SPEECH BY MINISTER FOR HEALTH, MR ONG YE KUNG, AT THE LAUNCH OF THE CENTRE FOR INFECTIOUS DISEASE EMERGENCY RESPONSE

Professor Dale Fisher, Director, National University of Singapore’s (NUS) Centre for Infectious Disease Emergency Response (CIDER)

Professor Chong Yap Seng, Dean, NUS Yong Loo Lin School of Medicine

Professor Yeoh Khay Guan, Chief Executive, National University Health System

Ladies and gentlemen

Excellencies, Ambassadors, High Commissioners

1.               A very good evening. Very happy to see all of you here. First, I want to congratulate Dale and all your colleagues for the launch of CIDER and this important book on infectious diseases, emergencies, preparedness and response. I am sure it will be a very good resource. I know it is a lot of hard work. It is an important milestone, and I hope your Master’s Programme will be launched with a roaring success.

2.               There are two other things I should do. Number one, I should talk a little bit about pandemic preparedness and lessons learnt in what we should do. Second, I am going to leverage this event to make an announcement on behalf of the Ministry of Health (MOH). It is somewhat related to infectious disease. I think it is an important announcement.

Strengthening our Preparedness

3.               Let’s move into to the first subject, which is pandemic preparedness. I think what Yap Seng said is quite right – that humans forget our lessons. When a society collectively goes through an ordeal like a pandemic like COVID-19, as a society, we forget the pain. But it is not bad to forget the pain, because then you are able to withstand the next one. But in the process, somehow you also forget the lessons.

4.               I think we talked a lot about science, clinicians, and all your contributions in preparing for the next pandemic, which will come. But I think there is also the role of the government. The government also has a duty to prepare ourselves for the next pandemic and make sure we learn from the last one. I think what we do are two things. This period before the next pandemic arrives, use the time to set up institutions so that we institutionalise the learnings.

5.               What are some things we did? Number one, we amended the Infectious Diseases Act, and updated it quite significantly. Now, we provide for a hierarchy of responses, depending on the severity of the emergency. In the past, it was binary – either you managed an outbreak, usually locally, or you declared an emergency. Now we have steps in between. For COVID-19, we did not declare an emergency. But when the next pandemic comes, we will find that the law will be better equipped to respond accordingly.

6.               Second, we are setting up the Communicable Diseases Agency as we speak. The law has been passed. It will help consolidate our expertise within one organisation, which will help us respond more quickly. It will also become an institution for us to continually learn and deposit the knowledge and expertise.

7.               Third, we are setting up a Healthcare Reserve Force, and this will be manned by about 1,000 volunteers. These are not medical personnel, but they are important to support non-clinical operational roles, such as testing and case management operations. They came in really handy during the last pandemic, when we relied a lot on the SAF. But for next pandemic, we want to build up our own voluntary reserve force. Many members of the community have responded in earnest, and we will continue to recruit and augment the force.

8.               Fourth, we also need to plug ourselves into the international collaborative effort to prepare for the next pandemic. It comes in the form of better global surveillance, and working on a 100-day mission to develop the next vaccine as quickly as possible. Because when the next pandemic comes again, it will be a global threat requiring a global response, with countries working more closely together.

9.               The recent decisions by the US and Argentina to pull out of the World Health Organization (WHO) is a major setback in this global effort. We need every country to be part of the future pandemic response, and especially the US, which is really a leader in this field.

10.           As I mentioned to the former US Health Secretary before, during COVID-19, Singapore bought US-developed vaccines and test kits, and used DHL and UPS to deliver them to Singapore and to the region, often on Boeing planes.

11.           It is important that the international community continues to collaborate on pandemic preparedness. And indeed, in the US, scientists and clinicians in cities, in states, hospitals and universities continue to share data on new infections and outbreaks. Philanthropic organisations continue to support worthwhile healthcare causes. Researchers and industries continue to work in collaboration with others around the world to develop future vaccines and therapeutics.

12.           This is a global collaboration, empowered by digital infrastructure. It is driven by a common mission. And it has to continue regardless of the development in WHO membership.

13.           The other thing that I think governments have to do, other than building up all these institutions, arrangements and mechanisms to prepare for the next pandemic, is in providing the right leadership in a pandemic. Sometimes when it is not present, there will be devastation. Because, like it or not, ultimately, it is the elected leaders who often have the authority to make important decisions during a pandemic, and I think all governments have a duty to do that. In the video, there was a comment made that you cannot just call out all the scientific facts to the public, who will react emotionally.

14.           I think leadership, especially, is important in first understanding the science, consulting the right experts, understanding things like – what are the characteristics of this pandemic? What is the severity and reproduction rate, incubation period, mode of transmission? Is there asymptomatic transmission? And then to be able to translate that into public health policies, in the way you influence societal behaviours, and decide if schools and the workplace should continue functioning. These are important public health decisions that leadership needs to translate scientific facts into measures and explain to the people. I think this is critical, and I hope that all governments in the world learn the lessons of the previous pandemic, and will be able to display them, and use those lessons in the next pandemic.

15.           As Dale mentioned, we did not learn from the Spanish Flu. In the same way, when COVID-19 arrived, developed countries had managed many difficult flu outbreaks, and treated COVID-19 as if it was a difficult flu outbreak. In Asia, in countries such as Singapore, we had to manage SARS, and so we treated COVID like SARS. That was how we learned from the last ordeal. We just reproduced the same response. Both responses were wrong, but fortunately, Asia's response led to fewer excess deaths.

