Ong Ye Kung
Singapore
“The Ministry of Health (MOH) recently enhanced the Community Health Assist Scheme (CHAS) dental subsidies, which are tiered by income, for common preventive and restorative procedures.”
“Healthier SG GP clinics may also refer their enrolled patients to Active Ageing Centres and Community Health Posts to fulfill their social prescriptions and for subsidised services, such as medication management.”
“Public hospitals, such as the National University Hospital, the Singapore General Hospital and Tan Tock Seng Hospital, have deployed robotic-assisted surgical (RAS) systems for minimally invasive soft-tissue surgeries.”
“The Health Sciences Authority (HSA) welcomes drug producers to choose Singapore as part of their first-wave filings. As long as a pharmaceutical product is approved by at least one regulatory agency, such as China's National Medical Products Administration (NMPA), it would also qualify for the abridged route.”
“A decrease in estimated glomerular filtration rate in patients with diabetes can be due to multiple reasons. Doctors will first investigate the underlying cause before determining whether the patient should be referred to a specialist. Some causes are reversible and cause transient reduction in renal function.”
“Information on the Lasting Power of Attorney (LPA) cannot be made visible on the National Electronic Health Record system as it is protected under the Mental Capacity Act. Such information may only be disclosed by the Public Guardian to specified persons upon satisfactory submission of evidence(s) required under the law.”
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“While ageing and changes to our demography are inexorable, we can improve the health of our population through effective preventive care that spans the entire life of an individual. This will be a major focus in the coming years. Good health starts from the womb. We will enhance mental health screening and psycho-emotional support for pregnant women and their spouses, and support families in cultivating healthy lifestyle habits from young. As the child gets older, schools and preschools are important platforms to foster and sustain healthy habits. We will partner MOE and MSF closely, to incorporate health education in the school experience, and lay a strong foundation of health for our younger generation. For adults, Healthier SG will be the key strategy to encourage healthy living and deliver preventive care. Enrolment into Healthier SG will start in July 2023, and this will kickstart the development of strong and dedicated patient-doctor relationships throughout society. Family doctors play an integral role in inculcating and strengthening good health habits, such a good diet, regular exercise, and routine health screenings and vaccinations. To support this effort, we are marshalling community resources and partners to organise physical activities in the community, and to reach out to residents and encourage them to enrol. Through the Health Promotion Board, we will continue to drive efforts to reduce sugar and sodium intake, equip consumers with information to make healthier eating choices, manage the consumption of tobacco and nicotine, and promote smoking cessation. By emphasising preventive care, Healthier SG brings healthcare out of hospitals and clinics, and into the community.”
“We will also review the Infectious Diseases Act (IDA) to deal with a wider range of public health situations, and better manage crisis communications. We will continue to invest in healthcare infrastructure and expand our care capacity. This includes the Woodlands Health Campus, the Tan Tock Seng Hospital Integrated Care Hub, the Eastern Integrated Health Campus, and the redevelopment of Alexandra Hospital. In the next few years, we will add 1,900 (or about 20%) more public hospital beds, from 11,000 beds today. By 2030, we will build 10 more polyclinics, making a total of 32 polyclinics. We will also expand the capacity of our nursing homes from 16,000 beds in 2020 to more than 31,000 beds in 2030. We will invest heavily in IT, focusing on mission-critical national systems for hospital billing, drug ordering and dispensation, and the maintenance of national medical databases. We will continue to develop our healthcare workforce. We plan to increase our nursing and support care manpower by 40%, from 49,000 now to 69,000 by 2030, by building a stronger local pipeline through pre-employment training and mid-career conversions, and complementing our local core with foreign healthcare workers. With good training opportunities and career prospects, Singapore will remain competitive in attracting foreign healthcare manpower. More opportunities will be made available for doctors to become Family Physicians and develop their competencies, such as through postgraduate family medicine training. We will continue to upgrade the skills and knowledge of nurses and Allied Health Professionals, so that they can assume greater responsibilities, including in leading more clinical community care initiatives.”
“The Ministry of Health (MOH) will continue to deliver good health outcomes for Singaporeans, while keeping costs affordable for individuals and sustainable for Singapore. We have been able to achieve these objectives through the delivery of high-quality care, supported by a dedicated healthcare workforce and resilient infrastructure built up over the years, and a S+3M (subsidies, MediSave, MediShield Life, and MediFund) system that instils financial discipline while providing a safety net for patients who need it. The COVID-19 crisis has given us new perspectives on our pandemic preparedness plans and public health capabilities. Furthermore, our population is ageing rapidly. Medical advancements are not only opening up new possibilities but also major challenges and dilemmas. Singapore’s healthcare system is therefore at a pivotal phase of its transformation journey. MOH will strengthen our capabilities and structures by setting up a Communicable Diseases Agency to oversee disease preparedness, prevention and control, surveillance, risk assessment, and outbreak response. MOH will set up a permanent Crisis Strategy and Operations Group, to maintain surge readiness for mid-sized outbreaks and other health emergencies, and to prepare healthcare institutions to be crisis-ready. We will also maintain a healthcare reserve force, to expand surge capacity if necessary. MOH will continue to make progress on PREPARE, the Programme for Research in Epidemic Preparedness and Response, to develop our capabilities in global surveillance so we may better understand new and dangerous pathogens. We will implement our vaccine strategy, to secure an early supply of efficacious vaccines when another pandemic breaks out.”
“The National Electronic Health Record (NEHR) was established in 2011, and has gone through many rounds of updates and improvements. It is a major national healthcare record system, to capture the updated summary medical records of all patients in Singapore. To date, the total expenditure on the system is around $660 million. As of 31 December 2022, over 90% of licensed private hospitals and nursing homes have view-access to NEHR; of these, close to half of them are contributing data. Over 30% of licensed private ambulatory care institutions, which include general practitioners (GPs), specialists, dentists and renal care providers, have view-access to NEHR; of these, 12% are contributing data. With the proposed Health Information Bill, all licensed healthcare service providers are required to contribute data. In the meantime, the Early Contribution Incentive (ECI) supports private healthcare licensees in contributing data to the NEHR. Among the 12 laboratories that applied for ECI, four have received the grant. The ECI scheme was extended in December 2022 to GPs, private hospitals, radiological laboratories and clinical laboratories, and we have received more than 900 applications thus far. Those taking up ECI are required to contribute to the NEHR, and will be given NEHR view-access.”
“The drug risdiplam, sold under the brand name Evrysdi, is an oral medicine registered with the Health Sciences Authority for the treatment of spinal muscular atrophy. The average yearly cost of risdiplam in Singapore is about S$375,000, compared to published prices ranging from S$260,000 to S$390,000 in some countries. The Ministry of Health does not regulate drug prices in private hospitals. However, for public health institutions (PHIs), the Agency for Care Effectiveness conducts value-based pricing negotiations with pharmaceutical companies, to ensure that prices are commensurate with the outcomes they deliver for patients and PHIs' charges would cover some operations and overhead costs.”
