Opening the Keystone Symposium 2006

10 Dec 2006

By Mr Khaw Boon Wan, Minister for Health

Venue: Raffles City Convention Centre Collyer Room

Global Collaboration + Local Actions

Dr Andrew Robertson, Chief Scientific Officer, Keystone Symposia

Mr Philip Yeo, Chairman of Agency for Science, Technology and Research

Distinguished Speakers and Guests

Ladies and Gentlemen

Welcome to the Keystone Symposia Conference. Last year, Singapore was honoured to host your first ever conference outside of North America.  You have now returned for a second conference.

I understand that you normally hold your conferences in winter and mountain retreats.  Well, Singapore is a little hot and as flat as it can get with our highest point at an embarrassing 164m.  But if you have the time, do visit our Botanical Gardens and nature reserves.  You will be surprised to find some very pleasant environment.  Do enjoy your stay here.

As the Health Minister, I welcome your decision to hold your conference in Singapore.  With a rapidly growing scientific community and in cities within a few hours' flight of Singapore, we very much welcome scientific conferences like this to provide opportunities for our scientists to share and exchange ideas.  Situated in this part of the world, with huge numbers of people living in close proximities with huge numbers of animals, the topic of your conference is of great interest to all of us.

Animal-To-Human Disease Transmission

I am not a scientist.  But as I see it, viruses want to survive; to survive, they have always and will continue to mutate.  Along the way, some strains will kill humans.  In the past, with poor transportation, humans did not move about much and if they did, slowly.  So when new viruses hit, they killed pockets of population and attenuated as they spread further.  Inefficient transportation and limited movement of people in the past thus offered us some protection by allowing time for viruses to attenuate and for animals and human to develop immunity.

 With technological and economic development, villages are now linked to towns, towns to cities, and cities to other cities around the world.  People move around a lot more, a lot faster, and in larger masses - witness the latest mega air carriers that both Boeing and Airbus are racing to build.  Viruses can now spread across the world at high speed and reach across continents before they have time to attenuate.  The movement of troops by trucks and ships contributed to the spread of the 1918 flu pandemic within months.  More recently, SARS showed how viruses can now spread across the world within days.  Infectious diseases outbreaks have now globalised.  We need to learn how to deal with infectious disease outbreaks real time, 24 / 7.

With economic development and greater wealth, more people around the world are also eating more meat.  More meat means more chickens, ducks, pigs and other farm animals.  More people living in close proximity to more animals increase the opportunity of viruses mixing up their genetic materials, creating a much more dangerous world.

The Next Influenza Pandemic

The world is now particularly worried about the dangers posed by the highly pathogenic H5N1 avian influenza virus.  Even as we talk, there is an active outbreak among the poultry in South Korea and Indonesia.  Among humans, there have already been more than 250 cases of H5N1 avian flu; more than half of them had died.  These are reported cases.  We do not know how many more have gone unreported.  Each day, nearly 100,000 persons pass through Changi Airport after spending hours cooped up in confined space with hundreds of other passengers in aircraft.  The possibility of flu pandemics is not something we in Singapore can afford to ignore.

The history of flu pandemics is dreadful.  But as Health Minister, I am worried about the possibility of other infectious diseases outbreaks too.  Nipah, SARS and other yet-to-be-named viruses may not spread as efficiently as H5N1, but can still kill and cause major disruptions to societies and economies.  It therefore pays to assume the worst and be prepared for outbreaks, extensive and prolonged, or limited and episodic.  We need to work out practical contingency plans.

Lessons From SARS

The SARS epidemic in 2003 taught the global community valuable lessons. First, being in the "developed world" does not protect us from so-called "developing world" infectious diseases, as the whole world is now one single quarantine area. Second, many modern hospitals are deceptively inadequate in infection control practices.  Third, international collaboration and cooperation under the leadership of the WHO is the best strategy to fight global pandemics.

During SARS, the WHO mobilised experts and scientists from around the world to work together round the clock. Information was shared freely. As a result, the causative agent was identified a month after WHO declared a Global Alert. The SARS coronavirus genome was sequenced shortly after that. Diagnostic kits could then be produced, enabling the earlier detection of infection and earlier implementation of control measures.

Global Collaboration and Effective Local Actions 

We need to rapidly build upon the lessons of SARS as we plan to battle the next flu pandemic. Our response must be both global and local.  We must collaborate globally, but every community must also respond with effective local actions.  All parties  have crucial roles to play.

(a) Scientists

First, scientists are our first line of defence against infectious disease outbreaks.  King Arthur and his Knights of the Round Table had Merlin to help them fight dragons and other evils.  You are our modern equivalent.  We need all of you to help us keep track of viruses, especially when they threaten to mutate into more virulent strains.  We need to be alerted early.  We need better test kits.  We need better anti-viral treatment.  We need vaccines.  We need them fast.  We need scientists from across the world to work in collaboration, 24 / 7.

(b) Nations

Second, nations must again work together to identify outbreaks and co-operate on containment.  Governments need to implement effective containment measures even when unpopular.  Vietnam showed what can be accomplished during SARS and more recently with Avian Flu when a Government acts decisively. 

In addition, samples and information must be freely and openly shared with the global scientific community and governments should facilitate this collaboration.  We must regain the spirit of decisiveness and openness which we acquired during SARS.  The new WHO Director-General, Dr Margaret Chan, has been elected.  She was in the thick of action during the SARS epidemic and has seen first-hand how the global scientific and health communities came together to overcome SARS. She has also been leading the WHO's fight against Avian and Pandemic Influenza. We look forward to the WHO leading the global community to a new level of cooperation in our fight against the common enemy.

(c) Healthcare Workers

 Third, healthcare workers will always be among the first to be exposed to new strains of viruses.  They will often become infected and then become the sources of infection in outbreaks.  This was what happened at the beginning of SARS outbreak at many hospitals that were affected.  We controlled SARS when we managed to control its spread within hospitals.  Thus it is crucial that healthcare workers must be on constant alert and maintain very high infection control standards at all time.  As Health Minister, I have directed all our hospitals to do everything possible to ensure that the facilities, policies and procedures and most importantly discipline are in place to ensure that hospital acquired infections be kept to the absolute minimum at every hospital. 

(d) Individuals

Fourth, individuals must maintain very high standards of personal and public hygiene.  This is the most basic step to protect ourselves and which is in our power to achieve it.  Wash our hands before we eat and wash our hands after toilets, and thoroughly.  We learnt this from our grandmothers.  We learnt it from our teachers.  During SARS, we heard it repeatedly on radio and TV and we practiced it.  After SARS, we seem to have slackened again.  Let us be like the Japanese and benchmark our personal and public hygiene against the Japanese standard.  We can do it.

Conclusion

 We do not know when the next flu pandemic will happen and how deadly a path it could take. We need sustained international commitment to a concerted coordinated effort to combat these threats.  This symposium is an excellent platform where scientific knowledge on such diseases is exchanged, and where partnerships and collaborations are strengthened.  Let us band together to meet the challenge ahead. 

I wish you all a very fruitful and rewarding meeting.