Rahayu Mahzam
Singapore
“We engage the insurance providers quite regularly, but we are very mindful about where we intervene, especially because they need to be competitive and there is a commercial dimension to it, which we feel that we should respect. So, how we intervene is via the conditions that are put in place vis-a-vis the consumers.”
“So, that is not something they can worry about. There is already the S+3M framework that is already in place, so we know that MediShield Life is one, they have their MediSave and if all else fails, there is MediFund.”
“Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes.”
“It is just a symptom, so the underlying cost pressures still need to be addressed. The description that we had put earlier in the past is that it is a knot that we need to untangle; and that is something we are doing with a multi-pronged, with engagements with different parties and stakeholders.”
“I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that.”
“But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.”
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“Based on the information that we have from the Immigrations and Checkpoints Authority, the vast majority of foreign spouses with Singapore Citizen husbands and have Singapore Citizen minor children are actually LTVP+. So, in that sense, the vast majority of spouses are therefore eligible for medical subsidies already. We generally receive very few appeals each year from Singapore residents for their sponsored dependants on LTVP. If you do have some of these cases, they can be surfaced, and they can approach medical social workers to request for financial assistance.”
“Based on the information that we have from the Immigrations and Checkpoints Authority, the vast majority of foreign spouses with Singapore Citizen husbands and have Singapore Citizen minor children are actually LTVP+. So, in that sense, the vast majority of spouses are therefore eligible for medical subsidies already. We generally receive very few appeals each year from Singapore residents for their sponsored dependants on LTVP. If you do have some of these cases, they can be surfaced, and they can approach medical social workers to request for MediFund. [Please refer to "Committee of Supply – Head O (Ministry of Health)", Official Report, 7 March 2025, Vol 95, Issue 160, Budget section.] [(proc text) Written statement by Ms Rahayu Mahzam circulated with leave of the Speaker in accordance with Standing Order No 29(5): (proc text)] I wish to make the following factual correction to my reply provided during the Sitting of 7 March 2025. My statement should read as follows:”
“Based on the information that we have from the Immigrations and Checkpoints Authority, the vast majority of foreign spouses with Singapore Citizen husbands and have Singapore Citizen minor children are actually LTVP+. So, in that sense, the vast majority of spouses are therefore eligible for medical subsidies already. We generally receive very few appeals each year from Singapore residents for their sponsored dependants on LTVP. If you do have some of these cases, they can be surfaced, and they can approach medical social workers to request for MediFund. [Please refer to "Clarification by Minister of State for Health", Official Report, 7 March 2025, Vol 95, Issue 160, Correction By Written Statement section.] The Member still looks very puzzled. I am happy to take this up separately and see if there are specific cases we can assist you with.”
“Let me refer to the portion that I responded to. So, actually, what I said was that foreign mothers who are married to Singapore Citizen fathers and, who are PRs or on LTVP+, can receive Singapore Citizen-level subsidies for delivery episode, in recognition that their child will be a Singapore Citizen; and PR-level healthcare subsidies for all in-patient services. So forth, for maternity care, when it is the delivery, they will actually get Singapore Citizen-level subsidies.”
“Indeed, HSA does monitor regularly on the upstream sales that we see on the online spaces and HSA actually works closely with the platforms to ask them to take down all the postings on the illegal sales of such product. So, HSA collaborates with platforms, like Instagram, Carousell and Facebook, to remove the postings. And MOH and HSA are currently working with MDDI as well to see how we can encourage social media platforms to further strengthen this effort to detect and remove these online sales of advertisements on e-vapourisers. This is something that I understand is a worrying concern and we will continue to look at how we can enhance our efforts in this space.”
“This journey requires our collective commitment and together, we can build a Singapore where every individual has improved opportunities and access to a more well-rounded, healthier life. [Applause.]”
“Efforts have also been made to streamline processes and reduce administrative tasks so that nurses can complete their duties efficiently and end their shifts on time. Today, the attrition rate of nurses in the public healthcare clusters has dropped from 9% during the pandemic years of 2021 to 2022 to around 6.7% in 2024. This decline in attrition, coupled with our sustained efforts to recruit new nurses, is helping to strengthen our nursing workforce and improve working conditions on the ground. Mr Ang Wei Neng asked about dental manpower sufficiency. To meet Singapore's evolving dental needs, the National University of Singapore has increased its annual Dentistry intake by 50% from 2015 to 2024. The number of registered dentists also grew by 35% in the same period, bringing our dentist-to-population ratio to 0.5 dentist to 1,000 people. This is on par with other developed countries, such as South Korea and the UK. Our local dentistry programme remains a steady and sufficient source of new dentists and hence, we do not currently provide pre-employment grants for dentistry. We will continue working with local Institutes of Higher Learning to meet national manpower needs for dental care. Nonetheless, Dentistry students who choose to study overseas are welcome to return to Singapore to contribute as our healthcare needs expand. Mr Chairman, in closing, health is more than the absence of illness. It is about the quality of life for ourselves, our families and our communities. From nurturing healthy habits to family planning and ensuring the well-being of our healthcare professionals, we are building a system that supports Singaporeans at every stage of life.”
“We agree that no one should have to forgo the opportunity to have a child because of the side effects from a medically necessary treatment for a condition. Hence, from June this year, we will extend subsidies for embryo, egg and sperm freezing for those whose fertility can be irreversibly affected by their medical treatment. From next year, we will also extend MediSave coverage for embryo freezing, and MediShield Life coverage to support embryo, egg and ovarian tissue freezing for such individuals. Those who still face challenges with the cost of their fertility preservation treatments arising from medically necessary treatments may also approach medical social workers at their public healthcare institutions for further assistance, including to apply for MediFund. With these changes, we hope to assure patients facing medical challenges that their dreams of starting a family in the future are still within reach. Mr Chairman, allow me to move on to healthcare manpower. A strong healthcare workforce is vital to support both our preventive health initiatives and treatment needs, and we remain committed to building this capacity. I thank Mr Louis Ng for his concern on rest time for nurses. The well-being of our healthcare workers, including nurses, continues to be a perennial concern. There are clear practices in our public healthcare institutions to ensure that nurses have sufficient rest during shifts. For example, nurses take staggered breaks during their shifts so that there is sufficient rest time for each nurse. Dedicated rest areas, separate from clinical spaces, are also provided to ensure breaks are uninterrupted. Between shifts, the clusters limit the number of consecutive working days.”
