GP Flu Pandemic Symposium

13 May 2006

By Prof K Satku, Director of Medical Services

Venue: MOH Auditorium

A/Prof Goh Lee Gan, Vice-President, College of Family Physicians Singapore;

Dr Wong Chiang Yin, President, Singapore Medical Association;

Members of the Organising Committee;

Colleagues;

Ladies and Gentlemen,

Good afternoon,

It gives me great pleasure to join you this afternoon at the 1st GP flu pandemic preparedness symposium. I believe this is the first symposium specially organised for our primary care practitioners. Let me explain why I felt this symposium is an important one to have.

The World Health Organization (WHO) first expressed concern over the possibility of the avian influenza in Asia evolving into an influenza pandemic in 2005. This influenza pandemic threat is real and the risk to public health could be severe as we are dealing with a new sub-type of the Influenza A virus, the H5N1 virus, to which humans have no immunity. WHO has further warned that although precise predictions of the occurrence of pandemics are not possible at this stage, the conditions favouring the emergence of a pandemic had all been met, all except for one: efficient human-to-human transmission.

Today, this formidable virus has not only become endemic in Asia, but has also spread beyond the region to as far as Europe, Middle East and Africa. As long as avian flu outbreaks continue among poultry, human infections can occur. With time, there is a likelihood that the H5N1 virus would mutate and acquire the ability to efficiently spread from person to person. To add to the gravity of the situation, human cases experience severe illness with a very high mortality rate.

During the recent Lancet Asia Medical Forum, some experts have expressed the opinion that a pandemic of influenza will eventually occur is an inescapable fact, but it is not inevitable that an avian influenza virus will cause the pandemic. Some felt that the H5 strain has historically never caused a pandemic and if anything, a H2 strain may be the cause of the next pandemic due to lowered herd immunity.

Whatever the strain of the virus, the fact remains that in the event of such a pandemic, the toll of human death is unimaginable. Even for those who fortunately survive, many cannot escape the pain of losing their loved ones or from the devastating economic impact that will most certainly accompany a pandemic. The magnitude of such an impact, both in terms of human death and economic downturn, is likely to be even greater than that of SARS.

The Need For Singapore To Be Prepared -- Our National Influenza Pandemic Readiness & Response Plan

Recognising the need for Singapore to be prepared to deal with the imminent threat of a flu pandemic, our National Influenza Pandemic Readiness & Response Plan was completed some time last year. The Plan, which is based on WHO guidelines, is constantly updated to make sure it stays relevant and responsive to global and local developments. The plan adopts a colour-coded risk management approach, with appropriate public health measures to be adopted for each alert level. The Ministry of Health (MOH) has been working with the various ministries, public and private healthcare institutions, as well as other stakeholders including Singapore Medical Association (SMA) and the College of Family Physicians (CFPS) to address the various operational issues of the plan.

Although the most effective control measure is to immunise the entire population against the new viral strain, development of pandemic influenza vaccine could take some time. Research is now underway to develop a vaccine against the H5N1 virus.

Tamiflu is the current drug being used for the treatment of H5N1 infections. Like many other countries, we have started to stockpile this drug. This will be used as prophylaxis for identified frontline personnel of essential services personnel and the treatment of flu patients in a pandemic. In addition, we are also stockpiling Relenza for use as a second-line drug.

Besides having anti-virals as a preventive measure, we have also built up other capabilities such as having a stockpile of N95 masks and other Personal Protective Equipment items.

In order to ensure that our national plan is operationally ready, the Ministry has already initiated hospital preparedness exercises. We are also planning for a 2-day Flu Pandemic Exercise, involving public participation. It will be a comprehensive exercise, involving different points of care delivery in the healthcare system - hospital, polyclinic, nursing home and selected GPs clinics. With these efforts, we hope to ensure that our plans are not mere paper descriptions but actual, operational plans. With each exercise, we learn and improve on our plans so that we can be even better prepared, should the pandemic strike.

Engaging GPs During A Flu Pandemic

In the event of a pandemic, the projected number of outpatient attendance and hospitalisation could overwhelm our public institutions in a short time. However, with the use of antivirals, we hope to reduce the number of patients requiring hospitalisation. Unfortunately antivirals will not have much impact in reducing the number of outpatient attendance.

The vast majority of patients who have flu-like symptoms are likely to first see a doctor in the primary care setting. These patients will be worried about their symptoms and wonder whether they have caught the virus. They seek not just treatment but also words of comfort. At the same time, as doctors we will have other patients who do not have flu symptoms but require medical attention. Thus, we have to ensure compliance to all infection control measures.

As we carry out our duty as a member of this noble profession, we will not want to inadvertently bring unnecessary risk to our families and loved ones. Of course, one could throw in the towel and call it quits as the pandemic approaches. But would we then be able to hold our heads high amongst our peers and patients when all are over?

I believe the answer lies not in convincing ourselves that the pandemic will not come, or in avoiding it should it come, but in being well-prepared. MOH is ready to partner GPs in this arduous journey. It is crucial that all General Practitioners are part of the National Pandemic Response Plan and be equipped and ready to fight the battle against the virus as a team.

As part of our preparedness planning, a flu pandemic taskforce for primary care was set up by MOH earlier this year. Included in this task force are representatives from SMA, CFPS and clusters' polyclinics. The role of this taskforce is to define the key areas and implementation strategies for primary care pandemic preparedness and response.

Under the ambit of this taskforce, we have jointly developed the Advisory in preparing primary care facilities for flu pandemic with College of Family Physicians. This advisory covers areas like procedures for triage, infection control as well as protection for clinic staff in the event of a pandemic. It is developed by a team of family physicians and I am sure you will find this practical and useful.

At the same time, we have also worked with the Singapore Medical Association to develop the National Primary Healthcare Pandemic Response Plan.

As a member of the Pandemic Response Plan, my Ministry recognises the need for us to provide integral support to our GPs, such as supplying personal protective equipment and Tamiflu. For a start, the workgroup have arranged for a mask-fitting session for all of you today. More professional training sessions and exercises will also be conducted in the future.

This symposium marks the beginning of our journey in partnership. I am pleased that this symposium has provided a platform for us to present the Advisory and Response Plan and seek your inputs on the further refinement of this plan. Rest assured that MOH is committed in working with all of you every step of the way. At the same time, I also ask for your commitment to join us in preparing for this battle, which I hope will never come. After this symposium, we will firm up the Advisory and Response plan, and send them to all primary care doctors, as well as make them available on the respective professional bodies' websites.

I would also like to take a moment to acknowledge our colleague from the Department of Health, Hong Kong, Dr Ronald Lam, who has taken time off his busy schedule to be here to share his primary care experiences with SARS and Avian Influenza. There is much that we can learn from our overseas counterparts who have dealt with these conditions.

Conclusion

I am heartened to see so many GPs here this afternoon. The battle ahead, should it come, could involve the loss of many human lives, some could well be people close to us. If one amongst us let our defences down, the consequences can be dire. The key to the success is held by each of you. Let us, the medical profession, unite as a team and prepare ourselves. I urge all GPs to join us in this concerted effort. Do give us the feedback that will make our plan better. Be assured that we will support you, should the pandemic come knocking on our doors. I am confident that such selfless contributions would make everyone proud to be a member of the medical fraternity.

On this note, I wish you all a very stimulating learning and sharing experience.

Thank you.