Amendments to the Singapore Infectious Diseases Act: Overview and Implications
Vista Health Pte Ltd
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The following is an opinion article from Vista Health, co-authored by Will Brown (Senior Director, Policy and Population Health), Rui Min FUNG (Senior Analyst) and Helen Sng (Analyst).
On 7th March 2024, the #Singapore Parliament announced amendments to the Infectious Diseases Act (#IDA) comprising changes that strengthen future outbreak responses and decriminalise non-disclosure of human immunodeficiency virus (#HIV) status for people living with HIV (PLHIV) with undetectable viral load.
These amendments reflect Singapore’s commitment to evidence-based policymaking, tapping into COVID-19 learnings to bolster the nation’s response to future disease outbreaks and embracing new concepts that reduce #stigma against PLHIV[1]. This opinion article discusses these amendments and delves into their implications for various stakeholders.
Ensuring Adequate Response Measures to Contain Future Infectious Disease Outbreaks
The IDA amendment relating to #pandemic response measures puts into action two key learnings from the COVID-19 pandemic[2]. First, it establishes a new hierarchy of responses to prompt appropriate public health actions based on the severity of an outbreak. Next, it leverages public-private partnerships to meet increased healthcare demands during outbreaks[2]. For?highly transmissible infectious diseases, stricter controls to minimise pathogen importation into Singapore, local transmission and exportation to subsequent countries were outlined to minimise burden on health systems.
Introducing a Hierarchy of Responses to Strengthen Public Health Response
Under the amended act, a hierarchy of responses will consist of four public health postures as outlined in Figure 1 below: Baseline, Outbreak Management, Public Health Threat (PHT) and Public Health Emergency (PHE). This allows the government to step up responses and taper down measures as needed.
As Health Minister Mr Ong Ye Kung noted, “COVID-19 is not going to be the last pandemic and we need better and permanent tools for the next threat”[3]. This new hierarchy of responses will ensure the nimbleness of Singapore’s health system to respond appropriately according to the severity of outbreaks. It will also be a tool for transparent communication used both internally by government agencies and externally for public communications, replacing the Disease Outbreak Response System Condition (DORSCON) framework.
While these amendments include forward-looking measures for future outbreaks, a detailed action plan outlining the roles and responsibilities of private players should be considered to ensure adequate preparedness of the health system. To achieve this, involving private players during planning phases to leverage their expertise, capabilities and knowledge is critical[5].
Leveraging Public-private Partnerships to Meet Increased Healthcare Demands
Private entities played a crucial role in supporting the government in their COVID-19 response, from providing frontline workers to ramping up health supplies production[6,7]. Recognising the significance of private sector involvement, Singapore has now included private sector employees in the pool of Health Officers to supplement the public workforce during a national response. This includes employees of private healthcare providers, prescribed service providers engaged by the government and auxiliary police[8].
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Public-private partnerships are common in Singapore and this move shows the government’s continued commitment to work collaboratively with the industry. Beyond the role of resource providers, private players can proactively support the government, given its established data networks and multi-sectoral expertise. Partnerships may take the form of data sharing and co-designing of outbreak response plans to resist, respond and recover from future outbreaks.
Amendment of HIV Disclosure Obligation
The updated IDA also removes the obligation of PLHIV to disclose the risk of HIV transmission to their sexual partners before sexual activity. This is provided that the individual has obtained undetectable viral load test results of below 200 copies/mL from a recognised laboratory for at least 6 months, with the latest result obtained within the last 9 months[8]. With this amendment, Singapore embraces the evidence-based Undetectable = Untransmittable (U=U) concept, where PLHIV who achieve and maintain suppressed or undetectable viral load through antiretroviral therapy (ART) have negligible risk of transmitting HIV. The U=U concept seeks to reduce stigma against PLHIV, encourage individuals to get tested regularly and if positive, get treated early to reduce their risk of HIV transmission[9]. As discussed in a multi-disciplinary advisory board by Abbott and Vista Health, achieving suppressed and eventually undetectable viral load was reinforced as a key step towards achieving UNAIDS’s 95-95-95 targets (click here to read the paper).
From repealing Section 377a which decriminalised sex between men in December 2022 to this current amendment, Singapore has moved towards more inclusive and?evidence-based policies. However, the desired outcome of this IDA amendment hinges on ensuring the accessibility and affordability of HIV laboratory tests. In Singapore, a quantitative HIV laboratory test costs around S$500, or S$300 with subsidies. Comparatively, in Australia, the test would cost S$200, or S$90 with subsidies[10–13]. Maintaining access and affordability requires a multi-stakeholder effort, from advocacy groups raising awareness to funders supporting innovative financing models and implementers facilitating the scale-up of tests.
The current amendments to the IDA illustrate Singapore’s commitment to evidence-based decision-making, be it applying learnings from past pandemics or embracing new proven concepts. Multi-sectoral partnerships across the public and private sectors remain critical in meeting evolving demands in times of outbreak or when adapting to new policy changes. As a next step, it is imperative to acknowledge the broader value of collaboration, extending beyond the provision of services and resources, to harness the diverse expertise and capabilities of various stakeholders to drive innovation in public health strategies.
Vista Health provides a range of services in the policy and population health space, ranging from policy monitoring, assessments and implications, to advocacy and policy design. Reach out to Senior Director Will Brown ?([email protected]) to see how we can help your organisation navigate complex and changing policy landscapes globally.
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