“There are, currently, about 40 to 50 persons in Singapore diagnosed with Spinal Muscular Atrophy. Risdiplam is the only treatment option registered with and approved by the Health Sciences Authority. It costs around $375,000 a year in our public healthcare institutions.”
“Rare diseases cover a broad spectrum of conditions. The Ministry of Health does not track the incident number of Singaporeans who are newly diagnosed with rare diseases or the life expectancy of patients with these diseases.”
“An estimated 2,000 to 3,000 people are afflicted with chronic rare diseases in Singapore. For the majority of this population, our national healthcare financing schemes, such as MediSave, MediShield Life and subsidies, provide financial assistance for treatments that this group of patients may require. Patients who face difficulty in affording their bills can also apply for MediFund through the public health institutions. For a small percentage, additional financial assistance may be required. The Rare Disease Fund (RDF) was set up to support high-cost medications for this group. Since its establishment in 2019, RDF has supported nine patients, which represents about 0.4% of Singaporeans with rare diseases. Given the limited size of the RDF, funding support is focused on treatments for rare conditions that are life-threatening and where the treatment is effective in extending the patient's lifespan. RDF lists new medications when it is able to attract donations to generate sufficient investment income to support patients who would, typically, require the medicines on a lifelong basis. Since its inception, RDF has expanded its funding support to cover seven medications for five conditions. RDF will continue to raise more donations and explore the coverage of more rare disease conditions. Donations attract three-for-one Government matching and enjoy tax deduction of 2.5 times the donation amount.”
“The Ethical Code and Ethical Guidelines of the Singapore Medical Council (SMC) guide medical professionals in providing medical care. In their clinical practice, medical professionals must regard the care of their patients as their primary concern. They should not engage in actions that, by commission or omission, jeopardise patient care or pose risks of harm to patients. This duty of care applies in all clinical settings, including in the operating theatre. Medical professionals must not allow themselves to be distracted during their provision of care to their patients. If they are called away to attend to more urgent matters, for example, to attend to other critically-ill patients, they should arrange for clinical cover so that the quality of care provided is not compromised. The use of handphones and other communication devices is, generally, not prohibited within the hospital. This is because medical professionals engage in team-based practice and need to communicate with one another to coordinate care for their patients. Medical professionals should use their handphones and other communication devices responsibly. Medical professionals will be held accountable, if they are negligently absent from the operating theatre when on duty. First, they will be subject to the disciplinary process of the healthcare institution. They may also be subject to sanctions under the SMC disciplinary process if a formal complaint is lodged.”
“The Ministry of Health (MOH) had consulted local experts from different disciplines, including nutrition, food science, behavioural science and public health epidemiology, to ensure that the Nutri-Grade grading system is scientifically robust and designed to spur industry reformulation and nudge consumer behavioural change. The Nutri-Grade grading system focuses on sugar and saturated fat, as they are the current key nutrients of concern in beverages. The Health Promotion Board (HPB) rolled out a public education campaign in December 2022, to increase awareness of the Nutri-Grade mark, including advisories that beverages graded C or D may still be recommended for individuals with specific dietary needs, such as full cream milk for children aged one to two years old; and 100% juice for seniors with difficulty in chewing whole fruit. MOH and HPB will continue to monitor the implementation of the Nutri-Grade grading system and the impact to the public and review it, as appropriate.”
“The Ministry of Health (MOH) does not have the projected capacity of private hospitals, as they are driven by commercial and other considerations. Nonetheless, MOH does facilitate the development of private hospitals, whose operating model can complement that of public healthcare institutions. We will announce such plans whenever they are available and ready.”
“A bit of supplementary information for Assoc Prof Jamus Lim. He mentioned several countries that rolled out their vaccination programmes earlier than us. I should point out that many of them used non-mRNA vaccines – AstraZeneca and others. So, we probably need some time to compile the data, then we know where we stand. But we were one of the first in Asia.”
“At the earliest possible juncture, we delivered the vaccines safely, efficiently, quickly to the arms of our people.”
“Thank you for pointing that out. I think I stated wrongly. We are the first in Asia. You see, in Europe, they have the European Union (EU). In America, Pfizer is an American company. They are big markets. They are at the front of the queue. The Global South is very far down in the queue. Asia, too. But due to the reasons and the decisions we made, we leveraged relationships with the pharmaceutical companies, particularly EDB, we were able to be higher-up in the queue, outside of the EU, outside of the Americas. I think we were still very fast, from that perspective. The Member seems to suggest there is a gap between procurement and rollout. As I mentioned just now, we got our first batch of Pfizer-BioNTech vaccines late in the year – I forgot which month, could be September or so – and then we rolled out in December. The first batch was not very much. It was 20,000, 30,000. Then, weeks later, more came. When we had sufficient volume – during that time, we had to set up a whole new machinery to handle the vaccine. Remember, mRNA vaccines need an ultra-cold chain. You have to maintain minus 70°C, all the way to the vaccination centre. Once you open it, it has a limited lifespan. Within days, it is gone. So, within those days, you accept appointments and jab it into the arms of people. Which also explains why – one of the questions that Mr Leon Perera raised yesterday – we did not use general practitioners (GPs) at that point. That is one reason, because of the ultra-cold chain and the logistical challenges. So, we had to set-up dedicated vaccination facilities and then push it out. There is no reason for us to delay. Absolutely no reason. We were racing against time. We had danger at our doorstep.”
“Sir, Mr Giam actually raised two separate issues. I think most of our clinicians and public health experts will continue to maintain the view that an index, somehow, you put different ingredients into it, you will come up – viola! – with one number and use that to decide your policy. That would tie our hands. As we learned during COVID-19, it is so fluid. It keeps changing. There are so many facets. You need the flexibility to decide what best to do. Having said that, a separate issue is what I mentioned just now, in reviewing the IDA, even with DORSCON today, you have different tiers. That is quite different from an index. In different tiers, you have a range of options, a range of public health options. So, when you have a pathogen that is dangerous, you first decide which tier you are at. Within that tier, what the range of options are. Then, from the range of options, you mix and match depending on the characteristics of the pathogen. If it proves to be insufficient, then, you upgrade and you explain to people why you need to upgrade the situational tier. I think this is a lot more flexible. There is a framework, but the framework is not equal to an index.”
