Speech by Mr Ong Ye Kung, Minister for Health at the ASEAN-EU Health Summit, 15 September 2021

Mr Donald Kanak, Chairman, EU-ASEAN Business Council

Excellencies

Distinguished Guests

Ladies and Gentlemen

1.     All health ministers today are seized with managing the ever-evolving COVID-19 situation, while still worrying about the significant challenges regarding the health of our populations and our healthcare systems.

2.      However, as abruptly as we were thrusted into the COVID-19 storm, every country had to adapt quickly to battle the evolving virus. We rolled out vaccination, tested our population widely, imposed social distancing measures, contact traced and quarantined those exposed to the virus. It is a frantic period for all of us, but a lot of good has also come out of it, for we were forced to build up healthcare management capabilities in double quick time.

3.      Throughout history, capabilities built up to respond to emergencies and crises proved to be enduring over time. Controlling floods in China helped build up central administrative capabilities. Earthquakes resulted in better building materials and methods.  Wars propelled the advancement of technology used largely for peaceful purposes now.

4.       Likewise, the capabilities we acquired in fighting the COVID-19 crisis has long term relevance to our healthcare systems.  Today, I will share five such relevant capabilities:

Wider Adoption of Vaccines

5.       First, wider adoption of vaccines.  Many countries have rolled out nationwide vaccination programmes which were largely kept voluntary as they were approved under emergency use. Governments thus had to explain to their people how the benefits of vaccines far outweigh the risks, and that everyone needs to do their part to get vaccinated to overcome the pandemic. Many countries have achieved admirable COVID-19 vaccine coverage. In Singapore, 82% of the total population have taken both doses and 85% have taken the first dose.

6.       Through this exercise, almost every child, adult and senior now know about vaccines and how they work. That there are different technology platforms; no vaccines are 100% protective but can make a big difference when it comes to saving our lives; it is the collective action of everyone coming forward for vaccination that helps to build up herd protection; and we should be alert to misinformation and falsehoods about vaccines.

7.       Today, our children are well vaccinated against diseases Hepatitis B, BCG and MMR. However, vaccination rate for diseases like Influenza has been low.  Based on the 2019 National Population Health Survey, about 1 in 5 Singapore residents aged 18 to 74 years reported taking an influenza vaccination in the past 24 months.

8.       Partially due to the low take up of the influenza vaccine, we still have 600-800 deaths from influenza yearly in Singapore, which could have been prevented by Influenza vaccines.

9.       I hope that post COVID-19, with greater awareness of the benefits of vaccination, our vaccination rates for the other infectious diseases will pick up as well. This will help us avoid more vaccine-preventable diseases and deaths. 

Primary and Community Care

10.     Second, a stronger primary and community care system. During the COVID-19 crisis, when infection numbers climbed, every healthcare system instinctively want to protect its intensive care and hospital capacity for those who needs the medical attention the most. They therefore decant those with mild or no symptoms to recover at home or in community health facilities. In fact, for patients with mild symptoms, it is often better for them to be taken care of by community General Practitioners or family doctors, than by hospital staff.

11.     A crisis like this brought out the importance of primary and community care as the first and most important line of defence. For example, we relied on Acute Respiratory Illness testing at the primary care level to identify COVID-19 cases early and initiate public health actions. This also allowed us to gauge the extent of community transmission. When it came to vaccinations, it was the primary care doctors who managed to persuade people who were hesitant, especially our seniors, to get vaccinated. Because they are not just doctors, but also trusted family friends.

12.     As our population ages, the community care setting is key to our efforts to right-site healthcare. This is where we screen our population for chronic diseases, dispense medical advice to help people lead healthier lifestyles and take preventive measures. We want to avoid the hospitals, because by the time we need their services it is often too late. We should focus on health care and not sickness care, and the former must take place in the community, at the primary care level.

Telemedicine

13.      Third, COVID-19 presented an opportunity to make telemedicine an indispensable feature of our future healthcare system.

