POLIO EPIDEMIC (Incompetence of Ministry of Health)

[Mr Speaker in the Chair]

2.31 p.m.

Mr Lee Kuan Yew: Mr Speaker, Sir, the motion which I am now moving asks the House to join me in deploring the inept and incompetent manner in which the Minister for Health and his Ministry have dealt with the current polio epidemic.

Sir, I wish to say at the outset that, as a responsible law-making body, we should not say today anything which might cause unnecessary alarm or panic amongst members of the population. What I have to say is not about the rights and wrongs of medical opinion on the use of Sabin vaccine, but on the completely inept and incompetent manner in which the public relations have been handled. At the outset, I apologise for having caused this inconvenience to the Minister for Health who, I understand, is just preparing to leave for his holiday in Hongkong and Japan. I am sorry that I have to bother him in a debate on this matter. But I would like to remind him that, before he leaves for his holiday, he should consider some of the points which I have to make.

Sir, whatever the final medical judgment on the use of Sabin vaccine may be, whatever the pros and cons, everybody that I have consulted agrees that, having started Sabin vaccinations, it is the duty of this Government to Sabinise that section of the population that may be open to infection. It is the duty of this Government to see that that is done efficiently, quickly, and thoroughly under expert guidance. This is a purely administrative job and there should be no difficulty in getting the whole mechanism geared up in order that the operation may be completed with the least possible delay. I have, however, this to say on the other aspect - the way in which this problem has been presented to the people, partly by the incompetence and ineptitude of the Minister and his Ministry, and partly because of the cleverness of the colonial language Press.

It is no exaggeration to say that, as a result of the often contradictory statements issued and published - one expert of the Ministry contradicting another expert - there has been a general loss of confidence in the work of the Ministry. Furthermore, they have allowed themselves to be drawn into a Press campaign which the Straits Times claims has probably forced the Government into taking action with regard to Sabin vaccine. Sir, an impertinent Press has this to say today:

"The second feature has been the use of vaccine to combat the epidemic. Publicity helped the authorities to make up their minds -"

Mr Speaker: Will the hon. Member disclose the name of the paper?

Mr Lee Kuan Yew: This is the editorial in the Straits Times published today. A group of journalists found great pleasure in believing that they had. rightly or wrongly, crowded the Government into taking this action. I should hate to believe it is true, and I would be prepared to listen to the facts and be relieved to hear that that is not the case. But whilst that may be just the fault of the newspaper, this sorry record, which has led to a loss of public confidence, is primarily the responsibility of the Minister and his Ministry.

This business started with an article on the 8th of October, 1958, in the Straits Times - I am quoting exclusively from this colonial English language paper - it says on page 9:

"A private doctor commenting on the Sabin vaccine last night said, 'It is still in the experimental stage in Canada and the U.S. latest report say its effectiveness has not yet been proved.

'There would probably be no harm in trying it here but, if it is not effective in giving immunity, it would give those who took a dose a false sense of security.'"

On the 11th October, the same newspaper on page 4 said:

"Is swimming dangerous while Singapore polio epidemic lasts?

'Yes' says the Health Ministry, which has advised parents to keep their children away from swimming pools, since the first warning of the epidemic was given on October 1st.

'No' is the apparent answer of the Education Ministry, which has done nothing to stop the present season of school swimming meets."

Then says the report at the end of the article:

"The Education Minister, Mr Chew Swee Kee, the Minister's Permanent Secretary, Mr Lee Siow Mong, and Dr Doraisingham were not available for comment yesterday."

Then on the 12th October again on the question of whether schools should or should not close swimming meets:

"The Permanent Secretary to the Health Ministry, Dr M. Doraisingham, said: 'It's for the Education Ministry to decide.'

The Minister for Education, Mr Chew Swee Kee, said: 'I don't know . . . it's an administrative matter. Ask my Permanent Secretary, Mr Lee Siow Mong.'

Mr Lee said: 'I've been in close touch with the Health Ministry and so far we have had no signal from them to cancel swimming sports, apart from the general warning.'"

Mr Speaker: Is that the Straits Times?

Mr Lee Kuan Yew: Yes. 17th October, says the editorial:

"This is the wrong time for tranquillisers."

