Infectious Diseases (Amendment) Bill

Mr Deputy Speaker, I stand in support of the Bill. Singapore is an open and connected country, and we receive well over 17 million visitors a year. While our openness has benefited the economy, a tradeoff that we accept is that it puts us at an increased risk of suffering from infectious diseases that may be carried over from other countries. Many Members of this House and, indeed. many Singaporeans, would remember the SARS outbreak in 2003, and how we narrowly escaped MERS in 2012. The review of the IDA is thus timely, but I have some clarifications on the Bill.

Mr Deputy Speaker, the Bill provides the Director of Medical Services broad and sweeping powers to require persons, whether entering, staying within, or leaving Singapore, to undergo a medical examination. The Bill also allows for a person to be subjected to medical examinations over a period of time and be placed under medical surveillance. While I fully agree that this is necessary and critical in the event of an infectious disease outbreak, there needs to be a safeguard in place to ensure that this power does not go unchecked. Could the Minister clarify if there are, or would be, any safeguards in place, or if there is a maximum number of consecutive days that a person can be subjected to medical surveillance?

The Director of Medical Services is also allowed to direct persons involved in professions that are deemed to likely cause the spread of any infectious diseases to stop carrying on with their occupation, trade or business. This is similarly a directive that would affect business continuity as well as workers’ livelihood. Could the Ministry consider specifying a maximum period of days for such a stop-work order, so that businesses can take this into account as part of their emergency preparedness plans? Such orders can be reviewed and a new order could be reissued if the situation still warrants it.

With freelancers and workers in the gig economy not covered by hospitalisation leave offered by employers, there is a large possibility of a loss of income following such directives. Can the Ministry consider setting up a fund that would help mitigate such an impact for this group of workers?

Mr Deputy Speaker, when an infectious disease pandemic is in full swing, many of our available resources will be stretched to the utmost limits. We experienced this during the SARS outbreak. To better aid the appointed health officers, some of whom would have to perform contact tracing, I would like to suggest establishing a pool of volunteer Health Officers. Let me elaborate.

Organisations can be large and have multiple worksites. It can, therefore, be challenging and time consuming for a Health Officer to perform contact tracing without some forthcoming help. Also, the number of Health Officers that we have is limited. I would, therefore, like the Ministry to consider establishing a volunteer Health Officer scheme. The desired outcome is for every large organisation to have an appointed volunteer Health Officer, who can aid a Health Officer in contact tracing as well as help to disseminate health advisories in the event of a crisis. This pool of volunteer Health Officers should be provided with adequate training to ensure they have the required skills to perform proper contact tracing and assist our Health Officers.

Mr Deputy Speaker, the amendments proposed to section 59A allows for the use of individually-identifiable information or human samples for the purposes of national public health research. It is important that we put in place rigorous safeguards for the use and disclosure of such data to protect the privacy and confidentiality of individuals. What safeguards will the Ministry put in place, and how will the Ministry ensure that third-party researchers adhere to these rules?

I will conclude by saying that, due to the nature of our economy, Singapore will always be at risk of infectious diseases carried from other countries. The amendments proposed are useful and timely in helping to enhance surveillance and prevent the introduction and spread of infectious diseases within our shores. However, we need to ensure that while we fight against the spread of infectious diseases, we do not inevitably cause irreversible disruptions to everyday life. With that, Mr Deputy Speaker, I support the Bill.

Mr Deputy Speaker, I thank the Members who have spoken in support of the Bill. Infectious pathogens and the environment in which we operate can and will change. We must not be complacent. The proposed amendments to the IDA are to ensure that our legislative tools remain relevant and allow Singapore to adequately respond to both current and future infectious diseases threats.

I would like to emphasise that the intent of the Bill and its amendments are for public health protection. My Ministry has put in place safeguards to ensure that use of the powers under the Act is commensurate with the public health concerns to be addressed.

Members have sought clarifications on the proposed amendments and some of our operational measures. I will take the House through accordingly.

I thank Er Dr Lee Bee Wah for her comments on the need to educate the community on infectious disease threats to generate awareness and a greater sense of social responsibility. Everyone has a part to play in preventing and controlling infectious diseases, and it is important to provide people with information to allow them to do so.

