SPEECH BY MR ONG YE KUNG, MINISTER FOR HEALTH, AT AMERICAN CHAMBER OF COMMERCE SINGAPORE’S HEALTHCARE CONFERENCE, 8 JUNE 2023, 9.55AM AT NG TENG FONG CENTRE FOR HEALTHCARE INNOVATION

Dr Hsien-Hsien Lei

CEO, AmCham Singapore

Distinguished guests

Ladies and gentlemen

1.     I am happy to join you today for the first AmCham Healthcare Conference.

Overcoming the COVID-19 Pandemic

2.     Let me first say something about the COVID-19 pandemic, given that we have just emerged from the crisis not too long ago.

3.     As we all know, it was a devastating pandemic in human history. But in truth, without the contribution of American enterprise, dynamism and innovations, it would have been a far worse pandemic.  

4.     For example, Pfizer’s and Moderna’s mRNA vaccines, which Singapore adopted, were game changers, as vaccination was the most effective tool we had to protect ourselves against COVID-19. They were mostly delivered to this region via DHL or UPS, on Boeing planes.

5.     Another key strategy we had was rapid testing to trigger timely intervention for patients and their contacts. Becton Dickinson’s Antigen Rapid Test kits have been extremely useful.

6.     Pfizer and Merck’s oral antiviral medications also helped protect our elderly and vulnerable subgroups by reducing the risk of severe disease or fatal infections. Thermo Fisher contributed essential laboratory supplies such as reagents for PCR tests.

7.     Smaller companies such as Lucira and Cue were also crucial players, as they had helped expand our testing capabilities with novel diagnostic kits.

8.     These are the numerous examples of US companies that contributed to the fight against the pandemic. Today, on behalf of the Ministry of Health (MOH), I would like to thank you for your innovation and contribution. Thank you very much.

The Innovator and the Implementor

9.     The COVID-19 pandemic illustrates an important aspect of the American corporate sector because of its ideals, and its embrace of talent from all over the world, it maintains an exceptional dynamism.

10.     So when it counts, America innovates, achieves technological breakthroughs and comes up with solutions. I hope the American society and US corporate sector will never lose this special characteristic.

11.     On the other hand, because of our size, it is difficult for Singapore to achieve similar technological breakthroughs over and over again. But as a well-governed city state, we use a combination of policies, laws, organisation and efficiency, sometimes just common sense, to translate technology and knowhow into concrete actions that improve lives.  

12.     We see that everywhere in Singapore – in the way we carry out urban development, operate our airport and seaport, recycle water, build up our security defence, wire up our country, and tackle the COVID-19 pandemic.

13.     And when Singapore makes things work, other cities around the world use us as a reference point. We don’t profess to be able to teach, but we can certainly share our experiences.

14.     If America is the breakthrough inventor, Singapore is the innovative implementor, translating and concretising inventions into workable, city-level applications. That is what I see as one of the most synergistic aspects of the partnership between Singapore and the US corporate sector.

15.     This is also where I think opportunities are present for closer partnership in healthcare. Healthcare technology is at the cusp of a major revolution, of which America will be one of the global leaders of change. Singapore anticipates the challenge of a demographic shift, recognises the potential of technology, and we are now reforming our healthcare system.

16.     Against this backdrop, I think there are at least three areas of co-operation we can work on together.

Digital Health

17.     The first is digital health. One of the major aspects of our healthcare reform is Healthier SG, our national preventive care programme, where we put very strong emphasis on upstream preventive care. Downstream preventive care is not going away. In fact, it is getting more and more expensive with costs escalating but we are trying to contain it with preventive care.

18.     Our implementation approach is holistic. We are changing funding models for hospitals, mobilising our General Practitioners (GPs), getting Singaporeans to enrol in Healthier SG with a GP of their choice, linking up GPs with community organisations to follow up on social prescriptions, fully subsidising many aspects of preventive care, and having a national health app that rewards physical exercise.