“Ms Sandra Goh, a lead stewardess with Singapore Airlines, who was furloughed when borders closed, switched to become a Care Ambassador at a hospital and now she is a manager at the Specialist Outpatient Clinics at Khoo Teck Puat Hospital. She told me she could transfer her skills from cabin to ward. Mr Mahmod bin Mohd Yahya and Mr Humam Sufi bin Mohamed Ali, they are a driver-medic pair from Ambulance Medical Services Pte Ltd, who at the height of the pandemic, they worked 14-hour days for several weeks, making up to 16 trips a day to ferry patients to and from COVID-19 care facilities. Mr Toh Guan Ru, one of my community volunteers, who, between the Institute of Technical Education and polytechnic, requested to work for MOH and handle home recovery cases. When he discovered that he did not qualify for the COVID-19 Resilience Medal because his stint was slightly short, he says, "It's okay. I am just proud that I was able to help." I sincerely thank all of them and the hundreds of thousands who contributed. We write the story to record suffering and sacrifice, but also the strengths and remarkable commitment on the part of so many to successfully overcome the crisis. We write to remember, but also to learn. If we do, then, in the next chapter, our hospitals and healthcare systems will be better, our laws more complete, our vaccines and medical supplies more secure. So, we write our next chapter, not knowing whether the world will dawn bright or dark, be hostile or friendly; but confident in ourselves that Singapore has become stronger through this crisis and we can stand taller to meet the next one. [Applause.]”
“The chapter on COVID-19 is a thick one in the story of Singapore, one with high drama, dark days, personal tragedy; as well as bright spots and many high points of courage, collective will and resourcefulness. The story featured so many men and women who fought to keep Singapore safe. I cannot name everyone but they are reflected today in the stories of some of their brethren. Dr Tan Chee Keat at Ng Teng Fong Hospital, who was part of the team to develop a negative pressure isolation chamber used to intubate infectious COVID-19 patients and helped keep her team safe during dangerous procedures. Dr Annitha Annathurai, who personally oversaw the set-up of medical operations at the S11 dormitory and helped calm and assure the migrant workers there, that they would be taken care of. Mr Salman Imtiaz, a volunteer with the SG Healthcare Corps, who helped as a vaccinator with Raffles Medical Group while pursuing his undergraduate studies. Ms Christine Joy Cordevilla Solacito, Senior Staff Nurse at Singapore General Hospital, who used her experience with MERS and Ebola to handle early COVID-19-positive patients from Wuhan, when she cared for ICU patients, administered chemotherapy in the isolation ward and delivered babies for the COVID-19-positive pregnant mothers. Dr Wong Jiayi from Minmed Group, who became a father three times over during the pandemic – one pair is a twin. But he stayed at his post, leading vaccination centres, a regional swab centre, mobile vaccination teams and home recovery operations. Captain Lee Jia Wei, who volunteered to care for migrant workers being isolated at Singapore Expo and, to protect his family, did not go home for 60 days and stayed at Changi Expo.”
“In response to Dr Tan Wu Meng, EDB will continue to engage other vaccine manufacturers to invest in Singapore, grow our biomedical sector capabilities and cement our position as a pharmaceutical hub of Asia. Finally, we will continue to do our part to strengthen global health security and support fair and equitable access to vaccines. There is now a global effort to develop safe, effective vaccines within 100 days of a Public Health Emergency of International Concern being declared. MOH is actively contributing to that effort. Mr Speaker, Sir, I will conclude with the last lesson – and that is to recognise that a crisis forces us to do or try new things. What we thought was not possible to do or would have taken years to implement were accomplished in a matter of months because we were pushed by the crisis. We were stretched and when released, will not rebound back to the old equilibrium. We will reach a new equilibrium. For example, today, we are in a new era of flexible work arrangements. Our schools built up strong digital capabilities and all secondary school students today have their own learning devices because of COVID-19. I am sure Changi Airport will rebound to a new level of capability, post-crisis. In healthcare, the changes are even more profound. During the crisis, public and private healthcare providers became connected by the same IT network. Everyone downloaded and got familiarised with healthcare apps. As pointed out by Ms Ng Ling Ling, telehealth became the norm. We became converts of preventive care as we became conscious of hygiene, got used to diagnostic tests, wearing masks and vaccinating routinely. This is really what sparked Healthier SG. It is a strategy born out of crisis and will profoundly change the landscape for healthcare in Singapore.”
“As for those who did not take the vaccine, they do not just put themselves in danger and at risk, they also put others around them, including their colleagues at their workplaces, at risk. Hence, VDS was needed as a public health measure. But we understand the hardship some of them have to go through. Some of them are allergic to the vaccine. Therefore, the moment we could step down VDS, we did so. More importantly, we must continue to be prepared in case a dangerous variant of concern emerges. So, this is our vaccine strategy going into the future. First, MOH will maintain and periodically refresh an adequate stock of COVID-19 vaccines, to allow continued protection of the elderly and vulnerable as needed and to facilitate a rapid response should there be a major or more severe pandemic wave. Second, we will maintain a network of vaccination centres – primary care clinics, polyclinics and a baseline footprint of five to 10 Joint Testing and Vaccination Centres – even during DORSCON Green. With this, we will be able to administer a booster to all persons aged 50 and above and the medically vulnerable within three weeks, if necessary. Third, we are negotiating agreements to secure early access to vaccines against other pathogens with pandemic potential. These might include new influenza and other respiratory viruses. Fourth, we will invest in vaccine research and development like the PREPARE programme I spoke about earlier. One of our objectives is to establish how to quickly develop a working vaccine, based on either the mRNA or protein-subunit platform and bring it to clinical trials locally. Fifth, through the Economic Development Board's (EDB's) efforts, we will be anchoring six vaccine manufacturing plants in Singapore.”
“Let me illustrate. Before vaccines were available, we had to resort to a circuit breaker in April 2020 to contain the pandemic. The two-month circuit breaker cost us around $11 billion in terms of gross domestic product (GDP) loss. We spent close to another $60 billion, over two financial years, to cushion the hardship for businesses and workers, not to mention all the heartaches and difficulties families had to go through. Without vaccines, we would certainly have to resort to further circuit breakers during the Delta and Omicron waves in late 2021 and throughout 2022. But we did not have to; because the vaccines, we got them early and they protected us. More importantly, our approach averted many deaths due to COVID-19 infections and protected Singaporeans against that catastrophic consequence. Let me now address a few questions regarding vaccines posed by Members yesterday. Ms Hazel Poa thought that MOH favoured mRNA over other non-mRNA vaccines in our regulatory approval. Actually, she is mistaken. Several non-mRNA vaccines could not secure HSA's approval because of insufficient data on safety and efficacy, and we cannot compromise on our standards. Ms Hazel Poa and Mr Yip Hon Weng also asked if VDS were too harsh on the unvaccinated. In a pandemic, measures can be harsh. The circuit breaker was harsh on everyone. The relevant question is, whether from a public health perspective, the measures are necessary and justified. We need to be mindful that while everyone should make their own medical choices, in a pandemic, individual actions affect not just yourself but also others around you. When the vast majority chose to take the vaccine, they not only protected themselves but also their loved ones; they raised our collective resilience.”
