SECTION_NAME:MINISTERIAL STATEMENT

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DENGUE CONTROL MEASURES:

(Statement by the Minister for the Environment and Water Resources) Assoc. Prof. Dr Yaacob Ibrahim: Sir, despite our high standards of public health, Singapore is experiencing its worst ever outbreak of dengue fever, at least since the 1980s. As at 17th September this year, the number of dengue cases has reached a high of 10,237, including 318 Dengue Haemorrhagic Fever (DHF) cases. There were 697 dengue cases in the week ending 17th September, a new peak. To date, eight people have died from dengue fever and DHF this year, the same figure as the whole of last year.

Over the last two years, in response to the dengue threat, the National

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Environment Agency has stepped up its efforts to control breeding of the Aedes mosquito which transmits the disease. NEA stepped up its inspection programme from about 55,000 inspections a month last year to about 59,000 inspections a month this year. It also beefed up its manpower resources. By the end of September, NEA will have a total of 510 personnel for dengue operations, more than four times the manpower last year.

Efforts by the community have also played a significant role in preventing mosquito breeding. In April 2004, NEA launched the Mozzie Attack programme in partnership with grassroots organisations and CDCs. By June 2005, all 84 CCCs had their own Mozzie Attack programmes. And the number of dengue prevention volunteers under the Mozzie Attack Programme has doubled to 4,000 this year.

Sir, these collective efforts have been effective in keeping down mosquito breeding. In fact, the total number of breeding sites found in NEA inspections actually fell to an average of 1,100 a month this year, down from 1,600 a month last year. Most of this reduction is because fewer breeding spots are being found in homes. I hope residents will continue to do their part to control mosquito breeding.

Understanding the problem

Yet, despite all these measures, we still have a serious problem. Even though we have reduced mosquito breeding, the number of dengue cases in Singapore has continued to rise. In fact, there is a resurgence of dengue worldwide in the tropics, and many countries in South-East Asia, including Indonesia, Malaysia and Vietnam, have reported much higher levels of the disease in 2005.

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Singaporeans are naturally concerned about the rise in dengue cases. We do not fully understand why this is happening. There are many possible factors, including rising temperatures, increased strength of the virus, increased biting rates of mosquitoes, lower immunity especially of the younger population, or the interplay of several of these factors. Possibly mosquitoes are breeding in non-traditional sites that we have not yet discovered.

Sir, we have formed a panel of international and local experts on dengue to study the sudden upsurge in dengue, and advise the Government on the best strategy to deal with the problem. The panel will also enhance the existing research programmes on the disease.

Breaking the cycle of transmission

It will take time for us to fully understand the full reasons for the rise in dengue cases in Singapore. Meanwhile, we need to take urgent action to avoid a public health problem and clogging up our hospitals.

Whatever the deeper causes, one thing is clear: dengue can only be transmitted through the Aedes mosquito. So there are two things that we must do to break the cycle of transmission. First, we need to further reduce the mosquito population. Second, we need to isolate dengue patients from mosquitoes, thus preventing people infected with the disease from being the source of further infections. Both measures require the combined efforts of the Government and Singaporeans.

Immediate action against mosquitoes

Our immediate task is to reduce the mosquito population to levels that pose little threat to people. We will continue with our localised efforts to track clusters

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of dengue cases. But we will also move beyond these localised efforts with an anti-mosquito blitz in all constituencies.

Sir, the blitz started last weekend in Ang Mo Kio, Hougang, Marsiling and Yishun. 700 volunteers from NEA, PUB, SCDF, HDB, and LTA, together with the Singapore Pest Management Association and Singapore SOKA Association, combed the estates thoroughly to search for and destroy breeding habitats. We chose four estates that have experienced more dengue cases this year in order to find out the state of mosquito breeding and if there are new types of breeding habitats of the Aedes mosquitoes that have previously not been detected. During the two-day operation, the volunteers covered the common areas of over 1,600 blocks of flats including common corridors, perimeter drains, open grounds, bin centre rooftops, pump rooms, and playgrounds. A total of 172 breeding sites were found and destroyed, which is about one breeding site for every 10 blocks of flats checked. Of the breeding sites found, 29% involved breeding in flower pot trays and water containers in corridors, 26% in discarded receptacles in open areas, 39% in outdoor areas such as perimeter drains, bin centre rooftops, and 6% in tree holes. This shows that we need to do more to promote household responsibility, deter littering, and to bring about better housekeeping in our estates. We need to make collective efforts to keep our neighbourhoods free from mosquito breeding.

During the 2-day exercise, there were 16 occasions when we detected mosquitoes and carried out fogging. I understand that there are some doubts about the efficacy of fogging. However, according to the World Health Organisation, thermal fogging is still an effective means for killing adult mosquitoes, and complements searching for and destroying all possible mosquito breeding sites.

