MOH Budget Speech (Part 4) - Medical challenges - new and old

07 Mar 2006

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: Parliament

"Medical challenges - new and old"

I thank Mdm Halimah, Mr Andy Gan, Dr Chong Weng Chiew, Dr Tan Cheng Bock, Dr Tan Sze Wee and Mr Arthur Fong for their questions and comments. Many of the medical issues brought up have been with us for a long time but one problem is new - bird flu. Hardly a day goes by without a news report in the media on developments related to bird flu

Flu Pandemic

2 Mdm Halimah and Mr Andy Gan have asked about our bird flu pandemic preparations. We must be prepared to manage three types of bird flu spread: 1. Bird to bird spread. 2. Bird to human spread and 3. Human to human spread.

Domestic Preparedness

3 I will begin with bird to bird spread. It appears that the H5N1 virus has established itself in wild birds. It has spread relentlessly from Asia to Europe and Africa. Fortunately, our poultry population is limited and is located in farms with good bio-security. AVA has strengthened surveillance of birds and implemented measures to keep H5N1 avian influenza out of our poultry population. So far, no H5N1 influenza virus has been detected in Singapore.

4 Next, there are sporadic cases of bird to human spread. This has occurred in our neighbouring countries when humans have had close contact with sick birds. We have advised Singaporeans to avoid chicken farms when travelling to other countries. We have put our doctors on alert against possible human cases of avian flu coming into Singapore.

5 Finally, we should be prepared for a pandemic in case the virus mutates and starts spreading from human to human. Will a pandemic occur? We don't know. Experts differ in their opinion. Looking back at the last century provides conflicting examples. In 1978, there was concern about a swine flu pandemic occurring and 24% of the population in the United States was vaccinated. The pandemic never occurred and no one died of swine fever. But the vaccination caused 500 complications and 25 deaths. On the other hand, in 1918, the Spanish flu pandemic spread across the world and caused 25 million deaths.

6 Managing a pandemic is a national exercise in science based risk management. Success depends on three factors: a strong effective political leadership, a cooperative public who follow health advisories during the pandemic, and a healthcare system that is well prepared to deal with public health challenges. In Singapore we have both- an effective leadership and a cooperative public. I want to assure the house that the third factor, the healthcare system, is well prepared.

7 We currently have some 700,000 courses of Tamiflu and are on track to build up our national stockpile by the end of the year. We have an assured supply of pandemic vaccine if we think it is necessary to vaccinate the population. Public healthcare institutions have put in place plans to manage the expected surge in outpatients and inpatients in a pandemic.

8 We have also worked with other government agencies to ensure that essential services will continue to operate during a pandemic so that there is minimal disruption to the economy and society. Through our outreach, we have given talks to MNCs, SMEs, private organizations and grassroots leaders to help them understand the nature of pandemics and the measures that they can take to be prepared.

9 We will conduct exercises in the next few months to test our pandemic preparedness. In the first stage, we will focus on all public and private acute hospitals to ensure that they are ready. The second stage will be a wider system-level exercise and will also involve other agencies such as CAAS and ICA, as well as the public.

International Engagement

10 As the risk of a bird flu pandemic is a global one, we are working with WHO and the international community to do our part in containing this threat. In January 2006, Singapore pledged $1 million at the International Pledging Conference in Beijing to fight bird flu. This will go towards our laboratory collaboration and capacity building efforts in Indonesia. In addition to this, together with the United States, we are also working with our Indonesian counterparts on a pilot project in Avian flu surveillance and control at the Tangerang Municipality just outside Jakarta. The project is expected to commence in April 2006. Singapore will be contributing both funds and technical expertise towards this project.

Genetic Counselling

11 Dr Chong Weng Chiew suggested that couples getting married attend genetic counselling and screening. This is indeed already happening today.

12 Public education about inherited genetic disorders such as Thalassemia and Hemophilia has been ongoing since the late 1980s.

13 Thalassemia is the most common inherited genetic disorder in Singapore. Two decades ago, about 15 babies were being born every year with Thalassemia Major. To address this problem, in 1991, the Ministry of Health introduced a Thalassemia prevention and screening programme for couples and pregnant mothers. The programme has been effective. The incidence of Thalassemia major has now declined to 1 case per year for the last 5 years.

Anti-Smoking Policy

14 Mr Arthur Fong proposed that we tackle the issue of smoking amongst the young.

15 Smokers are a diverse group requiring different strategies and educational messages to encourage them to quit smoking.

16 Singapore's smoking prevalence rate has declined. The smoking rate among those aged 18-69 years declined from 15% in 1998 to 12.6% in 2004, one of the lowest in the world. The smoking rate among young people aged 18-29 years has also declined from 26.2% to 12.3% over the same period. However, there is an increase in the proportion of young female smokers (18-29 years), from 5.2% in 1998 to 6.6% in 2004.

17 To curb this increasing trend in young female smokers, HPB has introduced targeted initiatives which are gender specific, such as the Fresh Air for Women Programme.

18 HPB is also exploring new outreach channels such as websites, youth blogs and chat rooms which youths frequent and are comfortable with.

Heart Disease Awareness

19 Dr Lily Neo has expressed concern about the mortality rate from heart attack in women, as compared to men. Local and international studies have shown that women who do get a heart attack, have a higher risk of dying from it compared to men. Two days ago, experts in cardiac resuscitation were meeting in Singapore for a conference. A senior cardiologist at the meeting told me that the problem was not with women but with men. Men have a lower life expectancy than women. They get heart attacks more often and die at a younger age. Since there are far more women living to an older age than men, the average age of women suffering a heart attack is much older and this contributes to the higher mortality rate in women.

20 When dealing with medical statistics, I am reminded of a saying of Mark Twain "Facts are stubborn, Statistics are more pliable". The facts are that Singaporeans have one of the longest life expectancies and women outlive men. But a single statistic like the mortality rate from heart attack is sufficiently pliable to draw different conclusions. Nevertheless, the Ministry will consider introducing new initiatives to further lower mortality rates from heart attacks in both men and women if the proposals are evidence-based.

National Blood Programme

21 Dr Chong Weng Chiew has expressed concern about the low stocks of blood during the festive period and has made useful suggestions on how to boost donations and autologous transfusions.

22 The number of blood donations collected has been steadily increasing by 7-18% and the number of donors by 3-8% every year over the past 3 years. This is an outstanding achievement. The national blood supply has been able to adequately meet the needs of patients in Singapore hospitals most of the time, but still faces episodic periods of blood shortage during the December to January festive months. The Health Sciences Authority (HSA) with the Singapore Red Cross will continue with its donor recruitment campaigns to increase awareness amongst Singaporeans about the need to donate blood regularly. These include specific programmes to increase blood donation amongst youths aged 16-25 years of age. In an emergency, there are contingency plans to boost blood stocks quickly.

23 Although autologous blood transfusion is encouraged in appropriate situations, the use of autologous blood for surgery has declined due to shorter waiting times for elective surgeries and an older patient population. The HSA will nonetheless continue to work with hospitals in encouraging autologous blood transfusions.

24 The Health Sciences Authority will take in Dr Chong's feedback in its ongoing review of blood donation adequacy for Singapore.