“(In English): For the next part of my speech, I will focus on family and fertility, which is an issue close to the hearts of many in this House. Ms Sylvia Lim asked about the differences in maternity fees for Singapore Citizens and PRs as compared to non-residents. We understand that healthcare costs are an important consideration in setting up a family, particularly for transnational families. Hence, foreign mothers who are married to Singapore Citizen fathers, and who are PRs, or on Long-Term Visit Pass Plus, LTVP+ in short, can receive Singapore Citizen–level subsidies for the delivery episode, in recognition that their child will be a Singapore Citizen and PR-level healthcare subsidies for all inpatient services. In fact, the vast majority of foreign mothers married to Singapore Citizens, and with Singapore Citizen children, are PRs or LTVP+ holders, and they would be eligible for these subsidies. Expectant mothers married to Singapore Citizens may apply for an LTVP, and those who are eligible for an LTVP+ will be granted subsidies accordingly. Beyond subsidies, the MediSave Maternity Package also allows couples to use their MediSave for their delivery and pre-delivery expenses. Singapore Citizen or PR fathers whose spouses are giving birth in Singapore may tap on their MediSave to defray the out-of-pocket cost of their maternity fees. For some individuals, however, the ability to build a family may be irreversibly compromised by medical treatments that are required to treat conditions, such as cancer. Such treatments can significantly impair one's fertility. I thank Dr Tan Wu Meng and his healthcare worker peers for tirelessly advocating for young cancer patients seeking fertility preservation.”
“For the Malay/Muslim community in Singapore, this is achieved through the Jaga Kesihatan, Jaga Ummah (JKJU) network, which comprises various organisations such as M³ agencies, Malay/Muslim bodies and religious organisations. This network, which initially started with just several mosques, has grown and continues to grow. The number of partners has increased from 100 in 2023 to over 160 in 2024. At the Sihat Bersama JKJU event last February, we acknowledged our partners and encouraged them to collaborate. Our partners also had the opportunity to showcase their efforts at the various booths which were also open to the public. At the Townhall session with me, Dr Wan Rizal and Ms Nadia Samdin, we openly discussed the health issues our community faces, how there is a socio-economic impact and different ways we can enhance our efforts to stay healthy holistically. I am heartened by the discussions we had and our partners' commitment to making a difference as we move forward. We have now entered the month of Ramadan and will continue with the programmes that have been planned. This year, I am encouraged to see our JKJU partners expand and move towards a more holistic approach to health, while tailoring their activities to the needs of the community. For instance, some of our M3 partners are collaborating with more JKJU Resource Partners like Caregivers Alliance Limited and the Stroke Services Improvement (SSI) Team under MOH to conduct talks on mental health and stroke awareness during this Ramadan, to promote heath screening and mental well-being. Indeed, Ramadan provides a good opportunity for our community to make healthier choices a way of life. I urge the community to make the most of this time and bring about a positive shift in our lives.”
“As Mr Ang pointed out, there are some common misconceptions around vaping and, to this end, HPB has launched a series of campaigns over the last two years to increase awareness of the illegality and harms of vaping. To further amplify awareness, multiple channels, including social media and youth content creators, were engaged to more effectively reach the intended target audience. Relevant stakeholders will continue to work closely to raise awareness among children and youths on the harms of vaping. On the enforcement front, the Health Sciences Authority (HSA) has increased enforcement operations, especially in public vaping hotspots, alongside other agencies, such as the National Environment Agency and National Parks Board. Collaboration with the Immigration and Checkpoints Authority has also been strengthened to combat the smuggling of e-vaporisers at the borders. In educational institutions, the Ministry of Education maintains a firm stance against vaping, with disciplinary actions taken and referrals to HSA for offenders. Looking ahead, MOH and HSA will be reviewing legal penalties to bolster deterrence against the importation, distribution and use of e-vaporisers. Education and enforcement against vaping are a long-term effort, which will be continually monitored and reviewed to ensure we address the vaping issue effectively. Mr Chairman, allow me to say a few words in Malay. (In Malay): [Please refer to Vernacular Speech.] In our health promotion efforts, we should take an approach that is nuanced and suitable for the groups we are reaching out to. This can only be done effectively if we work with a variety of groups and organisations in the community.”
“With the changes, we hope more residents will join the variety of physical activity programmes conveniently located in their neighbourhoods. We further recognise that some may prefer to exercise at their own pace and time. HPB offers virtual physical activity sessions on Zoom and self-directed digital programmes. An example is the 12-week Age Strong programme which was launched in November 2024 on the Healthy 365 app, catering to residents aged 50 and above. Participants can take part in customised workouts and learn about nutrient-rich diets and mental well-being. The programme also provides HealthPoints for completion of daily tasks. In response to user needs, HPB has also enhanced the Healthy 365 app with a new goal-setting feature and a refreshed set of milestone-based challenges in October 2024. Users can set personalised activity goals for their physical daily activity and sleep duration to suit their preferences and daily routines and earn rewards for meeting their goals. Today, more than 840,000 residents regularly use the Healthy 365 app to track their progress in meeting their activity goals, access lifestyle activities, recommended resources and programmes, and earn rewards from completing tasks and challenges. For those who have yet to come on board the Healthy 365 app, I urge you to be part of this journey to take steps towards better health. An area of growing concern that impacts on health and lifestyle is vaping. Mr Ang Wei Neng has expressed his concerns on this matter and urged stronger enforcement efforts. MOH, in collaboration with various stakeholders, has intensified our whole-of-Government approach to combat vaping through public education and enforcement efforts.”
“Everyone can now participate in activities suitable for their fitness level and at a convenient location. We are heartened that the programmes have been well-received by Singaporeans. Alongside the increase in physical activity programmes, the weekly attendances for these have increased from 36,000 participants in 2023 to 47,000 in 2024. 6.00 pm To support Healthier SG GP clinics in encouraging appropriate physical activities for residents, HPB has also developed a guide to Lifestyle Prescriptions available on the AIC webpage. The Healthier SG EventsGoWhere Portal was also launched last year to provide GPs and their care teams with a consolidated list of healthy lifestyle programmes from HPB, People's Association, SportSG and Active Ageing Centres to recommend to residents. As we continue to build the infrastructure to encourage physical activity in the community, we have also been listening to residents' feedback. We understand concerns over late arrivals and registration capacity for physical activity programmes. Some residents may also be unsure about the sign-up process. In response, HPB will exercise greater flexibility. For low and moderate intensity activities, including yoga, Zumba Gold and resistance band exercises, latecomers and walk-ins will be allowed, subject to capacity limits. For safety reasons, higher-intensity activities like High Intensity Interval Training will still require punctual arrival, as proper warm-up and safety checks are needed to minimise injuries. We encourage everyone to sign up for the activities via the Healthy 365 app and arrive on time. Prior to participating, residents should also monitor their own readiness and refrain from exercising if unwell.”
