SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH AND COORDINATING MINISTER FOR SOCIAL POLICIES, AT THE OPENING CEREMONY OF THE SINGHEALTH GENOMIC ASSESSMENT CENTRE

Mr Cheng Wai Keung, Chairman of the SingHealth Board of Directors

Professor Alex Sia, CEO, KK Women’s and Children’s Hospital

Professor Fong Kok Yong, Deputy Group CEO, SingHealth

Associate Professor Yeo Khung Keong, CEO, National Heart Centre, Singapore

Ladies and Gentlemen

1.              I am very pleased to join everyone here at this official opening of the Genomic Assessment Centre (GAC) at SingHealth.

2.              The speech today is slightly long so bear with me. Any speech regarding genomics is a bit difficult to write but we managed.

3.              Humanity has long pondered fundamental questions regarding life, evolution, and each organism’s or individual’s innate and unique characteristics. And then we discovered, as in, humankind discovered DNA and we made tremendous advancements in genomic science.

4.              But with that comes understanding of disease risk, and the ability to intervene earlier, and more precisely. So for example, we can now peek directly into a person’s DNA to look for clues and early warning signs, identify people who are at higher risk of certain diseases, and take early steps before the onset of diseases to prevent irreparable damage to their bodies. In other words, three “P”s – personalised, predictive and preventive care is now possible.

5.              This is therefore a potential inflexion point for healthcare, especially population health. There is great promise for the betterment of humankind. But with this promise also comes important ethical questions, about tampering with nature, the potential inequality that may arise when some can afford to think about genes and others cannot, genetic discrimination in society, and also issues concerning privacy.

6.              So just on privacy – who should have access to our genomic data and what can it be used for? Many of us are already sensitive about personal information. Of course, we are sensitive about our address, our phone numbers or health records, let alone the genetic coding that makes us who we are. This is as personal as it gets.

7.              Professional standards of practice and societal guardrails therefore need to evolve in tandem with technology, so that we continue to maintain public trust in healthcare, even as science and genomic science advances. Managing this balance between scientific advancement on one hand, and ethics and regulations on the other hand, is core to the healthcare transformation that we are pursuing. And today, let me outline the key approaches we are taking.

Taking Practical Steps

8.              First, we have to take practical steps forward. We do not make a big ideological, big bang adoption of genomic science. And that will inevitably lead to crossing the red lines of social mores. Instead, we take one practical step at a time, learning as we go along, constantly making progress, and ensuring that ethics and scientific progress advance together.

9.              One early practical step, which Kok Yong mentioned, is tackling FH, or Familial Hypercholesterolaemia. FH increases the risk of cardiac diseases at a younger age, and genetics is a key risk factor. In the past, we used to detect FH only after a young person had a heart attack sometimes in their 30s, sometimes in their 40s. By then, the damage has already been done.

10.         Today, we can evaluate the medical condition of an individual and decide if they are at risk of possessing the genetic mutations that predispose them to FH, and then we invite them to go through a genetic test for mutations, and if (such mutations are) present, take preventive actions. And we are talking about lifestyle changes and medication, before any harm occurs. So the test is sophisticated and high tech but the interventions are commonsensical. They are diet, lifestyle and medication.

11.         The National FH programme launched in June last year does precisely that.

12.         As of December 2025, more than 1,000 eligible individuals have been identified and referred for FH genetic testing. Suffice to say they all have fairly high cholesterol levels and they are suspected to possess the FH genetic mutation. Of these 1,000, about 600 of them have made an appointment at the GAC and then 420 consented to testing. And this represents an overall take-up rate of about 40% among those referred.

13.         The programme is still ongoing. Because FH is inherited, identifying one affected person can also help uncover risks among family members – blood-related family members. Hence, when an individual tests positive for FH, their parents, siblings and children will be encouraged to undergo the same test, even if they do not have high cholesterol levels. This is personalised and predictive preventive care in action. We started inviting family members for testing from late last year, and we hope more of them will take it up even though they have not manifested high cholesterol levels.

14.         A 40% take-up is a good start. But I think it can be better. It is below 50%, which in a Singaporean’s mind, is no good. From our conversations with individuals who declined genetic testing, most expressed concerns, and we want to be very honest here, about how the test results might affect insurance, employment or even how they would be perceived by relatives and society – exactly the ethical, privacy and trust issues I mentioned earlier. We need to address them so that people feel assured to take up genetic testing. This endeavour is not just about medical science. This endeavour is as human and societal as it can be. So that leads our the second approach.

Strengthen the Law

15.         And second, we must develop policies and practices to ensure that people can undergo genetic testing with confidence, and with trust. We must assure everyone that genetic testing is there to help. The tests can provide useful and unique information about your health risks. You can then make informed decisions about your lifestyle, your health, and your family planning. Take action earlier, to improve health outcomes for yourself and your loved ones, and avoid sufferings in future.

16.         But unfortunately, these sensible decisions for better health outcomes today are clouded by the impact on other issues like insurance. I go back to the first principle about insurance. In principle, insurance exists to protect us against the unexpected and bad luck, like traffic accidents, sudden severe disease, and indeed – for some, the unfavourable genetic hand that we are handled to at birth. People should therefore, as far as possible, not be judged or disadvantaged based on genetic predisposition.

