SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT THE PRECISION PUBLIC HEALTH ASIA 2023 CONFERENCE, 13 JULY 2023, 8.55AM, AT THE NG TENG FONG CENTRE FOR HEALTHCARE INNOVATION

Dato Dr Isham Jaafar, Minister of Health, Brunei Darussalam

Associate Professor Jeremy Lim, President, Precision Public Health Asia Society

Dr Clive Tan, Organising Chair

Ladies and Gentlemen

     It is my pleasure to be here with you at the Precision Public Health Asia (PPHA) 2023 Conference today.

2.     The regular participants of this Conference know that precision public health is a well-recognised term, which refers to the use of data, analytics and other technologies to help improve health at the population level. But when you take a closer look, precision public health is actually a rather provocative concept, because it juxtaposes two quite incongruent terms, ‘public health’ and ‘precision’, together. Let me explain why.

3.     When we talk about public health, it is focused on developing interventions aimed at reducing the disease burden at the population level. In the field of public health, we know that every population segment, whether classified by age, gender or even the geography that they are living in, possesses different health characteristics. 

4.     If we drill deeper, every individual is different and will respond to the interventions in varying ways.    

5.     In other words, public health deals with big numbers and is inherently imprecise. But that does not mean it is not powerful. When the interventions are well-developed and implemented across the population, they do influence individual behaviour, which collectively shapes the social determinants of health.

6.     The cumulative effect of individual actions, while not down to the last person, can deliver very good and cost-effective health outcomes. This is what we seek to achieve in the War on Diabetes and now Healthier SG. 

7.     Awareness of the importance of public health is rising following the COVID-19 pandemic. It is also due to the ageing demographic of many societies around the world that makes population level interventions necessary. Very importantly, I think it is also driven by the possibilities that technology can now offer. 

8.     The convergence of digitalisation, big data, wearables and AI, means that we can collect and analyse data, and influence population behaviour much more than before. Public or population health, I think, is at the cusp of a promising revolution.  

9.     At the other extreme end of the healthcare spectrum is precision medicine. The starting point is the recognition that individuals possess unique genotypic characteristics, and we may respond to external health factors, medication and treatment differently.

10.     Precision medicine therefore focuses on the development of personalised clinical approaches for an individual – no different from how social media platforms like Instagram or TikTok know your specific consumption behaviour on social media, and feed you the right videos. 

11.     With precision medicine, we can potentially sequence and analyse the genome of an individual, predict the likelihood of developing certain clinical diseases later on in life, adjust treatments to minimise the risk of unintended adverse reactions to the person, or design customised treatment regimens. 

12.     I should add a few major caveats about precision medicine, which is often a bit oversold at this point. Medical science has not fully figured out how best to make use of genetic information that can lead to meaningful and practical clinical follow-up actions. 

13.     Further, most of the applications envisaged, including treatments like gene editing, are experimental in nature and may only work on a selected few. Treatments can also be expensive, costing up to millions of dollars per treatment, that may not be financially sustainable for any healthcare system in the world. In fact, no healthcare system in the world is designed for treatments like these, and Health Ministers around the world have to figure what to do with precision medicine, when it becomes something that can be deployed to more people.

14.     Nevertheless, like public health, precision medicine is also at the cusp of a major revolution. Why?

15.     Again, it is because of digital technology. It has helped drive down the cost and ease of full genome sequencing. Data analytics using information on genotypes and social factors can be used to provide predictive models for individual care. mRNA vaccines are essentially derived from genomic data. 

16.     These developments have given rise to the current unprecedented situation in healthcare today. Public health and precision medicine continue to be at the opposite ends of the healthcare spectrum – one dealing with large numbers imprecisely, and the other about customised treatment of one individual. 

17.     But both ends are now brought together today by digital technology in medical science. Perhaps it is because numbers and codes can be found or run through the laws of nature.

18.     As a result, a new frontier of innovation in healthcare has opened up. We are already realising some of the potential of precision public health. Let me cite a few examples.

19.     First, we are using clinical data within electronic medical records with data from non-clinical domains, such as education, household income or lifestyles, to better understand the relationship between diseases and social parameters. In Singapore, we are using platforms like TRUST to enable better access to data for analytics and research.

20.     Second, under Healthier SG, we are developing health plans for individuals.  The initial versions are likely to be more generic, but over time we hope to improve them to make them more and more personalised.  This can be achieved as individuals use digital apps like Healthy 365 and other commercial apps like LumiHealth to track their health goals and nudge them to stay on top of their personalised health plans. As they review their progress with their GPs, health plans can be iterated and improved upon.

21.     Third, through RNA technology and advanced computational techniques, companies such as MiRXES and Grail are developing blood tests for multi-cancer early detection.  These are potential game changers in managing cancers.

22.     Fourth, in December last year, I launched the SG100K research programme, a collaboration between the Lee Kong Chian School of Medicine, Saw Swee Hock School of Public Health, National Heart Centre Singapore, Singapore Eye Research Institute and Singapore National Eye Centre. The programme entails the collection of detailed baseline health information, sequencing, and analysis of 100,000 Singaporean whole genomes across different backgrounds and ethnicities. The researchers will also monitor and follow the participants’ health and wellbeing over time, and cross-reference disease registries, and to health, social and environmental records.

23.     With the findings of SG100K, we can identify the genetic, social, environmental and lifestyle factors associated with diseases prevalent in our multi-ethnic population of Singapore. This will pave the way for better prediction and prevention of chronic diseases and provision of value-based, effective healthcare.

24.     Fifth, during COVID-19, we downloaded healthcare apps and allowed them to monitor our movements and close contacts, so that we can identify the risk of exposure to the COVID-19 virus. That was precision medicine applied at the population level.

25.     It is often said that innovation happens at the intersection of disciplines, and it is now happening between public health and precision medicine.

26.     This is also one of the less mentioned objectives of Healthier SG, a significant national healthcare strategy. If we put it in place, it means  clinical processes, IT systems and funding mechanisms must work and are in place. You have to bring in as many General Practitioners as you can into this system. When we have done all these, Healthier SG can be a powerful receptacle and crucible for innovation in healthcare. If there are new innovation techniques in precision public health, Healthier SG is there to receive and implement it. Of course, we have to make sure that it is cost-effective and clinically effective. We are hoping that with Healthier SG, the speed of adoption of future innovations will be much faster.

27.     I am confident that the engaging discussions at this conference will ensue with robust collaborations forged amongst many of you. I wish everyone a fruitful conference. Thank you.