SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AT THE SECOND READING OF THE INFECTIOUS DISEASES (AMENDMENT) BILL, 7 MARCH 2024, PARLIAMENT

Madam Deputy Speaker, I beg to move that “The Bill be now read a second time”.

Introduction

2.       The Infectious Diseases Act (IDA) was first enacted in 1976, and is Singapore’s principal legislation for the prevention and control of infectious diseases. It empowers the Ministry of Health (MOH) to undertake a range of public health measures to prevent the importation and spread of infectious diseases.

3.       For example, the IDA empowers MOH to conduct surveillance for infectious diseases, isolate and treat infected persons, and quarantine close contacts. The IDA also allows us to investigate and manage outbreaks with measures such as contact tracing and disinfection of premises.  The IDA has been an effective piece of legislation and saw Singapore through health crises such as SARS in 2003 and H1N1 in 2009.

4.       Then COVID-19 struck in 2019. Between Influenza and SARS, COVID-19 is somewhere in between.  It had a case fatality rate of about 2-5% when it first emerged, far higher than Influenza, but lower than SARS. However, COVID-19 was far more infectious than SARS, spreading via airborne droplets and by infected persons yet to display symptoms.

5.       It became clear that we were facing a new enemy, and it was no longer sufficient to solely rely on the approach of “test, trace, isolate” – our main takeaway during SARS – to fight this new virus. Nationwide restrictions and community-based measures became necessary to curtail disease spread, reduce deaths and safeguard our healthcare system.

6.       Part 7 of the COVID-19 (Temporary Measures) Act – in short I will refer to it as “Part 7” – was therefore enacted in 2020 to complement the IDA, and provided additional powers to MOH to combat the pandemic. As different variants emerged and various infection waves hit us, Part 7 enabled the implementation of many measures, including the Circuit Breaker, various gradations of safe management measures (SMMs), vaccination-differentiated SMMs, and also facilitated the implementation of TraceTogether and SafeEntry systems. 

7.       As our population was increasingly protected by vaccinations and safe recovery from infections, we cautiously re-opened our society and economy. Part 7 continued to provide the agility and allowed us to calibrate our SMMs, and to ease restrictions according to risk assessments.  

8.       The Government conducted a comprehensive review of our responses during the COVID-19 pandemic crisis, and its findings were released as a White Paper and debated in this House in March 2023. 

9.       One of the key recommendations of the White Paper was the need to review and amend the IDA. A key motivation behind the recommendation is that while Part 7 served us well for COVID-19, it was intended to be temporary and in fact it will expire next month. Which is why we have to table this Bill today after the Committee of Supply. COVID-19 is not going to be the last pandemic and we need better and permanent tools for the next threat. The pandemic has given us fresh perspectives on the management of infectious disease threats, and our laws, namely the IDA, need to be reviewed to be ready for the next pandemic.

10.      In this comprehensive review of the IDA, various Part 7 powers that continue to be relevant to future pandemic responses will be ported over to the IDA. We have also taken this opportunity to streamline the legislation, iron out the kinks and make provisions for operational effectiveness, by drawing on lessons from the COVID-19 pandemic. 

11.      I will introduce the key substantive amendments in the Bill in my speech. Thereafter, I will pass the time to SPS Rahayu, to elaborate on the other amendments to the IDA to enhance our disease outbreak responses.

A Hierarchy of Responses

12.      The main change to the IDA is to provide for a hierarchy of responses to address outbreaks of differing severity. This was a key takeaway from COVID-19, when we had to step up responses as the situation escalated, and taper down measures when the threat subsided. We need the IDA to provide the Minister for Health the powers to effect relevant measures at different phases of the pandemic.

13.      Currently, the IDA is somewhat binary; it is either peace or emergency. It only provides for the declaration of a Public Health Emergency, or PHE, by the Minister for Health. This was not declared during COVID-19, because while the pandemic situation was dire, we felt it fell short of an emergency, partly also due to the way we have managed the situation. We would associate an emergency with more extreme situations, like widespread riots, or war, or in the context of a pandemic, a healthcare system that is totally overwhelmed.