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This 'carpet-combing' blitz has helped to reduce the breeding sources of mosquitoes, and to better understand the breeding habits of Aedes mosquitoes. No new types of breeding habitats were found during the blitz. There were also some 2,000 potential breeding sites identified over the two days, which will be monitored and removed permanently, if possible. The information gathered in this exercise will be shared with all the Town Councils. NEA will be carrying out another 'carpet-combing' operation next weekend and plans to cover all the estates within the next six weeks. An in-depth analysis will be carried out on all the findings, in consultation with the expert panel.

Additional Government measures against mosquitoes

Beyond the blitz, we must sustain our efforts against mosquitoes. Keeping Singapore mosquito-free cannot be a one-off effort. The Government has thus committed an additional $30 million towards measures in the fight against dengue.

Sir, let me now inform the House of the measures that Government is taking.

Dedicated Pest Control Operators for Town Councils

Following the blitz and information provided on the breeding sites, NEA will proceed to work with the Town Councils to put in place a better and more comprehensive system to prevent mosquito breeding. Already, three Town Councils, namely, Hong Kah, Jurong and Sembawang, have programmes dedicated specifically to controlling mosquitoes. NEA is currently assisting other Town Councils to put in place such dedicated mosquito programmes islandwide through the Pest Control Operators (PCOs) by October. These PCOs will have to submit reports to the Town Councils and NEA.

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Having dedicated PCOs will also build up institutional local knowledge of mosquito breeding habitats. This should help bring down the number of breeding sites in common areas in our housing estates, such as perimeter drains, linkway roof gutters, bin centres and pump rooms. We are also asking all the Town Councils to appoint a dedicated Environmental Control Officer (ECO) on their staff. The ECO will be responsible for all public health programmes including dengue prevention.

Waterlogged public areas and drains

In addition, the Government will clear waterlogged public areas to break the cycle of breeding. We will be cleaning our drains more frequently as drains are one of the breeding habitats of mosquitoes. Often stagnant water accumulates in drains which are clogged with dead leaves and litter, creating places for mosquitoes to breed. We need to establish a new, permanent regime of maintenance and cleanliness of our common areas and drains.

Structural design and maintenance

The Government is also looking into longer-term measures that will help keep the incidence of dengue low. We will study infrastructure issues to avoid having structures that collect and retain water which allows mosquito breeding. We will review the design of perimeter and car park drains and other common areas in the housing estates.

Every Singaporean must play his part

Singaporeans play an equally important part in sustaining the fight against dengue. The Government cannot do it alone. We need to make a national effort, with the public showing community spirit and responsibility to

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ensure the health of our fellow Singaporeans.

The Campaign Against Dengue

To stop Aedes mosquitoes from breeding, we have to deny them any stagnant water. But NEA officers cannot inspect every home in Singapore. The Aedes mosquito can breed anywhere with clean stagnant water, such as flower-pot plates, pails and containers such as empty plastic cups or plastic bags that collect rainwater. In fact, a spot of water the size of a 20-cent coin is all it takes for the mosquito to breed.

So for the sake of your own health, and the health of your fellow Singaporeans, I ask all members of the public to be alert and regularly check your homes for potential breeding areas both indoors and outdoors. I am heartened to note that the number of households found breeding mosquitoes fell this year, for all types of homes. This shows that the people are already taking measures against mosquitoes. We should continue with such measures, and do even more.

To teach Singaporeans simple steps to follow to protect their households from mosquito breeding, we launched the Campaign Against Dengue yesterday. As part of the campaign, grassroots and Dengue Prevention Volunteers from all 84 constituencies were mobilised to conduct door-to-door visits to HDB blocks, private apartments and houses nationwide. During the visits, residents were given 'Ten-Minute Mozzie Wipeout' pamphlets in the four official languages. The pamphlet provides tips on dengue prevention in the form of a simple ten minute five-step routine to prevent mosquito breeding. This campaign will continue for the next few weeks for those households that have not yet been visited.

Sir, I ask everyone to perform this 'Ten-Minute Mozzie Wipeout' to protect

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their families from dengue. What each and every one of us can do in just 10 minutes a day will go a long way towards preventing mosquito breeding in Singapore. For example, flat owners should cover their bamboo pole holders when not in use. If they have plants in their homes, they should change the water in vases and flower bowls every other day. They can also put granular insecticide into vases and flower bowls to kill mosquito larvae.

Working adults should also be alert to potential mosquito breeding sites at their work place. This includes construction work sites and workers' dormitories. We will produce a pamphlet on how workers can check for and remove common potential breeding sites in the workplace in the four official languages plus other languages for foreign workers.

Business owners can play a part too in preventing mosquito breeding. For instance, hawkers, florists, and other businesses with many water receptacles should regularly inspect these containers to stop mosquito breeding.

Through this intensive campaign, we will raise our level of cleanliness and maintenance and keep it high. In order to prevent dengue in the long term, the good habits of the Ten-Minute Mozzie Wipeout must be part of our routine.

