Speech by Mr Gan Kim Yong, Minister for Health at the 25th East Asian Medical Students’ Conference (EAMSC) 2012, Singapore

1     It gives me great pleasure to address you at the 25th East Asian Medical Students’ Conference. Allow me to first extend a warm welcome to our participants from around the Region. We are honoured to have you with us, and I am heartened to see many of you here- young, aspiring, future medical doctors.

Introduction

2     The theme of this year’s conference is: “Infectious Diseases- Battling the Enemy on all Fronts”. The horn is sounded against infectious diseases, if I may add to the bellicose imagery. In order to “battle the enemy”, one ought to first have as much knowledge as possible about the enemy. In the fight against infectious disease, we need to think like infectious agents. If you were an infectious agent, what would you do to survive?

3     First, you might select the most efficient mode of transmission and the most reliable host, given that your chance of surviving in the external environment is extremely precarious. For instance, if you were an influenza virus, you would leverage a sneeze or cough in order to transport yourself to your next unsuspecting victim. Second, you might try to conceal yourself by not revealing any symptoms, so that you could silently replicate within the population while avoiding clinical detection. Third, you might choose to establish yourself in the most nurturing of environments, preferably where there is no available treatment. Should treatment be available, you might attempt to overcome the effects of therapeutic drugs by developing resistance. Lastly, if all else fails, you might play dead and become inactive for a short while, re-emerging only when opportunities arise. 

4     This is the “enemy” we are up against, and this morning, I wish to share with you Singapore’s approach in infectious disease control and management, i.e. our battle plan.

Singapore’s multi-pronged strategy to combat infectious diseases

5     From human pandemic influenza to the recent E.coli food poisoning outbreak in Germany, governments all around the world are increasingly faced with the challenge of emerging and re-emerging infectious diseases. The unpredictable nature of novel strains of pathogens is a litmus test for policy makers and health care professionals to act and manage uncertain and sometimes unknown threats in a responsive yet calibrated manner. 

Pandemic preparedness

6     Pandemic preparedness is Singapore’s foremost defense against infectious disease outbreaks. We adopt a “Whole-of-Government” approach. Our Homefront Crisis Management System brings together both ministerial and executive leadership, as well as ministries and inter-agency groups that serve to mitigate the direct and indirect consequences of an outbreak.

7     Additionally, the DORSCON (Disease Outbreak Response System) framework, which is a risk management tool that enables rapid response to outbreaks, serves to guide our policy in calibrating response levels according to the transmissibility and virulence of the implicated infectious agent. My Ministry has been working closely with clinicians and other public health stakeholders to develop and implement disease response plans aimed at the mitigation and containment of infectious disease outbreaks. During the 2009 influenza A(H1N1) pandemic, for instance, my Ministry assembled a coordinated response plan which was subsequently cascaded to all relevant stakeholders in the medical community. These plans serve as critical ammunition in the next battle of human pandemic.

Capabilities and capacity

8     Secondly, Singapore constantly seeks to maintain and improve its capabilities and capacity in the detection of, and response to infectious disease threats. That infectious disease does not respect geographical boundaries, and has the ability for rapid, cross-border human-to-human spread, necessitates continuous vigilance and monitoring of potential threats. Recognising the need for a comprehensive public health surveillance network, we have established a dedicated Public Health Intelligence (PHI) unit to detect changes in infectious disease landscapes both locally and overseas. In addition, the National Public Health Laboratory (NPHL) supports my Ministry in detecting and characterising infectious agents as well as responding to infectious disease threats.

9     Following the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, to ensure that our health care system is well-equipped to provide the optimal level of treatment and care in the event of a similar crisis, all our hospitals have now created sufficient isolation capacity. The number of infectious disease specialists has also increased from 16 in 2003 to 39 in 2010. In addition, the Communicable Disease Centre (CDC), which has been pivotal in the management of past outbreaks, will soon be expanded into a new purpose-built state-of-the-art facility for the isolation and management of patients with infectious diseases. 

