DIPHTHERIA IMMUNISATION BILL

Order for Second Reading read.

3.08 p.m.

The Parliamentary Secretary to the Minister for Health (Dr Sheng Nam Chin): Mr Speaker, Sir, -

Mr Speaker: Will a Minister signify the recommendation of the Yang di-Pertuan Negara?

The Minister for Home Affairs (Mr Ong Pang Boon): I so signify.

Dr Sheng Nam Chin: Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Diphtheria is a serious health problem in Singapore and some 600 cases of the disease occur annually with over 50 to 60 deaths. Both the occurence of the disease and deaths are preventable by immunisation, and this Bill is designed to improve preventive measures by making immunisation compulsory for infants and children.

Since 1938 in the City area and after the Second World War in the rural area, it has been the policy to encourage parents to accept inoculation against diphtheria on a voluntary basis. Unfortunately, the response has not been as encouraging as expected. Only approximately 50 per cent of the new-born every year obtained immunisation by the voluntary method. For the effective eradication or reduction of diphtheria, it is necessary that 90 per cent of the children should be immunised. Thus, it is considered to be appropriate at his stage to require compulsory immunisation of all infants and children by primary and booster diphtheria inoculation as defined in clause 2 of the Bill.

Compulsory immunisation by legislation is neither new nor unorthodox. Children are required to be immunised against diphtheria in such countries as Japan, Canada, Germany, France, the U.S.S.R. and Yugoslavia, and it has been the experience of these countries that such compulsory immunisation sharply decreases the incidence of the disease.

In the main immunisation will be effected by requiring every child to be administered with primary diphtheria inoculation within 12 months of birth. Alternatively, every child resident in Singapore, who is under the age of seven years and who has not been immunised against diphtheria, will be required to do so under clause 5 of the Bill. Booster diphtheria inoculation, which means a further inoculation against diphtheria for a person who has received a previous inoculation, will be made compulsory for every child residing in Singapore on attaining the age of four years. Provision is also made for a child to obtain a second booster inoculation upon entry to Primary School. Clause 6 refers to booster inoculation.

Clauses 3 and 4 of the Bill are to ensure that inoculation and intra-dermal test (to test the susceptibility of a person against diphtheria) shall be carried out by qualified persons. Also notification of such inoculation and tests must be made to the health authority in a prescribed manner.

Clause 7 will enable the postponement of diphtheria inoculation if the child is unfit or has acquired immunity or has been shown not liable to diphtheria by means of the intra-dermal test.

Clause 8 makes it clear that a guardian, which is defined as the person having custody of the child, must present the child for inoculation.

Diphtheria immunisation will be given free of charge at all Government Maternal and Child Health Centres, but provision is made in clause 9 of the Bill for intra-dermal tests and inoculations to be administered by private medical practitioners at the expense of parents or guardians who choose to obtain inoculation through private doctors.

To ensure success, some means is required to inform parents of new-born children that they must obtain immunisation under the Bill. Hence, clause 11 provides that the Registrar of Births and Deaths shall issue, after registering a birth, a notice to the guardian directing his attention to his responsibilities. I may say that the Registrar goes through the same procedure in respect of compulsory small-pox vaccination under section 48 of the Quarantine and Prevention of Disease Ordinance.

Clause 12 provides for penalties for persons who refuse or fail without reasonable excuse to submit to the provisions of the Bill. There are also penalties for obtaining false certificates. You will note, Mr Speaker, Sir, that no prosecution in respect of any offence shall be instituted without the written sanction of the Director of Medical Services.

According to modern medical practice, it is desirable to cease inoculation in the event of an outbreak of other infectious disease such as poliomyelitis. That is why clause 13 provides for the suspension of any or all the provisions of the Bill as a public health measure.

Likewise clause 14 provides the Minister with power to declare any area as an area of outbreak of diphtheria, and thereupon to require compulsory inoculation of all children under 12 years of age residing therein. In such an emergency, immunisation shall be free of charge.

Clause 15 provides for the making of regulations generally for carrying out the provisions of the Bill, and includes any fees or charges that it may be necessary to levy for the purpose of carrying out the provisions of the Bill. Among other things, the Minister is also enabled, under clause 15, to regulate the preparation or preparations to be used, the number of occasions they are to be administered, the mode of administration and so on.

It is necessary for the Minister to prescribe a maximum fee to be charged by practitioners who administer any intra-dermal test or inoculation. This is to ensure that there shall be a standardisation of fee and that, in any emergency, no variation of fees shall be allowed. Of course, such prescription of fees would not be made unless a situation to warrant it should arise.

In conclusion, I would say that this Bill represents an important step in the fight against diphtheria, towards eradication of this disease in Singapore by the compulsory immunisation of infants and children.

Mr Speaker, Sir, I beg to move.

Question put, and agreed to.

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

Assembly immediately resolved itself into a Committee on the Bill. -[Dr Sheng Nam Chin].

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