SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE LAUNCH OF NPM PROGRAMME PHASE III

Mr Peter Ho, Chairman of Board Oversight Committee, Precision Health Research, Singapore

Professor Patrick Tan, Executive Director, Precision Health Research, Singapore

Ladies and gentlemen, friends, partners

1                 It is a pleasure to join you today at the launch of Phase III of the National Precision Medicine Programme, and this marks an important milestone for Singapore’s healthcare transformation journey.

The Next Leap in Healthcare

2                 Around the world, healthcare systems are all under strain. Capacity crunches and escalating costs are challenges in all developing economies because the populations are ageing. We must move therefore, from a system that reacts to illness to one that predicts and prevents it – and ultimately preserves health.

3                 One major aspect of preventive care is lifestyle habits, which we all know – how we eat, how we sleep, how we stay active. This also includes our health-seeking behaviour, that is, whether we have a regular family doctor that we go to or we doctor hop, and the doctor that we regular go to must understand our health, reminds us when to go for health screenings, when to go for vaccinations, and able to detect problems early.

4                 Lifestyle and health-seeking habits; we can say it is within our control, although a lot of people say that it is not within our control, but actually it is within our control whether you smoke or do not smoke. But there is another equally important aspect of personal health which we cannot control, and that is our genetics. While we cannot choose or change our genes, they are the source codes of human beings and keys to how we understand, prevent and treat diseases.

5                 When the deep biological insights of genomics are combined with the predictive power of AI plus the policies of preventive care and population health, we transform the healthcare system in a very fundamental way. This is the foundation for a new kind of healthcare – one that not just treats illness and cure individual patients, but keeps people healthy for longer, and is potentially more effective and sustainable even as our population ages.

From Discovery to Delivery

6                 To realise this vision, alongside the implementation of population health programmes such as Healthier SG, we also established Precision Health Research, Singapore (PRECISE) to drive the National Precision Medicine (NPM) programme. This programme harnesses the potential of precision medicine while ensuring that its use remains ethical and equitable.

7                 Over the years, the NPM programme has evolved into a strategic national capability. Phase I started about 10 years ago in 2017, when we created a reference database of 10,000 Singaporean genomes. Phase II commenced in 2020, anchored by the SG100K project – a landmark national effort that recruited and sequenced the whole genomes of 100,000 Singaporean participants. 

8                 SG100K was a first-of-its-kind genomics project because of Singapore’s multi-ancestry Asian database. My wife and I both participated shortly after I joined the Ministry of Health. The project is now completed, which is a significant achievement that strategically positions Singapore as a key contributor to global genomic research, providing valuable and unique insights on Asia’s genetic diversity.

9                 As part of SG100K, PRECISE implemented five Clinical Implementation Pilots, where clinician scientists and health economists worked together to find ways to integrate precision medicine into existing patient care pathways. The researchers evaluated outcomes, cost-effectiveness, and system readiness. This rigorous process enabled MOH to translate research into practical applications, from bench to bedside.

10             The applications include preventive care. By knowing both the lifestyle habits and genetic characteristics of a patient, we can identify his specific health risks and take preventive steps to avoid the onset or to manage the progression of severe diseases. This is not just preventive care, but predictive preventive care. It charts the path towards Healthier SG 2.0.

Predictive Preventive Care

11             The logical and ethical way to develop predictive preventive care is not to simply use an AI engine to predict all kinds of possible diseases. It will scare you to death, and this just generates unnecessary anxiety and worry, and we do not want to turn Singapore into a nation of hypochondriacs! Instead, we should start with known existing diseases where there is already an established preventive treatment pathway, and for which we know genetic characteristics are one of the root causes.  

12             Our first use case as E Shyong mentioned, is Familial Hypercholesterolemia (FH) – a genetic condition that greatly increases the risk of heart disease, even amongst young people. The national FH genetic testing programme was therefore launched in June this year. Doctors identify the patients, such as those with very high LDL (or ‘bad’ cholesterol), to be referred for a genetic test to ascertain if they carry the abnormal genes that lead to very high levels of LDL. If positive, their immediate family members, namely parents, siblings, children, will also be offered the test. This is a process called cascade testing.

13              More than 200 individuals have consented to genetic testing under the FH programme so far. I will give a fuller update on the results of the Programme early next year, after it has a fuller run. For now, today, let me give an update on the practical policy questions which we had to confront and decide on because of the FH programme. And this is precisely the value of starting with a focused, early-phase programme, to ensure that health policies can be reviewed and can keep pace with the development of science.

Policies that Keep Pace with Science

14             The first question we had to tackle is “should we provide financial support for genetic tests?” Under today’s rules, the answer is no.

15             Because today, what are the categories? For a patient who is unwell, we subsidise and allow MediSave to be used for CT and MRI scans that he may have to undergo to diagnose his illness. That is straightforward. For someone who is well, we fully subsidise nationally recommended Healthier SG preventive health screening such as blood tests and mammograms for women. However, for someone who is well and just wants to do a CT or MRI scan to find out if there is anything wrong with him - and there are many of such people - there is no subsidy or MediSave coverage because clinically, strictly speaking, the scans are not absolutely necessary.

16             Where should genetic tests fall under? We concluded none of the above, they do not fall under any of our existing categories of diagnostic tests. The individual is well, and this is not a nationally recommended preventive care test for the population. Yet, the genetic test will help us understand the genetic characteristics of the individual. Unlike CT and MRI scans which will change from year-to-year, these results will not change, and can help guide preventive care today and treatments for the future for this individual. So the value is much higher. 

