Speech By Singapore Minister Of State For Health & Transport, Dr Balaji Sadasivan, At The World Health Assembly, Geneva

20 May 2003

By Dr Balaji Sadasivan

Mr President, Director General, Excellencies, Ladies and gentleman,

THE SARS ATTACK

The SARS virus attacked my country even before the virus was given a name. On 25th Feb 2003, it entered our borders. On March 1st, it entered our hospital system and sparked an outbreak that claimed 27 lives.

For Singapore, our battle against this virus began with WHO's alert about a new illness that Dr Urbani had recognized in Hanoi. Singapore would like to pay tribute to Dr Urbani for recognizing SARS as a new disease. If not for the alert that we received from WHO, the outbreak in Singapore would have been worse.

On the day of the alert, my Ministry was notified by our Communicable Disease Centre about three patients with atypical pneumonia. The 3 patients were isolated. Over the next few days healthcare workers stared falling sick and we realized we were dealing with a new illness about which little was known. Over the next 8 weeks, and after the virus had transmitted to 198 people, we brought the outbreak under control on 27 April 2003.

But our battle against SARS is not over. Two days ago, we detected a new SARS case. He has been isolated since 11 May as a suspect. He is a foreign national, resident in Singapore, who has traveled frequently to another country. We are investigating the source of his infection. He did not transmit the infection to anyone else in Singapore because he was isolated early. This single case of SARS this month has strengthened our resolve to be vigilant and to maintain our defenses against SARS as long as it remains a global problem.

FOUR DEFENCE RINGS

For an outbreak to occur, the SARS virus must cross our borders through an infected person and enter into the community. It must escape detection by the primary health care system and, again after the infected person's admission to the hospital, it must escape detection in the hospital system. To ensure that this chain of events does not occur, we have instituted comprehensive control measures that serve as four concentric rings of defense around our hospitals. The first defense ring protects our hospitals. The next defense ring is around the primary healthcare system. The third defense ring is in the community and the last defense ring is at our borders.

THE FIRST DEFENCE - Protecting the Hospitals

Our first defense ring is in the hospitals. Our strategy in the hospitals is to detect and isolate SARS early and to protect all healthcare workers against SARS. Hospital staff are fully protected with mask, gloves, goggles and gown. All healthcare workers have their temperature monitored twice a day and any cluster of fever among the healthcare workers will be investigated. Movement of patients and healthcare workers between hospitals has been reduced. No visitors are allowed into hospitals. The Genomic Institute of Singapore decoded the genome of the virus and developed a PCR diagnostic test kit that allows early definitive diagnosis of SARS.

THE SECOND DEFENCE - The Primary Healthcare System

In Singapore, a SARS infected person is very likely to consult a medical general practitioner or a traditional Chinese medicine practitioner when he first falls sick. They are the first contact between the SARS virus and the health system. We have trained these practitioners to detect SARS and to take adequate protective measures to ensure they don't catch SARS. The workflow of their clinics has been modified to isolate patients with fever. Special ambulances will take the patients to the hospital for further observation, if SARS is suspected.

THE THIRD DEFENCE - Social Responsibility in the Community

Through an intensive public education program, that includes a special SARS television channel, Singaporeans have access to information about SARS. SARS creates fear, and the fear of SARS may create more problems than SARS itself. Information is a powerful tool in the fight against fear. It empowers every Singaporean and allows him to fight SARS by becoming socially responsible. Singaporeans are encouraged to take their temperature twice daily and if they develop a fever, they are advised to seek medical attention. Our school children, about 600,000 students in all, are given a thermometer each. Every home will be given a thermometer and every citizen has the ability to monitor his temperature and his family's temperature twice daily. I take my temperature twice a day. This is an important measure as the SARS infected person is not infectious in the early stages of the illness.

THE FOURTH DEFENCE - Preventing Transborder Spread

The last barrier to spread of the SARS virus is at our border checkpoints. Through health declaration forms and thermal scanning technology developed by our local scientists, we are screening both outbound as well as inbound travelers for fever. We work with other countries to trace the contacts of suspected SARS patients who have traveled across borders.

THESE MEASURES WORK

Because of these defense measures, there has been only one case of SARS this month. Life in Singapore has normalized. Schools are open. Singaporeans and foreigners fill our restaurants and shopping malls without fear and without wearing masks.

In the battle against SARS, we are all on the same side fighting a common enemy. SARS does not discriminate against any race, religion, social group, or gender. It does not respect borders. With global air travel, every country in the world is only one air flight away. The world can only be safe from SARS when every country has SARS under control. Singapore will do its part in the global fight against SARS. We have given China our thermal scanners and diagnostic kits. We have been open and shared all our information about SARS with WHO. We are confident that under WHO's leadership and guidance, the world can eradicate SARS.

Singapore would like to thank WHO for its assistance. We benefited from the advice of WHO experts - Dr Osman Mansoor, Dr Ali Khan, Dr Dan Rosen, Dr Stephen Lambert, Dr Kathryn Murphy and Dr Bobbie Erickson. Singapore commends Director General Dr Gro Harlem Brundtland for her strong and enlightened leadership of WHO. We congratulate Dr Lee Jong Wook, the incoming Director General and we are confident that under his leadership, WHO will continue to play a pivotal role in improving the health of the world.

Thank you.