Speech by Minister of State for Health Mr Chee Hong Tat at the Launch of SG50 Commemorative book and video, Infectious Diseases and Singapore: Past, Present and Future on 28 Dec 2015, at Tan Tock Seng Hospital

Dr Eugene Soh, Chief Executive Officer, Tan Tock Seng Hospital

Associate Professor David Lye, President, Society of Infectious Diseases, Singapore

Professor Leo Yee Sin

Professor Chia Kee Seng

Distinguished guests, ladies and gentlemen

1.            I am happy to launch the book and video, entitled “Infectious Diseases and Singapore: Past, Present and Future”. This special publication tells the story of our fight against infectious diseases, and how these efforts have contributed to nation building and improving the well-being of our people.

Introduction

2.            Let me start by saying a big thank you to our pioneers in the field of infectious diseases. They include Dr Edmund Monteiro, the former Director of Communicable Diseases Centre; Prof Ti Teow Yee, the first practising infectious diseases physician locally and Dr David Allen who laid the foundation for the development of Infectious Diseases as a medical specialty in Singapore.   

3.            I also want to pay tribute to the late Prof Feng Pao Hsii, who recently passed away. Prof Feng was a renowned rheumatologist, he was also active in the field of infectious diseases. As the founding president of the Society of Infectious Diseases, his contributions had been invaluable in developing this discipline in Singapore.  

4.            We are also grateful to many of our pioneer clinical microbiologists who helped to lay a strong foundation for microbiology in Singapore.  They include Prof Lim Kok Ann, Dr Moses Yu, and Dr Jimmy Sng.  Collectively, their efforts have brought us this far and Singaporeans today are benefitting from the fruits of their labour.  It is important that we do not rest on our laurels and we must continue to develop our capabilities to enhance clinical management, as well as outbreak detection, investigation and response.

5.            I am glad that Associate Professor Hsu Li Yang and Dr Vincent Pang have come up with this excellent documentation of Singapore’s journey in dealing with infectious diseases. Also appreciate the support from the Society of Infectious Diseases (Singapore), and the inputs from all the story contributors.  The book and video will provide useful learning points for future generations of medical professionals, and hopefully inspire some of them to focus on this important area of work.

Enhancing our capabilities in the fight against infectious diseases

6.            Some of us may recall the crowded living conditions in Singapore during the early years of our independence, the unlicensed street hawkers and even the “night soil” collectors in their trucks with 36 doors.  We lacked a clean water supply and battled problems with basic sanitation and pest control.  Infectious diseases such as typhoid fever and malaria were common.

7.            Singapore has undergone a massive transformation and we now have one of the best infant and under-five mortality rates in the world.  Key success factors include our improved living conditions, better nutrition, enhanced maternal and child health as well as our successes in combatting infectious diseases. With good sanitation and hygiene, clean water, and the successful implementation of the National Childhood Immunisation Programme, many infectious diseases have been virtually wiped out from our population. One example is polio; Singapore was declared free from polio in 2000, along with the other countries in the World Health Organization’s Western Pacific Region.  

8.            The fight against infectious diseases is never-ending and continues to evolve as new threats emerge. As the world becomes more inter-connected through the constant flow of goods and people, international boundaries are now more porous. Many outbreaks, which may initially seem remote and obscure, can be just one flight away. We have witnessed how quickly outbreaks such as SARS in 2003, H1N1 in 2009 and more recently Ebola and MERS, can spread from one country to another. We need to remain alert and vigilant to these risks.

9.            One major initiative to enhance our ability to deal with infectious diseases is the establishment of the National Centre of Infectious Diseases, which is currently under construction.  Beyond infrastructure and equipment, we must also build on our capabilities by continuing to invest in our medical professionals and infectious diseases experts; review our systems and processes; and remain connected to global networks and our international counterparts so that we can share information and best practices, and help one another to manage the spread of infectious diseases.  