General incitement to get people excited! And on the 18th October - a Press conference:

"A Health Ministry statement on the subject said:" - on page 9:

"'The Ministry has now decided to use this vaccine as an immunizing agent against the disease, but this has nothing whatsoever to do with the outbreak now prevailing.

Up to now, the Ministry was not satisfied with this vaccine because sufficient experiments had not been carried out to prove its efficiency or safety.

Only recently has it been possible for us to say that this vaccine can immunize a person and, if carried out in large numbers, prevent the occurrence of the disease.

But this will not stem the present outbreak. An expert committee recently studied the Sabin vaccine and recommended that this should be used without delay - not because there is an outbreak of poliomyelitis, but there is little reason to postpone its use any further.'...

Reminded that the Health Ministry had advised the public not to have anti-polio injections during the epidemic, Dr Doraisingham said: 'We advised caution in having prophylactic injections generally.

I am a very busy man and when you reporters ring me up I cannot explain everything in detail on the phone.'"

Sir, I am glad to know that those engaged in the duty of looking after the public health are busy people - I should hate to believe they are not - but I wonder whether it is wise, in the midst of a busy programme, to carry on telephone conversations with the Press which one subsequently has either to modify or to deny, with catastrophic result in loss of public confidence.

Then on 19th October came the announcement that the Government was going to use Sabin, and the friendly Straits Times, under a headline, said:-

"MANY S'PORE DOCTORS WARN AGAINST VACCINE: DON'T BE GUINEA PIGS"

And that I call really helpful and friendly!

" 13 MORE HIT BY POLIO"

"thirteen" underlined just to remind everybody that there is some mystery attached to this number,

"Biggest total for one day" -

a Sunday newspaper carried the banner headline, and went right down to the bottom of the page under the sub-heading "GUINEA PIGS" - before that it said:

"According to Singapore's polio expert, Prof. J. H. Hale, there are about 100 cases of non-paralytic polio for every paralytic case. At this rate the number of people who have harboured the disease in the current outbreak would be 11,800.

Meanwhile many Singapore medical practitioners warned their patients of the danger of being made 'guinea pigs' of the Government's anti-poliomyelitis vaccination drive.

They told patients who approached them for anti-polio doses: 'It may do more harm than good to'"-

it continues on page 7-

"'you. It's safer to go without it.'

Doctors interviewed yesterday warned that people should not be misled into believing that vaccines against poliomyelitis might become a practical and safe public health measure.

One of them said: 'The established objection to using such vaccines is that they are not absolutely safe - in other words, there is a danger of their contracting polio after the inoculation.

And the germs are so readily transmitted from the recipient to his contacts that it is quite impossible, without extraordinary isolation precautions, to prevent their escaping into the surrounding communities where they might cause an outbreak.'"

Then a garbled version of the British Medical Journal publication about experiments in the Central Belgian Congo - how one village got immunized, and an epidemic broke out in the next village, and so it went on to the next village, and the village in between got it, and they had to immunize the whole lot, and everybody was safe. Sir, having warned - of course, not stating categorically themselves but just quoting medical practitioners spreading this line - they then went on to say on the 23rd October:

"SOS FOR MORE VACCINE TO MEET RUSH".

A sense of urgency, impending doom and disaster - S.O.S. Meanwhile the Minister just merrily read all this and added to the general comment. Said he at a Press conference -

Mr A. J. Braga: What day?

Mr Lee Kuan Yew: 23rd October -

"The Minister for Health, Mr A. J. Braga, spent half an hour at the Yio Chu Kang clinic today." Then Dr Doraisingham said:

"The 100,000 doses we have requested would not be sufficient to give vaccine to all children under the age of 10 but in the case of live vaccine - as the Sabin - it can be expected that twice as many or more are likely to be immunized by the transference of the virus from the vaccinated person to the unvaccinated."

Sir, this same spokesman for the Minister for Health had said, on the question of transference, in a written question/answer interview with the Singapore Standard the day before, October the 22nd, question:

"Knowing all this, why have you hesitated so long before using the Sabin vaccine?"

Says the doctor:

"'When it is known that, in very rare instances, the less attenuated forms of the virus can be excreted, it is possible in large countries such as India, to experiment with its use in isolated communities at the risk of subjecting the small population group to the prevalence of the virulent virus. Singapore is a small place, and what is a small experiment in an isolated population becomes a national experiment and, in consequence, extreme caution has to be exercised in order to prevent a calamity arising however remote that possibility might be.

