Speech by Dr Lam Pin Min, Senior Minister of State for Health, at the Public Health Thought Leadership Dialogue, 1 November 2017

Professor Keiji Fukuda, Director, School of Public Health, The University of Hong Kong 

Professor Chia Kee Seng, Dean, Saw Swee Hock School of Public Health 

Distinguished guests 

Ladies and gentlemen 

            Good morning. It gives me great pleasure to join you at the Public Health Thought Leadership Dialogue on Antimicrobial Resistance, organised by the National University of Singapore’s Saw Swee Hock School of Public Health. I am also delighted to welcome our overseas friends to Singapore. The dialogue theme, “From Knowledge to Action”, is timely as we shift from awareness of the problem caused by antimicrobial resistance (AMR), to the development and implementation of actions to slow its development and spread. 

The Need for Concerted Efforts to Combat AMR

2.           With the advent of modern antimicrobial treatments and advances in hygiene, deaths by infections have been drastically reduced. Yet, the evolution of microorganisms continues to pose an imminent threat to our medical advances. Often, it is only a matter of time after the discovery of an antimicrobial and its introduction to market that a microorganism develops resistance to it, often fuelled by the overuse or abuse of these antimicrobials.

3.           The extreme scenario of AMR – of having no effective antibiotics to treat infections, will bring us to a post-antibiotic era where simple infections may kill. Even today, there exist infections that do not respond to many treatment options. We must therefore take action now.

4.           AMR is a multi-sectorial issue. It is exacerbated by the extensive use of antimicrobials in modern medicine and agriculture. It is also a global issue, as microbes are transmitted through the food supply chain, human travel, and the environment. The coordination of efforts between sectors, and across international boundaries requires a strong will and good planning.

5.           I am pleased to announce that to strengthen Singapore’s efforts in addressing AMR, the One Health agencies, comprising the Agri-Food and Veterinary Agency, Ministry of Health, National Environment Agency and PUB, the National Water Agency, have come together to develop Singapore’s National Strategic Action Plan to combat AMR. Although each agency has been actively working to address AMR through its own initiatives for many years, this Plan consolidates the whole-of-government approach required to combat AMR.

6.           The National Strategic Action Plan sets the framework for Singapore’s response to AMR and prioritises key areas of action. It identifies potential areas that the One Health agencies will work on in collaboration with stakeholders such as the public, professionals and industry. The Plan takes into account recommendations by the World Health Organization (WHO), and aims to reduce the emergence and spread of AMR through the strategies of i) Education, ii) Surveillance, iii) Research, iv) Infection Prevention and v) Optimal Antimicrobial Use.

Raising Awareness to Establish Positive Behaviours

7.           Preventing AMR is possible with the collective and conscious effort of everyone. Individuals need to be equipped with an understanding of AMR and the tools to address it, to play a part in addressing the problem. The One Health AMR workgroup is looking into strengthening public education efforts through awareness initiatives for the general population to learn how they can contribute to efforts to prevent AMR. Activities in schools to engage our children from a young age are also important. These can include simple steps such maintaining good hand and personal hygiene, to more in-depth understanding of antibiotics and how they work.

Longer Term Efforts

8.           Three key elements or the three “I”s are essential in the longer-term efforts towards combating AMR. First, Integration. AMR is not the sole responsibility of any one agency, and there is a need to coordinate our efforts across sectors. The National Plan recognises that the coordination of surveillance activities and data sharing across sectors are important to improve our understanding of how AMR develops and circulates between humans, animals, food and the environment. This in turn facilitates timely risk assessment and control measures.

9.           In human health, MOH has been supporting surveillance of resistant infections and antimicrobial usage in public hospitals. Hospital surveillance teams actively monitor AMR and data from such activities have enabled the implementation control measures to prevent the transmission of infections by resistant microorganisms. Similarly, colleagues in the food and environment agencies have also been closely monitoring our food supplies and livestock to prevent the transmission of resistant foodborne pathogens to humans through the food chain.

10.          Second, In-depth research to understand the complex factors influencing AMR is important to develop innovative evidence-based initiatives. One example is the research project, Collaborative Solutions Targeting AMR Threats in Health Systems, which was recently awarded a 4-year Collaborative Centre Grant by the National Medical Research Council. This study, a collaboration between clinicians and researchers of 3 Singapore hospitals^[1], focuses on the use of novel diagnostics, infection control strategies, and behavioural sciences to strengthen institutional and national capability in targeting drug-resistant bacteria.

11.          Lastly, International. AMR is not just a local problem, but a global one. International momentum since the adoption of WHO’s Global Action Plan must lead to consensus building and action. Our domestic efforts must be complemented by cooperation and partnerships with our neighbours and international counterparts, where we learn from each other through the sharing of best practices in our collective effort to fight AMR. This thought leadership platform to learn from Professor Keiji Fukuda, who has spent years in WHO coordinating efforts against AMR, is a good example.

12.          I am also pleased to learn that the Saw Swee Hock School of Public Health has put in place an institute focusing on global health called LIGHT. Under the leadership of the incoming Dean, Professor YY Teo, LIGHT will build and expand on the school’s global health initiatives to look into issues such as AMR. 

Conclusion

13.          Singapore has embarked on our AMR journey some time ago, and has seen some success in our initiatives. More should and can be done. Today we have policy makers, researchers, and practitioners in this room to discuss on what is needed to combat AMR. I wish you a fruitful discussion and look forward to your continued support as we work together to keep AMR at bay. Thank you.

[1] National University Health System (NUHS), Singapore General Hospital (SGH), and Communicable Diseases Centre (CDC)