Public Consultation on Proposed Amendments to the Infectious Diseases Act

28 Sep 2007

The Infectious Diseases Act (IDA) is the principal piece of public health legislation that deals with the prevention and control of infectious diseases in Singapore.  It is jointly administered by the Ministry of Health (MOH) and the National Environment Agency (NEA).  The IDA has undergone several amendments over the years to keep up with the trends of outbreaks and the emergence of new infectious diseases.  The IDA was last amended in 2003 in the middle of SARS to incorporate provisions to deal with the outbreak in Singapore.

Some gaps in our public health response system were identified from the SARS experience. Beyond that, the experience of planning and preparing for a possible influenza pandemic have highlighted the need for MOH to have the further powers to deal with public health emergencies. In addition, there is a need to revise existing public health laws to achieve better control and prevention of HIV/AIDS.

The Ministry of Health is therefore proposing to amend the IDA to strengthen our capabilities to respond effectively to outbreaks that may be more serious and devastating than SARS.  The amendments would provide MOH with the legal powers necessary to ensure that public health measures can be implemented in a timely and effective way.

MOH will conduct a 6-week public consultation (28 September to 9 November 2007) to obtain feedback on the proposed amendments. The main amendments are summarized below.  Please refer to the Public Consultation Paper for more details.

PROPOSED KEY REVISIONS TO INFECTIOUS DISEASES ACT

(i) Public Health Surveillance

New infectious diseases like SARS, avian influenza and Nipah, and old diseases that are now resistant to treatment like Extensively Drug Resistant TB (XDR-TB) will continue to pose threats to the public health well-being of Singaporeans.  The increase in volume of international travel has also made it easier for infectious diseases to be transmitted from one country to another.  In order to avert outbreaks of such diseases in Singapore, it is important to have in place a strong and robust public health surveillance system which is able to track and detect cases of such infectious diseases before the disease spreads to the general population.  We would also need to have information on the factors within the population that may promote the introduction and spread of the disease. 

Leftover samples (e.g. blood) generated in the course of routine medical care in hospitals will be an invaluable source of information on the prevalence or incidence of an infectious disease in Singapore.  Such information can be used to determine the level of immunity of the population, and identify groups which may be particularly vulnerable to an infectious disease outbreak.  Therefore, we propose to amend the IDA to empower the Director of Medical Services (DMS) to obtain left-over samples, and send them for the tests and examinations for the purpose of monitoring the infectious disease situation in Singapore.  This will also help MOH to draw up necessary policies, programmes and action plans to protect Singapore from infectious disease outbreaks.

(ii) Closure of premises responsible for outbreaks

The IDA presently empowers the DMS to close any food establishment that is suspected to be the source or is responsible for the transmission of an infectious disease.

The Ministry proposes to expand the IDA to empower DMS to close any premises as non-food establishments may also be the source of an outbreak.  The DMS may also require the owner or occupier of such premises to clean and disinfect his premises.  The DMS will impose such requirements only as a last resort, and for not longer than necessary.  In addition, a person who is aggrieved by an order or requirement of the Director may, within 7 days, appeal to the Minister.

(iii) Obtaining information from patients

Early recognition and isolation of infected persons is necessary in order to effectively prevent and control infectious disease outbreaks.  In order to achieve early detection and isolation during SARS, medical practitioners were required to obtain from patients who had fever, information on recent overseas trips or exposure to other affected patients. This was done so that suspect cases of SARS could be isolated without delay, thereby minimizing the risk of transmission.  We propose to amend the IDA so that when required, the DMS may require medical practitioners as well as other categories of health care workers (e.g. TCM practitioners, dentists, pharmacists, etc.) to obtain disease related information from their patients.  This is because an infected person may approach other health care professionals for treatment during an outbreak.

(iv) Restrictions on gatherings in times of emergencies

A severe outbreak of a highly contagious disease, like an influenza pandemic, can spread quickly within the population and cause many deaths unless steps are taken to limit its spread.  Social distancing, or restrictions on meetings or gatherings, is therefore an important and effective strategy that can help to limit the spread of a highly contagious disease.

Existing legislation allows the prohibition of specific meetings, gatherings and public entertainment.  However, in a severe outbreak, a more extensive prohibition on gatherings may need to be quickly implemented across the island.  We propose to amend the IDA so

that the Minister may declare a public health emergency in the event of an outbreak or imminent outbreak of an infectious disease that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability in Singapore.  Further to this, the Minister may for the purpose of securing public health and safety declare that the whole or any part of Singapore to be a restricted zone, in which the entry and stay of persons, or the holding of meetings and gatherings, will be prohibited or restricted. Such restrictions will reduce opportunities for further transmission of the disease.

In view of the serious implications of such a measure, the declaration of restricted zones will only be carried out as a last resort, when public education has failed to achieve social distancing.  To ensure that restricted zones are declared only when necessary, and only for the shortest period necessary, the amended IDA will provide that the Minister for Health must first declare a public health emergency, and that an order for a restricted zone will expire after 14 days (unless further renewed by the Minister).  Furthermore,such orders will have to be presented to Parliament as soon as possible.

(v) Public health research

Public health research plays an important role in strengthening the country’s capacity to respond to an outbreak of an infectious disease.  We propose to amend the IDA to empower the DMS to undertake public health research to determine more effective infection control measures, as well as to develop new diagnostic tests or forms of treatment for infectious diseases. Under this proposed amendment, DMS may require any clinic, hospital or other institution to furnish him with such information or samples (e.g. blood) in his possession, as the DMS may consider necessary or appropriate for public health research purposes. To safeguard confidentiality, the data and samples obtained will be anonymised before they are provided to the DMS.  Public health research may only be conducted in the public interests.

(vi) Enhanced measures to contain HIV/AIDS

Despite efforts to educate the population on the prevention and control of HIV, individuals continue to engage in unsafe sexual practices, putting themselves and their

partners at risk of contracting HIV.  There is a need to step up efforts to reduce the spread of HIV, and one of the means by which MOH proposes to do so is by requiring a person who may have been exposed to the risk of contracting HIV to take the necessary steps to protect his sex partners from the risk of HIV infection.

It is presently an offence under the IDA for a person who knows that he is HIV-infected, to have sexual intercourse if he does not first inform his partner of his HIV status, and obtain his partner’s agreement to accept the risk of infection.   

MOH proposes to expand the IDA to address the situation where an individual who, although unaware that he is HIV-positive, has reason to believe that he has been exposed to the risk of contracting HIV or AIDS (e.g. by having unprotected casual sex with multiple partners).  The amendments will impose an obligation on an individual not to engage in any sexual activity, unless before doing so, (a) he had informed his partner of the risk of contracting HIV infection from him and that the partner has voluntarily agreed to accept the risk; or (b) he had tested negative for HIV and he had not, between the time of his test and sexual activity with the partner, engaged in any activity which might have exposed him to the risk of HIV infection; or (c) he takes reasonable precautions during the sexual activity (e.g. by wearing a condom) to ensure that he does not expose his partner to the risk of contracting HIV infection.

Public Consultation

The Ministry of Health will now like to seek the views and feedback of the public, specifically on the following issues:

• Public Health Surveillance

• Prevention, Control and Investigation of Outbreaks

• Public Health Emergencies

• Prevention of HIV/AIDS

A table on the current Act and proposed key amendments is shown below .

The public consultation document can be found on the MOH website. All feedback should reach the Ministry by 9 November 2007.

Reference

Draft Infectious Diseases (Amendment) Bill - for Public Consultation

Public Consultation on the Proposed Amendments to the Infectious Diseases

Act