Hence the reason for this cautious procedure.

Until we are entirely satisfied that the use of this vaccine is safe, we could not implement the immunization programme.'"

Sir, I seriously doubt whether there should be all these untrained Press Relations officers for each Ministry, It may be an accurate, honest and a fair appraisal of the medical situation. But to tell the public, when you had already decided to let go this Sabin vaccine, that there had been cases (though in very rare instances) where the less attenuated forms of the virus can be excreted - in other words the virulent ones can be excreted through passage! And then to tell them the next day, "Oh, well, although we have got only 100,000 doses, we are hoping that one fellow will pass on to the next chap and we'll have 200,000, maybe 300,000 thereby Sabinising by passage", having the day before told the public that, in rare cases, the virulent ones might be passed on by passage. Then on the 25th October, the Minister on the front page:

"...predicted today that the present polio epidemic would die out within a month."

Now, Sir, I do not know whether he did. If he did, then he must be a very, very unwise man, because nobody knows whether it is going to die out within a month or not. But there was no denial. Knowing that the Press was already giving his Permanent Secretary difficulties - so much so that he had to say that he was a very busy man, he could not explain everything in detail over the telephone - why should the Minister open himself to such constructions? Immediately after that, Prof. Hale, the only expert that the Government has got, at the same Press conference, said: "Your guess is as good as mine." Now is not that the kind of thing that is calculated to bring the Minister and his Ministry into ridicule and contempt? Said Mr Braga - this is by way of exculpating his Government:

"We can't give the vaccine at a large number of centres at the same time, but we will now be in a position to run morning and afternoon sessions.

We don't yet know exactly what the new supply of vaccine will cost, but it will be negligible - apart from the freight charges.

To have used Salk vaccine for 100,000 children would have cost $3,000,000 - three injections each at $10 a shot."

Is not that stupid, Sir, in the midst of a relatively minor polio epidemic - I agree with the Ministry that it is so; it has not reached the proportions epidemics have often reached in places like America - but nevertheless in the midst of a situation where parents are scared stiff, in a near-panic over their children, to say. "Ah, well, you know, it is no use using Salk vaccine. It costs $10 per shot. Three times ten is $30. It will cost in all $3-million. Therefore we are going to get something free or at negligible cost, apart from freight charges."

I do not mind the Labour Front Government saying stupid things to bring them to their doom. But I do mind Ministers, either through ignorance or general lackadaisical attitudes to matters which are their concern, saying things which exasperate the public, and convince them that the Ministry, or at least the Minister in charge, is a man guided by the wrong principles, that he was prepared to risk the lives of a hundred thousand kids because he was going to save his Government $3-million.

Meanwhile, patent medicine pedlars - the people who manufacture Salk vaccine - canvassed every Assemblyman. They sent a whole lot of pamphlets and leaflets through the post, saying: what a wonderful thing Salk vaccine was. If only they could sell $3-million worth of Salk vaccine! I am told that it actually costs only a dollar per tube and three shots will cost $3. So if the Minister thought he was going to pay $3-million for it, they might be able to sell it to him for $2-million and make a lot of money out of it! But the stupidity of the statement, to which, of course, quite rightly the Straits Times gave considerable prominence on its front page, is enough to have sent any group of intelligent parents into a rage. What I am at the moment amazed at is the calm and the resignation with which they have had to put up in the face of the incompetence with which this whole problem has been handled.

Sir, this is what Professor Hale said - I do not doubt that he is a polio expert and that he has been investigating the use of the attenuated form of virus in the Sabin vaccine - but was this likely to induce public confidence? At the same conference he said:

"It is estimated that the new supply will be used up within five weeks, but Prof. Hale, who is scheduled to leave here permanently in December, said he would remain to see the job through."

Now that is very kind of him, and quite proper. But then he went on to say:

"...there would be keen interest in medical circles in other parts of the world in the large-scale Sabin vaccine tests taking place in Singapore and he intended to write a full report on the matter."

