Speeches
OPENING SPEECH FOR SECOND READING OF INFECTIOUS DISEASES (AMENDMENT) BILL BY DR LAM PIN MIN, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, 14 JANUARY 2019
14 January 2019
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Mr Deputy Speaker, on behalf of the Minister for Health, I beg to move, “That the Bill be now read a Second Time”.
2 Singapore has made significant progress in controlling infectious diseases since the early days of independence. Improvements in public infrastructure, sanitation and hygiene have drastically reduced the rates of then common serious infectious diseases such as cholera and typhoid.
3 Vaccination requirements complemented by strong vaccination programmes have resulted in high vaccination coverage against highly infectious diseases such as measles and diphtheria.
4 Requirements for surveillance and reporting systems have also enabled the early detection of existing and new diseases, allowing for swift response to curtail disease spread.
5 However, we cannot let our guard down. Infectious pathogens and the environment in which we operate are continually changing, and we must regularly take stock of these changes and examine how we can better respond to them.
6 The Ministry of Health recognises that:
7 Firstly, Singapore is a densely-populated city state, and a global travel and trade hub. We remain vulnerable to the importation of emerging and re-emerging infectious diseases. SARS in 2003 is a stark reminder of how a new disease can wreak havoc on our healthcare system and socioeconomic fabric. We have also experienced the influenza H1N1 pandemic in 2009 and most recently Zika in 2016. Globally, ongoing outbreaks, which include Ebola in Africa and MERS in the Middle East, remind us of the need to be vigilant, and to be prepared for the emergence of new diseases.
8 Secondly, research and development, and technological advances have allowed us to rapidly increase our understanding of infectious diseases and develop better response measures. We cannot just rely on the old traditional methodologies, and must make provisions to allow for more effective and efficient ways – through IT, R&D, or the use of technology – to prevent and control infectious diseases.
9 Lastly, while the government takes the lead in safeguarding public health, infectious diseases can happen and spread anywhere – in homes, schools, workplaces, and from overseas destinations – and we will need the help of the community to safeguard Singapore against these threats.
10 The Infectious Diseases Act (IDA) was enacted in 1976 and was last amended in 2008.As part of our continual efforts to ensure that infectious disease prevention and control measures remain effective, this Infectious Diseases (Amendment) Bill seeks to amend the Infectious Diseases Act in the three key areas of:
Enhancing infectious disease surveillance;
Preventing the introduction of infectious diseases into Singapore; and
Lastly, strengthening infectious disease control within Singapore.
11 Last year, my Ministry invited the public to provide their feedback on the proposed amendments over a six-week period. We received comments from members of the public, healthcare professionals including infectious disease specialists, academia and stakeholders from the telecommunications and transport sectors. Overall, respondents expressed support for the proposed amendments. There was also broad recognition that the amendments are intended to ensure that our legislative and regulatory measures to detect, prevent and control infectious diseases entering into and within Singapore, remain relevant and allow for the calibration of operations to manage the risk presented.
12 Mr Deputy Speaker, please allow me to highlight the major provisions in the Bill.
13 First, let me introduce the amendments to enhance infectious disease surveillance.
A. ENHANCING INFECTIOUS DISEASE SURVEILLANCERISK-CALIBRATED SURVEILLANCE OF AT-RISK PERSONS 14 With better understanding of certain infectious diseases and advancements in IT, there could be new ways of monitoring the health status of persons who may have infectious diseases of concern, for example, through remote or indirect means. This reduces the burden and inconvenience to the person being monitored, and allows for a more scalable surveillance system. Clause 2 of the Bill clarifies the definition of “surveillance” in the Act to indicate that it may be periodic or continuous and explicitly provides a definition for medical examinations, which among others, could be conducted remotely.
NOTIFICATIONS OF INFECTIOUS DISEASES 15 As it stands, both doctors and laboratories are required to notify my Ministry of the same set of infectious diseases when detected. With the understanding that some infectious diseases come with distinctive clinical signs and symptoms which can be identified by doctors, while others can only be confirmed through laboratory testing, Clauses 4 and 27 of the Bill clarify Section 6, to allow for doctors, laboratories, and any other prescribed groups of persons to report different prescribed sets of diseases to the Ministry. This will allow us to streamline notification requirements and reduce duplication.
ORDER TO SUBMIT SAMPLES OR INFORMATION FOR PUBLIC HEALTH SURVEILLANCE
16 My Ministry undertakes public health surveillance where information and samples from healthcare facilities and laboratories are collected for testing and trend analysis. Strictly speaking, based on existing requirements, we must issue a new legal order each time we collect a sample, even though it may be an ongoing surveillance programme. Clause 5 of the Bill amends Section 7 to allow my Ministry to state, through a one-time order, the frequency and time period for the submission of samples or information.