Advice for those going on trips

Those who intend to be away from home for more than a week should also take measures to prevent water from stagnating in their homes, such as by covering up gully traps and toilet bowls. Pails and watering cans should be placed upside down so that they do not collect water. Water in flower vases and bowls should be removed. If you are going away for a long period, you should ask a family member or a friend to check on your home regularly. If you own a property which is vacant, please do the same.

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Some members of the public have expressed their concern about vacant properties that may be harbouring mosquitoes. The Government has the power under the law to enter vacant premises to check for mosquito breeding sites in order to protect public health. However, it will only do this under strict conditions and when the situation warrants it, such as when the owner cannot be located and there is a dengue cluster in the area. We will enter vacant premises even if we cannot contact the owner if there are strong indications that there is mosquito breeding in the premises, and if the owner did not leave behind a contact number for the authorities to make contact. So owners of vacant properties wishing to avoid such a situation should leave behind a contact number which the authorities can contact, if necessary. In any case, I urge owners of vacant properties to ensure that their premises are free from mosquito-breeding.

Avoiding littering

The public can also do its part to prevent mosquito breeding in public areas by not littering. Litter left in drains clogs up our drains and creates pools of stagnant water. Every day PUB clears up to 16 tonnes of litter, comprising plastic bags and bottles, from the booms across our rivers. Litter in common areas such as empty cans, drink cans, and plastic bags can also collect

rainwater and become mosquito breeding places. In fact, one of the top breeding sites found during the last weekend's "carpet combing" was discarded containers.

Hotline and website on dengue

Sir, we also need everyone to be our eyes and ears for possible mosquito breeding grounds. A dedicated 24/7 dengue hotline and a website ( www.dengue.gov.sg ) have been set up in conjunction with the Campaign Against

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Dengue for people to alert us to possible mosquito breeding grounds. Many civic-minded Singaporeans and residents from all walks of life have called the hotline to alert us to potential breeding sites and matters relating to the dengue problem. To help non-English speakers also to remember the hotline, we are providing two numbers, 1800-X-DENGUE and 1800-333-7777. People can also use the hotline and website to obtain advice and share ideas on dengue prevention.

Preventing people with dengue from infecting others

The public also plays a role in preventing people with dengue from infecting others. If a female Aedes mosquito bites a dengue patient, the dengue virus will be transmitted from the patient to the mosquito. If this infected mosquito then bites other healthy people, it will pass the disease on to them. This is how dengue spreads. Therefore, all dengue patients, or suspected dengue patients, should take precautions to avoid being bitten by mosquitoes. And how can they do so? They can apply mosquito repellent on themselves, wear long-sleeved clothing, sleep under mosquito nets and keep their rooms mosquito free. We have reminded all doctors to advise their patients to do this.

So dengue patients have a part to play in stopping the spread of the disease. If you are ill, and have symptoms such as a fever, joint pains and nausea, please see your doctor early. If your doctor suspects that you have dengue, he will recommend what you must do, to take care of yourself and to avoid transmitting the disease to others. Please heed his advice. This will help prevent your loved ones and others from becoming infected. Sir, again, I hope that this will become part of our routine.

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Conclusion

Sir, we can bring down the number of dengue cases in Singapore substantially, by denying the mosquito the conditions it needs to breed.

Sir, our collective response to this challenge is to step up our level of cleanliness and environmental vigilance to make it more difficult for the mosquito to breed. On the Government's part, the NEA and other agencies will continue to closely coordinate the ongoing efforts as well as the new initiatives. But the Government and the community must forge a stronger partnership to maintain a clean and healthy environment in Singapore.

Sir, I understand the anxiety Singaporeans must feel about the dengue situation. Fortunately, we do know how the disease is transmitted - through the Aedes mosquito. We thus need to take necessary precautions to prevent mosquito breeding. It only takes 10 minutes a day of five simple steps to protect your households from dengue and make all of us safer. And if we come down with the illness, we must take steps to ensure that our loved ones do not catch it from us. Tackling dengue requires concerted efforts from us all, but it does not require drastic changes in our daily routines, so we should continue with our daily lives.

In engaging the public and media, the Government will continue to provide full facts and figures. We will give Singaporeans the information and the knowledge they need to combat dengue. At the same time, the public can feed us information by being our eyes and ears on the ground. And we believe this partnership is the best approach for a successful campaign.

Sir, we must sustain our efforts against dengue to prevent another

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resurgence of the disease next year. All of us must play our part to keep Singapore dengue-free.

Mr Deputy Speaker: The Minister has indicated that he is prepared to take clarifications.

Mr Leong Horn Kee (Bishan-Toa Payoh): Mr Deputy Speaker, Sir, I would like to ask the Minister a few questions. In fact, I had been raising this issue with his officers and the Minister himself in the past. I am very pleased that now there is a real war that we are mounting against this Aedes mosquito. It is not just an attack but a real war.