My Ministry has initiatives to reach out to both the general population and specific groups. For example, the HPB's "FIGHT the Spread of Infectious Diseases" campaign encourages the public to practise good hygiene measures, such as frequent hand washing and keeping up to date with immunisations. For childcare centres, we have developed the Infection Control Guidelines for Schools and Child Care Centres on recommended practices to reduce disease spread among staff and students.

Sometimes, during an outbreak, there is a need to inform specific groups of persons about how to protect themselves, the symptoms to look out for and when to seek medical help, in an effective and targeted manner. For example, during the 2013 Avian influenza outbreak in parts of China, my Ministry worked with the Changi Airport Group and airlines with flights arriving from affected areas, to disseminate health advisory notices to their passengers. I thank the airlines for their cooperation.

As Ms Joan Pereira indicated, beyond cooperative arrangements, situations may arise where we would need to rapidly engage operators to effectively reach out to target populations. Clause 10, in inserting section 21B, enables my Ministry to do so. For example, an airline is in a good position to distribute information, in the appropriate languages, to its passengers travelling to, or returning from, an outbreak area. Likewise, a mobile phone service operator may be able to quickly send information to its subscribers travelling in an affected country.

I thank Er Dr Lee Bee Wah for her suggestion to tap on the Ministry of Foreign Affairs' (MFA's) platform to communicate information to travellers to high-risk destinations. We will study it, together with MFA.

However, we need to push out information to persons in a convenient way, for example, without requiring them to take special actions, such as opting into a service or downloading an app. My Ministry will formulate the content and messaging and coordinate with operators on the most appropriate form of dissemination.

Prof Fatimah Lateef, Er Dr Lee Bee Wah, Dr Chia Shi-Lu and Ms Joan Pereira commented on measures at the borders to prevent the introduction of infectious diseases. I will first address the comments on declaration of one's health status and travel history after visiting a high-risk area.

While my Ministry has taken measures to raise awareness and seek cooperation, we also recognise that awareness levels may differ and not everyone may exercise personal responsibility in measures, such as self-declaration. We must have the powers and capabilities to detect infectious diseases at our borders when needed. Clause 15, in transferring the subsidiary regulation that allows for the medical examination of persons entering Singapore to section 45A of the Act, strengthens the ability of my Ministry to prevent the import of infectious diseases.

However, it is not practical nor feasible to screen everyone for all diseases. Infectious diseases vary in severity and how easily they spread. To efficiently allocate resources and avoid unnecessary burden to travellers, my Ministry conducts risk assessments, taking into account infectious disease developments around the world and international practices, prior to adopting technology and implementing surveillance measures. For example, temperature screening at the airport is currently limited to flights from countries in the Middle East at risk of MERS transmission. Screening is done at the aerobridge to target at-risks persons and minimise inconvenience to others.

Dr Chia Shi-Lu asked whether section 31 of the Bill applies to emerging infectious diseases with no preventive or therapeutic measures. I wish to clarify that section 31 only applies to diseases that have vaccination or prophylaxis, such as Yellow Fever. It allows my Ministry to mitigate the risks presented by persons who arrive in Singapore without having undergone such vaccinations or prophylaxis. Refusing entry to all travellers from a country with an outbreak of a specific disease will need to be in line with our laws and international obligations.

Dr Chia Shi-Lu also said that there may not be established surveillance measures for certain diseases. I agree. Border surveillance does not pick up persons with infectious diseases during the incubation period. That is why we advise persons who have travelled to high-risk areas to seek medical attention should they develop symptoms. Our healthcare professionals in primary care clinics and emergency departments are very much on the frontline and need to be vigilant in picking up imported cases.

Prof Fatimah Lateef sought clarification on our coordination structures during outbreaks, both domestically and internationally. Infectious diseases do not respect borders. My Ministry taps on the International Health Regulations' National Focal Point network to communicate with WHO and other countries. All countries are required to have a National Focal Point accessible at all times to share information. My Ministry has also established links with WHO, our counterpart agencies and international experts, to obtain and share information early.