17 Next, allow me to introduce the amendments to prevent the introduction of infectious diseases into Singapore.
B. PREVENTING THE INTRODUCTION OF INFECTIOUS DISEASES INTO SINGAPOREMANAGING INCOMING TRAVELLERS UNVACCINATED FOR SPECIFIC INFECTIOUS DISEASES
18 Under Section 31, persons entering Singapore from specific areas may be required to be vaccinated against specified infectious diseases. To date, the only disease specified under this section, as guided by the International Health Regulations, is Yellow Fever – a serious viral infection. There is currently no cure for Yellow Fever, but it can be easily prevented through vaccination which protects the individual from acquiring the disease.
19 To prevent the import of the disease into Singapore, we currently require travellers coming into Singapore from Yellow Fever endemic areas to show that they have been vaccinated. The number of travellers without the required Yellow Fever vaccination has been small, at an average of about 50 per year. For these people, the Infectious Diseases Act provides for my Ministry to implement isolation or surveillance measures, or require them to undergo vaccination, to mitigate the risk of importation and possible spread. Travellers who are non-citizens, may be refused entry into Singapore, if they do not comply with our measures.
20 While we can vaccinate and monitor small numbers of travellers, it would not be practicable to do so if the numbers increase to hundreds or even thousands, for example if countries with high travel volume to Singapore are affected but fail to get their travellers vaccinated despite international advice. In such a circumstance, the entry of large numbers of unvaccinated travellers poses both a health and public security threat to our community. If necessary, we need to be able to protect ourselves against such threats. Clause 13 of the Bill therefore introduces additional flexibility to allow the refusal of entry of unvaccinated non-citizen travellers without needing to first provide vaccination, isolation or surveillance.
MEDICAL EXAMINATION OF PERSONS ARRIVING IN OR LEAVING SINGAPORE21 Vaccination verification is unique. Not all diseases are vaccine-preventable or serious enough for us to require all travellers from specific areas to show proof of vaccination. At a more general level, it is important to have measures for us to identify unwell travellers who may be potential carriers or cases of infectious diseases, to facilitate early public health measures, such as treatment or isolation. As an example, travellers arriving from countries with an ongoing risk of Middle East Respiratory Syndrome, or MERS, currently undergo temperature screening on arrival.
22 In a similar vein, Singapore should likewise be able to take steps to prevent the export of infectious diseases through unwell travellers to other countries, should we experience a serious outbreak. This was the case during the SARS outbreak, where travellers leaving Singapore had to undergo temperature screening.
23 These infectious disease control measures at the borders are currently provided for under Regulation 3 of the Infectious Diseases (Measures to Prevent or Control the Spread of Infectious Diseases) Regulations 2004.
24 As we recognise that these are basic and important means of preventing and controlling infectious diseases, Clause 15 of the Bill transfers this Regulation into the Act by inserting the new Sections 45A and 45B, to allow the medical examination and surveillance of travellers entering or leaving Singapore. These help reduce the risk of the introduction and spread of infectious diseases into the community in Singapore and the international spread of diseases from Singapore.
25 Lastly, I will introduce the amendments to strengthen infectious disease control within Singapore.
C. STRENGTHENING INFECTIOUS DISEASE CONTROL WITHIN SINGAPOREREQUIRING PREMISES TO CARRY OUT OR FACILITATE SURVEILLANCE OR CONTACT TRACING26 Regulation 4 of the Infectious Diseases (Measures to Prevent or Control the Spread of Infectious Diseases) Regulations 2004 provides for MOH to require workplaces and dormitories to conduct contact tracing and surveillance for specific diseases. This is to facilitate the identification and management of infected persons or contacts, to prevent disease spread.
27 The threat of infectious diseases is however not restricted to workplaces or dormitories alone. During the SARS outbreak, MOH put in place temperature monitoring of staff and students in schools, as a form of surveillance to identify and treat any infected persons, and prevent disease spread. More recently, in 2016, the detection of a cluster of tuberculosis cases in a block of flats in Ang Mo Kio was followed by the setup of on-site screening and contact tracing services to identify any other undiagnosed cases for follow-up treatment and monitoring.
28 While MOH had worked collaboratively with the relevant government agencies, such as the Ministry of Education and the Housing Development Board to institute the respective measures, the experiences surfaced the potential need for legislative levers to require persons in charge of different types of premises to put in place surveillance or contact tracing measures, to mitigate the spread of infectious diseases.
29 Clause 7 of the Bill inserts a new Section 19A to incorporate the current Regulation 4 of the Infectious Diseases (Measures to Prevent or Control the Spread of Infectious Diseases) Regulations 2004 into the Act, and expands its scope to include premises beyond workplaces and dormitories.
