Opening Address by Dr Lam Pin Min, Minister of State for Health, at the Singapore Clinical Research Institute Investigator-Initiated Trials Conference 2015, 28 September 2015

Associate Professor John Lim, Deputy Director of Medical Services (Industry & Research Matters), Ministry of Health and Chairman of SCRI

Associate Professor Teoh Yee Leong, CEO of SCRI

Distinguished Guests

Ladies and Gentlemen,

Introduction

1            It is my pleasure to be here today with all of you at this Conference and for the launch of the Singapore Clinical Research Institute (SCRI)’s SG50 Commemorative Book “Saving Lives through Clinical Research: A 50-year journey of Singapore’s scientific leadership”.

2            The commemorative book captures the emergence and growth of clinical research in Singapore and is a timely celebration of our Golden Jubilee Year. Despite being a small nation, we should be proud of the many achievements that Singapore has in the highly specialised field of clinical research.

3            The book makes for an interesting read, not just for the clinical research and scientific community but I hope also for the man in the street. It chronicles the first small steps Singapore took in this area, as well as the subsequent great strides made by our scientists and clinical researchers in Singapore.

4            We read first-hand accounts from renowned doctors of little-known facts and anecdotes on the evolution of local clinical research, and how it is helping ensure the continuing health and wellbeing of our nation through the search for new medical answers and treatment solutions.

5            Today, we are the beneficiaries of the pioneering efforts of many Singapore medical researchers whose painstaking efforts and dogged research have transformed once life-threatening diseases into treatable conditions. As a result, this has helped improve the quality of life of Singaporeans and extended the survival of our patients.      

Proven Clinical Research Record

6            The evolution of clinical research in Singapore is a fascinating journey. Beginning from the trials of live poliomyelitis vaccine in 1958 [1] to breakthroughs in cancer immunotherapy in 2013, the history of local clinical trials has seen many significant milestones, with direct life saving and life extending impact that benefits many patients in Singapore.

7            Over the past 15 years, the number of clinical trials conducted has been rising in Singapore. In 2014 alone, a total of 280 Clinical Trial Certificates (CTCs) were issued by the Health Sciences Authority (HSA). This is nearly double the 157 CTCs issued in 2000.

8            Let me share with you three clinical trials highlighted in the book that deserve special mention. The first was during the early 1970s, when viral hepatitis, particularly Hepatitis B infection, was a major cause of illness and death.

9            In the 1980s, Hepatitis B vaccines were costly to the parents when they first became commercially available. Clinical trials were thus carried out in Singapore to evaluate the effectiveness of a reduced dose vaccine. It was found that half the usual dose of vaccine recommended by the manufacturer was just as effective in preventing Hepatitis B virus infection as the usual dose. As a result of these evidence-based clinical findings, a half-dose was recommended in Singapore, rather than a full dose. The cost of vaccination was drastically reduced, and this consequently allowed more Singaporeans to be immunised. Moreover, parents may use Medisave to pay for their children’s Hepatitis B vaccination. With the implementation of the vaccination programme, the incidence of acute Hepatitis B infection fell by 60% - from 10 per 100,000 population in 1985 to 4 per 100,000 population in 1999.

10        The second notable clinical trial was the Atropine in the Treatment of Myopia (ATOM) Study, conducted by the Singapore National Eye Centre and SCRI in 400 myopic children. Singapore has one of the highest rates of childhood myopia or short-sightedness in the world, with about 80% of teenagers becoming myopic by 18 years of age and among them, 13% with high myopia. The trial found that low doses of topical Atropine eye drops could significantly help to slow the progression of myopia by 50-60% over a two-year period, and with fewer side effects as compared to higher doses. The findings from this landmark trial has benefitted many of our children being treated for myopia.

11    The third example relates to oncology or cancer therapy.  A local study on Non-Small Cell Lung Cancer (NSCLC) with Australian collaborators led by A/Professor Goh Boon Cher demonstrated that Asian populations experience more toxic effects than Caucasian populations when receiving similar chemotherapy combination drugs. Such examples of clinical research conducted in Singapore not only benefit our patients but also other Asian countries with similar ethnic and disease profiles. This also demonstrates the value of Singapore as a study site because of our multi-ethnic population, good healthcare institutions and professionals, and a robust research infrastructure.  

Strengthening Clinical Research through BMS Initiative

12    In 2000, the Government announced its vision to build a strong foundation for what has become today, a vibrant biomedical sciences (BMS) hub in this part of the world.

13        We recognised the potential of our local universities and developed research institutes in A*STAR. These efforts aimed at increasing the quality and quantity of our research talent have paid off and reaped strategic benefits in terms of developing positive economic and health outcomes for Singapore.

14        Following the successful launch of Phase 1 of our BMS initiative in 2000, a sound foundation was established for basic biomedical research in Singapore.

