Debated in Parliament on 7 Mar 2024.
Debate resumed.
Senior Parliamentary Secretary Rahayu.
Thank you. Members have sought clarifications on the proposed amendments. Allow me to respond.
Mr Louis Ng sought clarifications on how the guardian of an individual who lacks mental capacity should balance their responsibilities under the Infectious Diseases Act (IDA) and the principles under the Mental Capacity Act. I would like to clarify that the IDA does not limit the Mental Capacity Act. The principles under the Mental Capacity Act will therefore continue to apply.
Under the new section 2A, the IDA notice must first be served on the minor or individual. Where the minor or individual is not able to fully understand and follow through with the requirements in the IDA notice, the same IDA notice is then served on the parent or guardian, requiring them to facilitate the minor or individual’s compliance. This is a reasonable expectation, that the parent or guardian should play a part. Section 2A allows the Ministry of Health (MOH) to take action in cases of irresponsible parents or guardians, who without reasonable excuse, fail to do so.
Mr Ng asked about the safeguards for the management of information collected from classes of persons under section 7. The current section 7 already allows the Director-General of Health (DGH) to require any person to provide information for the purposes of public health surveillance, epidemiological investigations or surveys. The amendment is not an expansion of powers. Rather, it clarifies and makes explicit the manner in which DGH may exercise his power to require information from classes of persons. This facilitates operational efficiency. For example, a notice can be issued to the class of “persons who are in charge of a laboratory”, as opposed to multiple individual notices issued to each person in charge of a laboratory.
Data collected may not necessarily be anonymised. It may be necessary to match the samples collected to the data collected for the right patient. But where data can be used in anonymised form, such as to conduct trend analysis, MOH will do so.
MOH treats the management and protection of personal data very seriously, regardless of whether the information is collected from individuals or a class of persons. Sensitive personal data is managed and protected in compliance with whole-of-Government standards. Disclosure of information under the IDA requires DGH’s authorisation and is only for public health purposes, including measures to prevent and control an outbreak and national public health research. DGH may also impose additional conditions on the receiving party to better protect the information.
In relation to section 15 on the detection and isolation of persons, Mr Ng pointed out that while an individual may be ordered to be isolated in his own residence "for the protection of the public", this phrase is not used in relation to individuals being ordered to isolate in a hospital.
The difference in language is not new and already exists in the current Act. Isolation of persons in a hospital protects other patients and hospital staff, whereas isolation of individuals in their residence is more directly for the protection of the public within the community.
On whether MOH considered providing for a time limit for isolation orders under section 15, the duration of a section 15 isolation order is not open ended or arbitrary. During the COVID-19 pandemic and also in the context of other communicable diseases, the duration has always been based on public health considerations and grounded in medical science, typically until the individual is no longer infectious or potentially infectious.
I note that Mr Louis Ng as well as Ms He Ting Ru welcomed the provisions in relation to HIV. Mr Ng asked about the definition of undetectable viral load, length of the prescribed period and whether these would be periodically updated.
I would like to emphasise that the criteria for the maintenance of an undetectable viral load were rigorously determined based on latest scientific evidence and clinical knowledge after consultation with HIV and infectious diseases experts.
Ms He Ting Ru has also raised some other questions. In response, I would say that section 23 remains relevant to reduce sexual transmission of HIV, by requiring persons living with HIV with a detectable viral load and persons who do not know of their status, but have reasons to believe that they have HIV, to disclose their risk of acquiring HIV to their sexual partners prior to sexual activity. This allows sexual partners to make an informed decision before engaging in sexual activities and to encourage responsible sexual behaviour by taking mitigating measures such as ensuring condom use to protect themselves. The intention of the HIV laws is not to criminalise persons living with HIV, but to deter irresponsible behaviour.
She had also made reference to the high court judgment. The high court judgment will be superseded by the amendment.
In relation to the queries on the prosecution, from 2015 to 2023, seven people were convicted under section 23(1) for failing to inform their sexual partners of the risk of getting HIV infection from them. Of the seven, four had undetectable viral loads at the time of their offences. All four convictions had aggravating circumstances, including simultaneous offences under the Misuse of Drugs Act; committing a second offence while under investigation for a first offence; one victim was a minor; and one deceived and exploited a victim by lying and posing as a police officer. The law at that time was that a person living with HIV was required to inform their sexual partners of the risk of getting HIV infection from them. This law was informed by the state of medical science and there have since been developments in this, and that is why we are updating the laws to align with these developments.
Mr Speaker, to summarise, persons living with HIV do not need to disclose the risk of HIV transmission to their sexual partners if they have, first, maintained stable undetectable HIV viral load consistently below 200 copies per millilitre of blood, for at least six months, based on test results from a recognised laboratory. Second, their most recent undetectable viral load test result should be nine months or less before the sexual activity in question. Third, they had adhered to medical treatment for HIV infection up to the time of the sexual activity in question. Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner. We will set out the criteria in subsidiary legislation, to allow for timely and responsive adjustments should the state of medical science change in the future.