I am quite surprised that the Minister said that actually the number of breeding cases has reduced, but the number of dengue cases has increased. Maybe the Minister can clarify whether it is due to the special environment in Singapore that we have new mutants of mosquitoes that are more powerful and more intelligent, or that Singaporeans are now weaker in their constitution and therefore succumb to this Aedes mosquito problem.

My second point is on the idea of breaking the breeding cycle, which I think is very effective. I would like to encourage the Minister and the Government to do more of this nation-wide campaign. We can all do this together to mount periodic measures to eradicate this mosquito nuisance from time to time, so that the cycle can be broken. I would also like to ask the Minister whether he likes to encourage patients who are infected with the dengue fever to have their self-quarantine process so they do not transmit the dengue virus and infect other people. I think encouraging patients to do a self-quarantine process is a way to break the breeding cycle of the mosquito.

My third point is on rules and regulations, Sir. I would like to ask the

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Minister whether his Ministry can actually be more stringent in asking other Ministries which are in charge of other areas to also make the effort to look at measures that can help to reduce this problem. Let me give a few examples. On the parks, we now know that trees can have receptacles which encourage breeding of mosquitoes. For example, I think some particular types of palm tree, like the travellers palm, can provide a large catchment of water for breeding of mosquitoes. So the NParks can also look at issues like that when they plant trees. They should try to plant trees that do not encourage breeding of mosquitoes. These are measures which can help to reduce the problem. The second example is in the area of building control. I think the design of gutters in buildings and certain cornices and corners can also provide mosquito breeding areas. So, maybe we should now ask the Ministry of National Development to look at building control and building design to reduce less trappings for mosquito breeding.

I would also like to ask the Minister whether there is a practice that if you report to the NEA about mosquito breeding and when their officers come to your house and find that there are mosquitoes in your house, you get fined in the process. When neighbours are found to be breeding mosquitoes, they are fined as well. So, that may discourage people from reporting about mosquito breeding cases, thereby causing a deterrence in the process.

Finally, Sir, I would like to ask about private estates. In HDB estates, we have Town Councils being the central agency to wash up the area and do public cleaning and public maintenance, as well as fumigation. But in the private estates, we have, again, different areas of Ministerial responsibilities with regard to roads, drains, and park areas. Which department is in charge of this Aedes mosquitoes problem when it comes to

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private estates? I would like the Minister to consider having a central agency which can help to look into how this matter can be coordinated in the private estates.

Mr Deputy Speaker, one last point. I did not hear the Minister mention about any targets. What are his targets in terms of his programme? Does he intend to reduce the number of dengue fever cases by half within a month? Or maybe he could have some kind of a low target within the whole year. So, at least, we will have a common target to look towards to and see how our measures can be effective.

Mr Deputy Speaker: I saw many hands. Can you keep your clarification as short as possible? Dr Yaacob.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, some of the questions my other colleagues will reply, but let me just take the parts which I can answer. He is right. We are concerned why is it that the number of breeding sites is coming down, and yet the cases have gone up. And that is why we have formed an expert panel to study this. Is it because our herd immunity has gone down? Is it because of the rising temperature? Is it because of other factors and the inter-play of these factors which could be highly complex? But I think we must come back to what we know, and what we know is that we have to find a way to remove Aedes mosquito because the root cause of the problem is Aedes mosquito. So the reason why we are doing a lot of these programmes this past weekend and the coming weekends is also to help the expert panel to remove as much as possible any uncertainty in the entire picture. For example, if we have been able to remove and reduce the number of breeding sites and yet the cases have gone up, that may throw up some light for the expert panel to consider. So,

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clearly, our effort is to make sure that we try as much as possible to understand the phenomenon, help the expert panel to study further, to understand why this is going on. But, meanwhile, Sir, we have to continue with the vigilance that I have mentioned earlier - take all the necessary precautions, take the five easy steps and the 'Ten-minute Mozzie Wipeout' challenge.

Yes, I agree with the Member that we need to have a nation-wide campaign to try and break the cycle. The launch yesterday is part of that campaign and we hope that up to today, the various grassroots organisations and voluntary organisations at the ground will continue with their efforts. In fact, we do have the Dengue Prevention Volunteer Group, the DPVG, at the ground. As I mentioned in my speech, there are about 4,000 of them. I hope, as advisors, Members could actually encourage them do the house to house checks frequently. I have been told that our NEA officers in the various centres work very closely with the advisors during block parties to have campaigns and education materials on the dengue scourge.

On the issue of whether the patient should do self-quarantine, perhaps I will ask Dr Balaji to clarify further. But our position is that for the dengue patient who is carrying the virus, the one way to break the transmission is not to allow a mosquito to bite him or her so that that mosquito will carry the virus to another person. So, essentially, what we are suggesting is that when you protect yourself from mosquitoes, it does not mean you have to quarantine yourself from the society.

