A Tale of Two Wars

22 Jul 2009

By: Mr Khaw Boon Wan

SPEECH BY MR KHAW BOON WAN, MINISTER FOR HEALTH

AT THE NATIONAL MEDICAL EXCELLENCE AWARDS CEREMONY 2009

ON 22 JULY 2009 AT 7.30 PM AT CHIJMES HALL

“A TALE OF TWO WARS”

One Is Enough

1 After fighting against SARS in 2003, many of us in this room hoped that we would not have to fight another war against a novel virus.  But H1N1 came along.

2 Both are novel viruses and both have been damaging to human lives and the economy.  We have now lost three lives to H1N1, two today. All three have underlying serious medical illnesses which probably are the primary causes of their death; but H1N1 contributed to their death. That is why we urge Singaporeans and patients in the high risk groups to be extra careful during this period; avoid crowded places and just put on a surgical mask if unwell. Six years after SARS, the world has become much better prepared and the two wars were fought quite differently.  One contributing factor is that the world has enhanced its scientific research capabilities during the past 6 years.  As a result, the tools and the mode of engagement in fighting the enemy have changed in significant ways, with positive outcomes.

3 First, the world has better understood the need for transparency and timely disclosure.  While SARS was initially characterised by denials and cover-ups, we saw a more open attitude in the H1N1 outbreak.  Mexico has been transparent.  Its early alert and decisive action to close the country down, at great cost to its economy, has given the world more time to prepare for the eventual attack. The United States and Canada which were affected immediately were especially forthcoming with much needed information on the clinical manifestations of the illness and its epidemiology.  This set the tone for the rest of the world as the outbreak spread.  While there were some confusion on WHO’s alert system, WHO has done a great job in keeping the rest of the world informed through sharing of important data and viral samples.

4 Second, as a result of this timely sharing of information, the time for genomic analysis and mapping was considerably shortened. Researchers around the world pounced on this novel virus.  There was a certain free-for-all spirit, publishing their findings, even if provisional, Wikipedia like.  The genetic information of the new influenza strain was made available on the web within three days of WHO raising the alert.  In contrast, SARS took much longer.

5 Third, the rapid sharing of critical information enabled the scientific industry to respond quickly.  Our hospital experts were able to design new test kits within a week.  Once we started seeing our own cases and growing our own viruses, we were able to share the samples immediately with GIS to develop advanced capabilities for genetic analysis. To facilitate these scientific activities, we got Prof John Wong to chair a research taskforce. DMS Prof Satku chaired the National Scientific Committee to study the science behind the outbreak and to refine our strategy and control measures.

6 Fourth, the pharmaceutical industry was able to swing quickly into action.  Preparation for vaccine production work started soon after the pandemic broke out.  Yesterday, we heard that Australia will start clinical trials of the vaccine within the next month. We can now look forward to the H1N1 vaccine before year end, or earlier. 

We Are Still At War

7 But we are not yet out of the wood.  We are still at war with the virus, even though the first wave of the outbreak has entered its final mitigation phase.  While the rest of Singapore can return to life as normal, the scientific and medical community still have much to do.  Our laboratories continue to work round the clock, in partnership with our GPs and polyclinics, to sample flu patients for the virus.  This is to track the spread of the virus through the community and to look for any significant genetic changes in the months to come.  Our scientists continue their studies of the strain to spot any mutation of the viruses, looking for clusters of disease, with the aim of quickly recognizing changes in the viruses, and to be able to deal with the problem as fast as it occurs. 

8 Prof Edison Liu, Executive Director of GIS, has just led a team of scientists and clinicians on a successful visit to Mexico.  They had very productive discussions with their counterparts there.  Mexico was ground zero and had much clinical and scientific information to share.  Our experts have established valuable contacts and research collaborations to follow up. 

9 To support additional scientific work in this area, MOH has set aside $10 million to fund projects that address H1N1 research and operational issues.  We hope the emerging research in epidemiological studies, clinical trials and diagnostics can help us to better understand the disease and prepare us for a second wave.

