56th Session of the WHO Regional Committee for the Western Pacific

21 Sep 2005

By Mr Khaw Boon Wan, Minister For Health

Venue: Noumea, New Caledonia

"Battling Flu Pandemic Like Y2K"

Since our last meeting at Shanghai, the world has gone through several high-profile disasters, some natural, some man-made. These included the Indian Ocean tsunami on Boxing Day, the London bomb blasts by terrorists, and more recently, Hurricane Katrina in New Orleans and its surrounding areas.

The response to each of these disasters was different, and had varying effectiveness. Focusing on the public health response alone, I think we could rate the London health system a clear high distinction. The others did not quite measure up.

Operational Preparedness

How did London emerge from its tragedy better than others did?

First, the UK had put in place well-designed contingency measures. They had thought through potential bottlenecks, such as the robustness of the telecommunications network, and actively planned solutions to minimise such problem areas. London's multiple hospitals could respond as a network to spread out the casualty load and prevent localised breakdown in health services.

Second, the UK had in place a structure for real-time decision-making, so that within an hour of the first bomb blast, the UK Cabinet and key decision-makers were already assembled and directing the response and recovery efforts.

Third, the UK had regularly rehearsed its emergency plans and prepared its residents psychologically for the eventuality of a disaster situation. There were many reports of stoicism among Londoners, including many who resolutely went back to using the Underground system as soon as it was operational.

The Next Disaster?

I think being prepared and taking the preparatory efforts seriously, with frequent simulated exercises, underpinned London's success.

Nobody knows what the next major disaster will be: perhaps a bio-terrorist attack, or perhaps, a global flu pandemic.

Last month, I read a New York Times article (Aug 21) which estimated that a flu pandemic in New York City would infect as many as 2.8 million New Yorkers, send more than 200,000 to hospitals and kill 400 a day at its peak.

New York City has a population of 8 million and is number 16 among the mega-cities of the world. I cannot help noticing that Asia has 7 of the top 10 mega cities of the world, all of which are bigger than New York City.

So if there is a global flu pandemic, Asia will be especially vulnerable. The death tolls will be overwhelming. Many cities and countries will be crippled.

International Co-operation

We therefore have strong motivation to avoid such a calamity. The WHO has given guidelines on individual country preparedness, and some countries have published their plans.

Amongst WPRO Member States, we should also see how we can work together to conduct region-wide simulation exercises. I understand that the European Commission and the WHO are holding a joint exercise later this year. Such collaborations are critical, to raise awareness, identify gaps, build up a tradition of cross-border co-operation.

But besides just trying to control the downstream damage arising from an outbreak, we should seriously study if we can avoid this flu pandemic altogether. The consequences are so grave, that surely it is cheaper to prevent than to respond to a pandemic.

Preventing the Millenium Bug

Can it be done? Is it so far-fetched?

The world has done it before, and only recently. We had anticipated a global epidemic, and we had set out systematically to avoid it. I do not mean SARS.

Remember Y2K, the millennium bug?

It is not biological, but its potential impact on the world would have been largely similar. Banking systems infected by Y2K could be crippled. Air traffic control towers infected by Y2K could cause air crashes, with many lives at stake. World financial, communications and transport systems could have been severely damaged, if not wiped out.

Realising the disastrous impact, world leaders had set out systematically to think through and put in place preventive strategies. It was high on world leaders' agenda, at APEC, at ASEM, at the United Nations.

As a result of all these efforts, the world survived the change of the millennium without any major hitch.

Should we not now do the same, to avoid a global flu pandemic? The writing is already on the wall. People have been warned. But I agree with the Health Minister from Tonga that not enough attention has yet been paid on the preventive aspects of the flu pandemic.

How can we avoid a flu pandemic?

First, we must tackle the challenges upstream, head-on at the source, through reforming our high-risk farming practices. Farmers must learn to "bio-secure" their farms: simple sanitation measures and the importance of separating livestock by different species.

Second, we must reform our wet markets. These large open markets where consumers can buy live poultry and fresh meat have become incubators for infectious diseases because of unsanitary conditions and weak government regulation. We urgently need to change and better manage these risky practices.

Third, we need emergency antiviral intervention as soon as the first clusters appear. To achieve this, we need immediate warning, so that such emergency supplies can be despatched. This requires continuous surveillance to provide early warning of an outbreak.

Fourth, we need effective medical and operational response capability at the local level, to isolate and quarantine infected patients, as soon as the first pandemic wave hits. The medical capability must be able to ramp up quickly to deal with any subsequent surge.

Fifth, we need to speed up research efforts on a vaccine, so that if the pandemic cannot be avoided, the world can race to achieve immunity as soon as possible.

All these require intensive international co-operation, at the highest level. It goes beyond the traditional purview of health ministers. Issues of border control and cross border case management will test the patience and resources of affected and neighbouring countries, when an outbreak occurs.

Just as we battled Y2K successfully, world leaders must now lead the battle against the flu pandemic. We must now identify this as top national and international priorities.

I am glad that President Bush has called for international partnership against the flu pandemic. Let us convert rhetoric to actionable, co-operative international strategy.

There is much that we can do today, to build on existing collaborations with regional and international bodies. Singapore welcomes further opportunities for co-operation with WPRO and WHO Member States. Thank you.