong Chian School of Medicine, brings together academic, research and clinical experts from across Singapore and the healthcare spectrum to benefit Singaporeans living with lung diseases through academic research.

12           Lung diseases affect people of various ethnicities differently.  A pertinent case in point is lung cancer, where it is increasingly recognised that Asian and Caucasian lung cancer patients show marked differences in overall survival.  Asian patients tend to have higher survival and response rates, but experience greater toxicity to chemotherapy.

13           TARIPH’s flagship research effort aims to characterise lung diseases at the molecular level to understand how they take root and develop in Asian patients, while at the same time use clinical data from hospitals and clinics in Singapore to address pertinent questions that will improve clinical care in the future.

14           While the initiative is new, I understand that there are already a number of projects underway.  For example, a multi-institutional team of TARIPH investigators, from the Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital as well as A*STAR’s Institute of Molecular and Cellular Biology, and the Genome Institute of Singapore, have found that the rate of fungal infections underlying bronchiectasis, a disease in which there is permanent enlargement of parts of the lung airways, is remarkably high in Asian populations.  These fungal infections also induce allergic responses that need to be treated, and current research suggests that Asian patients are more likely to be affected than non-Asians.  Besides proposing localised guidelines that will take these findings into consideration, the team is looking at developing new rapid diagnostics to enable the early identification of patients, to prevent further damage to the patients’ infected lungs.

Singapore Initiative – Respiratory Consortium

15           In addition, six institutions from four continents – Nanyang Technological University and the National University of Singapore representing Asia; Sweden’s Karolinska Institute and UK’s Imperial College London representing Europe; University of Newcastle representing Australia; and Canada’s University of British Columbia representing North America – will sign a Memorandum of Understanding to form the Singapore Initiative – Respiratory Consortium to foster closer ties in the field of respiratory medicine.  The Consortium aims to advance our understanding of lung diseases, many of which are preventable.  It will provide seed funding and facilitate collaborations and PhD student exchanges between the partners.

16          These are exciting developments and I look forward to the work of TARIPH in advancing respiratory research.  In closing, let me wish everyone here a stimulating two days of discussions and exchanges, and the TARIPH team every success in this endeavour. 

17            Thank you.

^[1] Singapore Burden of Disease Study 2010. 

^[2] Ministry of Health; mortality data in 2016. 

^[3] HealthHub; https://www.healthhub.sg/live-healthy/641/About%20childhood%20asthma (last updated 2015). 

^[4] Source: Singapore Cancer Registry. Annual Registry Report 2015 

^[5]Ministry of Health; National Health Survey 2010. 

^[6] SNAP has been implemented in Ang Mo Kio, Woodlands, Outram and Pasir Ris polyclinics.