Parliament Speech 22 April Second Reading of the IDA (Amendment) Bill

22 Apr 2008

By Khaw Boon Wan

Venue: Parliament

Mr Speaker, Sir, I beg to move that “the Bill be now read a second time”. 

BACKGROUND

Five years ago, SARS appeared suddenly and for 3 months caused havoc around the world.  We lost 33 lives in Singapore.  SARS taught us many lessons.  First, infectious diseases are here to stay and new diseases will continue to surprise mankind.  We cannot let our guard down.  Second, in the fight against infectious diseases, being proactive is often necessary to pre-empt the escalation.  Reacting to the epidemic will grant the disease a head start which can prove disastrous.  Third, fighting infectious diseases requires a joint effort by all.  The public in particular play an important role.  Mobilizing and galvanizing the people into action in turn, requires transparency and timely information.  Prompt sharing of information with the people, what we know and what we do not yet know, helps to build trust, reduce speculation, fears and panic.  Fourth, we need effective legislation to mount a successful war against an epidemic.

The Infectious Diseases Act is our principal legislation for the control and prevention of infectious diseases.  SARS exposed some gaps in our legislation which we promptly plugged.  The House would recall that we met in the middle of the SARS crisis to make urgent amendments to the Act to provide the Health Ministry with additional powers to bring SARS under control. 

We have since significantly strengthened our capacity and capability to detect, prevent and control outbreaks of infectious diseases.  For example, we have acquired stronger capability in disease surveillance, contact tracing and quarantine.  Our hospitals have updated their infection control protocols to deal with potentially infectious patients.  They have created many more isolation rooms and built up a stockpile of essential medical supplies and drugs.  We conduct regular exercises among Government agencies and healthcare institutions to test our response.  Internationally, we also work closely with the World Health Organisation and other countries to reduce the threat of the spread of infectious diseases across international border.

Nevertheless, we have to be prepared for new public health threats that could be a lot more severe than SARS.  While SARS is infectious, it requires intimate intensive contact with a patient who is quite ill before transmission can succeed.  That was why most of the SARS victims were doctors, nurses and other hospital staff and close relatives who cared for the patients.  An exception was a minority of patients who for some reason ended up with very heavy virus load; they became highly infectious even for short encounters.  Fortunately their number was small.  Moreover, only patients with clear symptoms such as fever were infectious.  They could therefore be identified through temperature screening and be promptly isolated. 

But what if a virus comes along which is a lot more contagious than SARS, and not easily identifiable?  For example, if it is air-borne, a patient in a cinema or a shopping centre may easily infect many others who happen to be in the same enclosed space.  Or what if an infected person can be infectious yet without showing any physical signs?  This is not theoretical.  One such threat is that of a global influenza pandemic should the current bird flu mutate and become much more efficient in human-to-human transmission.  It had happened before. 

Influenza spreads rapidly because its incubation period is short, about 2 days, and it is highly transmissible.  Unlike SARS, those infected may develop no or very mild symptoms, yet they are infectious.  So contact tracing and quarantine may not be effective.

In such a scenario, what we can do is restrict and reduce social interactions through “social distancing” measures, in order to slow the spread of the disease in the community.  For instance, schools can be closed.  Cinemas and shopping centres may have to be closed too.  This will buy us valuable time until an effective vaccine becomes available.  Social distancing will also reduce the peak of the pandemic, thus minimizing the burden on our scarce healthcare resources. 

To be effective, social distancing measures have to be implemented soon after the first local cases appear, before the outbreak has become widespread.  But we would need to have the powers to effect social distancing measures swiftly. 

The current IDA allows the Ministry to prohibit specific meetings, gatherings and public entertainments when the holding of such events is judged to increase the spread of any infectious disease.  But it requires us to issue individual orders to prohibit each meeting or gathering.  This will be too slow in a major crisis like the flu pandemic. Valuable time and scarce public health resources will be wasted to bring all the premises under control.  This gap in our legislation will need to be closed. 

This is the main purpose of this Bill, to provide my Ministry with the necessary powers to impose social distancing measures speedily in response to a potential severe public health emergency as described.  At the same time, I am taking the opportunity to (a) refine the existing legislation, (b) tighten one aspect of HIV/AIDS control measures, and (c) update our laws to conform with the 2005 WHO International Health Regulations.

Mr Speaker, Sir, let me elaborate on each set of the proposed amendments.

(A) PUBLIC HEALTH EMERGENCIES

First, the amended Act authorises the Minister to declare a public health emergency if he is satisfied that an outbreak or imminent outbreak of an infectious disease poses a substantial risk for significant deaths and disabilities in the population.  Once such a declaration has been made, my Ministry will be able to take measures necessary to (a) prevent the spread of disease through social distancing measures and (b) to mobilise civil resources to help fight the outbreak. 