19.     We can potentially turbo charge Healthier SG through the digital health revolution. Preventive care is part of population health, which deals with big numbers, probabilities, risks, and the most effective interventions to mitigate them. Digital health, driven by a rapid advancement of AI, addresses exactly that.

20.     Hence, we are looking forward to future health apps that are even more user-friendly, relevant and effective in nudging and persuading people to adopt good health habits and generally live better lives.

21.     It gives agency to the individual to take charge of his or her own health. It will be the perfect complement to the family doctor.

22.     I am also hoping that in the very near future, we can use home devices to scan our palm or our eyes and use AI to estimate our blood sugar or lipid levels. I believe that opportunity will come. This can do away with intrusive drawing of blood, or the presence of healthcare personnel for health screening.

23.     It will be a game changer in preventive care. With Healthier SG, we have the platform to  embrace such technology advances.  

Precision Medicine

24.     The second area of opportunity is precision medicine. Like digital health, it represents another revolutionary change in healthcare. But I think the similarities stop there.

25.     Across the healthcare spectrum, digital health mostly intervenes at the health end, to help us live better so as to prevent onset of diseases. Precision medicine is at the other extreme of the spectrum, to cure diseases in unprecedented ways.

26.     Unlike digital health that deals with big numbers, probabilities and risks, precision medicine is what the name implies – it is about precision.

27.     By intervening at the genomic level, it personalises medicine, recognising that each of us have a unique genetic make-up, are subject to different health risks, and respond differently to diseases and treatments.

28.     It enables less complex diagnostic journeys and targeted treatments with reduced side effects. We are starting to hear stories of editing genes to cure cancer, predicting health risks through genome sequencing and taking early preventive action, etc.

29.     But we also need to be realistic and careful. Many treatments are very promising. But they are experimental in nature. They work on a selected few as of now and are not ready for broad deployment or are clinically actionable. As of now, treatments can be very expensive, costing up to millions of dollars per patient. No healthcare financing system in the world has been designed for that.

30.     Genome information may be able to tell us our future health risks. But it can lead to over-interpretation and excessive or unnecessary treatments. It can be misused to deny insurance coverage to those who need it most and undermine the principle of risk pooling.

31.     In other words, for every upside and promise in precision medicine, there are risks and downsides. Nevertheless, we cannot ignore this major development in medical science.

32.     Our approach towards precision medicine will revolve around three principles: First, we have to embrace the technology. Second, while doing so, we must ensure sound and good clinical practices. Third, we will ensure that the overall healthcare system must remain affordable and sustainable.

33.     Developing the use of precision medicine in Singapore will be a major endeavour. We will need to work with various partners.

34.     For example, Pfizer, along with several other pharmaceutical companies, are looking at Antibody Drug Conjugates, which is said to be a “biological guided missile” for targeted cancer therapy. We welcome the application to use the drug in Singapore, but we will have to assess its safety, efficacy and cost effectiveness robustly.

35.     We are partnering Illumina, a leader in genomics technology with a significant presence in Singapore, in the SG100K study. As part of the study, we will sequence and analyse 100,000 Singaporean whole genomes to create Southeast Asia’s most comprehensive consented population study.

36.     This will  yield deep insights into Asian genomic diversity and Asian-specific diseases. To show my support, I am one of the 100K, and I got all my tests done.

37.     We are also conducting clinical implementation pilots to trial precision medicine approaches in clinical pathways, and evaluate how precision medicine can provide value-based healthcare. A collaboration between Ambry Genetics, a US-based company, and LifeStrands Genomics, a Singapore-based laboratory, is currently underway.

38.     This partnership centralises clinical genetic testing services, improves consistency in test results across the various clinical implementation pilots, and helps reap economies of scale. They enable clinical genetic testing services to be performed in Singapore, in contrast to the previous practices where physicians routinely sent their samples overseas for clinical genetic testing services.