RISK-STRATIFIED MANAGEMENT OF CASES OR CARRIERS OF INFECTIOUS DISEASES30 Following the detection of infectious diseases, a person may be restricted from his occupation under Section 21, if the conduct of his occupation poses a risk of spread to others. For example, food handlers tested positive for diseases that spread through food would be required to stop work. This stop-work requirement is a blanket one, and does not facilitate allowing a worker to conduct other tasks, such as backend administration or cashiering that do not involve contact with food, and hence would not spread the disease. Clause 8 of the Bill calibrates Section 21 to allow persons of a lower risk of transmission to perform specific occupational activities assessed to be acceptable from the disease transmission perspective.
31 Likewise, Clause 9 of the Bill amends Section 21A to allow my Ministry to calibrate the restriction of movement placed on persons of lower risk of transmission, such as certain contacts of an infectious disease, to allow them some liberty to be at specified places, subject to conditions that would minimise the risk of disease exposure and transmission to others, instead of being disallowed in all public or common places outside of their homes. For example, a low-risk contact may be allowed to go to his or her workplace via a specified mode of transport, such as a private car, for a certain period of time.
DISSEMINATION OF HEALTH ADVISORIES AND PROVISION OF INFORMATION BY OPERATORS 32 I had spoken about the importance for my Ministry and other stakeholders to conduct surveillance and collect the necessary information to prevent disease spread. In the event of an outbreak or potential disease spread, it is also of utmost importance that we have the means to push out critical information to the public such that they may take the necessary steps to protect their health. Besides information shared through mass media, there may be instances where targeted sharing to generate awareness among specific population groups is necessary. For example, there would be value for persons travelling to or returning from a country affected by an outbreak to receive information concerning the disease and precautions to observe. During the 2013 outbreak of H7N9 avian influenza in various parts of China, collaborative arrangements were made between my Ministry, the Civil Aviation Authority of Singapore, Immigration & Checkpoints Authority, Changi Airport Group and the relevant airlines, to distribute health advisory notices to travellers returning from affected areas.
33 Clause 10 of the Bill inserts a new Section 21B, to provide the legal basis to tap on the capability, infrastructure and expertise of operators, to disseminate health advisories to persons specified in an order, such as (i) persons travelling to or returning from overseas areas affected by an outbreak, or (ii) persons within or likely to enter any place within Singapore affected by or likely to be affected by an outbreak. This provision also provides the legal backing to operators required to disseminate information in different formats including electronic ones. Examples of operators include (i) mobile operators; (ii) land, air and sea transport operators providing local and cross-border services; (iii) port and transport facility operators; (iv) persons who control or manage premises; and (v) event organisers.
34 Section 21B also allows my Ministry to require operators to provide information of relevant persons to facilitate the dissemination of advisories. For example, if a case of measles or infectious tuberculosis is discovered on an airplane, we would need to obtain the airplane’s passenger manifest, to provide passengers seated around the infectious person with information on the disease and mitigating actions to be taken.
35 When consulted, operators asked whether they would be in contravention of privacy laws such as the Personal Data Protection Act. In this regard, Clause 25 of the Bill inserts a new Section 67A, which confers immunity against legal liability under other laws, to persons disclosing or providing any information required under the Infectious Diseases Act, in good faith and with reasonable care in accordance with any requirement under the Act.
TIGHTENING MOVEMENT RESTRICTIONS FOR HIGH-RISK INDIVIDUALS 36 Even in our efforts to work with high-risk persons to prevent disease spread through necessary public health measures, a small minority may refuse to comply. For example, an infectious person served an isolation order may abscond, totally disregarding the risk to others. Section 56 currently allows such non-compliant persons to be arrested without warrant and to be punished, on conviction, with a penalty of a fine or jail term. However, an arrest does not directly mitigate the immediate public health risk of disease transmission to others.
37 Clause 20 of the Bill amends Section 56 to allow health officers to take necessary measures, including the use of physical means, to enforce a legal order served under the Act, for example by bringing an absconder back to the place of isolation, in lieu of arrest. It also makes explicit that persons under legal orders that restrict their movement in Singapore, would not be allowed to leave Singapore, unless otherwise permitted.
38 These provisions allow my Ministry to take steps to enforce the restrictions which are put in place on individuals. We are mindful that these powers should be exercised carefully and will put in place a framework for the assessment of cases, and safeguards such as limiting the exercise of powers to specific situations, for example where the immediate isolation of a highly infectious person is necessary.
DISCLOSURE OF INFORMATION TO PREVENT AND CONTROL DISEASE SPREAD39 Finally, in facilitating prevention measures and improving preparedness against infectious diseases, we will be strengthening provisions relating to (i) the disclosure of information for the prevention of disease spread and outbreak; and (ii) national public health research.
