Developing A Regional Infectious Disease Hub

21 Mar 2009

By Yong Ying-I

Introduction

1. May I begin by warmly welcoming you to Singapore. 

2. This conference is most timely, since Singapore has identified infectious diseases as one of our flagship areas of focus for our research efforts.  This covers the whole spectrum from bench-to-bed -- from basic science research to clinical treatment in hospital and care in the community.  More generally, Singapore regards the preparation for a potential pandemic from infectious diseases as one of the major risk scenarios our little nation must prepare for.  We have put in substantial effort across the entire government and indeed broader society to prepare for such a scenario.

3. I am not a scientist; I’m not even a doctor by background, so I am totally unqualified to speak about the genetics and genomics of infectious diseases, let alone to this very distinguished audience.  So I am going to steer clear of science and talk this morning about Singapore’s policy thinking behind the development of scientific capabilities in infectious diseases and what we are doing as a government to support this work.

The SARS experience

4. An avian influenza pandemic is a potential health risk that is high priority on every country’s agenda.  It is also high priority on the agendas of international meetings -- Whether at WHO, or at smaller regional groupings like APEC and ASEAN, sharing preparation knowhow and coordinating policies is a major area of work.  For Singapore, however, this threat is not seen as a theoretical one but a very real one, because we were one of the countries that lived through a SARS epidemic in 2003.  It was a searing personal experience for many of us.  Doctors and nurses in our hospitals learnt the meaning of fear as they saw some of their colleagues succumb, and they felt panic because they didn’t know how to stop the spread of the disease.   One of my own friends, who headed the ICU at one of our hospitals, caught the disease from a patient and almost died.  I myself was not in MOH at that time.  I was Permanent Secretary of the Ministry of Manpower, and I recall the mad scramble the first week as the epidemic spread and the economy began to shut down.  At MOM, we helped employers cope with sudden downturns in business, so that they wouldn’t retrench their staff.  I recall hotels for instance suffering single digit occupancies and we worked with them on staff support schemes. MOM also issues work visas for foreigners – so we started running quarantine camps for newly arrived foreign workers so as to assure ourselves that they were not turning feverish.  I had never run the equivalent of a refugee camp before and I never wish to do so again.  My Ministry’s ground officers helped with contact tracing of infected suspects -- I recall sending out enforcement officers to hunt for a vegetable seller carrying the infection who had escaped the shutdown of his infected vegetable market and was blissfully selling vegetables elsewhere.  My officers asked me whether the masks and clothing they were wearing would protect them from the disease when they came into contact with infected persons.

5. So I really mean it when I say it was a searing personal experience, and Singapore really means it when we say that we take the infectious diseases threat seriously.  I was one of those Government leaders who said “never again”.  To the extent that we can prepare for and mitigate this health risk to national survival, we must do so.  Singapore’s efforts to tackle a pandemic are helmed by the Deputy Prime Minister who has the mandate to mobilize and coordinate preparation efforts across the entire Government.  We meet regularly, discussing plans and policies covering everything from food supply in an emergency, border closures, public communications, to keeping bank credit going.  Naturally, the hospitals run emergency exercises.  But we have also roped in our primary care GPs, our nursing homes and community institutions to also be better prepared.  Business continuity planning is not limited to the healthcare sector or the government.  In August last year, the entire banking sector of over 100 institutions, took part in a business continuity planning exercise using a flu pandemic as the scenario.  This includes the global banks which have operations here.  We have also decided to spend funds on things that may not be needed in peacetime.  We stockpile Tamiflu and we have invested in expanded ICU facilities and ventilators in hospitals beyond what is needed in normal times.  The economic downturn will not affect our commitment or our funding to build capabilities in this area. 

6. This recognition of the scale of the potential disaster explains my Government’s and my ministry’s deep interest in tackling infectious diseases.  We recognize that infectious diseases can take many forms: it may not be avian influenza only.  Dengue is making a resurgence for instance, and we are now seeing the chikungunya variant.  Malaria is re-emerging and multi-drug resistant tuberculosis is a growing global threat.  So we have decided to strengthen our expertise.  Our existing Communicable Diseases Centre will be upgraded into a new National Centre for Infectious Diseases.  This national centre will bring together the full range of expertise in infectious disease control and management within a single organization, integrating clinical care provided by the CDC, public health management and research. 