(i) Restricted Zones

Clause 12 of the Bill inserts provision in the Act under which the Minister may establish restricted zones, a new after a public health emergency is declared. The entry and stay of persons in any premises or the holding of public gatherings in such zones may then be restricted or prohibited, in order to minimise opportunities for disease transmission through person-to-person contact or contact with the contaminated environment.  This can be quickly and effectively implemented by allowing the blanket prohibition of all or selected gatherings, meetings or public entertainment or closure of all or selected premises island wide. Police and other authorised officers will be empowered to enforce compliance in a restricted zone.

Invoking such a provision has serious implications as it will cause major disruptions to the businesses and the daily lives of Singaporeans.  Such a decision will not be taken lightly.  We have therefore put in safeguards.  First, every declaration of a public health emergency and restricted zone will expire after 14 days unless it is renewed.  Second, the Minister must ensure that such orders are published through appropriate media so that the public will have notice of it.  Third, every order must be presented to Parliament as soon as possible after it is made. The Minister will have to argue his case and justify the declaration of such an order.  Parliament may annul the order if it does not agree.

(ii) Requisition of Resources

Fighting a disease outbreak requires the participation of many sectors.  MOH and its resources alone will not be sufficient to combat the outbreak.  For example, during SARS, we had to use holiday chalets and hostels as quarantine facilities. Auxiliary police officers were called upon to deliver quarantine orders and monitor those who were quarantined. From the SARS experience, we can anticipate that in the event of a more serious outbreak, massive resources, both from the government as well as from the private sector will need to be mobilised.  To effect this, clause 36 of the Bill makes consequential amendments to the Requisition of Resources Act so that civil resources and services, including those found in the private sector, such as private hospitals, ambulances, doctors, nurses and other paramedical personnel, may be mobilised to help combat the outbreak.

Specifically, when a public health emergency has been declared under the Infectious Diseases Act, the Minister may order Part III of the Requisition of Resources Act to be brought into operation if additional land, property and services are needed to secure public safety.  Owners of these assets will be suitably compensated in accordance with the Requisition of Resources Act.

(B) STRENGTHENING EXISTING POWERS

Mr Speaker Sir, let me now discuss the second set of proposed amendments to strengthen the management and control of infectious diseases under normal circumstances.

(i) Enhanced Powers for Infectious Disease Surveillance

To respond to an infectious disease, we need sensitive and robust disease surveillance, to alert us to any outbreaks or imminent outbreaks. Currently, we monitor the local infectious disease situation through a system of mandatory disease notification by doctors and laboratories, and studies to measure population immunity against various infectious diseases. Clause 4 of the Bill will enhance our disease surveillance powers, by amending section 7 of the Act to empower the Director of Medical Services to obtain residual blood or body samples in the healthcare institutions to determine the level of immunity within the population or to monitor and track infectious diseases trends.  The primary focus of this additional measure will be the pooled statistical data.  However, if there is a need to contact a patient from whom a sample was obtained, such as for the purposes of contact tracing or to provide urgent medical treatment, we may invoke our powers to do so under the Act. 

(ii) Compliance by minors and those mentally or physically incapacitated

Clauses 5, 9 and 10 of the Bill amend the Act so that the Director of Medical Services may require the parent or guardian of a minor to ensure his compliance with an order to undergo medical examination, treatment, surveillance, or quarantine in order to control the spread of an infectious disease.  These provisions will only be invoked if it is assessed that the minor will not be able to understand and comply with an Order given to him.  Furthermore, clause 30 amends the Act so that a police or Health Officer may take necessary measures to give effect to an Order for the medical examination, treatment, surveillance or quarantine of a person who is mentally or physically incapacitated. 

(iii) Enforcement of Orders issued under the IDA

Currently, to prevent or limit the spread of an infectious disease, the Director of Medical Services may order an overcrowded building, food establishment or a business to be closed, or prohibit a meeting, gathering or public entertainment.  Clauses 13 to 16 of the Bill will amend the Act to empower the Director to enter premises to enforce such an order.  As a safeguard, any person aggrieved by such an order may appeal to the Minister within 7 days of the order.  As an additional safeguard, an order to prohibit gatherings or close premises will expire after 14 days unless it is renewed. 

