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Source: Government of Singapore Posted on: 21st March 2010
The Opening Of The Conference On Strengthening Health and Non-Health Response Systems in Asia ? Welcome Address by Senior Minister of State (Law and Home Affairs) Assoc Prof Ho Peng Kee, 18 March 2010.
Distinguished Guests, Ladies and Gentlemen
I am happy to be here this morning at the opening of this conference on strengthening health and non-health response systems to global crises of infectious disease in Asia.
This is an important conference which I believe will contribute significantly to ongoing global discussions on this issue.
Global outbreaks of infectious diseases are as much a concern as a terrorist attack. Infectious diseases can kill large numbers of people. Like terrorist attacks, disease outbreaks know no geographical boundaries. Both rich and poor alike can be affected. In the last two decades, some outbreaks have resulted in mass slaughters of poultry and other farm animals. Some have overwhelmed health services and directed resources from elsewhere. Others have affected trade and tourism.
Almost all outbreaks have stirred up public fear and anxiety.
Lessons from Influenza A (H1N1-2009) Pandemic
Let us turn our attention to the Influenza A (H1N1-2009) pandemic. The H1N1 virus emerged in Mexico in Mar 2009 and swept across the globe at an unprecedented speed, much faster than any other pandemic in history. According to World Health Organisation, past pandemics took more than six months to spread as widely as the H1N1 virus spread in less than six weeks.
The H1N1 pandemic is a timely wake-up call. It came at a time when some contingency planners were getting tired with years of preparations and were starting to question if medical experts and governments were crying wolf. The pandemic has reminded us that we need to constantly prepare to respond to, manage and recover from pandemics. It is not enough to be able to respond fast to a disease outbreak. We must also be able to manage an outbreak because it can last from days, to weeks and even months. Managing an outbreak well means that we must be able to reduce fatalities and handle patient loads over a prolonged period. And when the outbreak ends, we must be able to help society recover.
The H1N1 pandemic tested the response systems of countries, validating certain assumptions and response plans, but raising questions about others. Now that global H1N1 activity has abated in most areas, we should use this opportunity to take stock and learn from the experience. We cannot be complacent and let our guard down as the virus is still circulating and may mutate into a more severe strain.
There are public health challenges that countries have to review and decide for themselves how they should respond in the next pandemic. For instance, countries have to determine how scarce public health resources can be better deployed. No country can ever have sufficient treatment facilities such as intensive care units. Public health authorities must consider what options they need to put in place now to prepare for a more severe pandemic.
Another public health challenge involves vaccines. There are many issues surrounding vaccines. For instance, the world needs to address the inevitable situation that the initial global supply of vaccine will typically be insufficient and what would be the best way of allocating them. Some countries developed their vaccination plans based on the assumption that a vaccine would be available about six months after the pandemic virus first emerged. They expected large quantities of the H1N1 vaccines to arrive in October 2009, with a steady stream of shipments continuing through the end of the year. However, problems in the production of the vaccine created a global shortage and delays in delivery schedule. As a result, some countries had to revise their plans to make the most effective use of what little amount was available initially.
When the pandemic turned out to be less severe than thought, fewer people than expected got themselves vaccinated, leaving the countries with massive and expensive surpluses of vaccines. They have to come up with solutions to deal with the excess vaccines, such as donating some to developing countries, while at the same time, ensuring that their own preparedness would not be compromised.
Pandemic preparedness is not just a public health prerogative. There are many non-health measures that governments have to implement to prevent the public health system from collapsing. Countries which have not started multi-sectoral pandemic preparations should begin engaging non-health players such as the military, police, transport companies and community groups. During a pandemic when there is a surge in the number of patients, these non-health parties can help to alleviate the pressure on the public health systems through various ways such as transport of the sick and medical equipment, and setting up of temporary medical facilities.
Did the World Over-React to Influenza A (H1N1-2009) Pandemic?
Critics have accused WHO and some countries of over-reacting to a pandemic which has turned out to be relatively mild. With the benefit of hindsight, some even described the H1N1 outbreak as a ?false pandemic?. I think what these critics often choose to overlook is the difficult balance that governments have to strike when confronted with a pandemic. No one could have known initially if the new flu virus would be mild, or if it would turn out to be a scourge that would overwhelm hospitals, close schools and spread panic. But if governments act too slowly and large numbers of people are affected, they will be accused of doing too little, too late.
As practitioners as well as public health and non-health professionals, I urge you to take heed of criticisms. Learn from the criticisms where they are constructive. But do not be disheartened by critics who argue that we should do less and not do more to prepare for pandemics. The challenge for governments is that the first few weeks of a pandemic are most crucial. If they do not put up tough measures to delay the entry of the virus or mitigate its effects, and the virus turns out to be highly lethal, the consequences would be unimaginable.