Development of Research capabilities 

7. This leads me to research.  Singapore believes that biomedical and lifesciences will be a new knowledge industry that we would like to take part in.  So we have been investing in building lifesciences research capabilities.  A decade ago, the Biopolis was launched as the centre for our basic science research.  In the last few years, this thrust has extended from basic sciences into translational and clinical research, drawing in clinicians and capabilities from the health system.  I’d like to take a couple of minutes to highlight some of the key thrusts in our TCR efforts:

a. First, we have revamped some of our governance structures in our health system to better support this new thrust in translational and clinical research.  We are attempting to morph 2 of our university and hospital campuses into academic medical centres.  One of these is the merger of the National University of Singapore School of Medicine and the National University Hospital so that they are under a unified governance structure.  The second is at the Outram campus which houses Singapore’s flagship hospital, the Singapore General Hospital and various national specialty treatment centres.  Duke-NUS opened a Graduate Medical School there about 2 years ago, and the various entities on the campus are actively exploring how to have much closer collaboration including joint governance in many areas;

b. Second, we are developing our own pipeline of clinician scientists and researchers and we are recruiting international talent to complement our own.  Various training schemes and awards have been put in place to attract and nurture talent.

c. Third, Government has allocated substantial grant funding to support TCR.  These have included large competitive grants awarded in the last few years to infectious diseases.  I will just mention 2 of them.  A $25m flagship grant was awarded in dengue to a collaboration involving the Genome Institute of Singapore, 3 hospitals, the Novartis Institute for Tropical Diseases and some other agencies.  This consortium is studying the genetic epidemiology of dengue and aims to improve clinical management and develop new preventive measures and medicines.  Another award of $55m was given to MIT for an inter-disciplinary research group in infectious diseases.

d. Fourth, I should mention the key enabling infrastructure we are putting in, in medical informatics, to enable electronic medical records exchange and to support research.  We already have a working EMR exchange across the public sector that enables us to retrieve patients’ discharge summaries, x-rays, drug allergies and so on across all public sector hospitals.  The next step, happening now, is to expand this to the rest of the national health system.  We will also expand our EMR to support research, including facilitating the sharing of appropriately protected and anonymized data to support research studies. 

8. Research played a major role in tackling the SARS challenge. It was the sequencing of the SARS genome in Singapore by the Genome Institute of Singapore that led to the development of a SARS diagnostic kit.  The test kit co-developed by GIS, Institute of Molecular and Cell Biology, Roche Diagnostics and Genelabs Diagnostics, was distributed in record time.  It gave our clinicians the ability to diagnose SARS and enabled our scientists to work on pharmacologic solutions.

9. But in infectious disease, we cannot be an island unto ourselves.  In today’s globalised world, infectious diseases can cross borders very quickly.  Singapore is particularly vulnerable for 2 reasons.  Singapore is a trading and talent hub, a crossroads in the middle of Asia, where people and goods flow in and out of the country constantly.  We are also right in the midst of a region which is largely expected to be ground zero for the next pandemic.  As the head of the Wellcome Trust said to me when he called on me last month, “Singapore is within 4 hours flying time of 50% of the world’s population and 75% of the world’s chickens!” 

10. Infectious disease is therefore one disease that cannot be tackled alone.  It is an area that we need to collaborate with partners globally, whether it is policy, clinical treatment or research.  In policy, we work closely with countries under the auspices of the WHO.  Singapore contributed a Minister to chair the WHO Executive Board during our term as Chairman last year.  Closer to home, we are the designated location for the ASEAN Tamiflu stockpile and personal protective equipment stockpile (PPE).  Singapore is also working with the US CDC to develop a Singapore-Field Epidemiology Training Programme to strengthen local and regional capabilities in detecting and responding to outbreaks.  Singapore has also been helping our Indonesian neighbours with technical training and advice.  We worked with Indonesia on a pilot project initiated by the Heads of our 2 Governments to improve their surveillance capabilities in the Tangerang district outside Jakarta.  The ID clinicians in the region keep in close touch with each other so that they are alerted early when there are early warning signs. 

11. In that context, Singapore is seen to be a good place for research because we have good transport links to the region, and we are English-speaking, cosmopolitan, and have strong fundamental science and a good pool of ID clinicians.  So many parties are discussing collaborations with us.  Let me just mention a few key ones:  the Bill and Melinda Gates Foundation from the US, parties from the UK such as Imperial College, the Wellcome Trust and the Medical Research Council.  I hope many of these discussions will bear fruit. 

Conclusion

12. May I end by saying once again how delighted I am to have the opportunity to brief you on the many exciting research developments happening here.   I hope that you will in turn share your insights and your frank advice with us.  We are all learning together in this exciting and rapidly evolving field.