“The availability and affordability of healthier ingredients for F&B operators and consumers are key to the success of our efforts. To this end, HPB's Healthier Ingredient Development Scheme supports manufacturers and suppliers in their reformulation efforts while reducing the price gap between healthier and regular versions. These efforts have borne fruit. Today, over 1,700 eateries, including stalls in hawker centres, have switched to lower-sodium ingredients, compared to 500 eateries two years ago. We will continue to build on these efforts to advocate for healthier meals that are lower in sodium, saturated fat and sugar. Besides healthy eating, we must support active living. Mr Chairman, allow me to share the broader picture of healthy lifestyles and our progress towards shaping an active nation. I thank Ms Ng Ling Ling for her concerns on plans to increase participation in the HPB-led physical activity programmes and efforts to reach out to Healthier SG GP clinics to support these programmes as part of social prescription. HPB conducts regular fitness programmes that are accessible and convenient for residents in the neighbourhoods. These community physical activity programmes have been expanded to over 2,100 sessions each week, up from over 1,700 sessions in 2023. These activities are also now held at more than 1,300 locations. HPB has also expanded their programme offerings to cater to different segments. These include programmes, such as Steady Lah and Healthy Ageing Promotion Programme for You (HAPPY), to address frailty for seniors, Active Family Programme for young families, and Start2Move programme for individuals looking to kickstart an active lifestyle.”
“Mr Chairman, my speech will cover the Ministry's efforts in three areas: firstly, on reshaping our norms and choices in healthy living; secondly, on maternity costs and fertility preservation; and lastly, on ensuring a robust healthcare workforce. We have made strides in our efforts to reduce sugar consumption. As shared by Minister Ong, we will also tackle the issue of excessive intake of sodium and saturated fat. Ms Ng Ling Ling asked about the plans for extension of Nutri-Grade labelling for sodium and saturated fat in the F&B setting and the healthier alternatives that are available across cuisines. We understand from engagements with the industry that tackling sodium and saturated fat content in eat-out dishes is challenging. Given the diversity of cuisines in Singapore, the different cooking processes and recipes can lead to variations in the amount of sodium and saturated fat in a dish. Moreover, time is needed for consumers to adjust their palates to lower sodium dishes and for F&B operators to adopt healthier ingredients. Therefore, we are not applying the Nutri-Grade measures to dishes in the F&B setting for now. Instead, we are strengthening our engagements with F&B operators. This includes ramping up voluntary store-front labels to help consumers identify stores that offer healthier dishes, either by using healthier ingredients or using less salt or sauces when cooking. Besides encouraging F&B operators across various cuisines to use healthier ingredients and provide more healthier options through the Healthier Dining Programme, HPB is also actively engaging our hawkers on the importance of sodium reduction and providing them with samples of lower-sodium ingredients. HPB has reached out to 60 hawker centres, with 50 more planned for 2025.”
“So, there are different considerations for different surveys and, therefore, there is a different approach. The Member had one more question. Yes, on our services. I think we endeavour as much as possible to make sure that there are alternatives and support. Like I said, we set up the ServiceSG centres for the purposes of that. As much as possible, we will endeavour to make sure that those who are in need, who are unable to access it, will be able to get the help they need. And I think that can be done in many different forms. So, if there are concerns highlighted to us, we will see how we can close those gaps.”
“Mr Chairman, let me take the second and third questions. In respect of the surveys, just to clarify, MDDI does not coordinate all surveys that are done by the Government because each Government agency will have to look at that individually. They will have different needs and may address different issues. So, we cannot confirm that. It may be that, for some surveys, there may be a preference to have it as anonymised in that sense because the response, if you are told that it is something that is asked by the Government, may then not be accurate and may be skewed because if you are asked, say, for benefits, whether they should be improved or increased, without assessing the situation, the person might just respond because it is the Government, expecting that it should be changed, to just ask for more. So, I think there are certain considerations which I would not want to assume, because different agencies may do it differently. On the Member's third question, all surveys are done in the interest of the public. It is really, where possible, if the information that is garnered from those surveys is useful, we would want to put it up. We want to be as rich as possible so as to encourage public discussion. But there are certain matters that may not be as suitable. Considerations include, let us say, some data include confidential or personal data that can be reidentified if it is put out there. There may be certain sensitivities in issues of, say, racial and religious issues, if we have done surveys on that and certain matters come up. And there may be certain understanding or contracts that we may have with certain agencies that we partner in doing some of those surveys.”
“Indeed, NLB sees Gen AI as a useful tool and seeks to provide the platforms and opportunities for both to be edified about it. But we are also respectful of the different interests. We do see strong public interest in the different AI prototypes. An example is the NLB's interactive ChatBook featuring S Rajaratnam, which was powered by Gen AI. So, what NLB does is that it takes a measured approach to developing such prototypes and implements safeguards, such as using controlled datasets, securing copyrights and permissions from authors and creators to use their works, and carrying out extensive testing. This ensures that AI is used ethically and responsibly to complement, not replace, the efforts of authors and creators. Through such prototypes, NLB also hopes to help visitors discover writers, stories and content and experience them in different ways.”
“Yes, just two more paragraphs. The findings from the Government-commissioned surveys are shared publicly when it is useful to do so. However, as the surveys are commissioned primarily to shape public policy, not all findings are suitable for public release. As to Mr Giam's concern that Government-commissioned surveys could be used for non-public policy purposes, funding for such surveys is subject to the same governance requirements as other forms of public expenditure undertaken by Government agencies. To conclude, Mr Chairman, we invite everyone – individuals, companies and community organisations – to become a partner of the Digital for Life movement and join us in our efforts to help Singapore build an inclusive and cohesive digital society. All of us have a part to play in making our online space a safe, healthy and positive one.”