(iv) Appointment of Health Officers

The Act provides for Health Officers to be appointed with extensive powers to effect the prevention and control of infectious diseases.  Clause 3 of the Bill will amend section 4 of the Act, so that an employee of an institution which the Minister must prescribe in subsidiary legislation may be appointed as a Health Officer.  This will enable the Ministry to appoint the healthcare staff in public restructured healthcare institutions such as the Communicable Disease Centre for this purpose.  These officers perform important public health duties, such as contact tracing, patient counseling and epidemiological investigations, as part of their course of work.  The intent is to designate the public restructured healthcare institutions as the “prescribed institutions” under subsidiary legislation, which operate with MOH oversight.  

(v) Powers of Investigation and Arrest

To ensure compliance with the Act, clauses 29 and 30 will introduce provisions to empower my Ministry to investigate offences under the Act.  These include powers to record statements, enter and search premises, and seize evidence. It will also allow Health Officers to arrest a suspect without warrant for certain offences under the Act.

(vi) National Public Health Research

When faced with a new infectious disease threat, it may be necessary for us to expedite research into more effective control measures or new diagnostic tests or treatment.  Clause 32 of the Bill will amend the Act to empower the Director of Medical Services to acquire information or existing samples from patients, or order a doctor to obtain, with consent, additional samples from patients under his care, to facilitate such national public health research.  The information and samples will be anonymised to protect medical confidentiality.  In deciding whether to invoke this power, the Director must first consider the public health risk of the disease and the potential benefits of the research to Singapore.  MOH will work with the relevant clinicians, researchers and other stakeholders to carry out such research.

(C) ENHANCED MEASURES TO PREVENT AND CONTROL HIV / AIDS

Mr Speaker Sir, let me now discuss the third set of proposed amendments concerning HIV/AIDS.  HIV remains a problem in Singapore.  The number of new cases continues to grow.  In 2001, there were 237 newly notified HIV cases. Last year, that number has almost doubled to 422.  The main mode of transmission of HIV in Singapore is through unprotected sex with a HIV-infected person.

Section 23 of the current Act states that before sexual intercourse, a person who knows of his HIV status is required to inform his sexual partner of the risk of contracting HIV from him.  If the partner willingly accepts the risk, no offence is committed. Doctors regularly inform HIV patients about this law at the point of diagnosis. 

This law however is effective only when a person knows that he is HIV positive. Despite the easy access to testing in Singapore, it is estimated that for every known HIV case, there could be another 1 to 2 cases who are infected but remain undiagnosed, until the symptoms appear. The latter group may continue transmitting HIV unknowingly to their partners for many years during the asymptomatic period. 

Clause 18 amends section 23 of the Act to shift greater responsibility to individuals whose sexual behaviour, for example, puts their spouses and partners at risk of contracting HIV/AIDS.  A person who has reason to believe that he has, or has been exposed to a significant risk of contracting HIV/AIDS must take reasonable precautions to protect his sexual partner, such as by using condoms, even if he is ignorant of his HIV positive status. Alternatively, he can go for a HIV test to confirm that he is HIV-negative. Otherwise, he must inform his partner of the risk of contracting HIV from him, leaving the partner to voluntarily accept the risk, if he or she so wishes. The objective of this amendment is therefore to help promote condom use and regular HIV testing, while sending a strong message that no one has a right to put others at risk through his irresponsible behaviour.  

It is not our intention to go after every HIV infected person. We will only act if there is a complaint from an aggrieved victim, and only after a thorough investigation to establish the facts.  

The Bill will also amend the Act to raise the penalty for HIV / AIDS related offences.  The increase in the penalty reflects the seriousness with which society views such offences and, we hope, would deter potential offenders. 

(D) 2005 WHO INTERNATIONAL HEALTH REGULATIONS

The final set of proposed amendments are technical in nature, to update our legislation to be in line with the 2005 WHO International Health Regulations.  Under the regulations, Singapore may be required to disclose the identity of an infected person to the World Health Organisation or a member-state.  Clause 31 amends the Act to allow for this.  Disclosure of the identity of an infected person in other cases, and which are not governed by other laws, will be subject to strict requirements in order to protect patient confidentiality without compromising the public interest. 

Clauses 21 to 27 amend the vaccination requirements in the Act to comply with the WHO International Health Regulations. 

CONCLUSION

Mr Speaker, Sir, no country would welcome a disease outbreak.  But unfortunately, globalization and jet travel have combined to raise the risk of such a crisis.  We hope that it will never happen in Singapore but wishful thinking will not protect our people.  The more we assume that we will be hit and actively prepare for one, the more likely that we can minimize the number of casualties when a crisis strikes. 

This Bill is part of our preparation for such an eventuality.  I hope to get the support of all members for this Bill. 

Mr Speaker, Sir, I beg to move.