Training Session for MCYS/NCSS VWOs on Flu Pandemic and Business Continuity Plan

09 Oct 2006

By Mr Heng Chee How, Minister of State for Health

Venue: Bethany Methodist Nursing Home Auditorium

Distinguished guests

Colleagues, Ladies and Gentlemen

A very good morning to all of you

Let me begin by extending my appreciation to Bethany Methodist Nursing Home for offering us this wonderful venue today. Let me also thank you all for taking time off to participate in this training session.  This training session is one of the many sharing sessions that MOH regularly conducts in collaboration with our partners from the public, private and people sectors.  The aim is to share the latest developments on the avian influenza and to discuss how best we can prepare for a potential flu pandemic.  

Raising the Awareness of the Threat

This is important because the highly pathogenic Avian Influenza has turned out to be a most formidable foe.  As you might know, the H5N1 virus first surfaced Hong Kong in 1997, infecting some 18 and killing 6.  Since then, efforts by nations and international organizations such as the World Health Organisation, Food and Agriculture Organisation and the World Organisation for Animal Health have not been able to stop the epidemic of Highly Pathogenic Avian Influenza in poultry in many Asian countries. The infection has since spread westwards to West Asia, Europe, the Middle-east and Africa.

Avian Influenza virus is now entrenched in Asia. The risk of further human cases appearing will persist as long as countries in the region continue to have a large number of backyard farms and maintain unhygienic wet markets, where domestic poultry are in close contact with both wild birds and humans.

This presents many opportunities for disease transmission and fresh outbreaks in both poultry and humans.  It is likely that it will take a long time for the virus to be eradicated from the region, notwithstanding efforts by countries to cull and vaccinate their poultry populations.  We will need reforms in farming and market practices, which are beyond the resource of some of affected countries.

Bird-to-human transmission is being increasingly reported. As of yesterday, WHO reported a total of 251 confirmed human cases of avian influenza with 147 deaths in 10 countries. It is expected that more human cases will occur in the coming months.

The occurrence of efficient and sustained human to human transmission is all that is needed now to set off the next influenza pandemic.  But no one can predict when the next pandemic will be, nor how severe its impact will be.  The bottomline however, is that even a relatively mild pandemic can have far more outreaching impact than SARS.  We need to be prepared.

Overview of Singapore's Preparedness

In Singapore, different parties are working earnestly in preparation for a possible human influenza pandemic. The government has stockpiled antiviral drugs, personal protective equipment and other essential medical supplies.  Key government ministries and agencies, and private businesses are working on business continuity contingency plans.  Hospitals, polyclinics and GPs have been put through the paces.  Table top and simulated exercises have been and will continue to be conducted to identify gaps in our plans in response to this amorphous and changing viral threat.

MOH has provided guidance and assistance to government agencies, businesses and the public to help them prepare for a possible pandemic.  We will continue to do this in order to update our partners on the latest developments of the virus and provide useful and relevant information so as to facilitate our partners when they develop their internal flu pandemic business continuity plans.

The Need for Inter-Agency, Cross-Sector Collaboration

Such sharing and mutual learning is important.  The fight against the flu pandemic requires a "whole of Singapore" approach to ensure that Singapore is ready should a flu pandemic hit.

I am heartened to see that such inter-agency, cross sector collaboration is well in place in Singapore.  Such collaboration is important because everyone has a part to play - from the doctors, nurses, social workers right down to the patients. This session signals the expansion of planning and preparations between the public and people sectors.

I commend MCYS and NCSS for taking the initiative to organise this session so that we may be better prepared collectively should the potential influenza pandemic materialise.

I am also glad to see so many VWOs here this morning.

There will be much to share and learn about how we can best manage influenza patients in your facilities and how we should plan for and organize such services. It will give us an opportunity to identify any gaps in our plans.

This morning, I understand that the Lions Home for the Elderly will also be sharing its experiences in preparing and formulating its flu pandemic business continuity plan.  Thank you.  It would be useful to hear from them about their encounters and what they feel could be done to be better prepared.  Such info sharing will facilitate your own contingency planning which would be context dependent. 

Key Lessons Learnt From Exercise SPII

MOH will also be sharing some of its key lessons learnt from EX SPARROWHAWK 1 & 2, conducted from Apr to Jul 2006.  The exercises allowed us to validate the national flu pandemic plan and the SOPs of both the public and private healthcare institutions and selected government agencies.  I am pleased to report that our border agencies, healthcare institutions and security agencies are ready.  Our surveillance feelers are out to detect the first potential cases at the borders or when they present at our healthcare institutions.  And the system is in place to rapidly contain these initial cases through isolation and treatment and to identify and manage their close contacts.  When the pandemic hits us, we will be able to muster the entire healthcare sector to provide primary care treatment to the population within close distance of their homes. Should Singaporeans require critical care, hospitals will expand their bed capacities to cope with the surge. 

Sparrowhawk was also a learning experience which helped us review and refine the national plan.  It reaffirms the central role the public plays in limiting transmission in the community when everyone practices good hygiene and social responsibility.  I will share with you three key changes that have been made.

GP Clinics as an integral part of primary care provision.  Initially, the plan was to centralize treatment at the 18 polyclinics.  But we also recognize that most Singaporeans consult their family doctors in the private sector for acute illnesses like influenza.  We would want this relationship to continue even in a pandemic.  Furthermore, this will cut down unnecessary travel to and crowding at polyclinics.  In Sparrowhawk, we validated the feasibility of utilizing GPs to continue to serve to the population.  With some coordination we will be able to organise more than 1000 GP Clinics to provide primary care to the community.

Dedicated Flu Hospitals.  We have also reviewed the policy of having the Restructured Hospitals to manage all flu cases who required hospitalized care, while non-flu patients would be referred to Private Hospitals.  Segregation is useful in the pre-pandemic stages when our strategy is containment. However, we now recognize that many of the flu patients will have co-morbidities.  Some may even have their flu symptoms masked by the more serious complications.  It would be very difficult to fully effectively segregate such cases in a pandemic. Hence, hospitals, both public and private will need to be prepared to manage both.  We will work with the institutions to ensure that local segregation of flu and non-flu patients are carried out to minimize transmission within the hospitals. 

Infection Control Response Team.  All hospitals have adequate SOPs to handle suspect cases of influenza.  However, Sparrowhawk highlighted that it is impractical to expect that all staff have the same level of readiness and training and are able to sustain a high level of readiness over a prolonged period.  The key lesson is for hospitals to maintain and roster a team of dedicated HCWs who are very well versed with the handling of infectious cases and proficient in infection control measures including the use of PPE, and senior medical staff who are able to supervise the management protocol, confirm the diagnosis of the suspect case and raise the alert to authorize the activation of aggressive containment measures according to the institution's SOPs. 

Last but not least, Sparrowhawk allowed us to highlight Singapore's readiness to our regional neighbours to give them the confidence that we are committed to respond in a pandemic and will take the necessary steps to prevent its spread.  More importantly, we were able to continue to engage our population to familiarize them on what actions individually and collectively they must take when a pandemic does strike.  

Conclusion

Finally, I think this is a very important opportunity for us to network, share and learn about what is to be done if there was a pandemic outbreak. During SARS, while our acute hospitals were able to take themselves through successfully, we didn't really have the opportunity to help others build their capabilities.

On this note, I would like to wish all participants a rewarding learning and sharing experience.

Thank you.