Sir, on the stringent measures carried out with the other Ministries, that is why we set up the MSCD, the Ministerial Steering Committee on Dengue. We are working with the other Ministries to study this, as I mentioned in my reply. For

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example, we are studying some of the structural changes that we have to make. These are long-term solutions that we will have to study carefully. I understand that Mr Mah has something to say on this matter later, Sir.

Sir, on fines, in fact when we started out, for first-time offenders, we do not impose any fines. We put back the fine in February this year because we saw a resurgence of the cases, but yet we have been very flexible. My officers told me that very often we work together with the home owners and we help them. In fact, yesterday, Sir, during my house to house visit, the home owners were more than happy to invite our officers in for checks and to make sure that their homes are free of mosquitoes.

Sir, on the private estates, it applies exactly to my reply on the inter-Ministry coordination. We work together. For example, when the various agencies come across something which NEA will have to do, they will contact us. In fact, there is an inter-agency dengue task force chaired by the CEO of NEA, together with all the relevant agencies, to ensure that we coordinate this effort. So, for example, the drains which either belong to PUB or NEA are being cleaned more frequently because of this current challenge. So our target is very simple. We want to keep it low, but I think all the programmes that we have in place will take some time to take effect. We will review as we go along and monitor the situation very closely. A good example would be the things that we found over the weekend. What was the highest number of breeding habitats? Discarded receptacles and littering. Sir, I would urge Singaporeans to please be careful - if you throw away a plastic cup, a plastic bag, any plastic receptacle - these will collect water after a rainfall and they will become breeding sites. So our action, Sir, can help to tackle this problem. Maybe I can invite Mr Mah or Dr Balaji to reply.

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Mr Mah Bow Tan: Thank you Dr Yaacob for re-directing this question to me. I am a member of the MSCD. So I am also fully responsible for making sure that our campaign against dengue is successful. But having said that, I think we need to distinguish between what we can and cannot do and not over-react. When it comes to looking at longer term issues, such as the design of the buildings, this is something we really must take a closer look at. When we design buildings, while we want to achieve certain aesthetic objectives, we must also make sure that it is practical and that it is easy to maintain, and especially in the current situation, that it does not encourage the breeding of mosquitoes, such as encouraging stagnant pools of water to form, etc. So this is something the HDB and BCA will do. It will review the design of rooftops, secondary roofs in HDB blocks, water tanks, gutters on linkways, etc.

Does it mean that we get rid of all these things? The answer is: not necessarily so. So let us take a closer look first before we change. Some of these are for very good reasons. The secondary roofs in buildings, for example, help to cool the building down, and help to make sure that the leaks in buildings are reduced.

Does it also mean that we get rid of all our trees because trees are supposed to collect water which then breeds mosquitoes? I think the answer is no. Because if we do that, then we will need a Save Our Trees Campaign after this. The travellers palms are one of the species of trees which do tend to collect more water in the axils of the leaves. It does not mean that we get rid of all the travellers palms in Singapore. But it does mean that the NParks and other maintenance crew would have to check the palms, check the leaves, more thoroughly. There are certain things that they can do, for example, by treating the axils so that mosquitoes do not breed.

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They can even, in certain cases, drill holes in the leaves without hurting the plant such that the water drains down. But at the end of the day, I think there has to be a balance between what we can do in the design and also what we can do ourselves as citizens. As Minister Yaacob pointed out, more than half of the problems that we had detected in our campaign, in our comb-through exercise last weekend, was due to ourselves - cans being left on the ground, plastic bags, flower pots, trays, etc.

Does it mean that we completely disallow people from keeping plants in HDB estates? I think this is an opportunity for us to encourage our residents to practise good house-keeping if they do keep plants and also that they do not overdo it. But, reasonably speaking, we would have to allow residents to keep some plants on the corridors. But we should not over react. This is the approach that I hope we can take. We will encourage our residents to do more within the flat through the 10-minute checklist, but also be more responsible outside the flat, ie, the common corridor and in the common areas. In this way, I believe we would still be able to enjoy a clean and green environment.

Dr Balaji Sadasivan: Mr Deputy Speaker, Sir, there are two points that Mr Leong brought up that I would just like to clarify. First, he has pointed out that the number of breeding sites has gone down, but the number of dengue cases has gone up and he suggested that it may be because the virus is much stronger and is a new mutant, or he suggested it could be that we are weaker, our immune status is lower, herd immunity is down. Actually, both are possibilities. So we really do not know why we are having this increase in dengue cases, and that is why we are having an expert committee to look at all these factors to see which one of these

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factors, or a combination of factors, has given rise to this increase in dengue cases. We are also doing some research studies, in terms of the sero status of patients and the general public to see if the changes in the immune status may be partly responsible for the increase in cases.

