INFECTIOUS DISEASES (AMENDMENT) BILL

Order for Second Reading read. 4.40 pm

The Minister of State for Health (Dr Balaji Sadasivan): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Infectious Diseases Act provides for the control and prevention of infectious diseases in Singapore. This includes provisions to undertake investigations and institute control measures, including vaccinations and quarantine, to prevent the spread or the introduction of any infectious disease into Singapore.

Today, I propose new amendments to the Act to enable the transfer of the existing medical related functions required for the prevention and control of infectious diseases from the Ministry of the Environment to the Ministry of Health, to expand the definitions of infectious disease, and to enhance the Minister for Health's authority to order mandatory vaccinations.

Mr Speaker, Sir, I shall now highlight the major amendments that are being introduced in this Bill.

Historically, environmental health, quarantine and epidemiology, which include infectious disease surveillance and the investigation of outbreaks, were carried out by MOH. When the Ministry was established in 1972, it was made in charge of environmental public health, which includes the provision of safe water supply, public cleansing, solid waste and sewage disposal, drainage and control of food hygiene. As the control of many prevalent infectious diseases in the 1970s was closely related to environmental issues, the environmental health quarantine and epidemiology functions of MOH were transferred to ENV in 1972. These functions were taken over by the National Environment Agency (NEA) when it was formed on 1st July 2002.

Currently, the surveillance and control of infectious diseases are shared between MOH and NEA. Their responsibilities are divided according to the type of disease. Diseases like typhoid fever and hand, foot and mouth disease come under NEA. But tuberculosis and HIV AIDS are under the purview of MOH. The current system works reasonably well for the surveillance and control of known diseases, for which the division of work between MOH and ENV is well established. However, we need to develop new expertise to deal with new dangers from communicable diseases.

At present, almost similar expertise is being developed and deployed in the two Ministries for the surveillance and control of diseases under their respective purview. This has resulted in some duplication of work and efficiency loss. Nationally, new expertise has to be developed to tackle emerging diseases and new health threats arising from bio-safety and bio-terrorism concerns.

Instead of continuing with the current path of developing expertise in the two Ministries, it would be more efficient and cost effective to concentrate capability development within one Ministry. For this reason, the medical related functions for the investigation, prevention and control of infectious disease outbreaks, which are currently carried out by the National Environment Agency, will be transferred to the Ministry of Health with effect from 1st April 2003. NEA will continue to be responsible for the environmental determinants of health, such as environmental sanitation, food hygiene and vector control. This includes quarantine and port health, cleanliness of public areas, inspection of premises, control of vectors, environmental sampling, and execution of any environment-related measures in response to outbreaks.

With the transfer of the medical related functions for the investigation, prevention and control of infectious disease outbreaks to MOH, the following amendments are necessary in the Infectious Diseases Act.

Firstly, the existing Infectious Diseases Act empowers the Director-General of Public Health, NEA, to carry out infectious disease outbreak investigations and control. The revised Act will transfer this authority to the Director of Medical Services.

Secondly, the revised Act also provides for the transfer of authority from the Minister for the Environment to the Minister for Health to declare an area as an infected area when there is reason to believe that an infectious disease may be introduced into Singapore from the infected area.

Thirdly, the authority to regulate the importation of disease-causing organism will now rest with the Director of Medical Services, while the Director-General of Public Health, NEA, will retain his current role in regulating the importation of disease-causing vectors.

Fourthly, the Bill revises the Act to amend the definition of health officers to include any person who is appointed by the Director-General of Public Health, NEA, or the Director of Medical Services. This is to cater to the expanded role of MOH officers with the transfer of the medical related functions from NEA to MOH. Currently, NEA officers are empowered under the Environmental Public Health Act, Environmental Public Health Regulations, Sale of Food Act, and the Control of Vectors and Pesticides Act, to carry out functions related to the prevention, investigation and control of infectious disease outbreaks. This Bill revises the Infectious Diseases Act so that similar provisions will be included in the Infectious Diseases Act to enable MOH to better investigate and prevent the spread of infectious diseases in Singapore.