Effective prevention and control programmes

10     Thirdly, beyond the global proclivity towards epidemics of novel diseases, Singapore is concerned with the prevention and control of infectious diseases that continue to exist in the community. My Ministry, along with the Health Promotion Board (HPB), oversees and implements the National Childhood Immunisation Programme (NCIP), which aims to protect children in Singapore against diseases for which effective vaccines are available. Singapore is largely free of vaccine-preventable diseases due to the successful implementation of the NCIP. 

11     Singapore has also implemented a comprehensive surveillance programme to monitor anti-microbial resistance, anti-microbial usage, and infection control indicators in our hospitals to address the concern over emerging infections in health care settings.

12     Related to the issue of anti-microbial resistance, is the increase in drug resistance documented for diseases such as tuberculosis (TB). Singapore has adopted the World Health Organisation (WHO)’s Directly Observed Treatment (DOT) programme, so that treatment failure and the emergence and spread of drug resistance can be avoided. 

Active engagement in global health security 

13     Fourthly, WHO’s International Health Regulations (IHR) provides an effective channel for Singapore to engage in global health security. With high mobility and international connectivity of persons, goods, and services, Singapore is vulnerable to the importation of disease. The global community, under the leadership of WHO, has since ratified the new IHR (2005), requiring Member States to establish effective surveillance and early notification systems to inform WHO of any Public Health Emergency Of International Concern (PHEICs). Through the collective efforts of countries and WHO, considerable improvement has been made to countries’ core capacities, such as the establishment of event-based surveillance systems to detect infectious disease outbreaks. 

14     In addition to these regional and international efforts, my Ministry conducts training workshops for some of the Region’s public health officers to promote bilateral and multilateral exchange of knowledge and sharing of best practices. 

Growing research expertise

15     Fifthly, Singapore’s higher education institutions play an important role in our endeavour to continuously develop infectious disease expertise and leadership. I was most pleased to launch the opening of the Saw Swee Hock School of Public Health at the National University of Singapore (NUS) recently. The School aims to produce future public health leaders and fulfil a unique niche in utilising new technologies to provide local solutions to some of today’s most pressing public health challenges. 

16     Over the past decade, Government funding for infectious disease research amounted to approximately S$300 million, a large part of this- S$100 million- was for the Novartis Institute of Tropical Diseases from 2001 to 2012. Grants were awarded to research in disease areas such as dengue fever, malaria, tuberculosis, and influenza. The Translational Clinical Research (TCR) Flagship programme on “STOP DENGUE”, for instance, brings together a professional team of clinicians and scientists with complementary research strengths collaborating under the Singapore Dengue Consortium. 

17     With strong Government support, Singapore is well-positioned to serve as a regional focal point for developing clinical, research, and public health expertise in infectious disease control.

A united fight against infectious diseases

18     I have shared with you Singapore’s approach in our fight against infectious diseases. Lastly, in the battle against infectious disease, there are no solo fighters. “Battling on all fronts” necessitates a multi-disciplinary strategy. Where medical doctors and nurses have conventionally worked with epidemiologists and microbiologists, many infectious disease epidemics witnessed today have a strong, non-medical component, such as evolving human and vector behaviour. In view of this, I encourage you to read widely and develop interests beyond your discipline. This will broaden your outlook, give you a fresh understanding of your current field, and better arm you to fight the battle.

19     While the task is enormous, and team effort makes it no less daunting, compassion for patients will make the difference. As aspiring doctors, you will have no less opportunity to stand in the gap. You will be the crucial interface between patients and policy makers, serving as our frontline intelligence in detecting the first signs of unusual disease patterns. Infectious disease will remain with us for a long time, and we need a future generation of medical doctors who will discharge their duties empathetically and judiciously. 

Conclusion

20     I shall now conclude by wishing all of you a fruitful and memorable Conference. May this be the beginning of many new and lasting friendships for you, and may you develop a strong network and work towards a common platform for information and knowledge exchange. My congratulations to the organising committee for hosting this year’s Conference. 

Thank you.