“Mr Gerald Giam shared his experience with surveys and asked if they were commissioned by the Government. It is unfortunate that the poster did not disclose to Mr Giam the identity of the commissioning party for the survey. Without the benefit of seeing the actual questionnaire, it is difficult to say for sure that the surveys were conducted by the Government. In MDDI's case, we conduct regular polls to gauge the public's awareness of scams as well as the quality of mainstream and online media and the public's news consumption habits. When asked by respondents, our representatives would identify MDDI as the commissioning agency for the surveys. We conduct the media polls to help Government agencies adjust their public communication efforts to better reach target segments on key national policies. They also help shape our public broadcast funding. The poll findings on scams help MDDI to shape our policies to tackle online harm. The findings from the Government-commissioned surveys —”
“The Ministry of Health's updated guidance on screen use under Grow Well SG and the Parenting for Wellness Initiative equip parents so that they can better protect their children from inappropriate content and instil good screen use habits. Parents can also find bite-sized resources on IMDA's Digital for Life portal. Members may refer to the handout for a list of these resources. A Positive Use Guide on Technology and Social Media will also be available later this year. Youths are a key group of citizens who shape online behaviour and culture. Youths should be encouraged to use their influence to foster a positive online environment. I was encouraged to see students championing a kinder Internet at a recent digital well-being roadshow at the Singapore Management University. One booth featured an interactive game that showed participants how to navigate online conversations and respond to their friends with care and kindness. Over 650 students participated in the two-day roadshow. Toxic online discourse is worrying because it undermines our ability to understand one another and disrupts our social cohesion. As Mr Alex Yam mentioned, we must be civic-minded in the online space, just as how we conduct ourselves in our shared physical spaces like our neighbourhoods, parks and schools. The Government is committed to exploring new ways to nurture a positive online space. We will study issues like online polarisation that can negatively impact our social cohesion and explore ways to encourage a culture of positivity and civic-mindedness online. In the work that the Government does, it is always important to check in on the sentiments of the community. This allows us to accurately identify Singaporeans' concerns and align with the expectation for a responsive Government.”
“About 60% of primary schools and 40% of secondary schools will introduce AI for Fun this year. It is our endeavour to ensure that every Singaporean, regardless of age, is encouraged to learn, use and have fun with new technologies in an informed and responsible way. This brings me to the topic of online safety. Incidents that take place online, like the generation and dissemination of deepfake nude photos, cause real-life damage and are unacceptable. About 74% of Singaporeans had encountered harmful online content in 2024. This has led some people to be fearful of the Internet and how it appears to be changing the fabric of our society. But it is important to recognise that these harms are not caused by technology in itself, but by bad actors and bad behaviour. The Government will do our part to reduce online risks. Minister Josephine Teo earlier spoke about our regulations to make designated social media services and app distribution services responsible for putting in place safety measures to protect their users from harmful content. However, regulations are not foolproof. Bans and age limits like those being contemplated in other countries may sound compelling but, in reality, there will always be ways to circumvent such rules and restrictions, as Mr Eric Chua has pointed out. Citizens must also take steps to protect themselves and their loved ones online. Parents play a critical role in guiding their child's digital journey. The Government shares parents' concerns over excessive screen use and exposure to online risks amongst children.”
“I personally felt their enthusiasm for learning, sharing and collaborating when I attended one of the AI Wednesdays sharing sessions organised by Lorong AI. Within our Malay/Muslim community, many have already begun exploring AI. A group called PEREKA, comprising Malay/Muslim designers from various fields, shared how they use AI to improve their work. I had the opportunity to meet them recently, and was very excited to hear how they leverage AI to enhance their work processes. The aim is not to replace human creativity, but to facilitate the ideation process and gather information. All this is to produce design features that align with our cultural values and identity and at the same time, ensuring that the human touch remains at the core throughout the design process. I really hope that more dynamic local groups like these will emerge so that they can learn together and spark interesting ideas to harness technology for the well-being of Singaporeans. (In English): Mr Chairman, let me now turn to how we are equipping the future generation to benefit from Gen AI. We have an existing Code for Fun programme offered to all primary and secondary schools, which exposes students to computational thinking through coding as well as inventive thinking through digital making. From this year onwards, the Code for Fun programme will incorporate new AI for Fun modules, which provide students with hands-on opportunities to tinker with AI technology. For instance, primary school students will be taught how to use an appropriate Gen AI platform to generate stories and images to create a digital storyboard. Students will be taught the risks of Gen AI, such as biases and hallucinations, and the need to check AI-generated content against other sources.”
“There are also many Singaporeans who are keen to embrace new technologies like AI. Mr Alex Yam asked about new library initiatives to encourage tech adoption. Over the next few years, our public libraries will be rolling out showcases that allow the public to experience uses of Gen AI. We hope that these showcases will demonstrate the practical value of AI in daily life, excite citizens about these possibilities and at the same time, help them understand the limitations and learn how to use AI responsibly. Gen AI is a useful tool, but it cannot replace learning or original thought. These are just some of the activities that citizens can enjoy at our public libraries as National Library Board (NLB) celebrates its 30th anniversary in 2025. NLB will host a series of "NLB30" events to mark 30 years and beyond of empowering Singaporeans to read, learn and discover together. More details will be announced later this year. Sir, I will say a few words in Malay. (In Malay): [Please refer to Vernacular Speech.] One of the best ways for us to learn to use cutting-edge technology is to do it together with like-minded individuals. A pioneering initiative that creates opportunities for communities to gather and learn together is Lorong AI. It is a community hub that provides space for those who share similarities, interests and skills in AI to explore how they can drive AI development together. Through this platform, they exchange ideas and discuss the latest discoveries. They also create prototypes and explore the use of AI in our daily lives. Mr Muhammad Zahari bin Abu Talib plays a crucial role in Lorong AI. As Community Lead, he helps connect individuals, initiates discussions and links various groups.”