As for the issue of whether people should self-quarantine themselves, there is no necessity for it. Because this is not an infection that spreads directly from one person to another. So any amount of human contact is safe because dengue does not move from one person to another person directly. Although you cannot infect another person, you can infect the mosquito, and that can only happen during a five-day window period at the start of your infection when there is virus in your blood. So we have asked our general practitioners to give advice on how to stop you from infecting the mosquitoes.

As to whether you should stay at home or go out, actually if any other mosquito, other than the Aedes, bites you, that mosquito will not get infected with dengue. So it is quite safe to go to nature parks, etc, where I know sometimes you have large mosquitoes flying around and they are the noisy variety. But those mosquitoes will not get infected with dengue. It is only the Aedes mosquito and, unfortunately, the Aedes mosquito stays in urban places, like your home or immediately outside your home or in buildings. That is why there is so much of emphasis about preventing the breeding of Aedes mosquitoes. If we can stop humans from infecting mosquitoes, we can reduce the incidence of dengue. This is because mosquitoes do not spread dengue from one mosquito to another. So the infected dengue mosquitoes will die, ie, their lifespan is about three weeks. But for each new generation of mosquitoes to spread dengue, they have to grow from larvae to become adults;

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they need to bite an infected human and fly around for about a week while the virus incubates in the mosquito and gets concentrated in its saliva and then, after that, bites another human being in order to spread the disease. And this particular mosquito, in order to get infected, must bite a human during that five days when he has virus in the bloodstream. So if we can have dengue patients or dengue suspects protect themselves from being bitten by the mosquito at home, because that is where most of the Aedes mosquitoes are going to be in urban areas, then we can stop mosquitoes from getting infected with dengue and stop the dengue-infected mosquitoes from infecting new persons. So we have sent that advisory out to all our general practitioners and hospitals for dengue suspects to use repellents. So my advice to all Singaporeans would be to follow that advice. The GP will advise the use of repellents and use it as instructed.

Dr Tan Cheng Bock (Ayer Rajah): I am not so sure I can agree fully with the Senior Minister of State when he advised that patients should use repellents to prevent themselves from being bitten. I have advised my patients but they are very careless and they get bitten. Now, my worry is that the hospital is not taking in patients when their platelet count is about 100,000 or they have lowered down to 80,000, that means these patients who are dengue infected already are being sent home by the hospital back to the community where there are many mosquitoes lurking around and you cannot control the mosquitoes. So you are bringing in a reservoir of infection, which should be in hospital and sheltered, back into the community and the poor Minister would be struggling like hell trying to kill the mosquito which is so elusive.

Therefore, I think this practice of not taking in patients with that level of platelet should be reviewed by the high ministerial committee. It is a very

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dangerous practice. I would advocate sheltering, isolating and ringfencing all these patients who are already infected with dengue, in other words, we have got to build shelters. We have $30 million given to this committee. We should build special isolation shelters so that we can house all these suspected dengue and dengue-infected patients in these buildings, keep them there and do not let the mosquitoes get to them. Now, we are letting the patients go back to the community to be infected by mosquitoes.

Mr Deputy Speaker: Dr Tan, what is your clarification?

Dr Tan Cheng Bock: I am trying to say that the Minister's argument may not be so accepted. My question is to please spend some of the money in building special centres to isolate all our dengue and dengue-suspect patients.

Dr Balaji Sadasivan: First of all, I like to make it very clear that when the patient's platelets are low, it means he is quite advanced in his dengue, and at that time, he does not have a Viremia and he is not infective to the mosquitoes. So using platelets to decide who is going to infect the mosquito will not be the right thing to do. What we have done is that we have formed the expert committee, and the expert committee has come up with recommendations, which are being sent out to all the GPs. Because when there is a new outbreak of dengue, particularly when the number of breeding sites comes down, it is quite natural that everyone has an explanation why there is an increase in dengue cases, and everyone has his own idea of how it should be dealt with. But we need some science in dealing with this problem. So we have got an expert committee and they have made the recommendation that, in the early phase of the dengue illness, the patients should cover themselves with insect repellent so that they would not be bitten by the mosquitoes.

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Likewise on the issue of when should a dengue patient be admitted to a hospital. The majority of patients can actually be treated as outpatients. So we need clinical criteria. The expert committee has met and drawn up the criteria. These criteria are based on advice from Centers for Disease Control and Prevention in Atlanta and World Health Organisation, and these scientifically-based criteria would be used by our hospitals. And I think these issues should be left to the expert committee and anyone who has suggestions can forward it to the expert committee.

Dr Lily Neo: May I ask the Minister how effective is the present practice of fogging? Should it be reviewed and changed? What are the insecticides used presently and are they effective in controlling Aedes mosquitoes? May I also ask whether repellent should be given to infected individuals to use in order not to spread dengue fever and whether his Ministry informs and recommends on the safe and effective repellent available?