Update on the Taskforce to Enhance Detection and Response to Infectious Disease Outbreaks

10.         The recent Hep C outbreak in SGH is a painful lesson that we must learn from and take concrete steps to improve.  The taskforce which I am leading aims to strengthen detection and response to outbreaks in both healthcare institutions and the wider community. As the Independent Review Committee or IRC had highlighted in its report, we do have robust systems and processes for handling community infections such as dengue, avian flu and MERS.  In fact, I get updates very quickly whenever there is a suspected case, they alert all of us. The system is robust in dealing with these. This is the correct approach because these are diseases which have higher risks of spreading in the community, so it is correct that they are given higher priority.  The IRC pointed out that our current systems and processes are not as well-developed to detect and respond to unusual infections.  This is a gap which we will address.

11.         As part of our review, the taskforce will consult medical professionals and other experts to get their inputs and suggestions.  These include our healthcare workers on the frontline – doctors, nurses and allied health professionals, as it is important to ensure that our recommendations will fit well with actual operations and can be implemented effectively on the ground.  We will also learn from international best practices and adapt them to our local context.

12.         Let me share with you some of the preliminary views and initial thinking from the taskforce. We just had out first meeting so this is a set of prelim views and intial thinking. First, the taskforce members agreed with the IRC that our healthcare institutions already have good infection control protocols in place. Hence, the way forward is not to simply add more rules and procedures, as that could inadvertently add to administrative workload and take time away from key operations and patient care.  We need to balance this with the need to keep SOPs simple and helping our medical professionals to focus on their core responsibilities and to comply with existing infection control protocols.

13.         Next, the taskforce plans to make better use of data analytics and IT systems to improve the detection of potential outbreaks.  Our current system depends too heavily on human judgment to process large amounts of data and information and decide whether the risks are significant enough for escalation and further investigation.  While professional judgment remains central to outbreak detection and response, we think this should be supplemented with IT systems and data analytics to facilitate reporting, enhance the recognition of patterns and improve the detection of weak signals. This is similar to air traffic control, where decision-making remains in the hands of controllers, but they are assisted by computers and data analytic tools to help them make better decisions.  We hope to do the same for outbreaks, to supplement professional judgment and enhance our overall capabilities to detect and respond to unusual infections.

14.         Third, as suggested by some doctors, we will review the list of notifiable diseases under the Infectious Diseases Act and also look at the modes of notification, timelines and escalation process.  The taskforce will be careful about the downsides of adding more reporting and administrative burden for our healthcare institutions and medical professionals.  What we want is to encourage and enable medical professionals to report cases which they come across by providing clearer guidelines and simplifying the reporting process where possible, for example by having a direct link from the laboratory to MOH on positive cases.

15.         Last but not least, we will examine measures to strengthen our capabilities to respond to outbreaks in Singapore, bearing in mind that it is not feasible for every healthcare facility to develop its own full-fledged infection control response team that is capable of responding to complex and unusual outbreaks. One idea which we are studying is to set up a national-level “SWAT team”, comprising infectious diseases experts who can be mobilised at short notice to respond to outbreaks in any healthcare institution. The “SWAT team” members can come from different institutions in Singapore, both public and private sector.  There can be a few full-time members while the rest are experts from our hospitals, universities and government agencies whom MOH could call upon and activate during an outbreak.

16.         The taskforce has just started work and we are at an early stage of our deliberations and review.  Now, together with the medical and nursing fraternity, my taskforce members and I are determined to improve patient safety by enhancing our systems and processes, and strengthening the detection and response to unusual infectious outbreaks.  We need your support to achieve these objectives. We need to work hand in hand with our medical and nursing fraternity.

17.         Let me end by once again extending my gratitude to our pioneer generation of doctors, and also the current and future generations of infectious diseases professionals, for the important work that you do to protect Singaporeans and keep Singapore safe.  In a globalised environment where infectious diseases can spread quickly from one country to another, your efforts will allow all of us to sleep a little better at night.  Thank you very much.