17             And MOH therefore decided that genetic tests should be a category of tests on its own. Those proven to be clinically and cost-effective, and serve the objectives of an MOH-defined use case will receive subsidies and be eligible for MediSave use. Any downstream interventions that are required as a result of this test, such as drug treatments and intensified surveillance, will likewise be supported. With this change in policy, those who are recommended for genetic tests need not be deterred by the cost.

18             Hence, we take FH for example – after subsidies and MediSave – there will be an out-of-pocket cost of less than $100. Seniors aged 60 and above may further use Flexi-MediSave to completely cover their out-of-pocket costs. Cholesterol-lowering medications for FH-positive patients, such as specific statins and PCSK-9 inhibitors, are also subsidised.

19             Second question we have to confront, having known the genetic characteristics of an individual, how will this affect their life? Will this immediately affect their insurance coverage? If being tested positive for a genetic condition means denial of insurance or higher premiums, no one will come forward. It will be a major showstopper for the development of precision medicine.

20             To provide greater assurance on the use of genetic information, we implemented a moratorium in 2021, such that insurers generally cannot use genetic test results in insurance underwriting. However, the moratorium applies only to genetic test results of a well individual, and not those who already presented symptoms such as high LDL. In other words, the moratorium covers predictive genetic tests, but not diagnostic genetic tests. 

21             As we were developing the national FH programme, we realised that the coverage of our moratorium was not sufficient. Therefore, the protection was expanded to prohibit insurers from using all FH results under the national programme – diagnostic or predictive, all come under the moratorium.

22             Looking ahead, and we are thinking very seriously about this, MOH is working on legislation to enshrine the proper use of genetic information. We intend to provide legislative backing to the current moratorium on insurance. We also intend to expand the coverage to include employment. We are also reviewing the Human Biomedical Research Act to ensure governance keeps pace with advancements in research, including precision medicine. Responsible data use and strong governance are essential to maintaining public trust – the cornerstone of any national effort of this scale.

23             Then there’s a third question, we also have to decide on the financial support for another key subset of precision medicine, which is CTGTP, cell, tissue and gene therapy products. CTGTPs involve modifying cells or genetic material, to tailor treatment to an individual’s specific genetic or molecular make-up and address the root cause of a disease.

24             CTGTPs are still novel, can be expensive and difficult for individuals to access without support. So we have a very tough position. Hence, last year, we decided to judiciously include clinically and cost-effective CTGTPs into our mainstream financial support framework. So far, two products have been listed for subsidy, namely, Kymriah, for the treatment of B-cell acute lymphoblastic leukaemia, and Yescarta, to treat large or high-grade B-cell lymphoma.

25             As of June 2025, 22 patients have benefited from subsidies for these therapies. Since 1 October, MediShield Life and MediSave have also been extended to the same CTGTPs.

26             I have no doubt that we will encounter more policy questions in the coming months, or in the coming few years. We will work through all of them and we will consider each issue carefully and make the right decisions so that our healthcare system will evolve to better serve patients. We are guided by a simple and unwavering belief, which is that science must serve people and deliver better healthcare.

27             We are already taking further steps to develop predictive preventive care. For the next use case, we are exploring genetic testing for Hereditary Breast and Ovarian Cancer, or HBOC. We will assess if a genetic testing strategy for HBOC is clinically and cost-effective, given the potential benefit to identify individuals who are at risk of these cancers and they can take preventive steps early. Other potential use cases are also in the pipeline.

Scaling Up: NPM Phase III

28             With the completion of SG100K and Phase II of NPM, we will be opening the next chapter of precision medicine. Today, we are launching NPM Phase III, which will transition precision medicine from early studies to population scale implementation. In short, I call NPM Phase III, SG500K.

29             Over the next few years, the three healthcare clusters will work together to recruit another 400,000 to 450,000 participants, over and above the current 100,000 participants. So we will have over 500,000 participants, or roughly 10% of Singapore’s local resident population, who will have their whole genome sequenced.

30             Like Phase II, the genetic and clinical data of the participants in SG500K will help generate robust, population-specific evidence on how genomic information can be used responsibly in healthcare. It will help make more informed, preventive and targeted care decisions, as well as further integrate precision medicine into mainstream healthcare. If successful, and I think it will, it will help many people live healthier for longer. 

31             Phase III is expected to last six years. When completed, we will achieve three important outcomes:

32             First, a world-class database that reflects Asia’s diversity, allowing important studies that can lead to better clinical care with improved health outcomes.

33             Second, a healthcare system better prepared to deliver cost-effective genomic care.

34             And third, a thriving biomedical ecosystem, with many precision medicine innovations, an expanding role for genomics in healthcare for clinical adoption, foreign adoption of Singapore’s solutions, and growth in high quality enterprises and jobs.

The Highest Ethical Standards

35             I thank all the people behind our precision medicine journey – PRECISE, the healthcare clusters, partners, clinicians, researchers, and the Singaporeans who have contributed their data and trust to this national effort.

36             We are faced with a once-in-a-lifetime opportunity – to build a national capability that improves healthcare, uplifts lives, grows industry, and helps Singapore lead responsibly in Asia and beyond.

37             We will seize this opportunity with the utmost ethical standards – one that prioritises prevention, improves the welfare of people, safeguards trust and which combines science with care and compassion. Let us carry this work forward – with the same purpose and ethos that brought us here.

38             I wish PRECISE, our healthcare clusters, and their partners every success in SG500K. Thank you