“When they arrived, I can take the vaccine and we were one of the first in the world. We built up our population immunity and achieved DORSCON Green today. But there is a price to be paid. Because we deliberately over-procured to mitigate the uncertainty of the selected vaccine candidate not working and the possibility of supply chains being disrupted, there would be spare vaccine stock, which will expire. Some months ago, MOH was asked by the media how many of our vaccines had expired. We could only reply that about 10% of our stock had expired because of confidentiality agreements that we have entered into with vaccine suppliers. I would have preferred to be more transparent and forthcoming with the information. We have since discussed with the vaccine suppliers and they have agreed we can reveal the total value of the expired vaccines so long as we do not give further breakdowns of quantity that enable people to guesstimate or estimate the cost of each dose, which is what they are sensitive about. So, these are the numbers. To date, expired vaccines are about 15% of the doses we ordered, with a total value of S$140 million. In the coming months, this is likely to rise to close to 25%, as more vaccines expire. After that, it should stabilise. We had tried to donate our spare vaccines, but there have been no takers because there has been an oversupply of vaccines in the world. Manufacturers have ramped up their production capacity and demand has been going down as the pandemic stabilises. There are reports estimating that expired vaccines globally could range up to 500 million doses or more. The expiry of unused vaccines was an insurance premium – the price we were prepared to pay to stave off the risk of catastrophic consequences. What are these consequences?”
“The first batch of Pfizer-BioNTech vaccines arrived in late 2020, Singapore being the first country in Asia to receive them. We rolled out the National Vaccination Programme shortly after, from December 2020 – again, one of the first few countries in the world to do so. I think only after the UK, US and maybe, Israel. The Moderna vaccine was added to the National Vaccination Programme in March 2021, and Sinovac and Novavax in October 2021 and February 2022 respectively. While the mRNA vaccines were found to be highly-effective in protecting against severe COVID-19 infections, around the middle of 2021, we faced two new concerns. First, there were early indications that vaccine protection could wane over time, especially amongst the elderly. So, boosters would be needed. We, therefore, procured additional vaccine doses to administer boosters to the whole population. The second concern came up. New COVID-19 variants were emerging. There was a real possibility that one or more might break through vaccine protection and cause new major infection waves, causing many deaths or many cases of severe illnesses. Moderna and Pfizer-BioNTech therefore developed new bivalent vaccines that provide better coverage against the newer virus strains. In September 2022, we took the decision to make a clean switch to these new bivalent vaccines. The monovalent ones had to be stored away. Looking back, today, if we can go back in time, given the uncertainties, the high stakes, what we knew, what we did not know and the challenges we faced, I think we would have done things the same way. Because we secured safe and efficacious vaccines, delivered when we needed them most, Singaporeans took them with confidence, even with relief. I was relieved.”
“So, which one to buy? Second, every country was clamouring for vaccines and there was limited manufacturing capacity to meet that demand. As a small market, we lack negotiating power. That has always been so. This would normally push us down the priority queue for delivery. The situation was worsened by supply chain disruptions caused by the pandemic. But time was of the essence. So, how to secure assured and early deliveries for vaccines? On the first question of what to buy, the workgroup recommended a portfolio approach. Do not put all our bets on one vaccine, but buy a selected number of vaccines across different technological platforms. This includes both mRNA and non-mRNA vaccines. To identify the most promising candidates, the workgroup was advised by a panel of experts from the research institutes, hospitals and industry. Since we did not know which vaccine candidate would work and we had to buy several types – if one does not work, we must make sure the other one had enough volume to cover our population. Therefore, we needed to over-procure such that the combined volumes of all the vaccine candidates more than covered the population of Singapore. On the question of how to secure assured and early delivery, we leveraged our relationships with the pharmaceutical companies and entered into advance purchase agreements with fixed delivery schedules and quantities. That made them bite and we entered into the agreements. Then, to ensure quality and safety, all selected vaccine candidates were reviewed by HSA thoroughly before being authorised for emergency use in Singapore. The Expert Committee on COVID-19 Vaccination provided a second layer of independent review and gave recommendations on how to optimise the use of the vaccines.”
“Thank you. I believe that with the experience of SARS, H1N1 and now COVID-19, the Government knows much better, what measures are necessary and appropriate; and the people of Singapore understand much better, what to do during a pandemic crisis. With that, there is a lower chance of having a panic. The fifth area of improvement, we need to ensure that we have early access to efficacious vaccines for future pandemics. Without sufficient doses of vaccines, our mass vaccination strategy would have been a non-starter. So what if we are willing to take the vaccines, if there are no supplies? But securing vaccines is an art in itself, at best, an inexact science. This is where the judgement I spoke about at the start of the speech, made all the difference. How the vaccine procurement decisions were made in the early stages of the pandemic, is an important story to be told in this House and we shall do it today. Spoiler alert – this story has a happy ending, as noted by Mr Liang Eng Hwa. Despite our small size and despite the worldwide shortage, Singapore was the first country in Asia to obtain COVID-19 vaccines, enough for all our people. But we also paid a price. So, here was what happened. During the early phase of the pandemic, we set up an inter-agency workgroup chaired by the Head of Civil Service and comprising senior officials from agencies, such as Prime Minister's Office (PMO), MOH, the Agency for Science, Technology and Research (A*STAR), Economy Development Board (EDB) and Health Sciences Authority (HSA), to develop our vaccine procurement approach. Once they were formed, they immediately faced two challenges. First, COVID-19 was a new virus. Although several vaccines were concurrently being developed at that time, nobody knew which one would work.”
“These will buy us time to understand the characteristics of the pathogen, the six characteristics that I mentioned. The third tier is Public Health Threat, where more stringent, widespread and longer-term control measures and restrictions are needed. These include various SMMs and restrictions, up to and including a circuit breaker-like imposition. Then, finally, the highest tier is Public Health Emergency, where very stringent measures, such as curfews and requisition of public health assets and manpower, may be effected. When these changes come into effect, we can also use these four situational tiers to replace the current DORSCON colour coding. I think it is more intuitive to tell the public that there is an outbreak, a threat, or an emergency, as opposed to colours. And the law spells out what measures could take place under each situational state. Will this, therefore, prevent the panic buying that we saw during COVID-19, when we changed DORSCON to Yellow and Orange? Some are already shaking your head. Indeed, not on its own. You just change colours to descriptors; there is no reason why panic will just disappear. Whether a people panic during a crisis depends a lot on the information they are getting and whether they know what to do, to protect themselves and then contribute towards societal resilience. If people listen to rumours and they do not know what to do, then most likely they will rush to supermarkets and stock up on toilet paper and instant noodles – and Mr Seah Kian Peng will have a problem again.”
