4. However, public healthcare has also taken on a trans-national perspective.  The advent of affordable air-travel has made national borders very permeable, and enabled outbreaks of disease to spread quickly from country to country with crippling effects.  Responses to such outbreaks have also taken on a global dimension.  Even as countries struggle domestically to contain a disease outbreak, they have found it essential to cooperate with one another, sharing information on ground situations and research efforts, and providing urgent assistance, equipment or technical expertise to those in need. 

5. The SARS outbreak in 2003 was a stark reflection of this.  We in Singapore experienced it firsthand.  Not only was the public healthcare system put to the test, but our economy and society as a whole were confronted with one of their most severe challenges in recent years.  Lives were unfortunately lost.  International travellers, both tourists and businessmen, stayed away from Singapore.  Even Singaporeans stayed home, avoiding crowded places for fear of contracting the virus.  Business was badly affected and many Singaporeans found their livelihoods threatened. 

6. Fortunately, the government, employers and Singaporeans rallied behind our team of courageous and dedicated healthcare professionals, and together we brought the outbreak under control.  We realised early on that we could not solve the problem by ourselves.  We worked closely with our regional partners on critical areas including border screening, surveillance and early notification of new suspected cases.  Internationally, we were assisted by the World Health Organization and the US Centres for Disease Control and Prevention (CDC), which despatched experts to Singapore to help us deal with the problem.  We are deeply grateful to the WHO and the CDC for their help.

7. While the SARS scourge turned out to be transient, we continue to face other global health challenges. 

HIV/AIDS

8. HIV/AIDS is a major concern affecting the whole world.  The problem is particularly acute in Sub-Saharan Africa, where in some countries more than one-quarter of the adult population carry the HIV virus.   The situation in Asia is less grave, but there is a real risk of it deteriorating if countries do not tackle the problem well.  The region is already emerging as the new epicentre of the HIV epidemic. An estimated 8.6 million people are living with HIV in Asia, and there is an alarming trend of rising HIV infections in China and India, the world’s two most populous countries.  Within Asia, the prevalence of HIV is highest in Southeast Asia, fuelled by unprotected sex and unsafe drug injections.  Beyond a certain threshold, the HIV epidemic will explode. We are not there yet, but we must act now to control and prevent the spread of HIV/AIDS before it is too late.

9. There are no quick solutions for the HIV/AIDS epidemic. It is a complex and long-term problem. We must work on multiple fronts and across regional boundaries to address it. Until a cure or vaccine is found, the key to controlling the virus is prevention and public education. We need to actively engage many segments in society, reduce the social stigma and discrimination, raise awareness of HIV/AIDS and provide care for the afflicted. 

10. Singapore will occupy the Chair of the ASEAN Task Force for AIDS later this year.  We will do our part to coordinate efforts in the region, and work closely with the WHO and the international community to tackle this “silent pandemic”.

Avian Influenza

11. While HIV/AIDS is a disease that we will have to live with over the long-term, we also have to deal with the immediate threat of avian influenza and the spectre of a flu pandemic.  The deadly H5N1 virus has become common among birds in Asia and it has now spilled over to Africa and Europe.  Millions of chickens and ducks have been killed to contain the spread of the virus, with limited effect.  Humans have also caught the virus through close contact with the infected birds.  Since 2003, almost 300 people have contracted the avian flu, of whom half have died.

12. So far, there has not been significant human-to-human transmission, but scientists believe that it is only a matter of time before the virus mutates to become capable of this.  Then we may have a worldwide pandemic. The Spanish flu pandemic in 1918 killed 40-50 million people worldwide.  If a disease with similar characteristics breaks out in today’s globalised world, the impact will be far swifter and more devastating.    

13. One reason why Asia is a breeding ground for new strains of influenza is the animal husbandry practices in the region.  Ducks, chickens and pigs are allowed to commingle on farms with very little bio-security. Poultry are reared free-range, and people often live in the farms with their animals. This allows for a mixing of different strains of viruses, constantly creating new strains some of which will be able to infect humans more easily.  Changing and modernising these practices will take economic growth, social transformation, and a very long time.  Meanwhile, we will have to take measures to protect ourselves – each time there is an avian flu outbreak, we must respond quickly to detect, isolate and deal with it, so as to minimise the chance of humans catching the virus.

14. On our part, Singapore has been taking precautions, drawing on lessons learned from SARS.  We have been strengthening the capacity of our healthcare system and exploring ways to deliver care in a pandemic, so that the sheer number of patients will not overwhelm our hospitals.  We are stockpiling critical items like anti-virals and personal protective equipment, and ensuring that both public and private organizations have worked out business continuity plans.  We are also participating in global efforts to tackle this challenge.  We are part of the global surveillance network and are plugged into the international research grid to contribute to efforts to better understand the virus and how we can fight it.

15. Beyond the public health aspects, we are dealing with other just as critical questions.  How do we minimize the impact on our open, externally-dependent economy?  Can we ensure continued and adequate food supply?  How will the morale of citizens hold up in the face of such a calamity?  Are our people resilient enough? What about life after the pandemic? How do we pick up the pieces and move on?