“The Government will continue to be citizen-centric in our approach and make non-digital options available so that no one is left out. Let me move on to digital skills. Two in three Singaporeans have basic digital skills and are able to carry out day-to-day tasks online, such as buying products and services, searching for information and making contactless payments using a smartphone. To set ourselves up well for the digital future, Singaporeans also have to learn new technologies, such as Gen AI, which can help us with daily tasks. This upskilling is critical, as Ms Denise Phua emphasised in the Budget debate. Without this, the increasing use of Gen AI around us, like how many businesses now use chatbots to deliver customer services, can feel alien and scary. To demystify Gen AI, we must understand its risks and limitations and learn how to use it responsibly. The Government will continue to support less digitally-savvy citizens. Mr Gerald Giam and Ms Hany Soh asked about Seniors Go Digital. The SG Digital Office (SDO) will continue to help citizens acquire the digital skills needed for day-to-day living based on the Digital Skills for Life (DSL) framework. This prevents digital isolation, as Miss Rachel Ong raised in the Budget debate. Since 2020, SDO has trained more than 370,000 seniors. Ninety-six percent of seniors communicate online as of 2023, up from 87% in 2017. IMDA will be enhancing the DSL framework with content on Gen AI, explaining the basics of it, its risks and how to manage them, and applications for daily activities, like generating recommendations for places to eat at or leisure activities to try. Interested learners can register for SDO workshops or learn at their own pace through resources on the Digital for Life Portal.”
“The Oobee tool, which I mentioned earlier, is open-sourced and freely available for private sector companies to use. We encourage more to make use of this. Last year, GovTech held the inaugural Co-Creation Lab, which brought together representatives from Government agencies, private sector companies as well as community users. We were heartened to see so many partners step forward to understand the challenges that seniors and persons with disabilities face when using digital services, such as making e-payments, using ride-hailing apps and making healthcare appointments. These conversations helped service providers identify improvements to their services to make them user-friendly. The Co-Creation Lab demonstrated the need to strengthen partnerships across the public, private and people sectors. MDDI will launch a workgroup with partners from the public, private and people sectors to co-create and co-deliver initiatives to develop digital services that are more user-friendly. Details on this workgroup will be announced later. Even as we enhance the user-friendliness of digital services, we acknowledge that some Singaporeans will need physical support to access Government services. Dr Tan Wu Meng and Ms Denise Phua highlighted this in the Budget debate and Mr Gerald Giam raised this in his cut. Residents who need assistance with Government digital transactions can continue to get in-person assistance at Government agencies' physical service touchpoints. Trained service ambassadors will assist less digitally confident individuals with their transactions. Residents can also visit ServiceSG centres for assistance with 600 frequently used Government services and schemes.”
“That is why Singpass was enhanced in 2022 to support features, such as Dark Mode and Screen Reader, that enable those with visual impairments to navigate Singpass with greater ease. Mr Alex Yam asked about more efforts in this area. The Government takes inclusive design seriously and Government agencies are expected to be user-centric when designing their digital services. GovTech will do more to support agencies in this. This year, we are updating the Digital Service Standards (DSS) which guide agencies in designing user-friendly digital services. The updated DSS will better explain international standards, like the Web Content Accessibility Guidelines (WCAG), to agencies and provide recommendations on how to meet these standards. In addition, there will be greater emphasis on user testing before launch for high-traffic Government websites to make sure they are user-friendly. 2.15 pm We have also rolled out tools that agencies can use to support inclusive design. For example, GovTech developed the Oobee tool, previously known as Purple A11y, which uses a bot to help agencies test how easy their websites are to use and suggest improvements. GovTech will continue to enhance tools to help agencies identify and resolve such issues. These efforts provide agencies with stronger guidance and support to develop digital services that are easy for all to use, regardless of age or digital ability. GovTech will provide dedicated support to agencies with high traffic digital services. But the Government cannot drive this effort alone. Today, Singaporeans use a variety of commercial digital services daily. The private sector plays an important part in designing user-friendly digital services. We want to encourage and partner them in this.”
“Mr Chairman, many of us would find it hard to imagine our lives without the Internet or digital devices. In a survey conducted by MDDI in 2023, 80% of respondents agreed it was important for them to stay connected to the Internet. There are healthy ways of using digital technologies to enhance our lives, just as there are unhealthy ways that open us up to risks. My speech will focus on MDDI's efforts to galvanise our community, to build a society where citizens enjoy access to digital services that are essential to daily living; proficiency in using digital technologies; and safe, healthy and positive digital experiences through a whole-of-society effort. I thank Mr Keith Chua for his interest in these efforts. Let me start with access to digital technologies. Singapore is a highly connected nation; 98% of our resident households are connected to the Internet. But we must pay attention to those who are at risk of being left out. IMDA helps those who cannot afford it. Ms Hany Soh asked for an update on IMDA's schemes. DigitalAccess@Home has supported over 20,000 low-income households with subsidised broadband access, a laptop or tablet, or both broadband and a computing device since 2023. The Mobile Access for Seniors scheme has also supported low-income seniors with over 15,000 packages of subsidised smartphones and mobile plans, or mobile plans only, since 2020. Beyond connectivity and devices, day-to-day digital services need to be user-friendly. For some Singaporeans, like seniors and persons with disabilities, navigating services which are not designed to meet their needs can be challenging. A well-designed website or app can make a world of difference.”
“Like the smoking hotline, you can call HPB for their hotline and you can specify that it is an issue of vaping cessation, and the same support will be given to the individual who wishes to cease vaping.”
“Mr Speaker, I thank the Member for his questions and for raising this issue. Indeed, for that particular case, because the Member had raised it to us, we managed to remediate the situation and addressed the situation accordingly. In general, we do take a very nuanced approach with regard to a voluntary situation where they want to stop vaping and the parents bring the child forward. Typically, for this kind of situations, it will be flagged to HSA and we will then issue vaping counselling to the child, issue a warning instead. These are situations where we would need to continue addressing. What I would advise parents, if they are faced with a situation where they suspect their children of vaping, please use the HPB hotline to get them some help, and appropriate support will be given to the children. For those situations where there is an aberration and the matter is reported to the Police, please let us know if there are some difficulties. As mentioned in my earlier answer, it was only one case that we are aware of where the parents reported to the Police. In that case, a warning was issued instead. If Members are aware of certain circumstances where the parents have approached the Police instead and some fines are issued, you could highlight that case to us. What we want to do is to have a nuanced approach where we are supportive of parents who want to help their children cease vaping.”