Sir, I am sure it is right and proper for medical science that such large-scale tests should be fully documented. Undoubted effectiveness and so on of Sabin vaccine. But to tell the people of Singapore that the whole medical world was watching the situation and that he was going to write a paper on it! If the Government had a Public Relations Department which knew its job, it would have told the Minister and his experts that, however true that statement might have been, it is one which was misconceived and calculated to destroy public confidence. But, having gone to all this trouble to explain why Sabin vaccine should be used in an endemic area in the face of a rising epidemic - I do not know whether this is the Straits Times or Dr Doraisingham - but it said here, right at the end of it all "European victim" -

"The European boy aged 13 from Serangoon Gardens was admitted to the R.A.F. Hospital.

Dr Doraisingham admitted candidly today that the polio virus 'disdains all standard advice about precautions to avoid it.'

He added: 'Without active immunisation, people are really helpless in the face of it - it may strike anyone.'"

Now, was it competence to say all these things when you had the population already madly queueing around the two or three centres a day; parents waiting at the break of dawn trying to get their kids vaccinated? And you went on to say, "Well, we are helpless; it may strike anyone". That means doom; that we die.

Sir, the same newspaper today has the impudence, having quoted all those doctors to show why, in their opinion, Sabin (which has been given considerable publicity by courtesy of the Straits Times) should not be used. It went on to say in the editorial:

"Field trials last year in the Belgian Congo were conclusive (whatever the British Medical Journal may say) both as to the safety of the vaccine and its efficacy in stemming an epidemic."

Sir, to the extent that this was the result of a Press campaign which was beyond the control of the Minister, he is not to be blamed. But knowing full well from the very beginning that the Press was making this a popular issue and was selling the story, it was the stupidest thing in the world to have allowed three spokesmen at any one time. If there was one expert, then only that expert should have expressed his opinion. But to have three persons to attend the Press conference - one of whom was the Ministerial head (a person renowned for his hunting. shooting and riding activities, not including, unfortunately, the hunting of the polio virus) who said that it was going to end in one month, and then being properly contradicted by his polio expert, Prof. Hale, and having his spokesman, his Permanent Secretary, to add that the polio could strike anyone without active immunisation. Was it necessary or wise?

Sir, I hope it is not asking too much of the Minister before he leaves the day after tomorrow for Japan, to take some steps to make sure: first, that the Sabin vaccine is rapidly and effectively distributed to all who require it in Singapore. This is a pure administrative problem which can be overcome. Secondly, if there is any doubt in the matter at all, an expert team should be asked to come, study and supervise the use of this vaccine. Sir, when this article was written about the Sabinisation of a quarter million people in the Belgian Congo, it might interest the Minister to know that there were no less than five M.Ds., all persons of great professional standing - Directors of Laboratories in the Belgian Congo and the U.S.A. and other research institutions (I may refer, for his easy reference, to page 187 of the British Medical Journal dated 26th July) - leading the whole expert team to conduct tests. I would not be unreasonable if I suggested to him that, having already embarked on a nation-wide vaccination process which we all hope will be thoroughly successful, there is no harm in getting an expert team to see the job through. In the meantime he should stop talking in three voices. I know there is one school of thought which is very unkind to the Minister when it says, "Ah, well, anyway, thank God, he is not here to make matters worse." I am hoping that, before he goes away, he will try and do something to see that the machinery runs smoothly and effectively.

Sir, I am not suggesting, for one moment, that we should be other than democratic in our dealings with the Press. But I say this: that the Government has considerable powers of persuasion to bring them round to see that the selling of a story is less important than public morale, peace and tranquillity. To have allowed themselves to get caught up in a Press hysteria which has led to such a state that you find the vaccination centres besieger by very angry and very excited parents shows: (1) either the Minister is incapable of using his persuasive powers, or (2) he does not understand that a great deal of harm has been done to public confidence as a result of all this.

There are two aspects to this. I am not asking the Minister for Health to discover a cure for polio when the rest of the world have not gone further than Prof. Sabin and Prof. Salk, but I am asking him, even though we have not got the cure, we should at least try to prevent a situation where everybody is in a state of anxiety. Every parent who has a child in the vulnerable age group is in a state of fright - not because there have not been polio epidemics before, there would have been some anxiety anyway, but the presentation of the work of the Minister and his Ministry has led to a general loss of public confidence and the spread of alarm. I would like to say in this Assembly that it is our duty to check it: (1) to ask the Press not to aggravate the situation, and (2) to ask the Minister to get on with the job. He has decided on Sabin. He has had his expert advice. Now is not the time to start an argument whether Sabin should have been used or should not have been used, because all the experts are agreed that once you start Sabin, you Sabinise everybody who requires it. It is his duty to do that, otherwise he will have the wrath of more than the parents of a hundred thousand kids on his head.