Worthy Investment

10 The H1N1 pandemic is a good illustration of why we must invest in science and research.  It is not simply for prestige, to profile our scientific capabilities.  It can actually make a critical difference to our life and death.

11 The first wave of H1N1 will eventually run its course.  But there will be new waves.  And it is not just H1N1.  H5N1 remains out there among the chickens and the ducks.  For as long as agricultural reforms remain neglected, with farmers living close to and intimately with their farmed animals, the next lethal virus will just be around the corner.  We must continue to invest in research, to try to stay ahead of the virus, if not, not too far behind the curve.

12 To achieve success, we need strong collaboration between clinicians and scientists.  We are in the same team, fighting a common enemy, not rivals in an intellectual contest. Given Singapore’s limited resources, it does not make sense to duplicate. We have to learn to complement each other’s capabilities.

Our Research Priorities

13 Tonight’s ceremony is a reminder of what we strive to do in the area of medical research.  The focus in the past three years has been to drive translational and clinical research, linking up the basic research capabilities with the clinicians in the hospitals and medical schools. In the process, we train our doctors and researchers to think out of the box and approach problems from a different perspective.

14 Diseases like cancer and mental health are complex and in order to fully understand them, it is necessary to take a consortium approach to integrate, coordinate and leverage on the full spectrum of clinical and research capabilities in Singapore.

15 Our focus on a few large meaningful Translational & Clinical Research Flagship Programmes is making progress.  The gastric cancer project started a clinical study on early diagnosis of gastric cancer.  More than 2,000 people have been screened and 10 early cancers which would otherwise have gone unnoticed were diagnosed and cured.  The neuroscience project to identify markers of psychotic diseases has recruited more than 2,000 volunteers.  Some of them will be observed for a few years and should they develop symptoms, we can provide timely intervention.  A team at SERI has come out with a new antibiotic for eye infection, which has 30-60 times the same killing ability as conventional antibiotics.  These are encouraging developments which have benefited patients; this is the end goal of any research that we do.

16 Our focus is to groom a talent pool of clinician scientists who, in addition to seeing patients, are dedicated to doing research work related to their fields.  Clinical work used to be separated from research, with a clear line in between.  Less so nowadays.  Clinician scientists, like Prof Michael Chee, are now better appreciated and valued – for their ability to bring insight from the clinical work to the lab and vice versa.  MOH and A*STAR have a series of schemes to provide support for clinician scientists and their institution.  We will continue to promote a greater research culture in our hospitals.

Competition Heating Up

17 While we are making progress in many areas, we have to recognise that competition is heating up.  For example, stem-cell researchers in the US are celebrating President Obama's decision to reverse restrictions on embyronic stem-cell research.  Many had to leave the US to pursue their work elsewhere.  Some may see less need to do so now.  Likewise, biotech companies have now more choices to choose from, when setting up their research and manufacturing bases.  We must not be complacent.

18 We are completing Phase II of our Bio Medical Sciences Research programme next year. MOH, MTI, MOE and NRF are now formulating the strategy and direction for a proposed Phase III.  From MOH point of view, we hope to see even greater focus on expanding our capabilities in translational research, to fight common diseases that affect large number of Singaporeans.  We look forward to practical innovation and research that can help transform routine clinical care, so that Singaporeans can enjoy better health at a lower cost. 

Conclusion

19 On this note, let me congratulate the distinguished award winners tonight.  They epitomise the very best clinical, scientific and academic talent that Singapore hopes to see more and more of.  They are the role models of commitment, innovation, perseverance and mentorship. 

20 They are all our very own home-grown talents.  Through years of unwavering commitment, they have helped build up core capabilities in their respective specialties.  Together, their careers span over a century.  They have inspired, taught and mentored many young clinicians and scientists, many of whom went on to develop illustrious careers of their own. 

21 My heartiest congratulations to you all.  Thank you.