Mr Speaker, the COVID-19 pandemic has greatly widened our perspectives on the management of infectious diseases. The proposed amendments will allow Singapore to respond more nimbly to future infectious diseases threats, by providing the flexibility to calibrate our measures in accordance with the public health situation.
COVID-19 will not be the last pandemic that we encounter. The world remains vigilant against the next infectious disease threat; likewise, we must stand ready.
I am confident that with these amendments, Singapore will be better equipped to tackle future outbreaks and pandemics and safeguard the health of our population. I thank Members for their support of this Bill.
Minister Ong Ye Kung.
Thank you, Speaker. I just want to add a comment to the amendment to section 23. We are keeping section 23 because it is still relevant for those who are infected, or think that they are infected, that they continue to have an obligation to inform. At the same time, the Bill provides an exemption for those who have tested, sought treatment and then lower themselves to an undetectable and untransmissible level.
We think this combination best protects public health. Other countries might have come to a different combination, but MOH has studied together with the experts, and we find that this combination probably best protects public health.
As Senior Parliamentary Secretary Rahayu Mahzam has answered all questions, I have nothing further to add.
Are there any clarifications for the Minister and Senior Parliamentary Secretary? Dr Tan.
Mr Speaker, I declare that I am a medical doctor at a public healthcare institution.
I have a clarification to ask of Minister for Health Mr Ong Ye Kung. With the new Act and the new classifications of public health threat and public health emergency, a number of Clementi residents will be wondering what becomes of the older DORSCON classification – the Disease Outbreak Response System Condition Classification. A number of residents had shared that the different colours green, yellow, orange and red can mean different things to different people. So, can the Minister advise us what will become of DORSCON now that we have the clearer status of public health threat and public health emergency.
That was a very good question from Clementi residents. DORSCON stands for Disease Outbreak Response System Condition, it has four colours. It was used by the Public Service for agencies to coordinate response and to plan resources. It is actually internal. But during COVID-19, somehow it became an external communication code and it triggered all kinds of reactions in supermarkets.
With this change, now that we have the new Act, we have four levels of alerts, which is: Baseline, Outbreak, Threat and Emergency. I think it is more intuitive and clearer. So, amongst the agencies, through our Homefront Crisis Executive Group (HCEG), we agreed that this new four tiers will replace DORSCON, both for internal planning as well as our external communications.
Yes, Ms He Ting Ru.
Thank you, Speaker. I have two quick clarifications.
The first is, I thank Senior Parliamentary Secretary Rahayu Mahzam for saying that the amendment supersedes the ruling in GCP vs Public Prosecutor. I acknowledge that amendment supersedes the court sentencing framework. However, I am not clear about the use of the interpretation of meaning of risk of disclosing HIV. So, I would like to ask for further clarifications about that. What specifically in particular are the persons living with HIV are supposed to do in that context.
The second point that I wanted to seek further clarifications on is that I do not believe that there is any local study on the effectiveness of criminalisation of HIV non-disclosure on reducing HIV infection rates, albeit this time where we are talking about a reduced group of people that this applies to. I am just wondering what can MOH do to address the potential stigma that might arise from this continued criminalisation.
I thank Member for the question. In relation to her point, actually how this works is that when a complaint is made, the person investigated for the offence would then have to produce the necessary evidence or show undetectable viral load (UVL) that they have had.
So, when at that juncture, the strongest evidence for adherence of medical treatment would be the UVL test result from a recognised laboratory at the next regular medical follow-up visit for HIV after the sexual activity in question because it will show that they have maintained their UVL, as this would not have been possible without treatment.
There would be other circumstantial evidence for adherence to treatment that may include contemporaneous records at the next follow-up visit after the sexual activity in question, of documented treatment adherence, or documentation in past medical records of a consistent pattern of treatment adherence and consistent past UVL test results carried out by a recognised laboratory. These are the things that they would have to show in the event there is a complaint made and investigations follow.
In as far as how they would conduct themselves, the reality is that this is a law, a provision that says you are not supposed to do it. So, if they then do this and there is a complaint made, investigations will follow, and these are the provisions and the evidence that they can rely on.
On the second question on the criminalisation of non-disclosure, the amendments consider the established scientific evidence that transmission risk with an undetectable viral load is effectively zero. That is the premise upon which we are making this change.
In contrast, other sexual activities, although lower risk, pose some transmission risk. So, we will not want to change our position completely on this because what we are doing is based on data, based on evidence, and requiring disclosure of the risk of acquiring HIV prior to sexual activity so as to allow the sexual partners to make an informed decision before engaging in sexual activities, and be able to then take the mitigating measures, such as medications, to protect themselves.
Any other clarifications for the Minister and the Senior Parliamentary Secretary? None.
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. – [Mr Ong Ye Kung].
Bill considered in Committee; reported without amendment; read a Third time and passed.
Order. Leader.
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