CLOSING SPEECH FOR SECOND READING OF THE INFECTIOUS DISEASES (AMENDMENT) BILL BY MS RAHAYU MAHZAM, SENIOR PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH, 7 MARCH 2024

1. The members have sought clarifications on the proposed amendments. Allow me to respond. 

Responsibility of parents and guardians under the new section 2A

2. Mr Louis Ng sought clarifications on how the guardian of an individual who lacks mental capacity should balance their responsibilities under the Infectious Diseases Act (IDA) and the principles under the Mental Capacity Act. 

3. I would like to clarify that the IDA does not limit the Mental Capacity Act. The principles under the Mental Capacity Act will therefore continue to apply. 

4. Under the new section 2A, the IDA notice must first be served on the minor or individual. Where the minor or individual is not able to fully understand and follow through with the requirements in the IDA notice, the same IDA notice is then served on the parent or guardian, requiring them to facilitate the minor or the individual’s compliance. This is a reasonable expectation, that the parent or guardian should play a part. Section 2A allows the Ministry of Health (MOH) to take action in cases of irresponsible parents or guardians, who without reasonable excuse, fail to do so. 

Safeguards for management and storage of information 

5. Mr Ng asked about the safeguards for the management of information collected from classes of persons under section 7.

6. The current section 7 already allows the Director-General of Health (DGH) to require any person to provide information for the purposes of public health surveillance, epidemiological investigations or surveys. The amendment is not an expansion of powers. Rather, it clarifies and makes explicit the manner in which DGH may exercise his power to require information from classes of persons. This facilitates operational efficiency. For example, a notice can be issued to the class of “persons who are in charge of a laboratory”, as opposed to multiple individual notices issued to each person in charge of a laboratory.

7. Data collected may not necessarily be anonymised. It may be necessary to match the samples collected to the data collected for the right patient. But where data can be used in anonymised forms, such as to conduct trend analysis, MOH will do so.

8. MOH treats the management and protection of personal data very seriously, regardless of whether the information is collected from individuals or a class of persons. Sensitive personal data is managed and protected in compliance with Whole-of-Government standards. Disclosure of information under the IDA requires DGH’s authorisation, and is only for public health purposes, including measures to prevent and control an outbreak, and national public health research. DGH may also impose additional conditions on the receiving party to better protect the information. 

Powers to order detention and isolation

9. In relation to section 15 on the detection and isolation of persons, Mr Ng pointed out that while an individual may be ordered to be isolated in his own residence “for the protection of the public”, this phrase is not used in relation to individuals being ordered to isolate in a hospital.

10. The difference in language is not new, and already exists in the current Act. Isolation of persons in a hospital protects other patients and hospital staff. Whereas isolation of individuals in their residence is more directly for the protection of the public within the community.

11. On whether MOH considered providing for a time limit for isolation orders under section 15, the duration of a section 15 isolation order is not open ended or arbitrary. During the COVID-19 pandemic and also in the context of other communicable diseases, the duration has always been based on public health considerations and grounded in medical science, typically until the individual is no longer infectious or potentially infectious.

Definition of HIV Undetectable Viral Load and Length of Prescribed Period

12. I note that Mr Louis Ng, as well as Ms He Ting Ru, welcomed the provisions in relation to HIV. Mr Ng asked about the definition of undetectable viral load, length of the prescribed period, and whether these would be periodically updated. 

13. I would like to emphasise that the criteria for the maintenance of an undetectable viral load were rigorously determined based on the latest scientific evidence and clinical knowledge, after consultation with HIV and infectious diseases experts. 

14. Ms He Ting Ru had also raised some other questions. In response, I will say that Section 23 remains relevant to reduce sexual transmission of HIV by requiring persons living with HIV with a detectable viral load and persons who do not know of their status but have reasons to believe that they have HIV, to disclose their risks of acquiring HIV to their sexual partners prior to sexual activity. This allows sexual partners to make an informed decision before engaging in sexual activities and to encourage responsible sexual behaviour by taking mitigating measures such as ensuring condom use to protect themselves. The intention of the HIV laws is not to criminalise persons living with HIV but to deter irresponsible behaviour. She had also made reference to the High Court judgment. The High Court judgement will be superseded by the Amendment. In relation to the queries on the prosecution, from 2015 to 2023, seven people were convicted under Section 23 (1) for failing to inform their sexual partners of the risk of getting HIV infection from them. Of the seven, four had undetectable viral loads at the time of their offences and all four convictions had aggravating circumstances including simultaneous offences under the Misuse of Drugs Act, committing a second offence while under investigation for a first offence, or the victim was a minor, deceived and exploited the victim by lying and posing as a police officer. The law at that time was that a person living with HIV was required to inform their sexual partner of the risk of getting HIV infection from them. This law was informed by the state of medical science and there has been since developments in this and that is why we updating the laws to align with these developments.

15. To summarise, persons living with HIV do not need to disclose the risk of HIV transmission to their sexual partners if they have, first, maintained stable undetectable HIV viral load consistently below 200 copies per millilitre of blood, for at least six months, based on test results from a recognised laboratory. Second, their most recent undetectable viral load test result should be nine months or less before the sexual activity in question. Third, they had adhered to medical treatment for HIV infection up to the time of the sexual activity in question. Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner. We will set out the criteria in subsidiary legislation, to allow for timely and responsive adjustments should the state of medical science change in the future.

Conclusion

16. Mr Speaker, the COVID-19 pandemic has greatly widened our perspectives on the management of infectious diseases. The proposed amendments will allow Singapore to respond more nimbly to future infectious diseases threats, by providing the flexibility to calibrate our measures in accordance with the public health situation.

17. COVID-19 will not be the last pandemic that we encounter. The world remains vigilant against the next infectious disease threat; likewise we must stand ready.

18. I am confident that with these amendments, Singapore will be better equipped to tackle future outbreaks and pandemics and safeguard the health of our population.

19. I thank Members for their support of this Bill.