The revised Infectious Diseases Act will empower MOH officers to enter premises without a warrant for the purposes of inspection and search. They will be given the authority to take samples or confiscate any matter that is implicated in an outbreak. The person from whom the matter has been seized will be given the opportunity to lodge a complaint within a stipulated time to a magistrate's court against the seizure. The magistrate can then confirm or disallow the seizure, or even order that the owner be compensated for the loss resulting from the seizure.

The amended Act will include provisions which require persons to furnish information which may be useful in the investigations and, for persons suspected of being infected with an infectious disease, to submit themselves for medical examination and undergo treatment, where necessary.

Sir, if investigations indicate that a public place is implicated in an outbreak, the amended Act allows MOH to close or cordon off that public place, so as to prevent further transmission of the infectious disease. However, this power of closure does not apply when such power has already been conferred by law to another Government agency or statutory board. For instance, in the event of an outbreak of hand, foot and mouth disease among young children, it may be necessary to close down childcare centres as a measure to control the outbreak. The authority to close down such places would be with MCDS.

On the other hand, if there is an outbreak of a highly contagious infectious disease within the premises which are not licensed by any authority, the provisions in the Bill will give the authority to MOH to close down or cordon off the premises to prevent further transmission of the infectious disease.

New Provisions

Sir, let me now highlight some of the new provisions that are provided for in the Bill. The definition of infectious diseases in the Act will be revised since the current Infectious Diseases Act defines "infectious diseases" as diseases that are listed in the First Schedule of the Act. This means that under the existing Infectious Diseases Act, the provisions of the Act cannot be applied unless the implicated infectious disease is already listed under the First Schedule. This change is particularly important in the modern age of rapid travel, where new infectious diseases, eg, West Nile Encephalitis, Avian-Flu, etc, can potentially spread rapidly to other countries. The definition of "infectious diseases" in the Act will, therefore, be revised to encompass all infectious diseases, rather than be limited to those listed in the First Schedule.

Another new provision introduced in the Bill will enhance the Minister for Health's authority to order mandatory vaccination. The existing Infectious Diseases Act empowers the Minister for Health to require any person, who is not protected or vaccinated against an infectious disease, to be vaccinated, if there is an outbreak of the disease in Singapore. If there is an outbreak overseas, the existing provision will not apply, even though vaccination may be judged necessary for public health reasons to prevent the spread of the outbreak to Singapore. The Bill therefore revises the Act to allow the Minister for Health to order mandatory vaccination, even when there is no outbreak in Singapore when this is necessary to prevent the spread of the disease here.

The Bill also makes it an offence for persons with infectious diseases and who are likely to spread the disease to default on their medical examination and treatment when they are required to do so by the Director of Medical Services. It also gives MOH officers powers to arrest such defaulters.

Since 1972, the control and prevention of infectious diseases in Singapore has been a shared responsibility between MOH and ENV/NEA. Now, with the rationalisation of public health functions and the transfer of all medical-related public health functions from NEA/ENV to MOH, MOH will take charge of the surveillance, monitoring, outbreak investigations and control of all infectious diseases. MOH will assume lead responsibility in the event of any infectious disease outbreak. NEA/ENV will continue to be responsible for the environmental determinants of health.

Mr Speaker, Sir, the proposed amendments to the Infectious Diseases Act, as outlined in the Bill, will enable my Ministry to effectively carry out the public health functions which are being transferred by NEA/ENV to MOH. The amendments will also help to enhance our responsiveness so as to enable effective prevention and timely control of all infectious disease outbreaks in Singapore.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Jalan Besar): Mr Speaker, Sir, I stand to speak in support of the Infectious Diseases (Amendment) Bill.

The amendment in this Bill that enables the for the prevention and control of all communicable diseases, such as prevention and control of outbreaks, notifications, surveillance and investigations, from the National Environment Agency (NEA) to Ministry of Health (MOH) is appropriate, and I welcome it.