“While COVID-19 was a crisis and a serious threat, we did not declare a public health emergency. We wanted to restrict group sizes, but not to control the movements of people. We were not planning to impose curfews or invoke the Requisition of Resources Act to marshal resources. In other words, the emergency powers under IDA were too blunt and heavy, compared to the public health measures and SMMs we needed at that time. So, instead, Parliament enacted Part 7 of the COVID-19 (Temporary Measures) Act, or CTMA, to provide us temporary, complementary powers to IDA. This ad hoc legislation allowed us to deploy a broad range of tools to tackle COVID-19 at multiple layers, without declaring a public health emergency and this House just extended Part 7 of CTMA for another year. Ideally, we should review and amend the IDA. As it stands now, IDA envisages only two worlds of public health: peacetime or public health emergency, with no gradations in between. COVID-19 taught us that, in a prolonged pandemic, we can go through different phases. So, IDA must be amended to deal with a wider range of scenarios. It needs to be more future-proof. Once the amendments are tabled and if passed by the House, we can and we intend to rescind Part 7 of CTMA. We will put forth the full proposal to the House later this year. Just to share some preliminary thinking, we envisage four public health situational tiers under the amended IDA. The first tier is Baseline, which is a peacetime state. The second tier is Outbreak Management, where a pathogen of concern is detected and measures may need to be implemented urgently to manage disease outbreaks. These include contact tracing and quarantine, testing, border controls and masking.”
“In the initial stages of the pandemic, there was no clear understanding of the characteristics of the COVID-19 virus. We, therefore, aligned our policy to World Health Organization's (WHO's) recommendations, and WHO, even up to March 2020, maintained that: "a medical mask is not required for people who are not sick, as there is no evidence of its usefulness in protecting them." The risk of shortage of masks for healthcare workers would put their lives in danger because they are at the frontline. Is it a serious concern? It was, but it was not the basis of the prevailing public policy on masking. We aligned our policy with WHO. We reviewed and changed our masking policy in April 2020 – that was also when WHO changed its guidelines once the evidence on how the virus spreads became clearer. Particularly, there was now clear evidence that there was asymptomatic transmission via aerosol. Nevertheless, as acknowledged in the White Paper, the whole issue of masking is one area where our decisions could have been better. But no question that during this period, the Government was totally forthright with the people and told the people what we knew. The fourth area of improvement is to update our laws. The Infectious Diseases Act, or IDA, is the principal legislation for the prevention and control of infectious diseases. It empowers MOH to take various public health actions for disease outbreaks, such as contact tracing, isolation of infected persons, testing of contacts or the disinfection of premises and so on. The IDA also provides for the Minister for Health to declare a public health emergency in very grave public health situations. That will activate extensive powers for the Minister, such as controlling the movements and gatherings of people and imposing curfews.”
“Nevertheless, we will keep a permanent CSOG force to maintain surge readiness for a mid-sized outbreak as well as other health emergencies. This includes preparing healthcare institutions to be crisis-ready. In peacetime, when there is no emergency, they help us operationalise Healthier SG, as the skillsets turn out to be fairly similar. It is not surprising, because they are both public health-focused. In addition, we will set up a Healthcare Reserve Force, made up of ex-healthcare workers and volunteers. We will train and equip them to reinforce our operations during larger surges and they will complement the existing pool of SG Healthcare Corps volunteers. Finally, we will change the title of the Director of Medical Services (DMS). Instead of DMS, he will be called the Director-General of Health, which more accurately describes his role as the main overseer of both clinical and public health of Singaporeans. This will take place after the changes to the Healthcare Services Act come into effect later this year. This House has already approved the changes. With these changes, MOH will be organised to place greater emphasis on both clinical services and public health. They require different instincts, considerations, capabilities and skillsets. Both are important and critical, and will be institutionalised and built-up within MOH. Let me now address a question that relates to public health measures, specifically, on the issue of masking. Mr Gerald Giam suggested that the Government was not forthright with the people, that was what I heard. That during the initial stages of the pandemic, we did not impose masking requirements, not because of public health reasons, but because we did not have enough mask supplies. This is incorrect.”
“To do so, we will set up a new Communicable Diseases Agency, or CDA, under MOH. It will oversee disease preparedness, prevention and control, surveillance, risk assessment and outbreak response. This new agency will consolidate the relevant public health functions that, today, reside in MOH, National Centre for Infectious Diseases (NCID) as well as the Health Promotion Board. The National Public Health Laboratory (NPHL) is a critical national resource and will be transferred to the CDA. The CDA will maintain oversight of the clinical facilities in NCID. Many countries, such as South Korea, UK and US, they have similar set ups. They, too, after the COVID-19 crisis, are also reviewing their organisational set up. In addition, MOH will separately retain a permanent Crisis Strategy and Operations Group, or CSOG, in the Ministry. CSOG was established during the pandemic and grew steadily as the pandemic progressed. It is the machinery behind all the pandemic-related operations that we are familiar with – contact tracing, home quarantine, conveyancing to isolation facilities, testing, vaccinations and home recovery. All this, coordinated and implemented by CSOG in MOH. CSOG was staffed by officers from various Ministries, contract staff and also staff from industries affected by COVID-19. For example, we had quite a number of SIA pilots as well as cabin crew working in CSOG. Most of these staff have returned to their industries. As Ms Poh Li San said, it has rebounded from 2% to 80%. We lost all of them. We are sad to see them go, but we are happy that they are gone too because they are going back to their industries. So, the operations have scaled down greatly.”
“These organisational enhancements after SARS, built up capabilities that helped us respond to COVID-19. Given what we have learnt from the COVID-19 pandemic, we should, once again, review our organisation structure to better prepare ourselves for the next pandemic. The one big lesson this time is that we need to rely on a wide repertoire of responses. As I had explained in the chart earlier, each pathogen has unique characteristics needing different responses. In fact, COVID-19 shifted around the chart, requiring us to change playbooks along the way. Specifically, for a severe but less transmissible disease like SARS, we need an individual-centric approach, comprising testing, isolation, tracing, quarantining, that is precise, accurate and as error-free as possible. For less severe but highly transmissible pathogens like the Delta or Omicron variant, it becomes almost impossible to contact-trace and isolate, especially as the disease increases and spreads exponentially. It is also of no use insisting on gold-standard accuracy and precision. Instead, we need to manage the exponential growth of infected persons, through population-wide interventions: mask wearing, Antigen Rapid Test tests in the community, self-testing, self-quarantine for those who are exposed and home recovery for those with milder symptoms. The individual-centric clinical approach versus the population-based public health approach, they are actually not mutually exclusive. In fact, they complement one another and we adopted both during different phases of the COVID-19 pandemic. We should institutionalise both sets of capabilities for the long-term and be able to deploy both with flexibility and dexterity in future pandemics.”