40 First, the disclosure of information for prevention of disease outbreak or spread. To protect against the spread of infectious diseases, it is critical that entities responsible for carrying out disease prevention and control measures rapidly share information with one another. Currently, Section 57A of the Act requires, in certain circumstances, the Minister of Health’s approval for the disclosure of information on infectious disease cases, carriers or contacts, from my Ministry to third parties for the purpose of preventing disease spread. To facilitate expedient information sharing, Clause 21 of the Bill amends Section 57A to empower the Director of Medical Services to do so, without the Minister’s approval.
41 To provide for the direct sharing of such information between healthcare providers, as authorised by the Director of Medical Services, Clause 22 inserts a new Section 57B. I give the example of infection by multi-drug resistant organisms, which can be transmitted through contact with a carrier. A carrier of such organisms may seek care from different hospitals in different regional clusters; in this case, the sharing of information between hospitals is important, so that the necessary isolation measures can be taken to prevent the transmission of the disease to other patients. Information shared may include the identifiers of the person and these should only be shared or used to the extent that allows the necessary measures to be taken to prevent disease spread.
42 We recognise that the use and disclosure of information should be conducted strictly on a need-to-know basis. The healthcare services to which this new provision relates, and conditions to be adhered to by the disclosing and receiving parties, will be specified.
FACILITATING NATIONAL PUBLIC HEALTH RESEARCH43 Second, national public health research. National public health research is an important tool to understand diseases and is necessary for the evaluation of current operations and identification of more efficient ways to manage or prevent outbreaks. Research outcomes include the development of preparedness plans and prevention and control policies, for the benefit of public health and to facilitate the optimal deployment of resources during an outbreak.
44 We should not be doing research only when we are close to an emergency or already in one. It is well-recognised that public health research needs to be conducted well in advance of any possible outbreak during peacetime, to ensure that Singapore’s defences against any new or re-emerging infectious disease remain relevant and strong, so that we can effectively respond during an actual outbreak. Clause 23 of the Bill therefore clarifies that Section 59A allows national public health research to be conducted even when there is no imminent risk or crisis.
45 Clause 23 also amends Section 59A, (i) to allow the use of information or samples obtained through other sections of the Act for research, for example surveillance or disease notification data, as well as (ii) to facilitate the use by my Ministry and sharing of individually-identifiable information or samples with third party researchers, where research can only be carried out using identifiable information or samples, for example in tracing the transmission pathways and patterns of spread of a rare or new disease.
46 We recognise the importance of protecting the confidentiality of patients, and preventing potential misuse of data. I would like to assure the House that data protection remains paramount to us. In using identifiable data, we will assess that it will benefit the greater public health interests of Singapore and there are no other reasonable alternative means to conduct the research. Also, persons authorised to access identifiable data will be limited and must comply with conditions to ensure confidentiality.
47 There are also other amendments to the Act which facilitate its administration.These include:
Alignment of nomenclature for “HIV infection” and removal of “AIDS”, a late stage subset of HIV;
Clarifying the responsibility of the Minister for Health and the Minister responsible for health and sanitary measures in relation to vessels, aircraft, vehicles and persons entering or leaving Singapore;
Enabling the seizure of books, documents or records for investigation of offences, and the disposal of seized items; and
The adoption of standard provisions on how liability for offences by corporations and other types of entities is to be determined.
As I close my speech, let me once again highlight my Ministry’s commitment to continue building on the good work which had been put into developing Singapore’s capabilities to prevent and control infectious diseases.
CONCLUSION
48 Last year, Singapore was evaluated by the World Health Organization (WHO) on our capabilities in health security as stipulated through WHO’s International Health Regulations. I am happy to share that Singapore was assessed, and I quote, to “[have] demonstrated strong leadership and a highly developed capacity to detect and respond to potential public health emergencies”.
49 My Ministry recognises that we must not and cannot afford to be complacent. The Infectious Diseases Act is an important legal instrument that enables Singapore to prevent, protect against, control and respond to the spread of infectious diseases. This round of amendments to the Act was proposed following a detailed review of our existing levers and approaches.
50 The proposed amendments are intended to achieve two key objectives. First, to strengthen the Act based on the current infectious disease landscape and our operational experience. Second, to put in place risk-stratified approaches in managing outbreaks, and infected and at-risk persons, given our improved understanding of disease spread.
51 To sum up, the Infectious Diseases (Amendment) Bill is premised on the need to remain continually vigilant and maintain a high degree of preparedness against evolving infectious diseases. I ask for the support of all Members for this Bill.
52 Mr Deputy Speaker, I beg to move.