Mr Speaker, Sir, I beg to move,

That this House deplores the inept and incompetent manner in which the Minister for Health and his Ministry have dealt with the current polio epidemic.

3.02 p.m.

Mr Goh Chew Chua (Ponggol-Tampenis): Mr Speaker, Sir, I rise to second the motion.

It is said that the Minister for Health is more at home hunting big game in East Africa and fishing for small fish in local waters than he is in hunting down the virus responsible for the present polio epidemic. Sir, as a fisherman, he is even known to have fished in distinguished company for very small fish from military helicopters, and the excitement of such a novel method of fishing has caused him to become less and less aware of the afflictions of ordinary mortals like ourselves.

Mr Speaker: Order. I think at this stage it is proper for me to remind hon. Members of the Standing Order which reads:

"The personal conduct of Members of the Assembly shall not be referred to except upon a substantive motion moved for that purpose."

I cannot see in the present motion anything about the hon. Minister's fishing in Japan or elsewhere.

Mr Goh Chew Chua: Sir, many people pay him a compliment when they refer to him as Dr Braga. They do so in the mistaken belief that he has dedicated himself to the destruction of the microbes which afflict human society. But unfortunately for us, this is a sport in which the Minister for Health has shown very little interest. It is not surprising, therefore, Sir, to find the Minister suddenly jolted into action by exaggerated reports appearing in the Straits Times about the extent of the polio epidemic. One does not have to be associated with the Ministry of Health to know that the administration of drugs which have not been offered for public sale should be done under experts supervision. It is now his duty, Sir, to see that this is done. The way in which he has dealt with this outbreak of polio epidemic has confused the general public. As a member of the public, and as an elected representative of the people, I must register a strong protest at the deplorable way in which the Minister has dealt with the present polio outbreak.

Sir, my leader has wished the Minister for Health bon voyage on his departure for Japan on Friday. May I take this opportunity, Sir, to send my best wishes to the people of Japan, and I trust, with a little effort at quarantine when the Minister arrives in Japan, the authorities there will be able to control polio more effectively than the Minister for Health has been able to do over here.

Question proposed.

The Minister for Health (Mr A. J. Braga): Mr Speaker, Sir, I had originally intended to make a statement before the business of the day on the question of the outbreak of polio, the research that has been made and the final decision of the Government to release the Sabin vaccine, but the introduction of this motion by the hon. Member for Tanjong Pagar has forced me to hold my horses until this debate. I propose now, Sir, to give a full statement on this whole matter and that statement will cover the points which have been raised by the hon. Member for Tanjong Pagar, who has a flair for playing to the gallery and making political capital out of other people's suffering for the benefit of his Party.

Until recently, Sir, the only way in which some precautions could be taken against poliomyelitis was by giving standard advice. Until actively immunising vaccines were produced, the measures applied to the disease are given in the Report entitled the "Control of Communicable Diseases in Man" published as an official report of the American Public Health Association. That report from the "Control of Communicable Diseases in Man" published in 1955 has this note - "that the substance of this Report has been accepted by the Ministry of Health for England and Wales and the Department of Health for Scotland with certain reservations to meet international commitments and agreements and differences in legislative and administrative practice in Great Britain." I do not propose to burden Members with a detailed technical discussion. Suffice it to say that the standard advice given there has been repeated continually by members of my Ministry and by myself over Radio Malaya. We asked the people to see that children wash their hands before and after meals and keep away from swimming pools, and so forth. But perhaps I might read one or two of the measures recommended in this report at page 136; Epidemic measures:

"Protection of children so far as practical against unnecessary close contact with other persons, especially with other family groups or outsiders during epidemic prevalence of the disease. Urban schools should not be closed nor opening delayed, but intensive or competitive athletic programmes should be postponed..."