“Mr Speaker, the Health Sciences Authority (HSA) received about 4,000 and 5,000 cases involving possession or usage of e-vaporisers from the Singapore Police Force over the past two years. In these two years, only one of these cases was a parent referring his child to the Police for vaping. For this case, the person was issued with a warning instead of a composition fine and referred to the Health Promotion Board (HPB) for counselling. Parents who are concerned that their children are vaping can call the HPB QuitLine for a referral to HPB’s smoking and vaping cessation service. No enforcement action will be taken against the children.”
“Mr Speaker, the Seniors' Mobility and Enabling Fund (SMF) and Assistive Technology Fund (ATF) provide eligible seniors and persons with disabilities with means-tested subsidies of up to 90% for assistive devices, including motorised mobility devices, its replacement parts and repairs. SMF and ATF beneficiaries can purchase their subsidised motorised devices from vendors via different touch points including the Agency for Integrated Care (AIC), public healthcare institutions and social service agencies. We do not impose device repairs and replacements standards on every vendor working with these touch points today. Clients who need greater assurance can purchase devices from vendors who offer warranties that ensures repairs and replacements are completed within a stipulated time period. For example, all vendors appointed by AIC offer such warranties.”
“So, these are ongoing efforts and we will continue to enhance as we move on, on this.”
“Mr Speaker, I thank the Member for his questions. Firstly, I would like to highlight that the announcement is in its early days yet. In Singapore, we always take a collaborative approach with the social media platforms and we have always been in active engagement with them. With regards to this particular instance, we are in touch with Meta and we are working with them to understand the specifics and details of this policy and the implications to the US, as well as to the global larger population. We will continue to assess if there are areas of concerns and if there are areas where we need to enhance our regulations, to see if they will continue to meet their obligations under our existing regulations. So, that is one. We are already in touch, we are already assessing. Two, I would also highlight that we have always been on the lookout for all the new trends and developments, especially during sensitive periods like the election, which is why the Elections (Integrity of Online Advertising) (Amendment) Bill was passed recently, specifically looking into the integrity of information online during the election period. So, we will continue to keep an eye out for some of these developments. Thirdly, though, I would like to highlight that we already have existing safeguards. We have been outcome-based in our approach; we know the outcome we want. There are a lot of technologies and capabilities and different mechanisms to protect users in the online space in many different areas of concerns, like the algorithms. So, we are looking into some of these. But as a start, our safeguards make sure that the platforms are on the same page, with regard to the outcomes we want to achieve, that there is a safe online space and there is a high integrity of the content that is put out.”
“The investigating powers provided to such enforcement officers are outlined in Part 13 of the Bill. Beyond being provided with investigating powers, enforcement officers may also issue a remedial notice to require a person to remedy a contravention of any Part 9 regulation within a specified period, including directions to take reasonable steps to do so. Non-compliance with the remedial notice without a reasonable excuse will be an offence. The main intent is to limit the impact of a contravention on the general public. Enforcement officers will issue a remedial notice if it is appropriate to give the person an opportunity to remedy the contravention. Otherwise, MOH may prosecute a person for the contravention of a Part 9 Regulation without first giving a remedial notice. Let me conclude. A safer and more resilient food system that can also support better population health and nutrition is aligned with our ongoing efforts to strengthen preventive care and will empower Singaporeans to lead healthier lifestyles.”
“To continue with the PHO ban under the FSSB, the Minister for Health will need to determine that cardiovascular disease is an NCD of public health interest. This may be done in consultation with the Director-General of Health and the public will be notified of this determination. PHO will be identified as a target food as it contributes to the occurrence of an NCD of public health interest. More stringent regulations that continue the current PHO ban may then be made as subsidiary legislation under the FSSB. The other category of regulations can apply to all foods. These include regulations to restrict import of a food, prohibit or restrict content used in advertisements or labels of a food, require display of prescribed dietary and nutritional information about the food at food premises and prohibit or restrict the medium or way in which food is advertised, sponsored or promoted for sale. An example of an existing regulation in this category is the prohibition of claims on the advertisements or labels of infant formulas that idealise its use or compares it to breast milk. MOH intends for the existing food regulations for health promotion purposes to continue under the FSSB. Should there be any new regulations, MOH and the Health Promotion Board will appropriately consult the public and industry to ensure that measures are practicable and implementable, as per our current practice. For regulations to be effective and meet their policy intent, they need to be enforced appropriately. To support the enforcement of any Part 9 regulation, the FSSB will empower the Director-General of Health to appoint enforcement officers, who are referred to as Part 9 enforcement officers in the Bill.”
“FSSB will allow for clearer delineation of Ministerial responsibilities between the Minister for Sustainability and the Environment and the Minister for Health, while allowing MSE and MOH to regulate the food supply chain for our respective purposes under a common regulatory regime. Key provisions in the FSSB for better health and nutrition are consolidated under Part 9. Under Part 9, clause 174 of the FSSB sets out the types of food regulations, known as Part 9 Regulations, that the Minister for Health is empowered to make for health promotion purposes. They broadly fall under two categories. The first category is more stringent regulations that apply only to "target food". These include regulations to prohibit import of a food; prohibit or restrict the way a food is manufactured, supplied or used in the manufacture or preparation of other foods; prohibit or restrict the way the public acquire or access a food; and require warnings to be included in food advertisements or food labels. An example of an existing regulation that falls in this category is the ban on PHOs, which currently prohibits the import of any edible fat or oil that contains PHO for use as an ingredient in other foods and the use of edible fat or oil that contains PHO in the manufacture of other foods. In making more stringent regulations, the Minister for Health will need to determine a non-communicable disease (NCD) of public health interest and identify the "target food". Let me use the PHO ban as an example to show how this works. The PHO ban aims to reduce the population's consumption of artificial trans-fat which is associated with increased risk of cardiovascular disease.”
“Mr Speaker, as mentioned by the Minister for Sustainability and the Environment, the Food Safety and Security Bill, or FSSB, will contain provisions related to health promotion. It will enable MOH to issue, administer and enforce food-related regulations for the purposes of promoting better health for the general public. Food choices impact on nutrition and our health. Unhealthy diets increase our risk of developing chronic diseases, such as hypertension, diabetes, heart disease and cancer. Regulatory measures for health promotion purposes pertaining to food complement voluntary and educational efforts. MOH currently taps on SOFA and its subsidiary legislation, the Food Regulations, to make such regulations. Examples include, Nutri-Grade labelling and advertising prohibitions for beverages that are higher in sugar and saturated fat; and the ban on trans-fat, also known as partially hydrogenated oils (PHOs) in food. The intention is for SOFA to be repealed and replaced by FSSB. While the primary purpose of FSSB is for food safety and security, it would be appropriate for FSSB to also support better population health and nutrition, given the close link between food, health and nutrition. This will allow MOH to continue with our current health promotion measures that are in place under SOFA and to implement additional measures, if needed, to improve population health in the future. A key difference between SOFA and FSSB is that, FSSB will provide the Minister for Health with statutory powers to make food-related regulations for health promotion purposes. Today, such regulations are administered and enforced by MOH but made with powers vested with the Minister for Sustainability and the Environment under SOFA.”
