INFLUENZA PANDEMIC PREPAREDNESS IN SINGAPORE Developments Ethical

INFLUENZA PANDEMIC PREPAREDNESS IN SINGAPORE Developments & Ethical Considerations Communicable Diseases Division Ministry of Health, Singapore

Agenda 1 § Pandemic response plan 2 § Recent developments 3 § Ethical considerations

1 Pandemic response plan DORSCON Flu Alert Levels Trigger Responses Green (WHO alert 1 -3) Animal disease (potential threat) §Step up surveillance Yellow (WHO alert 4) Inefficient H-to-H transmission §Containment Orange (WHO alert 5) More efficient H-to-H transmission (limited) §Containment Red (WHO alert 6) Pandemic, widespread infection §Mitigation High mortality and morbidity §Public health vs. social / economic considerations §Strong social distancing measures Black (WHO alert 6)

2 Recent developments § From Nov 09 onwards, pandemic vaccines are made available for the public § With effect from 12 Feb 10, Singapore has stepped down from DORSCON yellow to DORSCON green – Stand down of PPCs (GP clinics and polyclinics) – Revised infection control measures – Continued vigilance

3 Ethical considerations A) Distribution of resources B) Restriction on individual liberties C) Obligation towards HCWs

Measures Considerations 3 Ethical considerations – Distribution of resources § How to ensure an appropriate order of distribution An illustration: Vaccine distribution in the recent pandemic § Estimating vaccine needs § Establishing priority groups for vaccination – High-risk group • pregnant women • people with chronic medical conditions* • young children from 6 months to under 5 years of age – Essential service personnel (e. g. HCWs) * Lung disorders, heart diseases, diabetes, kidney failure, neuromuscular disorders and immunosuppressed

Considerations 3 Ethical considerations – Restriction on individual liberties § Restriction on individual liberties in public health measures during crisis Measures § Border controls – Provision of necessary medical treatment, IHR (2005) § Isolation / Quarantine order – Tripartite advisory on workplace measures – Implementing quarantine based on time of exposure

Considerations 3 Ethical considerations – Obligations towards HCWs § Try to establish a right balance Measures § Infection control measures – Intensive monitoring of health – Appropriate usage of PPE § Temporary rotation to non-front line roles – Applicable for high risk group personnel (e. g. pregnant HCWs) § Anti-viral prophylaxis

Thank you