OPENING SPEECH BY MADAM RAHAYU MAHZAM, MINISTER OF STATE, MINISTRY OF HEALTH, FOR THE SECOND READING OF THE COMMUNICABLE DISEASES AGENCY BILL

Madam Deputy Speaker, on behalf of the Minister for Health, I beg to move, “That the Bill be now read a second time.”

2. In March 2023, during the Parliamentary Debate on the White Paper of Singapore’s response to COVID-19, the Minister for Health announced that Singapore will set up the Communicable Diseases Agency (CDA). Our current capabilities in managing communicable diseases reside in several entities. For example, MOH sets policy, NCID administers the public health control measures as part of the national programmes, and HPB does public education. By consolidating into a dedicated agency, it will help us systematically build up strong public health expertise and organisational capacity, and establish international linkages to better tackle future pandemics.

Threat of pandemics and outbreaks persists

3. Over the years, we have seen severe infectious disease outbreaks occur with increasing frequency. Since the 2003 Severe Acute Respiratory Syndrome (SARS) global outbreak, the World Health Organization (WHO) has already declared seven Public Health Emergencies of International Concern (PHEIC). These included the 2009 Influenza A (H1N1) pandemic, COVID-19 pandemic, 2022 mpox global outbreak, 2016 Zika global outbreak, all of which affected Singapore.

4. This increasing frequency of infectious disease outbreaks takes place amidst a complex ecological environment, with external forces driving the emergence and re-emergence of infectious diseases.

5. First, unplanned environmental encroachment has resulted in an increase in interaction between humans and animals, including the diseases they might carry. This has increased the risk of infections crossing the species barrier and infecting humans, sparking outbreaks of zoonotic diseases like Ebola Virus Disease and Marburg Virus Disease in Africa. Urbanisation has contributed to more dense human-to-human interactions and increased the risk of spread of infectious disease within communities.

6. Second, globalisation and cross-border travel greatly accelerates the speed at which infectious diseases spread internationally. Singapore as an aviation airhub is especially vulnerable.

7. Third, climate change is influencing and changing our environments. Increases in temperature allow disease vectors like the Aedes mosquitos which spread dengue fever, to expand their geographical range, placing more regions and people at risk of infection. Aedes aegypti, present in Singapore, becomes more efficient at transmitting dengue at higher temperatures.

8. Fourth, inappropriate antibiotic use drives the development of antimicrobial resistance, which render previously effective drugs useless against these resistant forms. An example of such drug-resistant disease is multi-drug-resistant tuberculosis or MDRTB, which is much harder and takes much longer to treat than normal TB. When these drug-resistant diseases spread, they may cause more severe disease and even death because they are more difficult to treat.

9. Finally, the vaccine hesitancy movement undermines vaccination efforts to protect the population from infectious diseases that could cause severe illness and death. As a result, some countries where vaccine-preventable diseases like measles were previously eliminated have seen resurgences and outbreaks due to the declines in vaccination uptake. For example, measles has resurfaced in the United States since 2019 and in European countries since 2023, despite ready-to-access vaccine in these countries.

10. We are fortunate that our vaccination coverage for diseases like measles and diphtheria remain sufficiently high to maintain herd immunity, but we must not rest on our laurels. We must do what we can to maintain these high rates of vaccination coverage, such as addressing misinformation and disinformation on vaccines and provide evidence of their safety, efficacy and importance to individual and public health.

11. It is against this backdrop that CDA is being set up. CDA will be the front-line agency to safeguard Singapore by preparing for, preventing, detecting and responding to infectious diseases.

Drawing upon the lessons learnt from COVID-19

12. The COVID-19 White Paper put forth a few key recommendations to consolidate our learnings and better prepare ourselves for future pandemics.

13. First, we must systematically build strong expertise and organisational capacity to tackle future pandemics. During the COVID-19 response, we developed and deepened capabilities in areas like data analytics and epidemic modelling to support policy decisions and response. These must not be lost and must be maintained and developed to better prepare Singapore to manage future pandemics. CDA will do this by bringing together the expertise in Ministry of Health, Health Promotion Board and National Centre for Infectious Diseases, and leveraging academia and international technical networks to further develop CDA’s capabilities.

14. Second, the White Paper recommended that we institutionalise the use of science and technology in responding to infectious disease threats. This involves tapping on the research ecosystem to coordinate and promote public health research that inform and guide public health actions and policies. With rapid technological advancements, new tools are continuously being developed, which must be evaluated and adopted to better prevent, prepare for, manage and respond to infectious diseases.

15. Lastly, we must strengthen the structures and capabilities for forward planning and preparedness to respond to the next pandemic in a more agile and fluid manner. In consolidating the public health functions for the control of infectious diseases, CDA will oversee end-to-end disease prevention, surveillance and risk assessment, preparedness and response, and disease and outbreak management. This will allow the Government to quickly respond to disease outbreaks as one concerted public health effort.

What CDA will do

16. CDA is the response to the three key recommendations above. It will bring together public health functions under one roof. There are five areas of responsibility- ‘prevent’, ‘prepare’, ‘detect’, ‘respond’ and ‘enable’.