Furthermore, our health officers, sanitary inspectors, health visitors and other staff have been actively engaged in advising householders. Everything possible to impress on the minds of the people the need for taking these elementary precautions was made, short of addressing each and every householder by letter.

Until immunising vaccines became available, such advice could only be given. Without vaccines, the medical profession was, in fact, helpless. Hon. Members may be interested to know that even in countries where sanitary conscience and sanitary discipline are highly developed and where people are likely to observe the advice given almost with religious fervour, particularly in the face of an epidemic, epidemic visitations have recurred. I would like to quote from the Epidemiological and Vital Statistics Report prepared by the World Health Organisation, Sir, Volume II No. 7 of 1958, on the question of the visitation of polio in other countries as late as 1958.

In the United States in 1951 there were 28,386 cases with 1,551 deaths - this was not taken over the whole area but in the areas where polio had struck. In 1952 there were 57,879 cases with 3,145 deaths; in 1954, 38,476 cases with 1,368 deaths; in 1956, 15,140 with unknown deaths (this is when the vaccine began to be used); and in 1957, 5,903 cases. In most other countries such as the United Kingdom, Italy, France, Sweden, Australia, the pattern of prevalence has been similar. All the advice, however, does not appear to have retarded in the least the tragic succession of periodic outbreaks. In England in 1951, there were 2,614 cases, and in 1955 6,153. I am saying all this just to show that in the absence of immunising agents, the medical profession is helpless. All the precautionary measures taken were palliatives, both in apology for our helplessness and to appear that something is being done, however futile it may be. When the first few cases of poliomyelitis were notified in late September this year, criticisms were levelled at my Ministry as to why active immunisation was not carried out in order to prevent the occurrence of such an outbreak as we now have in Singapore.

I would like to give a short statement of the visitation of polio in Singapore. In 1946, there were 237 cases with an unknown number of deaths; in 1948, there were over 200 cases with 21 deaths; and then there was a steady prevalence. In 1949, there were 76 cases with 2 deaths; in 1950, 82 cases with 10 deaths; in 1951, 81 cases with 9 deaths; in 1952, 55 cases with 10 deaths; in 1953, 43 cases with 5 deaths; in 1954, 71 cases with 3 deaths; in 1955, 24 cases with 2 deaths, and then there was an outbreak in early 1957 of well over 100 cases with 7 deaths.

The figures today, Sir, from an analysis which I have got here of cases from August to October, are in August 6 cases, September 32 cases, October 168 cases, and up to 4.30 p.m. yesterday, 26 cases. I have got the breakdown figures, if any Members are interested, the nationality and sex of the victims.

Now, poliomyelitis in man, Sir, is essentially an infection of the gut - the alimentary tract in which the virus multiplies. In a very small percentage of cases the virus enters the blood stream and subsequently, in a relatively few cases, may invade the nervous system resulting in paralysis. An infection with polio virus does two things. Firstly, the gut becomes resistant to attack. Secondly, it produces antibodies which circulate in the blood stream and so neutralises the virus that may invade the system.

From the statements which I made over Radio Malaya and in the Press, hon. Members are no doubt aware by now that there are two types of vaccines available. One the killed vaccine, which is the Salk, and the other a live vaccine, such as the Sabin. The disease poliomyelitis is now known to be caused by three types of virus, and to effectively immunise a person with the killed vaccine such as Salk, three doses are given by way of injections at stated intervals, the first taking 6 weeks to be effective, and the last dose being given 7 months after the second dose. When this is done the body reacts to the vaccine and produces antibodies which circulate in the blood. It does not, however, prevent the infection of the gut by virulent organisms nor protects any one who may be incubating the disease within this period. Salk vaccine, therefore, provided all the three inoculations have been given, acts as a barrier against the invasion of the nervous system by the virus and so would prevent a paralytic attack. Recent evidence shows that the original figure of 70 per cent protection of persons so inoculated is incorrect and is found to be very much less. There is one thing certain that it does not do, and that is, it does not prevent the infection of the gut and, therefore, does not prevent the inoculated person excreting the virulent virus and so cause disease amongst the non-immune. To be effective as an anti-epidemic measure, the inoculation must be carried out on a very substantial scale and within as short a time as possible. By the importation of large quantities of the vaccine which has only become available recently, and by employing large numbers of persons to carry out the inoculations, and at tremendous expense, involving several million dollars, it is theoretically possible to immunise a large percentage of the population temporarily. Such vaccine, however, does not stop an epidemic in progress.

