SECTION_NAME:ORAL ANSWERS TO QUESTIONS

[Mr Speaker in the Chair]

ORAL ANSWERS TO QUESTIONS: Column No : 1776

AVIAN FLU:

(Vaccination for young children and old people): 1.

Mdm Cynthia Phua asked the Minister for Health, with regard to avian flu, how many young children and old people have taken vaccination jabs because they are, or intend to travel, overseas.

The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir,first, letme explain that avian influenza is caused by an avian virus, of which H5N1 is one such strain which is currently endemic among birds and poultry in many parts of the world. In Asia, H5N1 has been found to jump from chickens to human in a number of cases, but fortunately transmission remains inefficient. The risk is that H5N1 may mutate to become a human virus with far greater transmission capability among human beings, causing a global influenza pandemic.

At any one time, there are several predominant circulating strains of human influenza viruses. These are quite different from avian viruses, like H5N1. Fortunately, human influenza is usually a self-limiting illness. But serious complications may occur in certain high risk groups, like the elderly or those with chronic heart and lung diseases.

There are vaccines for human influenza. But because human influenza viruses constantly undergo minor genetic changes, WHO issues regular updates on the prevailing dominant strains in the northern or southern hemispheres. Based on these updates, vaccine producers will formulate influenza vaccines which are deemed to have the best chance of protection against the prevailing strains. These updates are made every six months. Following each WHO update, my Ministry would use the opportunity to issue advisories recommending influenza vaccination for the high-risk groups.

Young and healthy persons visiting temperate countries during the winter season are not in the high-risk group, but if they wish, they may receive influenza vaccination to reduce the risk of getting infected.

Let me stress that current influenza vaccine does not protect against the avian influenza virus. For those visiting countries affected by avian influenza, their best protection is to avoid contact with live poultry and avoid handling or eating undercooked poultry and eggs. And of course, keep a high standard of personal hygiene, including frequent and thorough hand-washing.

Mdm Phua asked for data on the number of Singaporeans who have received travel-related influenza vaccination. We do not keep track of such data. However, so far this year, our public hospitals have vaccinated some 400 young children and 4,000 elderly. Many more may have done so in the private clinics.

Mdm Cynthia Phua (Aljunied): Sir, I understand that currently all the clinics have run out of the human influenza vaccines. The advice is for the elderly and children to have this jab before they travel. When will the nextstock come in and what is the quantity?

Mr Khaw Boon Wan: Sir, there is a temporary global shortage of human influenza vaccines. This is partly because, just like Singaporeans, many people in the West and other countries were mistaken that this vaccination will protect against bird flu which is now endemic among the poultry and birds. So there is a run on the vaccines which caused a temporary shortage. Members will recall that last year there were some production problems of one major vaccine supplier in UK. So several factors have compounded it.

For Singapore, our annual demand for human influenza vaccine is not big. I have looked at the data and last year, we consumed something like 200,000-odd doses. This year alone, we have used up 210,000 doses. But additional supplies have been coming in progressively. Another 40,000 doses will be coming in soon and they are coming in by batches. Somebody sent me an email to say that a particular polyclinic ran out of the vaccine but a few days later, after I responded to him, he said that he was able to get it.

My message remains the same: it is only for the high risk group. If everybody goes and chases for the vaccine, it will be like a run on a bank. If you belong to the high risk group, by all means, have the vaccination and, if it is recommended by GPs, I am sure they will ration accordingly. For the rest of the people, just stick to basic principles - keep a high standard of personal hygiene and stay away from live birds.

Dr Lily Neo (Jalan Besar): Sir, two supplementary questions. May I ask the Minister whether he concurs with the top local infectious diseaseexpert that vaccination with flu vaccine is a strong preventive measure to prevent the deadly H5N1 bird flu virus from mutating? Secondly, in view of the very limited supply of flu vaccines,could he procure the availability of more vaccines for the use of Singaporeans?

Mr Khaw Boon Wan: I have not seen scientific studies of human vaccines being able to protect against a new mutated virus, because how do you prove it. The virus has yet to appear and it remainsa hypothesis that this vaccine will protect againstsomething which you do not know how it will look like andhas yet to be seen. In healthcare, we have to go with evidence. Without any scientific evidence, I cannot make anyassessment one way or the other.

There may be speculation for various personal reasons such as wanting to up the sale of vaccines. At the population level, let us stick to the best practice and it is still human influenza vaccine only for the high- risk groups and bear in mind that, even then, it is only protection against the current strain of human influenza and it is not 100% effective. There have been studies which show that for adults taking the human influenza vaccine, protection may, at best, be 70-80%. So there are stillpeople who are down with influenza, let alone an unknown bird flu.

Whether we should stock up the vaccines, I think,is related to the first reply. If you are not sure of its efficacy and you stock up, then you may be just holding on to a stock which is useless. In fact, that underlines the great difficulty of vaccine suppliers. I have been studying the economics of vaccine production. Why is it that over the last 10-15 years, the number of vaccine producers has kept on shrinking? There are only a few suppliers in the world left because it is bad business. They have to stock up. They produce certain vaccines and every six months WHO issues new updates and so their vaccines may expire. If they overstock, they lose money, and if they understock, like now, the whole world is against them and asking why they did not stock up more. That is the problem of producing vaccines.