16.           But I am quite sure that it is almost guaranteed that when the next pandemic comes, we will treat it like COVID-19, and it will be wrong. So it is our duty as leaders, as scientists, to really get together and understand the next pandemic and respond accordingly.

Population Health and Shingles

17.           Now let me segue to talk about something else. There is one aspect of pandemic emergency preparedness that is less talked about, and which I want to highlight today, and that is population health. In a pandemic, one of our first and primary objectives is to protect the healthcare system, to prevent it from being overwhelmed by a large number of severely ill patients.

18.           That task may become more challenging, because all around the world, other than the African continent, populations are ageing, with rising chronic disease prevalence. This drives up the risk and incidence of severe infections during a pandemic. In addition, the seasonal activity of known infectious diseases worsens the situation.

19.           The good news is that these challenges actually can be managed, or even prevented through population health measures. We need to educate people to adopt good lifestyle habits to strengthen their health. On a day-to-day basis, people need to maintain good personal and workplace hygiene. Individually, we can all do our part to be socially responsible and stay up to date with the recommended vaccinations, which strengthens our population immunity

20.           That is why post-COVID-19, MOH rolled out Healthier SG to better drive good population health.

21.           I believe all these population health efforts have produced some initial results. We are seeing better health screening and vaccination rates. In 2024, our influenza vaccination coverage amongst those aged 65 and above was about 40%, low by developed country standards - in Europe or the US for example – but it is double the figure in Singapore in 2021. I believe we can still do a lot better.

22.           Here, let me talk about the varicella zoster or chickenpox virus. Vaccination against it is around 89% for those aged two years old. Chickenpox is largely, for the young, a self-limiting disease, with the great majority of patients recovering uneventfully. However, a bigger problem arises when latent chickenpox virus manifests as shingles amongst older people. For this group, it is painful and very long-lasting.

23.           There is a clinically effective vaccine against shingles, but it is not cheap. Not in Singapore at least. The full course, comprising two doses, costs around $900. Many seniors have therefore understandably asked if the government can subsidise shingles vaccination, or at least be allowed to use their MediSave to pay for the vaccination.

24.           Part of the reason for the high cost of the shingles vaccine is that the pharmaceutical industry practises differential pricing across geographies. As Singapore is a small market deemed to be high income, we often end up paying more for our drugs, including vaccinations.

25.           To be clear, I am not begrudging the industry here, but explaining this is how the industry works, in order to pay for the large investments in research and development to develop the new drugs. In fact, this differential pricing system is in turn founded upon intellectual property protection, and is one of the basis for pharmaceutical companies to invest in production plants in Singapore. However, when it comes to procuring the drugs, Singapore is in a disadvantaged position under this system.

26.           That puts MOH in a dilemma. We know the vaccine is not cheap. We want to subsidise the shingles vaccine to help Singaporeans avoid the pain of getting shingles. However, if we do, we will very likely entrench the high price of our supply.

27.           Thankfully, we have a good partner in GSK, which has a long history of relationship with Singapore. We had good discussions with them and arrived at a good outcome. GSK will adjust the price of the shingles vaccine; MOH will subsidise the vaccination; bring it under our population health measures; and recommend shingles vaccination under our National Adult Immunisation Schedule, alongside others, such as influenza and pneumococcal vaccinations.

28.           The subsidy for Shingrix will be effective in September this year and will apply to seniors aged 60 and above, and younger adults who are immunocompromised. The subsidy will also be means-tested.

29.           Because of these changes, the reduction in the out-of-pocket cost of shingles vaccination to a member of the public can be quite significant. If you are a Pioneer Generation Singaporean, the cost of two doses of vaccination will fall from about $900 today to about $75. For a high-income senior, it will fall from around $900 to about $300.

30.           From 2026, MOH will also allow the remaining out-of-pocket cost to be paid using existing MediSave schemes. So the cash payment is potentially $0.

31.           I also want to thank Singaporeans for their patience and understanding, for giving my MOH team and I the time and space to discuss the matter with the vaccine supplier, and arriving at a good outcome. My staff sent me this link to a public petition addressed to me, to subsidise shingles vaccination. I went to the website and saw that the response was quite modest – a couple of thousands of people had signed the petition.  If it had generated a huge response – tens of thousands or hundreds of thousands signatories – it will generate quite strong pressure on my Ministry and I, and we may end up having to subsidise the vaccine at a high price, entrenching the high price. So I thank Singaporeans for their understanding and patience.

32.           This is the Year of the Snake in the Chinese Lunar calendar. Coincidentally, shingles in Chinese is called 生蛇. It literally means ‘snakes growing in your body’ because you have blisters and your nerves are inflamed. With the extension of financing to the shingles vaccine, we hope to support eligible patients in taking up the vaccine this year, to avoid snakes growing in your body in the Year of the Snake.

Closing

33.           In closing, I would like to thank and commend Professor Dale Fisher, the book authors, and the entire team at CIDER for this outstanding work. I look forward to the Centre’s important contributions to regional and global health security. Your continuing work demonstrates the power of unified efforts in advancing public health to create a safer, healthier and more resilient future for all. Thank you very much.