17. First, ‘prevent’. This combines public education with robust vaccination policy and implementation, building and promoting infection prevention and control capabilities and practices across different settings, and combating the threat of antimicrobial resistance through a collaborative One Health approach. CDA seeks to prevent infections from taking root in the first place.

18. Second, ‘prepare’. Our COVID-19 experience has reinforced the need to invest in preparedness and readiness measures. The next pandemic can occur at any time, and we must be prepared and stand ready to respond swiftly, flexibly, decisively and effectively. The groundwork for this must be laid during peacetime, drawing upon lessons from past experiences and anticipating future ones; developments and learnings from across the world; and continuously reviewing and updating our plans and strategies so that they remain relevant.

19. COVID-19 demonstrated that pandemics can last much longer than previously anticipated. It lasted three years, much longer than the three-months-long response for 2003 SARS and 2009 Influenza A (H1N1). It also caused massive societal and economic disruption, far beyond the health sector. We must therefore prepare and be ready for a protracted, inter-sectoral, whole-of-Singapore response.

20. To do this, CDA will lead and coordinate public health preparedness and readiness efforts. It will work with stakeholders from various sectors and agencies to build sectoral readiness against infectious disease crises, and to safeguard national interests such as vaccine and therapeutics development and access. CDA will also work with MOH and healthcare institutions to build capabilities and capacity in key areas such as laboratory testing and clinical management.

21. Third, ‘detect’. Surveillance is key to this, as continuously monitoring the infectious disease situation locally and internationally allows us to sense-make and identify unusual developments. Early detection of warning signs allows us to respond promptly to mitigate the impact of an outbreak. CDA will strengthen our surveillance capabilities, including exploring the use of new modalities of surveillance such as through genomic testing and wastewater testing to supplement traditional surveillance approaches, and explore data analytics and artificial intelligence to enhance our ability to make sense of large volumes of data.

22. Fourth, ‘respond’. CDA will investigate and respond to cases and outbreaks of infectious diseases in Singapore. This takes place routinely for endemic diseases and during potential crisis. During a pandemic, the approach and strategy will be driven by the Ministry of Health, or the equivalent of a Multi-Ministry Taskforce during COVID-19. CDA will provide policy and scientific recommendations, and also work with MOH and other agencies to carry out the operations. These will include a calibrated combination of public health and social measures that include case investigation, contact tracing, masking, physical distancing, and border control measures.

23. Finally, CDA needs to support its function with strategic enablers. One important enabler is research. Research is an important aspect of preparation, to ensure a scientifically robust, data-driven response to infectious diseases. For instance, research conducted during COVID-19 allowed us to determine the duration people infected by COVID-19 were likely to remain infectious. This in turn informed the duration of isolation for these individuals so as to prevent transmission. CDA will coordinate and conduct public health research. It will make use of the findings from local and international studies and translate research findings into public health and clinical actions and policies.

24. Another key enabler is international co-operation. The next pandemic is likely to come from abroad, CDA will also engage overseas stakeholders and counterparts to enable Singapore to respond swiftly to rapidly evolving global disease situations. This allows us to access and share information, expertise and the latest developments and best practices in infectious diseases control. This will also allow us to detect international emerging situations of concern earlier, and buy us invaluable time to prepare for and implement mitigating measures.

Arrangement of the CDA Bill

25. I will now highlight the significant elements of the Communicable Diseases Agency Bill.

26. Part 1 of the Bill introduces the terms used in various provisions of the Bill. Part 2 establishes CDA as a body corporate with a structure similar to major statutory boards. Within it, Clauses 5 and 6 describe the functions and powers of CDA, which are based on what the consolidated MOH, HPB and NCID units do today, and what we envisage CDA will do after it is established, which I have described earlier.

27. Parts 3 to 6 lay out CDA’s governance structures and requirements, which are aligned with the requirements under the Public Sector (Governance) Act 2018. They cover the membership, appointment and decision-making procedures of CDA’s Board, as well as personnel and financial matters.

28. Part 7 covers miscellaneous provisions necessary for the administration and enforcement of the Bill.

29. Part 8 allows for the transfer of assets, liabilities and employees from relevant MOH and HPB departments or divisions, as laid out in the Schedule, to CDA. As NCID today is part of Tan Tock Seng Hospital which is a corporate entity, NCID assets, liabilities and employees will be consolidated under CDA through other means, such as via contract novations or direct employment by CDA.

30. Part 9 will make consequential amendment to other Acts. The key amendment will be to the Infectious Diseases Act 1976, where relevant provisions on vaccinations notifications and vaccination exemptions will be amended to replace HPB with CDA. This reflects the transfer of these functions related to the National Immunisation Registry from HPB today to CDA after it is established.

Closing

31. Mr Speaker, the Bill presented today sets out the legislative framework to establish the Communicable Diseases Agency. If the Bill is passed, the CDA will be established in the first half of 2025. It will be the lead agency in Singapore to prevent, prepare for, detect and manage infectious diseases, and will play a pivotal role in safeguarding Singapore from infectious disease threats. Sir, I beg to move.