14.      The IDA will therefore enable the Minister for Health to declare either a – Public Health Threat (PHT) or Public Health Emergency (PHE) – depending on the severity of the situation.  It will also provide the powers for the Minister to respond appropriately based on each situation. 

PHT

15.      Let me first explain what PHT entails. The Minister may declare a PHT if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health, and it is necessary to take measures to prevent, protect against, delay or control such incidence or transmission.

16.      The outbreak of COVID-19 in Singapore in 2020 would have been considered a PHT under the new provisions. The Minister will also have powers to make regulations to implement measures to respond to the PHT (as we had). These include movement restrictions, prohibitions of gatherings or events beyond a specified group size, or the suspension of non-essential businesses, up to and including a Circuit Breaker.  All these powers are currently found in Part 7, and will be ported over to the IDA, as powers under a PHT.

PHE

17.      What constitutes a PHE? A PHE will trigger powers in the most dire of situations.  Declaration of a PHE is already an existing provision in the IDA, but we are finetuning the criteria of a PHE, and proposing to make adjustments to the powers of the Minister under this situation.

18.      We have enhanced the existing criteria for the declaration of a PHE, by factoring in the state of our healthcare systems and resources, in addition to the epidemiology of the disease. The amended IDA will empower the Minister to declare a PHE if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health, and he additionally finds that the disease poses a substantial risk of either – (1) a significant number of fatalities or incidents of serious disability of persons in Singapore; or (2) a severe shortage or impairment of healthcare services and supplies in Singapore.

19.      A PHE declaration, if done, will unlock two additional powers for the Minister for Health:

20.      First, based upon the current PHE powers in the IDA, the Minister will be able to declare the whole of or any area in Singapore to be a restricted zone and impose curfew-like measures in those zones. These are envisioned to be much more stringent than the measures, including a Circuit Breaker, provided for under a PHT. For example, the Minister may impose an islandwide curfew during specific time periods of the day, or limit the number of persons that may leave a home every day.

21.      During COVID-19, some countries had imposed such curfew-like measures. For example, in parts of India, persons were restricted from leaving the home overnight, and some China provinces restricted the number of persons per household who could leave the home and only to obtain necessities.  Fortunately, we did not need to impose any of these highly-restrictive measures during COVID-19, partly because our hospitals, while strained and stressed, were never overwhelmed like in many other countries where a big number of patients had to be left unattended. But we cannot be complacent and assume that we will be as fortunate in the next pandemic. There is a need to be ready for a situation where more stringent measures are needed to avoid a public health catastrophe.

22.      Second, the Minister for Health will be able to exercise the relevant powers under the Requisition of Resources Act 1985 (RORA) for the requisition of necessary resources to secure the safety of human life and health.

23.      The RORA can already be exercised by the Minister for Defence during a PHE. What we will be doing with the amendments to the IDA is to also allow the Minister for Health to exercise requisition powers in a PHE. This is consistent with the overall objective of RORA, one of which is to provide for requisition of resources as necessary for the securing of the safety of human life and health in the event of a Public Health Emergency. We can envision that in a situation when Disease X strikes, the Minister may need to acquire private hospital beds, medical equipment, ambulances and manpower to shore up resources to tend to our population who may otherwise not be able to receive care expediently. Parties affected by such requisitions will be appropriately compensated under the RORA.

Duration of PHT and PHE

24.      PHT and PHE declarations can be in force for a duration of up to 90 days, and the duration is extendable. Drawing from our experience with epidemic waves, including that of COVID-19, 90 days will provide sufficient time for the effect of measures to kick in, and for MOH to review and assess the impact on the public health situation. If needed, the duration can be extended. If the situation subsides early, the declaration may be revoked early.

Safeguards and accountability

25.      The measures under a PHT and PHE can be intrusive and disruptive, so they need to be triggered only when necessary to protect lives. These decisions will only be taken following careful consideration based on prevailing scientific evidence and risk assessments, and at the highest level of the Government. 

26.      There will also be safeguards in place. The Minister must first, by order, declare a PHT or PHE, and publish a notice to bring the order to the public’s attention. All orders to declare or extend a PHT or PHE, and any regulations made during a PHT or PHE, must be published in the Gazette and presented to Parliament as soon as possible. Parliament has the authority to scrutinise the order or regulations, and if unsatisfied with the decisions, vote to annul them.