Assoc. Prof. Dr Yaacob Ibrahim: Sir, fogging, according to the WHO, is still the most effective means of killing Aedes mosquitoes. We have standard operating procedures where we have trained our PCOs to carry out fogging judiciously and fogging is only effective, we have been told, in the morning and dusk where the adult mosquitoes go out for a bite and during those times when the weather is a bit cooler, the chemicals will remain longer in the atmosphere so that there is a greater chance of killing the adult mosquitoes. But this is also one of the issues in which we will refer back to the expert panel for them to review as to whether our current practice needs to be enhanced or changed. But meanwhile, where we find a population of adult mosquitoes, we will carry out fogging as we have done over the weekend. We

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found 16 sites and we did 16 fogging actions.

On repellent, Sir, this is available in the market. Basically, there is no reason for us to give it free. It is quite reasonably priced. I bought a couple of it over the weekend. I think this is quite affordable. NTUC has embarked on a campaign to help Singaporeans by giving reasonable discounts. All the repellents where chemicals are used would have to be registered with NEA. We do not check the effectiveness of the repellents. We leave it to Singaporeans to decide.

Are there enough websites on certain types of chemicals? I am not an expert in this matter. I have been told by my EHI officials that most of the repellents in the market are quite good and effective. So I think the information is already available on our website, in terms of the chemical composition that is needed in each repellent. For example, we have been told that citronella is quite good. So now you see soaps being sold with citronella oil that will leave you a layer of citronella that could repel mosquitoes. So I bought a bottle yesterday and used it this morning. I think we have to take the necessary precautions. There are enough of these products in the market. Singaporeans are wise enough and NTUC has helped us to put some of these products up so that Singaporeans can easily access them.

Mdm Halimah Yacob: Sir, there is an impression down the ground that the incidence of dengue cases has increased because there is some linkage to the way cleaning is done at the ground. And the way cleaning is done is also associated with the people doing the cleaning. So the question is whether, because there is now a lot of outsourcing of cleaning work and, therefore, that has in some ways affected the way cleaning is done which is not so thorough and not so well. Previously, when these were done by the

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direct employees, and they had been doing the job for many years, they had a certain instinct as to where the mosquitoes could possibly be hiding. They have some experience and the ability to do that. But now that it has been outsourced, the contractors come in, they employ people and they may not be the ones---

Mr Deputy Speaker: Madam Halimah, can you raise your clarification? What is your question?

Mdm Halimah Yacob: Sir, my question is this: is there some truth in that? That because we have been outsourcing cleaning work, that is the reason that has contributed to this perception of the standard of cleanliness and the number of dengue cases increasing.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, I do not think we can say that because it was done once by the daily-rated employees, they did a better job as compared to the private contractors. Both NEA and PUB check very closely to ensure that the places in which we are responsible are well kept and well maintained. But having said that, we have stepped up our cleanliness regime. In terms of the flushing of our drains, we do it more frequently. So I think we will continue to review and learn. And, in fact, the exercise over this weekend has revealed some very interesting things for us to do together with the Town Councils in terms of how to keep our common areas clean. So I do not want to debate whether there is truth in the matter or not. More importantly, let us learn from the experience, work together, and move forward in this process. But I will be most happy to listen to Members' suggestion on what more at the ground our agencies can do. As mentioned by Mr Mah, this is a long-term thing in terms of some of the changes that we have to make but I think the immediate task is to reduce the population of mosquitoes, and

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this is where if we can step up our maintenance and cleanliness regime several notches, I think we will be able to put this challenge under control, Sir.

Dr Tan Sze Wee: Sir, in reply to the previous Member's question, a lot of these measures in place would take time to take effect. Do we have any expectation or how much reduction in terms of dengue infection rates? We are talking about 130 to 150 cases a day being reported now. What is the expectation with these measures being put in? How much reduction are we looking at? Because it is a lagging effect and, as most Members know, Singapore is already being put on quarantine watch in terms of dengue outbreak areas in South East Asia by, for example, Hong Kong's Department of Health. So the last thing we want to remember is what happened during SARS and to be labelled as a dengue hot spot, and that will affect tourism and our economy as well.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, I think that is the reason why PM announced the Ministerial Committee over the last weekend because we are seeing a worrying trend and we have to tackle this quickly. I think it is very difficult for all of us to really put on a number because, as mentioned earlier, the relationship between breeding sites and the number of dengue cases is indeed very complex. So I think the more important thing is to try and go out and send the message and get Singaporeans to adopt that routine while the expert panel do the study. If you ask me and the members of my Committee and the Government, obviously we want to reduce it as much as possible in the shortest possible time. But there are things in which we can do, and that is our appeal to the community. Let us do the things that we can do, so that we remove as much as possible the uncertainty in the entire picture, and the expert panel would at least have more information to study

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and to come up with recommendations that would really help us to reduce this as much as possible.

