Why does S'pore need a new Communicable Diseases Agency and what can it do in future pandemics? Experts give their take

SINGAPORE — The new Communicable Diseases Agency has the potential to not only act as the main liaison with other countries in the event of future pandemics, but also as the central organising agency for the region.

This is what some medical experts envision for the agency, they told TODAY on Wednesday (March 22), a day after Health Minister Ong Ye Kung announced its formation in Parliament during a debate on the Covid-19 White Paper.

The Communicable Diseases Agency will be set up under the Ministry of Health (MOH) to oversee disease preparedness, prevention and control, surveillance, risk assessment and outbreak response, Mr Ong said.

It will consolidate relevant public health functions that now reside in MOH, the National Centre for Infectious Diseases (NCID) and the Health Promotion Board.

The National Public Health Laboratory, a department under NCID that investigates outbreaks, will be transferred to the Communicable Diseases Agency, which will also maintain oversight of the clinical facilities in NCID.

Mr Ong added that similar setups are already adopted in other countries such as South Korea, the United Kingdom and the United States.

WHY CREATE A NEW AGENCY?

Would it not be enough to just have NCID in Singapore to deal with future pandemics?

Associate Professor Jeremy Lim, director of global health at the National University of Singapore's Saw Swee Hock School of Public Health, pointed out that NCID predominantly serves a clinical services function during a public health crisis.

Otherwise, it focuses on surveillance and policy work, he added.

Infectious disease expert Leong Hoe Nam from Rophi Clinic at Mount Elizabeth Novena Specialist Centre said that although NCID was often sought for medical advice and its knowledge was used in managing outbreaks, its involvement was “primarily consultative in nature”.

TODAY has sought comment from NCID. 

Assoc Prof Lim said the Covid-19 pandemic has shown that the “policy response is very tightly coupled to the clinical response”, and therefore, having both clinical and public health functions under one roof would make for “better policy translation”.

On the five points that the Communicable Diseases Agency will consolidate — disease preparedness, prevention and control, surveillance, risk assessment and outbreak response — Dr Paul Tambyah said that they are now overseen by various government ministries and agencies.

Dr Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the Communicable Diseases Agency can thus serve as a “reference point for all other agencies” that do various parts of outbreak prevention and response.

Professor Dale Fisher, a senior consultant at National University Hospital's division of infectious diseases, anticipates that the Communicable Diseases Agency will ultimately create a more streamlined, efficient and coordinated system.

“(This will) improve our preparedness for outbreaks as well as alerts, early warnings, risk assessment and a prompt response,” he said.

Assoc Prof Lim stressed, though, that the creation of the new agency does not indicate that there was anything wrong with the way Singapore's healthcare systems were organised previously to deal with infectious disease outbreaks. They were appropriate for the time.

"Nobody ever thought there'll be outbreaks on the scale of a global pandemic," he said.

"Having learned from Covid that the next outbreak can be very large and move very fast, we do not have the luxury to spread the powers and responsibilities (to deal with the crisis) and hope that when the next pandemic comes, we can hold hands and integrate nicely."

HOPES FOR THE NEW AGENCY

As Mr Ong did not provide more information about the Communicable Diseases Agency, TODAY has reached out to MOH for more details.

In the absence of such information, the experts have drawn on the experiences of analogous foreign organisations to weigh in on the possible form and function of the new agency.

Assoc Prof Lim said that the “Covid experience” has made it clear that cross-border interactions are important during a global health crisis.

“Like it or not, we should organise in a way that the world organises so that we have (similar) counterparts to make interactions easier,” he added.

Similar agencies to the Communicable Diseases Agency would include the United States’ Centers for Disease Control and Prevention, the European Centre for Disease Prevention and Control, and the Africa Centres for Disease Control and Prevention.

If Singapore remains without a similar organisation in the event of a future pandemic, Assoc Prof Lim believes that it could be troublesome for cross-border communication since there will be multiple parties to deal with here.

“The harder it is to interact, the less the interactions will occur,” he added.

In a similar vein, Dr Tambyah hopes that the Communicable Diseases Agency can be the “nucleus for the Association of Southeast Asian Nations (Asean) CDC or even the Asian CDC” where work can be carried out to target diseases of public health importance for the region.

Dr Tambyah also suggested that the Communicable Diseases Agency could be more effective in managing future pandemics than NCID — if it focuses on areas such as surveillance, public health, education and training, rather than providing clinical care.

He added that the present NCID leadership and staff members are burdened with multiple responsibilities, whereas a specialised approach could help the Communicable Diseases Agency to be more focused.

“Of course, all the medically or nursing qualified public health leaders would need to provide some clinical care in order to ensure that the policies are relevant, meaningful and practical… But this should not be their primary responsibility.”

Dr Tambyah is also of the view that the new agency should not take on a regulatory role, which he said is best left to the ministries.

Separating the two, he said, is invaluable in public health, as illustrated in the case of the surveillance for sexually transmitted infections.

“The Department of Sexually Transmitted Infections Control can honestly tell people that it is not involved in enforcement, so people working illegally in the commercial sex world can safely get treated and contact tracing done without the fear of prosecution,” he said.

“That kind of model could be expanded to other infectious diseases.”