Pandemic Preparedness

39.     The third area of collaboration is pandemic preparedness. COVID-19 today has has been treated as an endemic disease, but a next dangerous pathogen is on the horizon. We don’t know when it will arrive, but it will.

40.     The question is: will the world be better prepared for it, than we were for COVID-19?

41.     Individually, I think countries will be better prepared, as they would have developed emergency plans, border controls, social distancing, and health protocols that can enable us to better respond to the next pandemic. But the most important aspect of pandemic preparedness remains the same: which is there has to be a global effort to develop a safe and effective vaccine, which is our ticket out of a pandemic.

42.     The Coalition for Epidemic Preparedness Innovation, or CEPI, is on a mission to develop a safe and effective vaccine in 100 days. Singapore is contributing to that effort.

43.     Over the past months, and evident by the discussions at the recent World Health Assembly in Geneva, there is a strong push for a regional approach to developing and producing vaccines.

44.     Many countries, like South Africa and Brazil, are hoping for technology transfer and joint ventures to develop their national vaccine capabilities, which they will leverage to provide for their respective regions.

45.     The hopes of the developing world for greater self-sufficiency in vaccines to prepare for the next pandemic is totally understandable, given the very uneven distribution of vaccines at the height of the pandemic. If these regional projects succeed, indeed we will be much better prepared for the next pandemic.

46.     But a regional approach is not without challenges. Technological transfer is not a straight-forward matter. Even if pharmaceutical companies are prepared to, vaccine production can be a very precise and complex process.

47.     Cost is also an issue. A national or regional approach essentially prioritises national security, which will inevitably carry a premium in production cost.

48.     The most critical challenge goes back to vaccine equity. With a regional approach, developing countries may be able to secure vaccine supplies during a pandemic, but we have to ensure that small states like Singapore will not be bypassed. Regional producers with large markets will need to commit to export and supply vaccines to the world from Day One of production.

49.     More importantly, we have to ensure that a regional approach to vaccine production builds up, rather than fragments, global cooperation in vaccines development and production.

50.     That is why Singapore welcomes pharmaceutical companies to base their vaccine production here. The Singapore Economic Development Board (EDB) is actively working on this, and has anchored four producers so far. As a small market, our domestic needs are small and we always honour our contracts to export to our region and the world.

51.     We need to draw the right conclusions from this pandemic. Global cooperation did not fail, because if it did, we would not be able to develop vaccines in record time and exit from the pandemic crisis by now. Instead, I think the correct lesson is that global cooperation and multilateralism work, but they need to be better, and we do constantly strive to make it better.

Closing – Co-operation Based on Shared Values

52.     Let me conclude.  AmCham has been in Singapore for 50 years. 50 years would date back to a time not long after Singapore became independent.

53.     That was when as a small young nation, we needed to find our footing in the world and earn ourselves a living. We soon concluded that to do so, we had to plug ourselves into the global economy.

54.     Now, thousands of multinational corporations (MNCs) are in Singapore, Singapore companies can be found all over the world, we have a network of Free Trade Agreements, and numerous partners and friends around the world.

55.          While recognising the risks and downsides of globalisation, we remain a firm proponent of globalisation being an indispensable part of humanity which we need to constantly sustain and work on.

56.     It is in this spirit that we developed multi-faceted, strong and enduring partnerships with the US corporate sector. This has been nurtured by organisations like the EDB and AmCham over many decades.

57.     But more importantly, I believe the relationship was built upon a strong foundation of shared beliefs – that Singapore must remain open and welcoming to foreign investments; we ensure that we have a conducive investment environment and honour our commitments; while US investors leverage our strengths, invest in our country, invest in our people, and raise our capabilities collectively.

58.     On the occasion of AmCham’s 50^th anniversary, I wish that our shared beliefs continue to sustain and strengthen our partnership, and I look forward to many more decades of contribution by AmCham. Thank you.