I would like to read the World Health Organisation Technical Report of 1958 - this is the World Health Expert Committee on polio - and I am reading at page 8:

"In July 1956, during a period of rising incidence, the Chicago Board of Health initiated a mass vaccination programme in which 1,750,000 doses were injected in less than two months. However, there was no demonstrable effect as to dampening the epidemic."

Hon. Members of this House are aware how Government has been pleading with parents in the rural areas to bring their children forward to receive protective inoculation against a far more dangerous and fatal disease than poliomyelitis, namely, diphtheria. This has received some success after prolonged sustained appeals. The response has been poor in the city, possibly because it involves injections, and two visits must be paid. Immunisation with Salk vaccine involves three painful inoculations.

An ideal immunising agent for Singapore, therefore, is one that should effectively protect the population against disease and, more important, one that the population will readily accept. An even more important consideration is that the vaccine should be safe to use, and I repeat that, Sir, "the vaccine should be safe to use". If there happens to be a vaccine that does not require a syringe with its threatening needle, if there is one which is pleasing to the children taking it, if there is one which at once produces full resistance to invasion by the polio virus and further produces neutralising antibodies in blood stream and it is at the same time safe to use, this vaccine would be the vaccine of choice.

Much research has been carried out in this direction and, as is usual, experimental work has been undertaken in regard to various types of live vaccines. Live vaccines will have the virtue of being administered by the mouth, of effectively immunising the gut and of producing antibodies in the blood stream. The problem has been to develop a virus considerably weakened, I repeat, considerably weakened, yet possessing full immunising properties so that it would not cause the disease in the most sensitive of animals - animals far more sensitive than man is - when injected directly into the spinal cord.

Unfortunately, Sir, the co-ordinated series of experiments were interrupted by an experiment on man in Belfast with a strain of virus prepared in 1956 and the methods used did not comply with the strict standards set by the World Health Organisation. When live vaccine is being given by the mouth, the attenuated virus infects the gut, multiplies therein, as does a natural infection, and are excreted in the stools. It so happened that in this particular experiment in Belfast, the outgoing virus in a number of cases reverted to full virulence. That is the virulence acquired through passage, and the experiment was found dangerous and called off. That experiment produced a real scare. It was widely publicised, and the medical profession certainly and some members of the public are aware of this experiment. The dangers inherent in the experiment in Belfast did not deter research which continued, and it is now possible to produce a live vaccine like the Sabin that would both be safe and would prevent the gut from such further invasion of the virus and, at the same time, produce antibodies in the blood stream, and when excreted would not revert to virulence.

Late in 1956, a batch of over 10,000 doses of a highly attenuated vaccine produced by Professor A.B. Sabin, and which conforms with the World Health Organisation Expert Committee's rigid standards, was sent to Professor J. H. Hale, Professor of Bacteriology of the University of Malaya, for field trials. Professor Hale carried out experiments among European and other volunteers with this vaccine, and over a considerable period of time, in order to assess its safety, watching carefully to see whether any virulent virus would be excreted. Simultaneously also in other countries experimental research with this type of vaccine was undertaken.

In the meantime, Sir, the World Health Organisation had appointed an Expert Committee comprising eminent virologists from twelve different countries to further study the problem of poliomyelitis and the use of vaccine. Now the members of that Conference were Israel, Australia, Scotland, Sweden, South Africa, Singapore (Professor Hale attended), Japan, Canada, United States, France, Poland and Russia. They sat in Geneva from 15th to 20th July, 1957. The Report was published in 1958 and that Committee's Report was received by this Ministry on the 13th of August this year. The Ministry immediately entered into discussions with Professor Hale, who was a member of that Expert Committee, regarding the cautious statements contained in the Report, but the discourse appearing on page 24 of the Report shows that studies with the most highly attenuated strains, one of which is Sabin, showed that the excreted virus was harmless even when injected directly into the spinal cord of the most sensitive of animals - animals more sensitive than man is to poliomyelitis. The Committee itself was so convinced of its safety and efficacy that it made certain recommendations which I will read.