55th Session Of The World Health Organisation's Regional Committee Meeting

15 Sep 2004

By Mr Khaw Boon Wan , Minister for Health

Venue: Shanghai

Address By Minister For Health Mr Khaw Boon Wan At 55th Session Of World Health Organisation Regional Committee Meeting, Shanghai, 15 Sep 2004, 2.30pm

Ministerial Round Table On International Cooperation In The Face Of Public Health Emergencies

Yesterday, Dr Omi gave 6 reasons why we should lose sleep over the current avian flu outbreak. I agree with his analysis and share his worry.

Whether the current avian flu outbreak will actually trigger the next global flu pandemic is less important. The important point is that there will be a new flu pandemic and most likely it will hit our region first.

So the key questions are two. First: can we prevent it? Second, if we cannot prevent it, then are we ready for it?

Yesterday, Prof William Hsiao talked about the differences between a doctor, an engineer and an economist. His advice is that each should stick to its profession. I am an engineer and an economist. So I leave the preventive question to the doctors and scientists. My only comment is that the way farmers practise their trade will have to be reformed if we are to prevent new diseases from crossing from animals to human. Hygiene standard will have to improve and animals will have to be separated. Biosafety measures will have to be enforced. But I am no authority on this as Singapore does not have a significant agricultural sector. We do have 2 million chickens but they are bred purely for chicken eggs.

As Health Minister, I do have to worry about the second question: are we ready? I am actually quite pessimistic.

SARS was a good wake-up call. We were lucky that SARS was not as infectious as influenza. SARS spread through very close physical contact. Hence, so many of our hospital workers were infected.

But if a new virus emerges which is as infectious as influenza, we will be seeing casualties many times larger that what we experienced last year. With SARS, we could institute temperature checks at airports; but with influenza being infectious even before fever develops, such checks are useless. What it means is that cross-border activities will be severely curtailed, either by law, or in practice. Even within national borders, curfews may have to be imposed as a blunt way to control the spread.

WHO has got nations to start thinking about the flu pandemic. It is therefore relevant that we are discussing international cooperation in the face of public health emergencies today. There are many aspects to this issue, but let me only touch on three.

Promoting Greater Transparency

First, we need international cooperation to promote greater transparency and information sharing. This is an important lesson which we learnt during SARS. The current bird flu outbreak is another good example.

Malaysia's handling of the outbreak is exemplary. As soon as it was discovered, Malaysia informed us, a close neighbour, immediately. This has allowed us to quickly activate our contingency plans, upping our surveillance and carrying out an exercise to sharpen our skills to better manage a bird flu outbreak, should it arise.

Domestically, the transparent approach instilled public confidence. More importantly, because fighting the outbreak required a great deal of public cooperation, transparency of information increased public awareness and made it easier for the government to rally its people.

Assisting countries to deal with outbreaks 

Second, we need international cooperation to help countries deal with the outbreaks more effectively. This can take various forms. Capacity building is one important area, not only in terms of hardware, but also in terms of ensuring that our public health officials are properly trained to deal with the various aspects of fighting an outbreak.

Equally important, we need to build a network of trained personnel who can contribute to the pool of resources which countries can call upon when dealing with infectious disease outbreaks. Such sharing of expertise is critical, as we in Singapore found out during our battle with SARS, when we benefited from the experts from the World Health Organization and the US CDC.

Another area of helping countries deal with outbreaks is working together to better calibrate our responses. Sweeping measures to prevent the spread of an outbreak come at high economic costs, to both the exporting and importing countries. We need to work together to develop creative solutions to contain the spread of the disease and at the same time, minimise the impact of our measures on the affected country already reeling from the outbreak.

In the case of the current outbreak of bird flu, for example, Singapore is working closely with Malaysia to look into resuming the export of poultry and eggs from areas in Malaysia which are still free from bird flu, by ensuring that adequate biosecurity measures are put in place to create disease-free zones. We would, of course, need to take a cautious approach and make a realistic assessment of the risks and the possible counter-measures, before we decide whether to proceed. But our officials are in dialogue with one another, and hopefully, they can work something out which will be win-win for both sides. If not, the important thing is, in the spirit of cooperation, we tried.

Research Collaboration 

Finally, we need international cooperation in research collaboration. Although infectious diseases, aided by globalisation, have become more formidable enemies, science and technology have, at the same time, made tremendous strides in enabling us to detect, understand and respond to new health threats.

Molecular and genomic methods today enable us to trace the origins of an outbreak, track the mutation of the virus strain, and develop PCR kits for rapid diagnosis and vaccines. For example, during our battle with SARS, work by the Singapore Genome Institute, in collaboration with other research institutes, led to the understanding of the genetic make-up of the new disease and development of a diagnostic test kit. With that, we did not have to fight the enemy in the dark.

It is thus important that a key focus of international cooperation is fostering research collaboration. This must encompass a whole range of activities, from upstream research on existing and new pathogens, to mid- to downstream activities such as the development of test kits and vaccines, and bringing them to the market.

Conclusion

It was against this backdrop that the US and Singapore set up the Regional Emerging Diseases Intervention (REDI) Centre, to promote cooperation in tackling emerging infectious diseases, whether naturally occurring or man-made. This would include disease surveillance, prevention and research, outbreak response systems and capacity building and training.

The REDI Centre is working closely with WHO and APEC, to survey the preparedness of countries in the region in flu pandemic preparedness. This is an important first step to assist countries in the region in planning and capacity building for flu pandemic preparedness.

We need to identify more such areas of cooperation, put in place a framework and culture of close cooperation between our public health professionals and ensure that our countries are battle-ready. Singapore is happy to continue our support for the good work of the World Health Organization.