While we take reference from the recommendations of international bodies and respected public health authorities, we must also have our own framework to monitor and identify risks to Singapore and calibrate our responses. My Ministry performs horizon scanning of disease situations around the world, and assesses the risk to Singapore, based on public health principles. This is especially important in time-sensitive situations where we need to act while pending, for example, WHO's advice.

Locally, my Ministry maintains a close working relationship with other Ministries, Government agencies and stakeholders. The Homefront Crisis Management System allows us to harness the expertise across agencies and coordinate preparedness and responses to crises, including infectious disease threats. To ensure that preparedness plans are continually strengthened, regular joint exercises and reviews are conducted.

Let me address Er Dr Lee Bee Wah and Prof Fatimah Lateef's questions on the management of infectious persons on board flights, and disinfection.

My Ministry has channels of communication with our land, air and sea checkpoints through the Immigration and Checkpoints, Civil Aviation and Maritime and Port authorities. In the event of a severely ill passenger suspected of having an infectious disease, there are arrangements in place between these authorities and my Ministry that cover the medical assessment, conveyance and management of the ill passenger, as well as the handling of other passengers and the vessel itself.

Airlines are guided by international standards provided by the International Civil Aviation Organization, the International Air Transport Association and WHO on routine cleaning and standard disinfection procedures for aircrafts. These procedures apply while investigations are underway for a suspected case. Upon confirmation of a serious disease which may require additional disinfection procedures, the IDA provides the powers for my Ministry and the National Environment Agency to require them to be carried out. Likewise, these powers are applicable to other types of vehicles.

I thank Ms Joan Pereira for her suggestion to verify Yellow Fever vaccination at the point of embarkation. My Ministry is working with CAAS and the airline association to examine how we can better educate travellers from affected countries on the need for Yellow Fever vaccination. Airlines have the burden of bringing travellers who are denied entry back to the country of embarkation, so they have a strong incentive to remind and verify that travellers have been vaccinated.

I thank Er Dr Lee Bee Wah for recognising the importance of mitigating the risk of infection for our hardworking healthcare staff. On this note, I want to echo what Mr Murali Pillai has said in recognising all the hard work provided by our healthcare professionals, especially during times of crisis.

My Ministry takes the protection of our healthcare staff very seriously. We have operational requirements and guidelines to prevent and control disease spread in the healthcare setting. My Ministry provides advice and guidelines to hospitals, clinics, nursing homes and registered healthcare professionals, such as recommendations on vaccinations, information on specific diseases, such as MERS, workflows on assessing a patient's travel history, and clinical management.

I thank Ms Irene Quay for highlighting the importance of tackling AMR. As Ms Irene Quay had mentioned, the interaction of the human, environment and animal sectors, and AMR is very complex.

Singapore's National Strategic Action Plan on AMR sets the framework for the national response among key Government agencies. To further build our capability to tackle AMR, my Ministry had set up the AMR Coordinating Office last year within the National Centre for Infectious Diseases (NCID). This office, together with our other capabilities, including the National Public Health Laboratory, and infectious disease research, plays a key role in coordinating with stakeholders and shaping initiatives in surveillance, prudent antimicrobial use, education and infection control.

I thank Prof Fatimah Lateef and Mr Louis Ng for their comments on the importance of safeguarding the confidentiality of information while upholding public health principles.

In preventing and controlling outbreaks, there is often a need to use the information of cases and contacts of infectious diseases for interventions, such as contact tracing, surveillance or response by healthcare institutions. My Ministry has in place operational processes to ensure the lawful use or disclosure of personal information for the purposes of the Act. As an added safeguard, the healthcare provider disclosing the information and the specified person receiving the information under the new section 57B must comply with conditions imposed by the Director of Medical Services in authorising such disclosure. Any person who fails to comply with such conditions is guilty of an offence.