So I agree with the Member that this is something that we have to tackle immediately. But at the same time, Sir, as I have mentioned in my speech, life must go on. We have to continue to work. In fact, yesterday, I had a visitor from America. She came in with my brother, very happy to visit Singapore, went to the Lantern Festival at the Chinese Garden. She asked me whether there was anything to be wary about. I said, "Nothing. Go and enjoy."

So I think the impression must be given that Singapore is taking care of this. And, at the end of the day, our daily routine need not be changed so dramatically as long as we adopt some of the steps that we have highlighted over the weekend, and then let the expert panel do the study. And I am confident that over time we can put this problem under control, Sir.

Dr Amy Khor Lean Suan: In the case of Hong Kong, which has one and a half times the population of Singapore and a much denser area, they seemed to have coped much better in the fight against dengue. Are we going to look at whether there are lessons we can learn from the Hong Kong experience in fighting dengue?

Another question I have is: would NEA remain the main coordinating agency for dengue related issues over the longer term so that people would not be passed from pillar to post?

The third question is: for pest control companies that the Town Councils would be employing under the scheme currently launched, has NEA actually worked out with the Town Councils some kind of minimum performance standards, KPIs

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and so on, to ensure that these pest control companies are effective? Because in the short term, practically all the Town Councils will be employing pest control managers. Would they have enough trained people to actually undertake this task?

And, finally, incidentally, I would like to ask the Minister if he has actually come across anyone who has said that, instead of planting trees or plants which are actually receptacles for breeding mosquitoes, plants that will actually repel mosquitoes and keep mosquitoes off? Because during the weekend when I visited the residents, one of the residents showed me a plant and he said it was very effective in keeping off mosquitoes.

Assoc. Prof. Dr Yaacob Ibrahim: Sir, the nursery near my house also told me about a similar plant. We bought it, for about a month, it did not work, we threw it away. I think the more important thing is that we do what we can based on the measures that we have outlined. And I think if we do all that, we can keep things under control.

Sir, in the case of Hong Kong, we will study it. In fact, the expert panel will study all the experiences. But we have to also know their differences. In Hong Kong, for example, they have colder weather and that will help to basically clear some of the mosquitoes. So we cannot compare it but we will look at their regime and see whether we can learn from them. And I think it is important for us to keep an open mind.

NEA will continue to be the centre. In fact, the two dedicated hotlines have been operating since 14th September. And we have told all the callers we will call back within 24 hours, which we did, either with a follow-up action or the status of the request that they have put in. We basically do at the backend our coordination with the various agencies.

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So I would like to assure Singaporeans that NEA will continue to be the centre for them to call and report some of the cases in which we have to deal with.

On the pest controllers, I agree with Dr Khor that we have to establish minimum standards and that is what we are doing at this point in time. We are drawing up specifications. NEA is now assisting Town Councils to make sure that those specifications meet the minimum standards, first, based on the experience of the three Town Councils and also based on the experience that we have learned so far. And in terms of the training, we are ramping up very quickly, working with WDA to allow the pest controllers to hire more workers, and they will do on-the-job training. But training will be on a continuous basis to ensure that the workers remain up to scratch in terms of their capabilities in dealing with this problem.

Mr Deputy Speaker: I will allow one last question. Cynthia Phua.

Mdm Cynthia Phua: I am not surprised - although Mr Leong is surprised - that the number of breeding grounds has been reduced because there are two non-accessible areas that the residents and volunteers could not access. One, the three-storey gutters in private estates. Nobody could access them. Second, the carpark drains or the covered drains in private estates as well as in HDB estates. These are areas that are impossible to access. And in terms of the breeding grounds, you can only flush for a certain period of time, you cannot flush them always.

Mr Deputy Speaker: Mdm Cynthia Phua, so what is your question?

Mdm Cynthia Phua: Can the Minister tell us specifically how do we eradicate these breeding grounds in covered drains as well as in three-storey gutters?

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Assoc. Prof. Dr Yaacob Ibrahim: Sir, as I have mentioned in my speech, as far as the drains are concerned, we are working together with MND to look at a long-term solution. But, meanwhile, we will continue to increase the frequency of our flushing of the drains to make sure that there are no pools. We will also look at the design, as Mr Mah has announced. But this is where you need the experts to come in, the pest control companies, to work together with NEA. This cannot be done by the public. It has to be done by the experts. Similarly, for gutters, we have referred to the committee to study further. But for Singaporeans who have homes with gutters, they can call in people to help them to check. In fact, over the weekend, Sir, we actually got SCDF officers who have those tall ladders to help us.

An hon. Member: That is not their job.

Assoc. Prof. Dr Yaacob Ibrahim: Yes, I understand, but we need this only as a one-off exercise. But if home owners really need assistance, they can call up NEA, who can advise them what are the things that they can do with respect to the gutters. I think we have to step up our maintenance and vigilance, and we are more than happy to assist home owners.

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