“Mr Speaker, currently, Singaporeans requiring root canal treatment are eligible for subsidies at Public Healthcare Institutions and, under the Community Health Assist Scheme (CHAS), at participating dental clinics. Notwithstanding, there have also been many requests to allow the use of MediSave for root canal treatment. Indeed, root canal has become a more common treatment to preserve teeth and maintain quality of life, especially for seniors. The Ministry of Health is still reviewing this.”
“Mr Speaker, there are a few questions that the Member has raised and I would ask that we be careful not to conflate the issues. The first point on the issue of any difficulties arising from billing delays, I can acknowledge and appreciate that that would be of concern to residents or patients. As I have explained, in this particular situation with NCCS, they have provided assistance. And in general, the Public Healthcare Institutions do offer support by providing interim bills for insurance reviews and letters to policyholders on reasons of delay in claim submission if this happens, so, there is already support. The other matters raised by the Member relate to issues of portability and that is also something that we had addressed in another question that was raised previously. There are concerns. We have studied this and we have already indicated that there are some downsides of portability and unintended consequences, including increase of premiums. So, this is a separate issue. On the issue of rejection of claims. This is something that does get surfaced every once in a while. The point is, it really depends on the facts. If there are some concerns and issues of unfairness, the matter can be surfaced to the Ministry, and we can take a look and see how we can assist.”
“Mr Speaker, in general, insurers do not reject claims if the delayed submission was of no fault of the patient. However, the Ministry of Health (MOH) is aware of a few cases where billing delays at the National Cancer Centre Singapore (NCCS) have resulted in patients facing difficulty in making insurance claims. NCCS has provided affected policyholders with letters to their insurers to explain the delay in claim submission. More resources are being deployed to NCCS to clear the outstanding bills. Policyholders who still face issues with claim submissions after sharing NCCS' letter with their insurers may approach NCCS for more support.”
“CDA will work together with these Ministries and agencies on the communicable disease issues that will arise. Given CDA's mandate for end-to-end disease prevention, preparation, detection and management, it will need sufficient support for its manpower and resources to achieve its objectives. As a Statutory Board under MOH, the CDA will be accountable to the Minister for Health in the performance of its functions. CDA will also comply with the financial governance requirements under Public Sector (Governance) Act 2018. Mr Speaker, to conclude, CDA will play a vital role in strengthening our nation's preparedness and resilience against future infectious diseases threats. With that, Sir, I seek to move. 5.49 pm”
“This is part of our efforts to enhance Singapore's preparedness and readiness for pandemics, and also for the control of endemic diseases. To enhance communication and coordination, CDA will build upon existing platforms and strengthen information exchanges with all stakeholders, including timely sharing of important information with the public. Both Dr Wan Rizal and Mr Yip Hon Weng have asked about CDA's role in the area of international engagement, including working with organisations, such as WHO to advance our public health interests. As diseases know no borders, CDA will represent Singapore on infectious diseases at relevant fora to establish strategic collaborations with our bilateral and multilateral counterparts, and to bolster global disease preparedness and response. CDA will also contribute actively to international scientific and surveillance networks to facilitate the exchange of disease information and sharing of expertise. This will allow Singapore to detect and understand novel pathogens faster, which can buy us time to respond. For instance, as the National Focal Point for WHO's International Health Regulations, CDA will be the primary point of contact for WHO and other countries on disease outbreak, notification and information sharing. Upon establishment, CDA will also be a national member of the International Association of National Public Health Institutes to closely engage and collaborate with other national public health institutes worldwide. On Assoc Prof Jamus Lim's point about expanding to disaster management, the CDA's aims is to focus on communicable diseases, as its expertise is in this area. For natural or man-made disasters, MOH and other Ministries already have the capabilities to respond to them.”
“Throughout this transition, we have consulted with the respective organisations and the Public Service Division. The new CDA scheme is designed to support the professional growth, career progression and development of CDA's officers. To grow expertise, CDA will provide structured learning opportunities to equip officers with the relevant competencies to perform their jobs effectively. CDA officers will also be given opportunities to rotate to other roles and functions within CDA, across the wider healthcare or public service family, and even obtain international exposure. Dr Wan Rizal, Mr Yip Hon Weng and Assoc Prof Jamus Lim also asked about CDA's role in multi-agency coordination. As part of the transition, we have ensured that CDA's work aligns with national policies. CDA will continue to work closely with MOH and other public agencies. For instance, today we work closely with NEA to mitigate the impact of vector-borne diseases like dengue fever, with the Singapore Food Agency on food safety and with the National Parks Board on diseases that may affect both animals and humans. These collaborations are part of a multi-agency cooperation framework termed "One Health". CDA will continue to work with the One Health agencies as part of a multi-sectoral, integrated approach to prevent, detect and respond to new and emerging public health threats. Our preparedness and response plans for "Disease X", as asked by Assoc Prof Jamus Lim, also includes tapping on the whole-of-Government agencies. This recognises the wide impact of outbreaks and pandemics, and the need for a multi-pronged effort. Working with other Ministries and agencies is not just during a crisis, but also during non-crisis periods.”