27.      To sum up, what I have just described can be found under Clause 22 of the Bill, which inserts into the IDA a new Part 3A on the control of infectious disease during a PHT and PHE. Further details on amendments to enhance operational efficiency during a PHT and PHE will be elaborated on by SPS Ms Rahayu.

Summary of public health postures

28.      In effect, with these amendments, our public health response will comprise four postures.

29.      First, Baseline – this is a peacetime state where routine disease prevention and control measures, along with public health surveillance programmes, are in place. During peacetime, the primary objective is to detect outbreaks early to prevent and mitigate disease spread.

30.      Second, Outbreak management – where there are signs of an emerging infectious disease overseas, upstream measures, such as pre-departure health requirements, temperature screening or stay orders on persons entering Singapore, may be implemented to prevent the disease from being introduced into Singapore.  This will help prevent disease importation and transmission and buy us time to understand the new disease. In the event of a local outbreak, measures such as testing, treatment and contact tracing may be implemented. This is what we did recently at Bukit Merah due to a local tuberculosis outbreak. 

31.      The IDA does not explicitly mention ‘Baseline’ and ‘Outbreak Management’ situational tiers. These measures are already well-established and routinely carried out. For these two tiers, they are already legally backed by various sections in the IDA. These two are useful lexicons for us to remember.

32.      Third tier is Public Health Threat – which I have described to be for situations that may require more widespread or prolonged measures, up to and including those that were imposed during the Circuit Breaker.

33.      Fourth, Public Health Emergency – being the most dire of public health crises where even stricter measures, such as curfews or the requisition of resources, may be implemented.

34.      These four public health postures will inform the application of the IDA henceforth, and will greatly facilitate nimbler management of different stages of an outbreak or pandemic.

35.      They will also become our common language. 

Repeal of CTMA Part 11

36.      As part of this Bill, the Government will be proposing the repeal of Part 11 of the COVID-19 (Temporary) Measures Act – in short I will refer to it as “Part 11”. 

37.      Part 11 was introduced in 2021 to provide assurance to the public that personal contact tracing data collected using digital contact tracing systems including TraceTogether and SafeEntry (TTSE) were limited for the purposes of contact tracing for COVID-19 and for criminal investigations and proceedings in respect of serious offences.

38.      TTSE have not been active for about a year as we transitioned to treating COVID-19 as an endemic disease and safe management measures were stepped down. Senior Minister Teo Chee Hean, as the Minister charged with the responsibility for digital Government and public sector data governance, in consultation with MOH, determined that these digital contact tracing systems would no longer be required after 5 January 2024. TTSE have since been removed from the app stores, and the backend digital infrastructure supporting the TTSE systems have been dismantled. TTSE websites have also been shut down. As of 1 February 2024, all COVID-related personal contact tracing data derived from TT and SE has been deleted, with the exception of TT data pertaining to a murder case in May 2020 which will be retained by the Police indefinitely.

39.      With the deactivation of TTSE and the deletion of personal contact tracing data, Part 11 is no longer required and we will therefore repeal it.

40.      As for the future, with the rapid advancement of digital technology, precision medicine and Artificial Intelligence, it may not be wise to pre-judge what we may or can do in future pandemics. We may collect different kinds of data digitally; we may use them differently to fight the pandemic; the public may need new forms of assurances. Part 11 is bound to be obsolete when the next pandemic hits us.  

41.      In the event of a future pandemic crisis, and should we implement a digital personal data collection tool to be part of our arsenal to fight the pandemic, we will need to address data protection concerns and provide assurance to the public. To do so, the Government will come back to Parliament to pass legislation, if necessary.  

42.      In the meantime, we will closely monitor the technologies available, their possible use cases and relevance for future pandemics. This will allow us to quickly determine, at the onset of the next outbreak, whether and what tools should be deployed, as well as the relevant safeguards to be implemented to ensure that individuals’ personal data are used with discernment.

43.      Madam Deputy Speaker, besides the amendments relating to pandemic management, there are also other refinements to the IDA to enhance future disease outbreak response. I will pass the time to SPS Ms Rahayu to elaborate on these amendments. Thank you.