15        In Phase 2, covering the period 2006 to 2010, we moved into translational and clinical research (TCR) where discoveries generated in our laboratories were applied to studies in human subjects. We enhanced our pool of dedicated clinical researchers and clinician scientists to integrate healthcare delivery with our basic sciences expertise. In doing this, we were able to successfully bridge the gap between bench and bedside. Two new Academic Medical Centres at the Outram and Kent Ridge campuses were established to further drive greater integration between clinical service, research and education. The SCRI was also set up to enhance Singapore’s clinical trial capabilities.

16        The National Medical Research Council (NMRC), under the MOH, oversees the development and advancement of clinical research in Singapore. To date, the council has helped develop over 90 Clinician Scientists through its human capital awards. This is a significant number for a small country like ours that did not start off with a strong clinical research culture.

17        In the following phase for the period 2011 to 2015, the Government continued to build on the investments from the earlier phases, with increased emphasis on encouraging collaborative research, having competitive research funds and realising the outcomes of research.

18        Currently, around 7,000 researchers carry out BMS research and development work in Singapore across more than 50 private companies, in our local universities, and in 30 public-sector research and healthcare institutions under A*STAR and the MOH. This is no mean feat and one that we can be justifiably proud of.

19        While clinical research has achieved significant milestones, there is still more to be done to reap the benefits of research.  MOH will continue to improve patient care by focusing on disease areas that are of national priority and encouraging high-impact research collaborations between global companies, local healthcare institutions and research agencies such as SCRI.

20        The private sector has also contributed significantly to strengthening clinical research in Singapore, through public-private collaborations as well as in-house research models. Examples of notable industry partners include GlaxoSmithKline (GSK) and Bayer HealthCare.

21    About 15 years ago, GSK funded the largest clinical trial in Singapore involving more than 9,000 infants for a vaccine to treat Rotavirus that causes severe diarrhoea in young children.  The trial was a success and the GSK vaccine was licensed by Singapore’s Health Sciences Authority ahead of the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA).  Following this, the company has continued to invest in other clinical trials in Singapore, for example for H1N1 pandemic and H5N1 pre-pandemic vaccines, HPV vaccines against cervical cancer, and childhood pneumococcal vaccine.  They have also invested in building a new S$480 million vaccine manufacturing plant in Tuas which was opened by Prime Minister Lee Hsien Loong in 2009.

22        Bayer HealthCare has partnered public institutes - including the SingHealth Duke-NUS Academic Medical Centre and the National University Hospital System (NUHS) - to invest S$30 million in increasing research efforts in cancer treatment.  This has also expanded into research for therapies to treat heart and eye diseases.  The setting up of the Integrated Translational Oncology Network by Bayer and five local research institutions in 2013 was a key milestone to mark the company's commitment to its partnership with Singapore.  To date, Bayer has invested more than S$20 million in joint research, and increased its clinical trials conducted in Singapore three-fold, from six in 2007 to 20 in 2014.

23        Such public-private collaborations have yielded positive healthcare and economic outcomes.  We are committed to ensuring that Singapore remains an attractive place for global companies to invest more R&D and manufacturing resources, and look forward to a virtuous cycle in which the health outcomes for Singaporeans are also positively affected and improved.

The Importance of Academic Medicine to Clinical Research

24        Our two Academic Medical Centres - SingHealth and NUHS are integral to the TCR landscape in Singapore. They nurture and develop  clinician scientists that are crucial in driving the translation of bench discoveries to bedside applications to improve patient health.

25        The efforts of our clinical researchers and clinician scientists have led to cutting-edge treatments through advances in medical research and innovation. Recently, a potential made-in-Singapore new cancer drug by the team from A*STAR and Duke-NUS has advanced to clinical trial stage, providing a potential new option for cancer patients in the future.  The drug candidate, which aims to help up to 5 per cent of patients whose cancer is caused by particular genetic mutations, is the first publicly-funded one developed from scratch in Singapore to be tested on patients.

26        As we move on from our Golden Jubilee year, we will continue to integrate the knowledge and capabilities across various disciplines, institutions, agencies and universities to achieve even greater health and economic impact to support active ageing and a continuing high quality of life for all Singaporeans.

Conclusion

27        Looking back, Singapore has come a long way in the past 50 years. Today’s Conference and the launch of the SCRI SG50 Commemorative Book are testament to MOH’s commitment to improve patient care on various fronts and in this particular case, through clinical research.

28        Singapore’s healthcare landscape will continue to face further challenges ranging from new disease patterns to rising healthcare costs. To provide quality and cost-effective healthcare for all Singaporeans, MOH will continue to invest in and develop clinical research to help us ensure that our people continue to receive the best healthcare.

29        In closing, it is now my privilege to launch SCRI’s SG50 Commemorative book and declare this Conference open.

30        Thank you very much.