14.       Telemedicine is not new to Singapore. In 2018, we introduced a regulatory sandbox for telemedicine to gauge its acceptance, better understand the benefits and risks, as well as co-create solutions with the industry. However, like all new things that concerns our health, the take up has been patchy.

15.        COVID-19 has forced us to quickly scale up deployment of telemedicine operations to support the fight against COVID-19. This is especially when we are pushing for home recovery for COVID-19 patients who are fully vaccinated, young, healthy and have no or mild symptoms. Remember in Asia, our starting point was to follow the medical protocol for SARS, and all COVID-19 patients were warded instead of recovering from home. Switching to home recovery now requires a mindset shift and the provision of 24/7 telemedicine support allows us to provide greater reassurance to the patients.

16.        The pandemic has therefore brought digital health technologies into the fore.  Post COVID-19, I hope there is greater acceptance and confidence with telemedicine, and healthcare can be made more accessible, and brought effectively to the comforts of one’s home.

Better Personal Hygiene

17.       Fourth, personal hygiene. In 2020 and 2021, the incidence of Influenza, other bacterial and viral infections have plunged. Hospitals are reporting record low hospitalisation due to such infections. I for one has not fallen ill since the beginning of last year.

18.       This can be attributed to our population observing safe distancing, and importantly, wearing masks and practising good hygiene habits such as washing our hands more frequently. Singaporeans do not have the habit of wearing a mask when they are ill, but now everyone is wearing one.

19.        In our public hawker centres, we instituted a new rule for patrons to return their trays, something which we probably should have done earlier. In schools, we also instituted a new practice where students will clean up and sanitise the table after their meals in the canteen. Good habits need to be inculcated young, and the pandemic is a good time to for us to start the effort.

20.        I hope all these can become permanent habits of Singaporeans. It will make us healthier and more resilient to diseases.   

A Vaccines Supply Chain and Manufacturing Hub

21.        Fifth, we now have an opportunity to develop Singapore into a vaccines supply chain and manufacturing hub.

22.        Despite COVID-19, the Changi Airhub continues to serve as a node in the world, with a comprehensive network of connections. We have been investing in pharmaceutical cargo capabilities such as cold chain infrastructure. Today, Singapore serves as a COVID-19 vaccine distribution centre to regional countries, in Southeast Asia, Australia and New Zealand.

23.       Building upon our existing base of pharmaceutical manufacturing capabilities, we have further attracted investments from global pharmaceutical companies to manufacture vaccines in Singapore.

24.      BioNTech has announced plans to establish its Regional HQ for South East Asia and a fully integrated mRNA manufacturing facility in Singapore around 2023.  The facility will supply a pipeline of mRNA-based products, and can rapidly respond to potential pandemic threats in the region.

25.      Sanofi also announced its plan to invest EUR400 million to build a new vaccine production site in Singapore. It will be a regional centre of excellence with multiple vaccine manufacturing capabilities.

26.       Lastly, Thermo Fisher Scientific announced that it would establish a new USD130 million Fill-and-Finish facility by 2022 to manufacture vaccines and therapeutics in Singapore.

Pandemic Preparedness

27.       Finally, COVID-19 has helped us become more prepared for future pandemics.

28.       After SARS in 2003, we had a robust system to contact trace and isolate individuals exposed to the virus. We also decided to build a National Centre for Infectious Diseases with 330 beds in 17 isolation and cohort wards. 17 years later, these investments in capabilities and infrastructure have helped us immensely as we confront COVID-19 in 2020.

29.       With COVID-19, we have again built up a whole new arsenal to deal with future pandemics. We are now able to roll-out a national vaccination programme for the whole population. We have a system of widespread testing and surveillance – more than 10,000 PCR tests per million population per day - to detect outbreaks. We have the knowhow to conduct phylogenetic studies and variant detection.

30.       We have an IT system leveraging Bluetooth technology, to elevate our contact tracing capability to the next level. We have put in place a multi-tier system of medical care, for infected individuals with varying degrees of illness severity.

31.       Most importantly, we have a people hardened by the pandemic crisis, such that we know how to co-operate with each other and work in unison to overcome a major challenge like COVID-19.