“Mr Speaker, I thank Members for their support and for their comments and questions on the Bill. Mr Yip Hon Weng asked about the mechanisms to ensure that CDA will be able to leverage the strengths of MOH, HPB and NCID fully, given that each of these entities already hold deep expertise in various aspects of public health. CDA will harness the collective expertise of MOH, HPB and NCID, fostering closer teamwork and synergy. We will create an ecosystem where public health practitioners can share knowledge and solve problems together. We will also be strengthening both our capabilities and capacities for communicable disease prevention, control and response. Under CDA, these talented professionals will have greater opportunities to grow, learn from one another and raise standards in public health practice. We are focused on continuity of operations. As Dr Wan Rizal rightly pointed out, critical public health functions must continue seamlessly. Since the Minister for Health's announcement of CDA's formation in March 2023, we have ensured a smooth transition, with our public health operations remaining robust and effective throughout this period of change. In end 2023, we established the interim CDA as a pre-operations structure, where critical functions, including disease surveillance, monitoring and investigations, can steadily transit and continue to operate effectively. We have also worked on refining our work processes to enhance critical public health functions and activities. Next, I will move on to other questions posed by Members. Dr Wan Rizal and Mr Yip Hon Weng asked about the measures in place to protect and develop staff. We have been conducting regular engagement sessions with staff and unions to provide information and seek feedback.”
“This reflects the transfer of these functions related to the National Immunisation Registry from HPB today to CDA, after it is established. Mr Speaker, the Bill presented today sets out the legislative framework to establish the Communicable Diseases Agency. If the Bill is passed, the CDA will be established in the first half of 2025. It will be the lead agency in Singapore to prevent, prepare for, detect and manage infectious diseases and will play a pivotal role in safeguarding Singapore from infectious diseases threats. Sir, I seek to move. [(proc text) Question proposed. (proc text)]”
“This will also allow us to detect international emerging situations of concern earlier and buy us invaluable time to prepare for and implement mitigating measures. I will now highlight the significant elements of the Communicable Diseases Agency Bill. Part 1 of the Bill introduces the terms used in various provisions of the Bill. Part 2 establishes CDA as a body corporate with a structure similar to major statutory boards. Within it, clauses 5 and 6 describe the functions and powers of CDA, which are based on what the consolidated MOH, HPB and NCID units do today and what we envisage CDA will do after it is established, which I have described earlier. Parts 3 to 6 lays out CDA's governance structures and requirements, which are aligned with the requirements under the Public Sector (Governance) Act 2018. They cover the membership, appointment and decision-making procedures of CDA's Board as well as personnel and financial matters. Part 7 covers miscellaneous provisions necessary for the administration and enforcement of the Bill. Part 8 allows for the transfer of assets, liabilities and employees from relevant MOH and HPB departments or divisions, as laid out in the Schedule, to CDA. As NCID today is part of Tan Tock Seng Hospital, which is a corporate entity, NCID assets, liabilities and employees will be consolidated under CDA through other means, such as via contract novations or direct employment by CDA. Part 9 will make consequential amendment to other Acts. The key amendment will be to the Infectious Diseases Act 1976, where relevant provisions on vaccinations notifications and vaccination exemptions will be amended to replace HPB with CDA.”
“CDA will investigate and respond to cases and outbreaks of infectious diseases in Singapore. This takes place routinely for endemic diseases and during potential crisis. During a pandemic, the approach and strategy will be driven by MOH, or the equivalent of a Multi-Ministry Taskforce during COVID-19. CDA will provide policy and scientific recommendations, and also work with MOH and other agencies to carry out the operations. These will include a calibrated combination of public health and social measures that include case investigation, contact tracing, masking, physical distancing and border control measures. Finally, CDA needs to support its function with strategic enablers. One important enabler is research. Research is an important aspect of preparation to ensure a scientifically robust, data-driven response to infectious diseases. For instance, research conducted during COVID-19 allowed us to determine the duration people infected by COVID-19 were likely to remain infectious. This, in turn, informed the duration of isolation for these individuals so as to prevent transmission. CDA will coordinate and conduct public health research. It will make use of the findings from local and international studies and translate research findings into public health and clinical actions and policies. Another key enabler is international cooperation. The next pandemic is likely to come from abroad. CDA will also engage overseas stakeholders and counterparts to enable Singapore to respond swiftly to rapidly evolving global disease situations. This allows us to access and share information, expertise and the latest developments and best practices in infectious diseases control.”
“The groundwork for this must be laid during peacetime, drawing upon lessons from past experiences and anticipating future ones; developments and learnings from across the world; and, continuously reviewing and updating our plans and strategies so that they remain relevant. COVID-19 demonstrated that pandemics can last much longer than previously anticipated. It lasted three years, much longer than the three-months-long response for 2003 SARS and H1N1. It also caused massive societal and economic disruption, far beyond the health sector. We must, therefore, prepare and be ready for a protracted, inter-sectoral, whole-of-Singapore response. To do this, CDA will lead and coordinate public health preparedness and readiness efforts. It will work with stakeholders from various sectors and agencies to build sectoral readiness against infectious disease crises and to safeguard national interests, such as vaccine and therapeutics development and access. CDA will also work with MOH and healthcare institutions to build capabilities and capacity in key areas, such as laboratory testing and clinical management. Third, detect. Surveillance is key to this, as continuously monitoring the infectious disease situation locally and internationally allows us to sense-make and identify unusual developments. Early detection of warning signs allows us to respond promptly to mitigate the impact of an outbreak. CDA will strengthen our surveillance capabilities, including exploring the use of new modalities of surveillance, such as through genomic testing and wastewater testing to supplement traditional surveillance approaches, and explore data analytics and artificial intelligence to enhance our ability to make sense of large volumes of data. Fourth, respond.”
“This involves tapping on the research ecosystem to coordinate and promote public health research that inform and guide public health actions and policies. With rapid technological advancements, new tools are continuously being developed, which must be evaluated and adopted to better prevent, prepare for, manage and respond to infectious diseases. Lastly, we must strengthen the structures and capabilities for forward planning and preparedness to respond to the next pandemic in a more agile and fluid manner. In consolidating the public health functions for the control of infectious diseases, CDA will oversee end-to-end disease prevention, surveillance and risk assessment, preparedness and response, and disease and outbreak management. This will allow the Government to quickly respond to disease outbreaks as one concerted public health effort. CDA is the response to the three key recommendations above. It will bring together public health functions under one roof. There are five areas of responsibility: prevent, prepare, detect, respond and enable. First, prevent. This combines public education with robust vaccination policy and implementation, building and promoting infection prevention and control capabilities and practices across different settings, and combating the threat of antimicrobial resistance through a collaborative One Health approach. CDA seeks to prevent infections from taking root in the first place. Second, prepare. Our COVID-19 experience has reinforced the need to invest in preparedness and readiness measures. The next pandemic can occur at any time and we must be prepared and stand ready to respond swiftly, flexibly, decisively and effectively.”