16. There are no easy answers.  But we have to think through the unthinkable, and spare no efforts in planning for bad eventualities.  Let me suggest three broad strategies for preparing ourselves both domestically and internationally.

RESPONDING TO THESE CHALLENGES

Greater Cooperation and Collaboration
17. First, there is urgent need for greater cooperation and collaboration. Since the SARS outbreak, the global community has begun to prepare the world for the next global health security threat.  Countries have invested heavily in surveillance and response systems. The WHO has played a leadership role in getting different stakeholders together, for example, by forming alert and response networks, assisting countries in pandemic preparedness and setting the rules for proper international conduct through the revised International Health Regulations.

18. But more needs to be done.  To deal effectively with future global health threats which are yet unknown but possibly catastrophic, we must share information, combine our efforts, and pool our resources.  Unfortunately, despite frequent calls by the international community for the release of more data, scientific agencies today are still holding back information.  We need to move away from this dangerous, outdated mindset.  In the war on terrorism, necessity has forced intelligence agencies in many countries to share information about terrorist threats and activities with one another.  There is no reason why health agencies cannot develop a similar culture.

19. To develop a viable basis for information sharing, we have to address several critical issues.  Some countries have been reluctant to share viral samples for vaccine research because they want to ensure access to vaccines for themselves at reasonable prices.  On the other hand, vaccine discovery is a costly affair.  Pharmaceutical companies assume big risks when funding research for vaccines.  They need assurances that intellectual property arising from their research will be protected, so as to earn adequate returns on their investments. 

20. The challenge is to strike the right balance between addressing the urgent public health needs of developing countries, and protecting the intellectual property rights of the patent holder.  Despite many attempts to resolve this issue, a completely satisfactory solution has not been found.  The World Trade Organization allows countries to issue compulsory licenses to produce cheaper generic drugs.  But the precise conditions under which compulsory licensing is allowed have been the subject of heated debate.  More work is needed to devise practical and sustainable solutions that provide life-saving drugs and vaccines to those truly in need. 

21. In parallel, the WHO has pursued a different approach with Indonesia.  Both sides have recently reached an agreement for Indonesia to resume sending viral samples to the WHO, on the understanding that these will only be used for research purposes.  At the same time, the WHO will set more transparent rules governing the sharing of these samples, mobilise financial support for vaccine stockpiles, and develop guidelines for the equitable distribution of vaccines to countries if a pandemic occurs.  This arrangement is a positive step forward.  It is one possible model for sample and information sharing involving other countries.   

Openness and Transparency

22. An essential pillar supporting greater cooperation is openness and transparency.     

23. Giving full, accurate and timely information is an essential part of facilitating early detection and prevention of the spread of infectious disease.  Our experience with SARS has demonstrated the importance of rapid and transparent information exchange between countries and the WHO.  In the early phase of the SARS epidemic, the failure of some governments to deal transparently with the problem contributed to the further spread of the virus both within and between countries.  It also hindered work to understand the nature of the disease and its causative agent, and to determine appropriate responses.  We must not allow this to happen again. 

24. At the most fundamental level, there is a need to build relationships of trust.  We face a common enemy which disregards national bureaucracies, politics and boundaries, and our response must be a united, global one.  If we can forge a common understanding that as we help others we help ourselves, and make progress in our understanding of how to avert or deal with an influenza pandemic, all of us will benefit.  This will require a framework that engages every member of the international community, encourages transparency and openness, and at the same time, takes care of the needs of the affected and less-developed countries.

Translating Words to Actions

25. Finally, even as we discuss principles of cooperation, openness and transparency, we need to focus on translating the plans on paper into concrete actions on the ground. 

26. This is not a straightforward matter, as the avian flu example has shown.  The challenge of ensuring that assistance and resources being offered are both helpful and practical is real. Different countries are at different levels of development and thus have differing resources and capacities, including infrastructure and technical expertise. Plans will have to be adapted to the local epidemiological and socio-political context; otherwise solutions which appear eminently logical and sound on paper will prove quite unworkable in practice. 

27. Ultimately, translating plans into meaningful, effective action will require a flexible, not dogmatic, approach, based on a deep understanding of the local ground situation.  This can only come about when there is constructive engagement based on mutual respect and trust.  The solutions need to be adapted, customised and worked out together, and not based on a single one-size-fits-all template.   

CONCLUSION

28. Responding to the changing global landscape and health security threats requires new strategies and new attitudes in cooperation between stakeholders.  We cannot predict when and what will actually happen. Nature has its way of reminding us how unpredictable and devastating diseases can be, despite all the progress of medicine and science.  But history has also shown us that if we work together and better prepare ourselves, we have a fighting chance of mitigating the impact and averting the worst.  We have no choice but to give it our best shot.

29. This begins with a willingness to discuss the issue and learn from each other’s experience. Today’s Debate in conjunction with World Health Day is timely.  I wish you a fruitful discussion.