32.      These are important improvements to our pandemic preparedness for any future crisis. 

Singapore’s Position

33.      The secretariat asked me if I could share Singapore’s model of responding to COVID-19. Today, Singapore finds itself in a rather unique position. We know that it is not possible for a global city state like us to eradicate the virus within our borders. Lockdowns inflict pain and suffering to many workers, families and businesses, especially the small and medium sized businesses.

34.      We will need to open up social and economic activities progressively and safely. People in Singapore – from families, students, workers, executives, businessmen, entrepreneurs, researchers, scientists and leisure seekers - must be able to travel to other countries and back again without prolonged quarantine.

35.      We have therefore decided to embark on a journey to transit to a resilient nation that can live with COVID-19.  But the path we take will not be straight forward, but full of unexpected twists and turns. More importantly, Singapore is trail blazing a road that others have not trampled on.

36.      This is because we know that to live with COVID-19, there must come a time when we will have to ride through at least one big wave of transmission in the community.

37.     Most countries, including many European countries, went through this the hard way and paid a huge price in human lives. Today, you have opened up and people go about their lives quite normally.

38.      Singapore is in a middle of a big wave of transmission in our population, the difference is we are doing so only after vaccinating 80% of our population. So, we are riding this wave in a relatively naïve state, without natural antibodies but with vaccine-generated immunity. Currently, we are monitoring anxiously to see if vaccinations will prevent the rising number of infections from translating into many more severe illnesses and deaths. This will give us the confidence that we can live with Covid-19 safely.

39.      This is where we stand currently: Over the past 23 days, which was when the current wave started, there were about 6,600 new infections detected, with seven admissions to ICUs and two deaths, predominantly accounted for by unvaccinated individuals. The next few weeks will be crucial.

40.       So I am afraid I have no answers on what is the best battleplan against COVID-19.  I can only share that we are at a critical moment and the outcomes in the coming weeks will guide our next steps. We are in this current position, because of the unique approach that Singapore has taken to accelerate our vaccination programme and take calibrated steps to re-open our society and economy.

41.      This is an outcome of medical science, as well as a people who are prepared to hold the fort against the virus until we feel we are sufficiently inoculated, and we are fortunate to be in the position to adopt this approach.

Conclusion - A Common Baptism of Fire

42.     COVID-19 does not recognize nationalities and is a common threat to humankind. Every country and people has been put through a stringent baptism of fire.

43.     In that process the world came together in many ways – sharing scientific discoveries, findings and knowhow in combating the virus, and linking up our supply chains to deliver test kits, medical equipment and vaccines.

44.      We are learning from each other.  For example, over the past 20 months, we witness the healthcare responses of European and Asian countries. For Europe, the starting point was closer to a response for an Influenza outbreak, where individuals rest at home and seek medical help when they are unwell. But that proved to be inadequate against a deadlier virus like COVID-19.

45.     In Asia, the starting point was SARS, where every case was hospitalised, and his contacts identified and isolated to prevent further spread. But that provided to be unsustainable as COVID-19 is far more infectious and affects many more people.

46.      Over time, European countries too started to conduct tracing and isolation, while Asian countries like Singapore are making home recovery the default for vaccinated individuals who are healthy with mild or no symptoms.

47.      I also hope that as soon as we are ready, Europe and Asia can start to rebuild the bridges across our continents again. Singapore and the EU are in discussion on mutual recognition of health certificates, which will pave the way for us to reopen our borders to each other safely.

48.       At ASEAN, member states have committed to the ASEAN Comprehensive Recovery Framework (ACRF) which was adopted at the 37^th ASEAN Summit last November. It serves as the region’s coordinated exit strategy from the COVID-19 pandemic and reflects ASEAN’s commitment to build back better in a pragmatic and sustainable manner.

49.      The key initiatives include the establishment of the ASEAN Regional Reserve of Medical Supplies for Public Health Emergencies, the ASEAN Travel Corridor Arrangement Framework to revive essential business and official travel within ASEAN while prioritising public health and safety.

50.      May this spirit of co-operation stay strong, to help see all of us through this pandemic. Thank you.