International Bird Flu Symposium

11 Feb 2006

By Prof K Satku, Director of Medical Services

Venue: MOH Auditorium

Prof Lim Boon Leng, Chairman of the organizing committee

Distinguished guests

Colleagues, Ladies and Gentlemen

A very good morning to all of you

1  Let me begin by extending a very warm welcome to our overseas guests. Welcome to Singapore and to the Ministry of Health. I hope you will have a pleasant stay here in Singapore.

2 The highly pathogenic Avian Influenza A/ H5N1 has turned out to be a far more formidable foe than initially conceived.  As you all know it first surfaced as a human disease in Hong Kong in 1997.  After excellent public health measures which removed the source of infection the virus appeared to have receded.

It re-emerged some two years ago in South Korea. However the initial success at containment in Hong Kong and in South Korea became extremely difficult to repeat.

3 Efforts by WHO, FAO, OIE, multilateral and bilateral efforts between nations and efforts by affected countries, have not been able to stop the epidemic of Highly Pathogenic Avian Influenza in poultry in many Asian countries. The infection has spread westwards to West Asia and Eastern Europe and now Africa.

4 Avian Influenza A/H5N1 virus is now entrenched in Asia. The risk of further human cases appearing will persist as countries in the region have a large number of backyard farms, 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.

5 Last month, an International Pledging Conference on Avian and Human Influenza was held in Beijing. The conference assessed financing needs at the country, regional and global levels. During the conference, the international community pledged a total of 1.9 billion US dollars in financial support and discussed international coordination mechanisms to combat avian influenza and prevent a potential human influenza pandemic.

6 However, it will also be crucial to have political will, expertise, and commitment from many parties to change the course of events if we are to prevent the potential human pandemic influenza.

7 Bird-to-human transmission is being increasingly reported. As of February 9, this year, WHO reported a total of 166 confirmed human cases of avian influenza A H5N1 with 88 deaths in seven countries. It is expected that more human cases will occur in the coming weeks and months.

8 The occurrence of efficient human to human transmission is all that is needed now to set off the next influenza pandemic.

Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three influenza pandemics occurred.

9 Globally and in Singapore itself, different parties are working earnestly in preparation for a possible human influenza pandemic. Governments have stockpiled antivirals and are looking to purchase vaccines. Businesses are working on business continuity contingency plans.

For the health care sector, the logistics to address a pandemic are being worked out and put in place. Table top and simulated exercises are being done to identify gaps in our plans. Within healthcare institutions, measures are in place to detect possible cases of avian influenza through syndromic surveillance and a heightened clinical awareness. Avian influenza A H5N1 in humans is now a notifiable disease here in Singapore.

10 My Ministry has conducted many briefings to government agencies, businesses and the public to help them prepare for a possible pandemic.

11 Within the medical community, Public Health colleagues have been working together with our veterinary colleagues on measures to contain avian and human influenza outbreaks not only in Singapore but also the region. They are assisting in reforms to modernize agricultural and commercial market practices.

In urban populations like Singapore, responsible social behaviour and hygiene need to become social norms to prevent or at least minimize the spread of infections like influenza. This includes socially distancing oneself when one is not well, the wearing of masks when one is ill with respiratory tract infection and frequent hand washing.

12 This conference signals the expansion of planning and preparations within the health care institutions amongst the medical community.

I commend the Singapore General Hospital, the Society of Intensive Care Medicine and the Society of Infectious Diseases for taking the initiative to organise this symposium so that we may be better prepared within the hospital should the potential influenza pandemic materialise.

13 I am indeed glad to see so many clinicians here this morning.

There will be much to share and learn about how we can best manage influenza patients in the wards and in the intensive care units and how we should plan for and organize such clinical services.

It will give us an opportunity to identify any gaps in our care plans and I look forward to receiving a report from Prof Lim Boon Leng and others on the state of our preparations.

14 Going forward, I look next to the family physicians to organize similar scientific meetings. They have already been briefed on our plans but it is imperative that they meet and discuss the preparations in the context of their practice. We will need to identify colleagues with the appropriate experience both locally and from the region to instruct and guide the discussions.

Some of our primary care colleagues had dealt with SARS patients and some were concerned about their own safety after the encounter. Primary care colleagues in countries with human cases of H5N1 influenza must be practicing in an environment of heightened concern. It would be useful to hear from these doctors about their encounters and what they feel could be done to be better prepared. My Ministry will lend its support to our primary care colleagues to help them organize such an event.

15 Finally I would like to take a moment to acknowledge our colleagues from the region who have had first hand experience managing patients with H5N1 influenza and who have taken time from their busy schedules to be here to share their experiences so that all can be better prepared for a possible pandemic.

Their gesture underscores the collective efforts we must take to be prepared and equally importantly the fundamental values of the medical profession, in wanting to share knowledge for the common benefit of all humanity. I am sure that such selfless contributions make each and everyone of us proud to be a member of the medical profession.

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

Thank you.