“So, using this framework, what happens when a new pathogen of concern emerges in future? We may have to respond quickly with appropriate border and domestic SMM measures, to minimise infections and to buy time. Then, with good science and the local and global capabilities I just described, we hope to quickly ascertain key characteristics of the pathogen, where it lies on the graph, and then determine the right responses. Concerted efforts to develop and secure effective vaccines and therapeutics will proceed in parallel. The third area of improvement is MOH will restructure to strengthen our organisation. This is something we also did in the wake of SARS outbreak in 2003. MOH put in place a pandemic preparedness plan involving the primary care sector, which evolved into today's Public Health Preparedness Clinics (PHPC) Scheme. Polyclinics and PHPCs served as our first line of defence – to test and treat COVID-19 cases, they support home recovery, they also administered vaccinations and helped in surveillance efforts. So, contrary to what Mr Leon Perera said, our family doctors actually have been and will continue to make an immense contribution during the pandemic and for healthcare in future. We set up the National Public Health Laboratory (NPHL). It conducts laboratory surveillance of infectious diseases and aids in outbreak investigations. When COVID-19 first emerged in Wuhan, it was the scientists from NPHL who designed the polymerase chain reaction (PCR) test for COVID-19, two days after the scientists in China shared the genome sequencing with the world. We established the National Centre for Infectious Diseases, which opened its facilities in 2019 and it provides high standard of infectious disease clinical management.”
“We can plot pathogens on a graph. In this chart, the horizontal axis measures transmissibility and the vertical axis measures severity. It is a simplified way of measuring the six characteristics that I spoke about. So, Members will notice at the top right-hand corner what looks like a durian or explosion, that is Disease X – the disaster that we dread, where the pathogen has high transmissibility and high severity and is deadly. And if you move to the left, you will notice the red dot, that is SARS, with high mortality but low transmissibility. So, when you encounter something like that, it favours a strict containment approach – with extensive contact tracing, chase down, isolate every case, until the virus is eventually wiped out, which we did. As for COVID-19, which is the blue dot, you will notice there is a blue dot near the red dot connoting SARS, called COVID-19 wildtype, that is the initial COVID-19. When it first appeared, the wildtype strain is slightly southwest from SARS. This is why in the early phases of the pandemic we treated it like SARS and adopted a zero-COVID-19 policy. But over time, COVID-19 mutated. As it mutated, it became Delta, became Omicron BA.1, now we have got XBB, XBB1.5, 1.9. They are constantly moving to the right, meaning they are more transmissible. But, with vaccination, we do not just let them move to the right, we also make them move down and suppress the severity of these strains. So, you see the blue dots now moving down closer to the green dot where influenza is. So, overall, with vaccinations, later variants are closer to where influenza is on the vertical axis, which is why we are then able to open up and move towards living with the virus.”
“It is a global non-profit platform for open sharing of genomic data of viral pathogens and, today, it is the world’s largest repository of SARS-CoV-2 sequences. Singapore will work closely with GISAID, and they have established a base here in collaboration with A*STAR. After we understand the characteristics of a dangerous pathogen, what do we do with the information? Having gone through SARS, H1N1 and the various phases of COVID-19, we have developed a range of responses. The characteristics of the pathogen will determine our response. Deputy Prime Minister Lawrence Wong mentioned this briefly in his opening speech yesterday, but let me elaborate a little. Mr Speaker, Sir, can I show a chart on the screen please?”
“Now, let me move to the second area of improvement, which is, we will boost our pandemic preparedness and response. This means having the capability to quickly understand what this virus or pathogen we are dealing with is, and then what actions to take. When dealing with any infectious disease, we, generally, need to understand six key characteristics in order to formulate the right response. COVID-19 really helped us boil down to these six important characteristics. One, how it spreads – for example, between persons in close proximity; or is it airborne through aerosol. Two, the length of its incubation and infection periods. Three, R0 or reproduction number, which is a measure of its infectiousness. Four, how deadly it is. Five, who are the vulnerable groups? For example: is it seniors, children, or both? Spanish flu, for example, affects young children especially. And six, how to treat and prevent it. Without good answers to these six basic questions, we will be fighting in the dark and, most likely, end up fighting the last war. As Dr Tan Wu Meng and Mr Yip Hon Weng have pointed out, we need strong public health scientific and research capabilities to quickly assess these key characteristics. That is the objective of PREPARE. It stands for the Programme for Research in Epidemic Preparedness and Response that I launched in November last year. This is our national epidemic R&D plan and a major initiative arising from the crisis. It will also strengthen our international pandemic research partnerships – to build a network of partners and allies to play our part in strengthening global surveillance of emerging pathogens. We will leverage the Global Initiative on Sharing All Influenza Data (GISAID). GISAID played an instrumental role during the COVID-19 pandemic.”
“We cannot rule out that this could be after-effects of being infected with COVID-19 for some, or it could be a rebound of other forms of infections post-crisis and, during the crisis, suppressed. Once masks are removed, we go back to the Disease Outbreak Response System Condition (DORSCON) Green, they rebounded. It may also simply be a result of our population ageing very rapidly. As I have explained to this House, MOH is doing many things to address this. I will not repeat them today and this includes the recent announcement to strongly protect our healthcare workers against abuse and harassment. However, a post-crisis initiative, which I have yet to explain, is the Transitional Care Facilities (TCFs). TCFs are for medically-stable patients from public hospitals waiting for long-term care arrangements, such as going to a nursing home or going for home care. During the pandemic, we set up 500 TCF beds across five sites operated by five private sector healthcare providers. The TCFs have proven to be very useful. They are very well-utilised and it is as good as adding 500 more beds to our acute hospitals. We have, therefore, decided that TCFs will become a medium or even long-term feature of our healthcare system. We will retain the current facilities, including continuing to use Changi Expo Hall 9 primarily as a TCF. We have about 200 beds there. I thank MTI for sacrificing some exhibition space for MOH. Today, we do not have a TCF in the West and we will start one there in the next few months, in close proximity to the Ng Teng Fong General Hospital. We will also continue to expand the community and step-down care sector, such as community hospitals and nursing homes.”
“If we had relaxed the SMMs, the number, I think, would have easily doubled, probably tripled. This is equivalent to three or four full general hospitals set aside as spare capacity during peacetime, waiting for a surge and then be deployed. So, it is just not realistic to set aside so much spare capacity. So, we should not size the healthcare system to take on the full brunt of the next pandemic. This pandemic has taught us that true resilience must not come from just adequate infrastructure, but also from our social resilience – our collective behaviour. That said, with delays in our infrastructure development due to COVID-19 and rising hospital workload post-crisis, our healthcare system today is less resilient than ideal. Dr Wan Rizal and Mr Gerald Giam raised concerns in this area, which I agree with, especially the stress that it is giving our healthcare workers. Our public hospital bed occupancy has risen, from a pre-COVID level of 87.6% in 2019, to 93.1% in 2022. It has gone up by almost six percentage points. This is largely driven by patients staying longer in hospitals. From an average of 6.1 days in 2019, to seven days in 2022. So, that increase alone explained for all the increases in occupancy. Why is that so? Because we are seeing more older patients with complex conditions and they need to stay longer in hospitals. So, the percentage of senior patients aged 65 and above has risen from 39% in 2019 to 43% now, that is, 2022. Many of them are frail and with co-morbidities and we also found an increasing number being hospitalised because of other viral infections. Not COVID-19 but other viral infections, respiratory illnesses, including pneumonia.”