I refer to Dr Chia Shi-Lu, Mr Melvin Yong and Mr Louis Ng's comments on public health research and the use and disclosure of individually-identifiable information. There are criteria under section 59A that the Director of Medical Services considers before conducting public health research, including whether the research can acquire new knowledge and benefit public health. My Ministry may not have the resources to perform complex research and may appoint institutions to conduct them and share the outcomes with us. Individually-identifiable information or samples will be used only if the Director of Medical Services is satisfied that the research can only be carried out with such identifiable information or samples. My Ministry will ensure that there are proper safeguards to protect such information or samples.

Mr Murali Pillai asked about how the list of prescribed infectious disease under section 6 will be drawn up. Allow me to clarify.

The amendments to section 6, read together with the new provision in section 73(4)(a), allow my Ministry to distinguish between the infectious diseases that medical practitioners, laboratories or a specific class of persons, are required to notify, by prescribing the infectious diseases applicable to each group. Let me elaborate. For example, some diseases can only be confirmed by a laboratory test. Take the case of Salmonella food-borne infection causing diarrhoea, fever and vomiting. These symptoms are similar to other forms of food-borne infections or gastroenteritis. In this case, the Act allows the Ministry to prescribe Salmonella as an infectious disease to be notified by laboratories but not the medical practitioners. That is to say, the prescribed infectious diseases are subsets of the infectious diseases listed in the First Schedule.

I thank Mr Melvin Yong and Mr Murali Pillai for their comments on providing support to mitigate loss of income arising from measures that restrict occupation. Support for persons whose livelihood is seriously affected by public health measures is important. During the SARS outbreak in 2003, the Government provided ex-gratia payments to eligible persons on home quarantine orders and employees of small businesses which were ordered to be shut. Additional help was also provided through the Community Development Council. These are some examples of viable sources of assistance, and my Ministry will work with the relevant agencies to ensure that adequate support is provided where necessary.

To Mr Murali Pillai and Dr Chia Shi-Lu's comment on whether there are appeal mechanisms for persons placed on stop-work orders or movement restrictions, I wish to clarify that placing persons on such orders is meant to prevent disease spread. As necessary, my Ministry will review requests for such persons to conduct specific activities, so long as public health and safety are not compromised.

I thank Mr Melvin Yong for his suggestion on setting up a volunteer Health Officer scheme to aid in contact tracing. It is, indeed, important for my Ministry to be able to activate the community quickly in times of crisis. We have a reserve pool of trained contact tracing officers from within the public healthcare family. Clause 7, in inserting section 19A, allows my Ministry to enlist the assistance of managers of premises to conduct contact tracing and surveillance. This will further augment our ability to quickly ramp up our public health responses.

I agree with Mr Louis Ng and Mr Melvin Yong that the powers conferred to my Ministry and its officers should be accompanied by checks and balances. In implementing public health measures, there is sometimes tension between individual liberties and the common good. I would like to assure Members that my Ministry will only impose measures under the Act for public health purposes. In deciding the extent and duration of public health measures, we take into account relevant considerations, including disease characteristics, expert advice and recommended practices, and conduct thorough risk assessments. For example, the number of days a person is subjected to surveillance or quarantine is dependent on the disease’s incubation period. Likewise, the duration a person is restricted from certain types of occupation is related to the risk of disease transmission. The approval of the Director of Medical Services, guided by professional ethics and advised by risk assessments, would be sought for such decisions.

In closing, I would like to reiterate that the proposed amendments are meant to enhance the ability to detect infectious diseases threats, prevent their entry into Singapore, respond to outbreaks and arrest further spread. There are legislative and operational safeguards to ensure that the powers under the Act are used appropriately and judiciously. For measures that are farther-reaching or more restrictive, my Ministry has ensured that a stronger governing authority is present. For example, the Director of Medical Services, the chief medical officer and lead of the medical profession, provides oversight for many of the measures under the Act.

I am confident that the revised Act will help us to further build our capabilities towards the prevention and control of infectious diseases. Mr Deputy Speaker, I thank the House once again for their support of the Bill.

*Question put, and agreed to.*

*Bill accordingly read a Second time and committed to a Committee of the whole House.*

*The House immediately resolved itself into a Committee on the Bill. – [Dr Lam Pin Min.]*

*Bill considered in Committee; reported without amendment; read a Third time and passed.*