Sir, the Ministry of Health is most suited to assume this responsibility of prevention and control of all communicable diseases. The Ministry of Health is in a better position to understand the different types of communicable diseases and is able to monitor the diseases better because those affected are usually under its care. Furthermore, the Ministry of Health has the support of personnel and laboratories to better investigate any diseases, is in a better position to inform and notify diseases more effectively, and is able to involve all the doctors in Singapore in the surveillance of any outbreak.

This Bill is relevant indeed in view of the new infectious disease named Severe Acute Respiratory Syndrome (SARS) that is threatening us presently. The amendment in new section 2(c) of this Bill enlarges the definition of "infectious disease" to include certain diseases not specified in the First Schedule, but if left uninvestigated or unchecked, would result in an epidemic of that disease. SARS definitely falls into this ambit as it is not listed in the First Schedule, although it is a highly contagious and dangerous disease. Bio-terrorism is also the concern of the day. A good example would be the recent Anthrax scare. Anthrax is another example of a highly dangerous infectious disease that is not in the First Schedule.

Sir, only 10 days ago, on 12th March, the World Health Organisation issued a global alert about the outbreak of SARS. As of today, there are 34 Singaporeans with SARS. Other than the initial three cases, there are an additional 31 patients who had been admitted to hospital. All these have been in close contact with the patients of SARS. My question to the Minister of State is which Ministry is taking on the responsibilities of the urgent situation of SARS now, since the transfer of responsibility from NEA to MOH is scheduled to be effective only from 1st April. We need to have one Ministry taking the lead responsibility and seeing through the whole process. Otherwise, this transitional stage will be detrimental to our well-being. Could the Minister of State enlighten us on what has been done by the Ministry of Health and what role had been played by the National Environment Agency (NEA) with regard to SARS?

Sir, clause 13 amends section 32 to transfer the responsibility for the cleansing, disinfection and treatment of infected vessels, vehicles and personal effects to the Director and Health Officers authorised by the Director. May I ask the Minister of State how the Ministry of Health is preparing to take over this responsibility as this will be completely new for MOH? Are there personnel that can assume this role in MOH? Is MOH setting up a new department to take over this role?

Sir, clause 20 of this Bill empowers the Minister to order mandatory vaccination of persons in certain cases. May I seek the assurance from the Minister of State that this order will not be taken lightly until it is proven to be absolutely necessary? This is due to the fact that vaccines are not without side-effects themselves. At times, they can do more harm than good in some people. Moreover, we may not be aware of the long-term side-effects of certain vaccines. Even if this order is implemented, we have to be mindful that it is not a blanket order without exception, as it may kill people, such as the frail-elderly, the infants and those with immune deficiencies.

Sir, section 29 of the Infectious Diseases Act seems to empower the Director-General or Port Health Office to obtain information to ascertain the health of the persons on board. But there is no provision for the "Entry Declaration" for travellers coming into Singapore.

Sir, it was reported in the Straits Times today by Salma Kahlik that the three Singaporean women, who brought SARS here, had been traced to a Hongkong hotel. They were all staying on the same floor as the doctor who has since died. In view of this current outbreak of SARS, and the fact that SARS is highly contagious and potentially deadly, should we not make sure that there is provision in this Bill to provide implementation of urgent measure on the containment of this illness?

Sir, it may be prudent that we take steps to ensure that travellers do not enter Singapore without declaring that they are free of such disease and/or not in contact with person who had contracted such disease. May I ask therefore whether we can implement a clause of "Entry Declaration" for travellers by way of subsidiary legislation?

Sir, I hope that the Minister of State can address my concerns.

Dr Balaji Sadasivan: Sir, first let me explain a little bit about the role of MOH and NEA with regard to managing and preventing disease outbreaks.