“You had to switch playbooks – from Queen to The Beatles, from a zero-COVID-19 policy to something closer to managing a bad influenza season. This was a major psychological leap for doctors, MOH and the society. Countries adopted different timetables to this reopening. I think Australia probably went first. They took the first step, followed by Singapore. China only recently opened up. Looking back, in all three decisive moments of judgement, I think we, collectively, made the right calls. Despite this, COVID-19 has been a humbling experience. We have a duty to learn from the crisis and ensure that those whose lives were lost to COVID-19, did not pass in vain. It will not be in vain. We have translated the trials and tribulations of the pandemic into six areas of improvements, to better prepare Singapore for the next pandemic. Sir, for the rest of my speech, I will go through each of these areas. The White Paper had mentioned them briefly but I will elaborate. First, we will strengthen our hospital capacity. Our healthcare system was severely tested during the pandemic. At one point, we were monitoring bed availability, capacity, caseloads almost by the hour, to detect any signs of imminent collapse. Fortunately, we had the SMMs in place; we had high coverage of vaccinations, which protected our hospitals. At that time, many questions were asked, including in this House: why did we not plan for more hospital capacity in anticipation of the pandemic crisis? At that time, I was asked: if we did, we could have relaxed the SMMs. This would not be a realistic course of action. To illustrate, even with vaccinations and SMMs, at the peak of the Delta wave in 2021, we had almost 1,300 patients hospitalised, 140 in ICU.”
“We were clear and transparent and published the incidence of side effects every quarter. The incidence of severe adverse effects for the vaccines has been low – typically, five to seven per 100,000 – and a great majority recover on their own, without even going to the hospital. So, the benefits far outweigh the risks. Fortunately, the great majority of Singaporeans and the public trusted our recommendations to take the vaccines. We achieved over 90% vaccine coverage and I thank the Workers' Party for supporting this very pivotal national effort to vaccinate our population. This is our collective judgement, as a people, to achieve high vaccination coverage. And this is the other big reason why we could minimise the number of deaths due to COVID-19. Then came the third judgement call – the tricky one – which is, having achieved high population immunity, when should we open up? For many countries in Europe and America, after the virus had spread widely, with many people infected and many deaths, their population immunity was actually high and they could afford to open up early. So, in the course of the pandemic, many people also urged MOH and MTF – can you quickly open up like other countries in the West, in Europe, in the Western Hemisphere? The desire is understandable, but they overlooked the key difference between us and them. They paid the price in human lives, which we refused to pay. We, along with a small handful of countries, managed the situation tightly, contained the spread of the virus and used the time to vaccinate as many people as possible. Then, came a time to open up and you had to switch from one set of rules to another.”
“Doctors had to turn away patients who were very ill and they were all just waiting along the corridors. When a hospital bed or ventilator became available, the doctor had the heart-wrenching task of deciding – who do I save? This judgement call – the careful husbandry of our hospital beds before the great majority of our population was vaccinated – is the primary reason why Singapore kept our COVID-19 mortality rate low. The second judgement call has to deal with vaccination coverage. Most countries rolled out national vaccination programmes and they achieved varying levels of coverage and then resilience. Those, if Members remember, were confusing times, because the vaccines were new and anti-vaxxers were out in full force, spreading falsehoods and half-truths to persuade people to avoid vaccinations. I know of friends who do not want to take the vaccines. But I think it is one thing to have a personal preference, and quite another to make it into a public campaign because that affects other lives. I had to exercise my authority under the Protection from Online Falsehoods and Manipulation Act (POFMA) when I judged that a circulating falsehood was misleading people into avoiding vaccines. The law was designed for such occasions, especially when lives are at stake. It is worth stating in this House, again, that the weight of global evidence clearly shows that COVID-19 vaccines are effective and safe. Our latest MOH data shows that during the Omicron waves of 2022, vaccines lowered the probability of severe disease and deaths for the elderly by more than five times. Do COVID-19 vaccinations have side effects? Definitely, they do. Dr Lim Wee Kiak, my colleague, always says, if a medicine has effects, it can have side-effects. A medicine without side effects has no effect.”
“And every one took their own or its own path – some by choice, others forced by circumstances. I would say how each country or region faired in this COVID-19 common challenge, essentially, boils down to the following three judgement calls. First, whether through our decisions and, in the early stages of the pandemic, we effectively made hospitals the singular defence against the virus. Here, past experiences mattered. Many countries in Europe or the Western Hemisphere – the Americas – deal routinely with influenza, including very severe winter seasons. The influenza playbook – they used that and it was proven to be inadequate for COVID-19. So, the virus spread widely, hospitals effectively became their singular defence, which became overwhelmed, leading to many deaths. On the other hand, places like Singapore, South Korea, China, we had seen "ghosts" before. We had seen SARS and the Middle East Respiratory Syndrome (MERS). We had the processes and capabilities in place and then we moved quickly to contain our initial outbreaks with stringent border measures, testing and isolation of cases, tracing and quarantining of individuals. So, we used our entire public health arsenal and we succeeded in preventing our hospitals from being overwhelmed, especially in the initial stages of the pandemic before there were vaccinations. If there was one thing the Prime Minister constantly reminded the MTF chairs, it was this golden instruction – protect our hospitals' capacity – and we took it all very seriously. Because when the entire weight of the country's health rests on hospitals, even if that was not the intention, it will not just be COVID-19 patients that die, but everyone who needs urgent medical attention can die. In many countries, this was what happened.”
“Mr Speaker, Sir, 1,711 – this is the number of people in Singapore who had died of COVID-19 infections as of 31 December 2022 and as reported in the White Paper. MOH estimated an additional 2,000 deaths over the course of the pandemic – that is above the expected number of deaths based on pre-pandemic trends. These individuals, not recorded in the official death toll for COVID-19, might have died of undiagnosed COVID-19 infections or COVID-19 could have worsened some underlying conditions, leading to their deaths. All in, over 3,700 deaths, estimated – most of them older, with co-morbidities, underlying illnesses, many unvaccinated and they are most affected by COVID-19 infections. We will never know the exact number or all the names and the faces of every victim of this pandemic crisis. Never had Singapore gone through a crisis that inflicted such a heavy toll on the lives of our fellow men and women since Independence. I think nothing even comes close. This is, indeed, the crisis of a generation. And behind every passing, there were family members, loved ones, doctors and healthcare workers doing their best to comfort them, to save them. At MOH and, I am sure, in this House, we mourn their deaths and extend our deepest condolences to their families. COVID-19 placed lives and livelihoods in very stark contrast – or, maybe more aptly put – it put in contrast your desire to survive and live vs what is the purpose of living. This same challenge was faced by every country, every region, which is: how do you navigate out of this dangerous conundrum, regain your normal lives while protecting the lives of your people as much as possible? Every country and region faced this challenge.”