I have been studying this problem for quite some time because, if indeed there is a flu pandemic, I see as one of our key weaknesses, not only in Singapore but in many countries, a lack of domestic production capability for vaccines. But it is related to the economics of it. Unless it is a viable proposition, who wants to sink hundreds of millions of dollars building vaccine factories. But we may find it strategic to want to support some local production capability. This is one big headache which I am studying very closely now.

Mdm Halimah Yacob (Jurong): Sir, there have been some reports about deaths involving Japanese children after being vaccinated with the Tamiflu vaccine. I would like to ask the Minister for his comments whether the Tamiflu vaccine is still safe for use.

Mr Khaw Boon Wan: The observations by some Japanese doctors have been rather intriguing and global attention is on it now. One of the key tools in our toolbox against a possible flu pandemic is Tamiflu and all of us, like many other countries, are stocking up Tamiflu and if Tamiflu turns out to be a killer, in this case for children, it will be troublesome. The global attention is now on this observation. TheUS FDA has been studying it and will continue its study. Right now, in Singapore, I can only say that we have not received any such adverse reports. As far as I know, for the Tamifluused in Singapore, we have only received two adverse reports and those are the traditional ones, like vomiting, nausea,but not on this particular observation by some Japanese doctors that there were hallucinations leading to suicides by children.

Like all things, we have to see what is the cause and effect. If it is correlated because of some other reasons causing those deaths, that may be so. We are watching and in consultation with the US FDA and they have not banned this product or asked that it be withdrawn. We stand by those judgments by the experts.

Column No : 1781

AVIAN FLU:

(Monitoring of migratory birds): 2.

Mdm Halimah Yacob asked the Minister for National Development (a) what measures are in place to monitor the migratory birds that land in Singapore, to ensure that they are free from the avian flu; (b) what has been done to prevent these birds from infecting other birds in Singapore; and (c) whether the birds that are commonly found in Singapore, such as crows and mynahs, which live in close proximity to people, are safe.

The Minister for National Development (Mr Mah Bow Tan): Mr Speaker, Sir,to monitor and ensure migratory birds that land in Singapore are free from the avian influenza, AVA has put in place an active surveillance programme since August 2003. So far, samples taken from the migratory birds at Sungei Buloh Nature Reserve and Pulau Ubin have all tested negative for avian influenza.

Measures have also been taken to prevent migratory birds from infecting local poultry or ornamental birds. AVA requires our local poultry farms to be bird-proofed to prevent contacts between migratory birds and poultry. AVA inspects the farms regularly to make sure that the bio-security measures are strictly maintained. AVA also requires mainland residents to cage their pet poultry.

Since June 2005, it has banned poultry rearing on Pulau Ubin. Birds at the Jurong Birdpark and Singapore Zoo have been vaccinated against the avian influenza. The vaccination programme has also been extended to free-ranging birds in the Botanic Gardens and Sentosa.

AVA also carries out tests on dead birds submitted by the National Environment Agency (NEA) and the public. So far, the dead birds were mostly local birds, such as crows, mynahs, pigeons, and swallows, commonly found in our urban setting. Their samples have tested negative.

Sir, I wish to reassure the Member that Singapore is free from avian influenza, and AVA will continue to be vigilant and guard against the spreadof the disease into Singapore.

Column No : 1782

AVIAN FLU:

(Review of wildlife trade laws): 3.

Dr Geh Min asked the Minister for National Development, in view of the risk of zoonotic diseases like avain flu increasing by contact between humans and wild animals, whether he will provide an update on the review of present laws relating to the wildlife trade.

The Minister of State for National Development (Mr Heng Chee How) (for the Minister for National Development): Mr Speaker, Sir, wehave legal provisions in place to safeguard Singapore against zoonotic diseases such as the avian influenza and rabies that could be brought into the country through imported animals, birds and wildlife.

The Animals and Birds Act, for example, allows AVA to impose veterinary conditions on the import of animals. Depending on the animal species and the risks involved, AVA may impose import restrictions, set quarantine, testing and vaccination requirements, and require that proper health certificates be presented before allowing certain animals to be imported.

The Endangered Species (Import and Export) Act, or ESA in short, allows AVA to regulate the trade in endangered species of wildlife.

AVA officers work closely with the Police and the Immigration and Checkpoints Authority (ICA) on the ground to curb any illegal wildlife trade that might also bring zoonotic diseases into Singapore.

AVA regularly reviews and updates these trade controls and requirements to ensure that they remain relevant and effective. It has recently completed a review of the ESA. I will be introducing a Bill in today’s sitting to update the Act.

The Bill, when enacted, will enhance AVA’s powers to regulate trade in endangered wildlife,and thatwill also help reduce the risks of our exposure to such zoonotic diseases.