17.         Actually we just have to go through a thinking exercise, the thought process. If we do and given that each of us has unique genetic characteristics and distinctive risk exposure to different diseases, every one of us – different genes, different risk exposure, the logical conclusion is that insurance product can be customised to each of us. The logical conclusion therefore is that risk pooling becomes meaningless, because the risk pool gets smaller and smaller, until it becomes one individual. And when risk pooling breaks down, products like health and critical illness insurance will also break down.

18.         Hence, to maintain the logic and objective of risk pooling in insurance, we should try to keep genetic information out of insurance processes. Since June 2025, the Ministry of Health (MOH) and the Life Insurance Association (LIA) have expanded the Moratorium on Genetic Testing and Insurance so that insurers are prohibited from requesting and using all genetic test results obtained from the national FH genetic testing programme in their insurance underwriting. That is already in the moratorium.

19.         But we should not confuse genetic tests with medical diagnosis, which is needed for insurance underwriting. Where a medical diagnosis is made, patients will need to disclose this as part of their medical history when they buy insurance policies. However, while doing so, the underlying genetic reason is protected and cannot be used in insurance decisions.

20.         Let me describe what this means in practical terms, and this goes out to those who are invited to the FH programme testing. And I use the national FH programme as an example. If an individual has been identified as potentially having the FH genetic mutation, he or she already has high cholesterol and is diagnosed with Hypercholesterolaemia. This diagnosis is already part of the individual’s medical history. Otherwise, we will not invite you for the test out of the blue. And it will most likely be already considered in insurance underwriting, regardless of whether a genetic test is done. It is already included in your underwriting.

21.         Conversely, if an individual has normal cholesterol levels and is invited to undergo the test, maybe because one of their blood relatives possesses the mutation, and he undergoes genetic testing because a family member has the FH genetic mutation, the test results are also protected from insurers and cannot affect insurance underwriting.

22.         In other words, considering both scenarios, undergoing genetic testing does not place individuals in a worse position, as far as insurance underwriting is concerned. These safeguards should provide individuals with better peace of mind to undergo FH genetic testing under the national programme and benefit from preventive and earlier intervention.

23.         But there is an exception to what I described earlier. This involves very large insurance products, with claims of maybe a million dollars or more. This is indicative of possible abuse, meaning someone does a genetic test, finds out he has a mutation that can lead to severe diseases later on in life, and then loads up on insurance hoping to claim later. And this is abusing the system. In such circumstances involving very large policies, insurers may request for additional information, including genetic test results. And this is intended to ensure fairness across all policyholders. This is also consistent with the practice in many other countries.

24.         So moving forward, we will enhance the moratorium in line with the approach I described earlier, and will entrench it in law, not just the moratorium, to provide greater reassurance. MOH will be commencing public and stakeholder consultation on the proposed legislation in the first half of this year.

25.          Ultimately, we must achieve this, which is the decisions about genetic testing should be guided by health considerations, not by insurance considerations.

The Role of GACs

26.         The third aspect of our approach is to better educate individuals about genomics, what it means for their health and their loved ones, and the actions they can take. And this is the purpose of the GACs, the first of which we are opening today officially.

27.         Eligible family members can access the GAC’s services, without the need for a referral. We have invested in setting up a team of dedicated professionals at the GAC, comprising medical doctors, genetic counsellors, and genetic counselling associates.

28.         They will provide guidance to individuals and families navigating genetic information, and provide a listening ear and a helping hand. We will continue to strengthen these capabilities and build expertise as the demand grows. This ensures that genomics is integrated into care in a responsible and patient-centred way.

29.         Besides SingHealth, we also have expanded our genetic counselling and testing capacity by opening two other GACs under NHG Health and also National University Health System (NUHS), which have begun accepting referrals from the beginning of this year. The progressive expansion in genetic testing capacity will benefit more people with earlier testing and timely interventions where appropriate.

Towards Better Science

30.         With FH as our first use case, we are looking at rolling out further programmes for conditions such as hereditary cancers. We are also studying how to integrate AI into genomics-enabled care. For example, we can certainly use AI to help us further refine the FH programme, enabling us to identify high-risk individuals with greater accuracy. The convergence of genomics, preventive care, and AI holds immense promise as we transform healthcare.

31.         Each of us is born with a unique genetic blueprint. For much of human history, this blueprint could not be decoded or deciphered, and its secrets remained locked. It is no longer the case. While our understanding of genomics today is probably still the tip of the iceberg, our knowledge is expanding and deepening quickly.

32.         But what is the implication of this understanding of each individual’s fundamental make-up? Does it drive us to believe that our health is predetermined and lead us down a path of fatalism? Or will we recognise that knowledge is power, that in understanding our biological blueprint, we are better able to take charge of our health?

33.         We must choose the latter path. Our genes are not our destiny. They determine where we start in life, but not where we end up. How we live, how we eat, how we manage stress, how we make friends, how we seek early intervention, and how we find purpose and happiness – these choices still matter greatly.

34.         The real question before us is therefore not a scientific one, but a philosophical one, which is the extent to which ethics, morality, social and legal norms should circumscribe human medical interventions. As the saying goes, “Genetics loads the gun. The environment pulls the trigger.” Determining what constitutes the gun and the trigger, what is nature and what is nurture, is the core of the enterprise we are embarking on.

35.         We will move forward in a practical way, step by step, evolving legislation, regulations and safeguards, and educating as many people as possible along the way.

36.         I would like to thank all healthcare leaders, doctors, nurses, staff and partners who made this Centre possible. With your commitment, this Centre will not just deliver care, but build trust, confidence and better health for the community it serves. Thank you very much.