“There are three GLP-1 receptor agonist drugs which have been approved for use in Singapore by the Health Sciences Authority (HSA) for the management of diabetes. Of these, two have also been approved by HSA for the purposes of obesity management.”
“The Ministry of Health constantly monitors best practices and technological innovations in other countries, including in aged care, that are suitable to be used in local settings. However, we do not deliberately evaluate how we fare compared to other countries in this area, as circumstances differ across countries. Over the years, we have embarked on numerous projects that use technology to enhance care for seniors. One example is a web-based health management system that integrates technology and home care services, such as smart home sensors, medication adherence and meal planning and delivery. Another project aims to create a safe home environment for seniors through a sensor-enabled fall detection system. Service providers also adopt technology in different ways, including leveraging telehealth for remote monitoring of vitals, checking in on mental and emotional well-being, and delivery of care services. There are also ongoing trials to bring companion robots that were developed in other countries, such as Japan, into nursing homes and community hospitals to improve seniors’ social engagement.”
“The Ministry of Health's (MOH) healthcare budget is used to support the prevention, control and treatment of a wide range of conditions and diseases, including mental health conditions. An average of $385 million was spent on mental health annually from FY2020 to FY2022. Table 1 below provides the breakdown of MOH’s expenditure on mental health treatment and promotion and prevention.”
“With our high level of resilience, the great majority of COVID-19 infections are mild and there is no need to routinely test every person with acute respiratory infection (ARI) symptoms. Hence, the Ministry of Health (MOH) no longer imposes any mandatory testing for public health reasons. Testing is mainly for patients who are medically vulnerable, for example, the elderly or immunocompromised, who can benefit from early COVID-19 diagnosis and treatment. Such patients can tap on prevailing subsidies for their testing and treatment fees. Oral antivirals remain free-of-charge for clinically eligible patients. As for the national ARI surveillance programme, this helps us monitor the trends of COVID-19 variants and other circulating respiratory viruses, such as influenza, in the community. These tests remain free.”
“The public Assisted Reproduction (AR) centres, generally, have sufficient capacity, with current utilisation rates at around 67% and average wait times of around four to eight weeks. The public AR centres are also expanding to prepare for an increase in patient load. The National University Hospital completed renovations of its in vitro fertilisation (IVF) laboratory in 2022, while the KK Women’s and Children’s Hospital is in the process of building a second IVF laboratory. Nonetheless, we recognise that there could be scope to consider extending co-funding to the private sector as some couples may prefer to seek treatment at private AR centres. As part of the ongoing review, the Ministry of Health (MOH) is studying the merits of doing so and assessing how best to ensure clinical outcomes are monitored and acceptable, that couples are charged reasonably and that co-funding monies are used prudently. We aim to complete the review by the end of this year.”
“Based on publicly available data from the Singapore Association for Counselling (SAC), the number of counsellors registered with SAC increased from 940 in 2020 to 1,240 in 2022. Besides professional counsellors, other healthcare professionals and social workers provide counselling as part of their work. There is no international benchmark on the ratio of counsellors to population. The tiered care model for mental healthcare delivery currently being developed by the Interagency Taskforce on Mental Health and Well-being will serve as the basis for agencies to plan and develop counselling services and manpower across different sectors. More details will be released in due course.”
“For the period up to 31 December 2022, the reported rate for myocarditis is one per 1,000,000 doses for the bivalent mRNA vaccines, compared to 11 per 1,000,000 doses for the monovalent mRNA vaccines. Since September 2021, the Ministry of Health has advised individuals to avoid strenuous exercise or physical activity for two weeks following any dose of the mRNA vaccine as a precaution. The World Health Organization and many international jurisdictions, including the United States and the United Kingdom, do not recommend this unless there are symptoms post-vaccination. Many work activities, such as walking and working while standing, are not strenuous and workers can continue with them as long as they are well. However, the level of physical exertion differs between jobs, settings and individuals. Employees and employers should discuss work arrangements so that employees can work safely after vaccination.”
“Thank you for reminding us about the My Legacy portal. It will be a very useful resource. But on an issue as personal as how you decide you want to go and where you want to go, it goes beyond a portal that we actually need to consciously speak to patients and their loved ones about, and have that conversation early on. You never know, with Healthier SG, once you develop a long-term, patient-doctor relationship with a trusted doctor, at some point, it is something that the doctor can speak to you about. And once you think about it, these are things you may have to even discuss within the family and, in that context, then refer to My Legacy portal. This is how I think it will work. It is quite unlikely that you are surfing the Internet, ChatGPT – how should I go – and suddenly come upon a revelation, it is quite unlikely. It requires quite a serious intimate discussion with somebody you trust. Second, will MOH consider micro jobs? I think we will. I am keen to look into that. Many of our AACs actually look into that. They do have one word of caution – that you do not want to pay your volunteers just cash. In fact, for many seniors, it is not about the payment but about getting involved, feeling useful and then being recognised in some way. Does not need to be paid. It could be health points or could be something else. So, we will think along those lines. But these are important suggestions.”
“I think there is an option to give vouchers. I will confirm. I believe there is. Second, is the reward system after the sign-up. Because when it comes to preventive care, you cannot run away from exercise and taking steps, keeping your heartbeat moderate to intense certain times of a week and, therefore, Healthy 365 is one way to keep you going. Yes, keep on reminding you that you can accumulate health points by having an active lifestyle. So, this is the reward system that is long-lasting. How to get more people onto Healthy 365? I think your neighbour has a very good suggestion – to hold carnivals. That is one way to get it kickstarted because we do know that if you hold a carnival, people do come down, participate and we will have ambassadors – we will mobilise all our Silver Generation Ambassadors who were very useful when we rolled out the Pioneer Generation and Merdeka Generation packages. Now we can leverage their network to help people sign up for Healthier SG and also sign up for Healthy 365. The Member mentioned the two apps – one is Health Hub; and the other is Healthy 365. I just want to explain that we need both apps. I know there was a suggestion to lump everything into one app. But I think we have so many apps in our smartphone, we can live with two. There is a good reason. HealthHub is your private data. Your medical data, summary health data, is in there and you should access it using Singpass and have sufficiently high security. But it will also be shared when the Health Information Bill is passed by this House. These are data that can be shared across healthcare providers in different settings. Healthy 365 is your own lifestyle data. It should be just for yourself. You can show your doctor, but this is actually your data, it will not be shared.”