NEA has capabilities in dealing with the environment and how we can change things in the environment that can cause disease. MOH has the expertise in treating people who are sick and diagnosing illness in sick people. Both NEA and MOH have always worked together and they will continue to work together. What has happened in the last 30 years is that our concerns have shifted. In the past, our concern was more primary focus on outbreaks of diseases like malaria, dengue and food poisoning. In the future, our concerns will be more on infectious diseases like SARS as well as bio-terrorism.

Since these new types of diseases that we are concerned about will be first handled and seen by MOH rather than ENV, the department has been shifted from ENV to MOH. However, even with the shift, MOH and ENV will have to work together.

In the current outbreak, there is a task force monitoring the management of this outbreak. It is chaired by DMS, and it includes NEA officers, as well as all other relevant people involved. They meet every day and they make decisions so that there is a coordinated response.

With regard to her second concern, which is on vaccination, it will require some extraordinary events in countries outside Singapore before we will consider ordering vaccination of Singaporeans to protect ourselves from such an infection.

Dr Lily Neo wanted to know what measures we have taken with regard to SARS and how we can prevent the disease from coming into Singapore. Let me give a brief history of how the disease came to Singapore. Dr Neo is correct. A professor of medicine from Guangzhou fell ill while in Hongkong. He stayed at a hotel in Hongkong on 21st and 22nd February. He had previously been treating pneumonia cases in Guangzhou. He infected seven persons at the hotel, including the three Singaporeans. The three Singaporeans returned on 25th February 2003 and they were well at that time. Between 1st and 3rd March, they fell ill and they were admitted to our hospitals as cases of pneumonia. On 6th March, WHO issued an alert that healthcare workers in Hanoi, who had treated an American who had come from Hong Kong, were falling ill. When WHO issued this alert, MOH instructed hospitals to isolate the three patients and to implement stringent isolation measures.

Between 14th March and 21st March, which is today, 36 patients have been admitted with SARS. Half of them are healthcare workers, half are family friends and close contacts. Infections in all the cases have been traced to contact with the first three cases when they were not isolated. So far, we have no case of a person being infected after the first three patients were isolated, or of any infections coming from contact with the 36 patients who have now been admitted and isolated. So, having legislation to prevent people coming in or through declarations is not necessarily an effective measure to prevent the disease from coming into Singapore.

The steps taken by MOH to control the infection are the following: We want to identify all suspected cases early. So MOH has informed the public on what symptoms to look out for. All hospitals and doctors have been notified on the evaluation of these cases and what measures to take. The disease has also been made a notifiable disease under the Infectious Diseases Act. All patients admitted are in strict isolation. There have also been measures implemented in emergency rooms so that triage nurses would know how to deal with suspected cases. NEA officers have been doing contact tracing. They call all contacts daily and check on their status. Health advisories have been issued to airlines on what precautions they should take to prevent sick people boarding their planes so that these sick people will not enter Singapore. Health advisories would also be issued to parents, schools, pre-schools and childcare centres and, directly, parents will be told to look out for fever in their children, if they have recently travelled to areas where this disease has been known to occur. The task force looking after the disease meets daily and issues press alerts and updates the public on what happens. The information is also on the MOH website and there is a hotline that the public can call.

Sir, this outbreak is quite serious. We still have 37 patients in the hospital, five of whom are critically ill. We are not out of the woods, but the outbreak appears to be under control. We can be sure only in one or two weeks' time. We are working closely with WHO and CDC to try to control this outbreak.

Dr Lily Neo: I just want to seek clarification, Sir. Should we think that we need to implement self-declaration by travellers later on, can we implement the clause of the entry declaration by way of subsidiary legislation? Could I also ask whether our public is getting sufficient advice and guidance presently with regard to SARS?

Dr Balaji Sadasivan: I think the public has been given all the necessary advice and we will continue to update the public if there is any further advice that they need to know. With regard to whether it can be done by way of subsidiary legislation, we will ask our experts to look into it.

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 Balaji Sadasivan].

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