Many governments have thus chosen to adopt a prudent approach during the H1N1 pandemic. During the early stages of the outbreak, some countries implemented measures at the borders which critics described as ?harsh? and ?unnecessary?. For example, China isolated large numbers of people entering the country if someone onboard a plane showed flu-like symptoms. Some countries also suspended visa-free entry for travellers from Mexico, triggering diplomatic tensions. Implementing tough measures is therefore not without its costs, but in these instances, the countries had assessed the measures to be necessary for delaying the entry of the virus.
Concluding Remarks
The H1N1 pandemic is not the last and definitely not the worst pandemic the world has faced. But it is a good teachable moment for humanity. While some countries are prepared for a pandemic, there are others that do not have the resources to manage it. Our inter-connected global existence means that even countries that are well prepared for a pandemic would inevitably be affected by those that are ill prepared and badly hit.
And let us also not forget that the H5N1 avian influenza outbreak among poultry could worsen over time into a human pandemic that is more severe than the H1N1 pandemic. In 2009, there were 72 cases of H5N1 in humans, with 32 deaths. This constitutes a 44 per cent fatality rate. According to WHO data, the areas where human H5N1 cases proliferate are also areas where the H1N1 virus is making inroads. We need to continue monitoring the H5N1 situation. Countries can work together to develop an effective system of disease surveillance and reporting in every high-risk area. This is especially important when overall capacity and quality of animal health and public health services remain low in many high-risk areas.
Finally, I would like to thank the Centre for Non-Traditional Security Studies for taking the initiative to keep pandemic preparedness on the agenda. I remember that at the inaugural conference last year, speakers warned that a human influenza pandemic was overdue and that the only way to deal with a pandemic was through a multi-sectoral response approach involving all sectors in a country.
Little did we expect that three months after the conference, the world experienced its first influenza pandemic since 1968.
This is the second year that the Centre is organising a conference on preparedness for infectious disease crises. Let us hear your candid views on the challenges in today?s health and non-health response systems and what must be done to overcome them. I wish you a very fruitful discussion. Thank you.
Topics: 2010, anxiety, Asia, Bird Flu, children, China, clinics, community, constitution, death, Department of Health, doctors, fatality, flu, Flu Bug, Governance, government, Green Alert, H1N1, H1N1 flu vaccine, H5Nq, Health and Human Services, health care, Health Care, health insurance, Ho Peng Kee, hospitals, immunizations, Infection, influenza, intensive care, internet, laws, Ministry of Health, MOH, monitor, news, online, outbreak, pandemic, President Obama, Public, public fear, schools, seasonal flu, seniors, Singapore, society, Swine Flu, U.S., UN, United Nations, United States, vaccination, vaccine, virus, White House, WHO, World Health Organization, young adults
The Opening Of The Conference On Strengthening Health and Non-Health Response Systems in Asia ? Welcome Address by Senior Minister of State (Law and Home Affairs) Assoc Prof Ho Peng Kee, 18 March 2010.
Distinguished Guests, Ladies and Gentlemen
I am happy to be here this morning at the opening of this conference on strengthening health and non-health response systems to global crises of infectious disease in Asia.
This is an important conference which I believe will contribute significantly to ongoing global discussions on this issue.
Global outbreaks of infectious diseases are as much a concern as a terrorist attack. Infectious diseases can kill large numbers of people. Like terrorist attacks, disease outbreaks know no geographical boundaries. Both rich and poor alike can be affected. In the last two decades, some outbreaks have resulted in mass slaughters of poultry and other farm animals. Some have overwhelmed health services and directed resources from elsewhere. Others have affected trade and tourism.
Almost all outbreaks have stirred up public fear and anxiety.
Lessons from Influenza A (H1N1-2009) Pandemic
Let us turn our attention to the Influenza A (H1N1-2009) pandemic. The H1N1 virus emerged in Mexico in Mar 2009 and swept across the globe at an unprecedented speed, much faster than any other pandemic in history. According to World Health Organisation, past pandemics took more than six months to spread as widely as the H1N1 virus spread in less than six weeks.
The H1N1 pandemic is a timely wake-up call. It came at a time when some contingency planners were getting tired with years of preparations and were starting to question if medical experts and governments were crying wolf. The pandemic has reminded us that we need to constantly prepare to respond to, manage and recover from pandemics. It is not enough to be able to respond fast to a disease outbreak. We must also be able to manage an outbreak because it can last from days, to weeks and even months. Managing an outbreak well means that we must be able to reduce fatalities and handle patient loads over a prolonged period. And when the outbreak ends, we must be able to help society recover.
The H1N1 pandemic tested the response systems of countries, validating certain assumptions and response plans, but raising questions about others. Now that global H1N1 activity has abated in most areas, we should use this opportunity to take stock and learn from the experience. We cannot be complacent and let our guard down as the virus is still circulating and may mutate into a more severe strain.
There are public health challenges that countries have to review and decide for themselves how they should respond in the next pandemic. For instance, countries have to determine how scarce public health resources can be better deployed. No country can ever have sufficient treatment facilities such as intensive care units. Public health authorities must consider what options they need to put in place now to prepare for a more severe pandemic.
Another public health challenge involves vaccines. There are many issues surrounding vaccines. For instance, the world needs to address the inevitable situation that the initial global supply of vaccine will typically be insufficient and what would be the best way of allocating them. Some countries developed their vaccination plans based on the assumption that a vaccine would be available about six months after the pandemic virus first emerged. They expected large quantities of the H1N1 vaccines to arrive in October 2009, with a steady stream of shipments continuing through the end of the year. However, problems in the production of the vaccine created a global shortage and delays in delivery schedule. As a result, some countries had to revise their plans to make the most effective use of what little amount was available initially.
When the pandemic turned out to be less severe than thought, fewer people than expected got themselves vaccinated, leaving the countries with massive and expensive surpluses of vaccines. They have to come up with solutions to deal with the excess vaccines, such as donating some to developing countries, while at the same time, ensuring that their own preparedness would not be compromised.
Pandemic preparedness is not just a public health prerogative. There are many non-health measures that governments have to implement to prevent the public health system from collapsing. Countries which have not started multi-sectoral pandemic preparations should begin engaging non-health players such as the military, police, transport companies and community groups. During a pandemic when there is a surge in the number of patients, these non-health parties can help to alleviate the pressure on the public health systems through various ways such as transport of the sick and medical equipment, and setting up of temporary medical facilities.
Did the World Over-React to Influenza A (H1N1-2009) Pandemic?
Critics have accused WHO and some countries of over-reacting to a pandemic which has turned out to be relatively mild. With the benefit of hindsight, some even described the H1N1 outbreak as a ?false pandemic?. I think what these critics often choose to overlook is the difficult balance that governments have to strike when confronted with a pandemic. No one could have known initially if the new flu virus would be mild, or if it would turn out to be a scourge that would overwhelm hospitals, close schools and spread panic. But if governments act too slowly and large numbers of people are affected, they will be accused of doing too little, too late.
As practitioners as well as public health and non-health professionals, I urge you to take heed of criticisms. Learn from the criticisms where they are constructive. But do not be disheartened by critics who argue that we should do less and not do more to prepare for pandemics. The challenge for governments is that the first few weeks of a pandemic are most crucial. If they do not put up tough measures to delay the entry of the virus or mitigate its effects, and the virus turns out to be highly lethal, the consequences would be unimaginable.
Many governments have thus chosen to adopt a prudent approach during the H1N1 pandemic. During the early stages of the outbreak, some countries implemented measures at the borders which critics described as ?harsh? and ?unnecessary?. For example, China isolated large numbers of people entering the country if someone onboard a plane showed flu-like symptoms. Some countries also suspended visa-free entry for travellers from Mexico, triggering diplomatic tensions. Implementing tough measures is therefore not without its costs, but in these instances, the countries had assessed the measures to be necessary for delaying the entry of the virus.
Concluding Remarks
The H1N1 pandemic is not the last and definitely not the worst pandemic the world has faced. But it is a good teachable moment for humanity. While some countries are prepared for a pandemic, there are others that do not have the resources to manage it. Our inter-connected global existence means that even countries that are well prepared for a pandemic would inevitably be affected by those that are ill prepared and badly hit.
And let us also not forget that the H5N1 avian influenza outbreak among poultry could worsen over time into a human pandemic that is more severe than the H1N1 pandemic. In 2009, there were 72 cases of H5N1 in humans, with 32 deaths. This constitutes a 44 per cent fatality rate. According to WHO data, the areas where human H5N1 cases proliferate are also areas where the H1N1 virus is making inroads. We need to continue monitoring the H5N1 situation. Countries can work together to develop an effective system of disease surveillance and reporting in every high-risk area. This is especially important when overall capacity and quality of animal health and public health services remain low in many high-risk areas.
Finally, I would like to thank the Centre for Non-Traditional Security Studies for taking the initiative to keep pandemic preparedness on the agenda. I remember that at the inaugural conference last year, speakers warned that a human influenza pandemic was overdue and that the only way to deal with a pandemic was through a multi-sectoral response approach involving all sectors in a country.
Little did we expect that three months after the conference, the world experienced its first influenza pandemic since 1968.
This is the second year that the Centre is organising a conference on preparedness for infectious disease crises. Let us hear your candid views on the challenges in today?s health and non-health response systems and what must be done to overcome them. I wish you a very fruitful discussion. Thank you.
Topics: 2010, anxiety, Asia, Bird Flu, children, China, clinics, community, constitution, death, Department of Health, doctors, fatality, flu, Flu Bug, Governance, government, Green Alert, H1N1, H1N1 flu vaccine, H5Nq, Health and Human Services, health care, Health Care, health insurance, Ho Peng Kee, hospitals, immunizations, Infection, influenza, intensive care, internet, laws, Ministry of Health, MOH, monitor, news, online, outbreak, pandemic, President Obama, Public, public fear, schools, seasonal flu, seniors, Singapore, society, Swine Flu, U.S., UN, United Nations, United States, vaccination, vaccine, virus, White House, WHO, World Health Organization, young adults
