Infectious Diseases (Amendment) Bill

Order for Second Reading read.

3.40 pm

The Minister for Health (Mr Ong Ye Kung): Mdm Deputy Speaker, I beg to move, "That the Bill be now read a Second time." The Infectious Diseases Act, or IDA, was first enacted in 1976 and is Singapore's principal legislation for the prevention and control of infectious diseases. It empowers the Ministry of Health (MOH) to undertake a range of public health measures to prevent the importation and spread of infectious diseases.

For example, the IDA empowers MOH to conduct surveillance for infectious diseases, isolate and treat the infected persons and quarantine close contacts. The IDA also allows us to investigate and manage outbreaks with measures, such as contact tracing and disinfection of premises. IDA has been an effective piece of legislation and saw Singapore through health crises, such as severe acute respiratory syndrome (SARS) in 2003 and H1N1 in 2009.

Then, COVID-19 struck in 2019. Between influenza and SARS, COVID-19 is somewhere in-between. It had a case fatality rate of about 2% to 5% when it first emerged, far higher than influenza, but lower than SARS. However, COVID-19 was far more infectious than SARS, spreading via airborne droplets and by infected persons yet to display symptoms.

It became clear that we were facing a new enemy and it was no longer sufficient to solely rely on the approach of "test, trace, isolate", our main takeaway during SARS, to fight this new virus. Nationwide restrictions and community-based measures became necessary to curtail disease spread, reduce deaths and safeguard our healthcare system.

Part 7 of the COVID-19 (Temporary Measures) Act – in short, I will refer to it as Part 7 – was, therefore, enacted in this House in 2020 to complement the IDA and provided additional powers to MOH to combat the pandemic. As different variants emerged and various infection waves hit us, Part 7 enabled the implementation of many measures, including the circuit breaker, various gradations of safe management measures (SMMs), vaccination-differentiated SMMs and it also facilitated the implementation of TraceTogether and SafeEntry systems.

As our population was increasingly protected by vaccinations and safe recovery from infections, we cautiously reopened our society and economy. Part 7 continued to provide the agility and allow us to calibrate our SMMs and to ease restrictions according to risk assessments.

The Government conducted a comprehensive review of our responses during the COVID-19 pandemic crisis and its findings were released as a White Paper and debated in this House in March 2023.

One of the key recommendations of the White Paper was the need to review and amend the IDA. A key motivation behind the recommendation is that while Part 7 served us well for COVID-19, it was intended to be temporary and, in fact, it will expire next month which is why we have to table this Bill today after the Committee of Supply. COVID-19 is not going to be the last pandemic and we need better and permanent tools for the next threat. The pandemic has given us fresh perspectives on the management of infectious disease threats, and our laws, namely the IDA, needs to be reviewed and be ready for the next pandemic.

In this comprehensive review of the IDA, various Part 7 powers that continue to be relevant to future pandemic responses will be ported over to the IDA. We have also taken this opportunity to streamline the legislation, iron out kinks and make provisions for operational effectiveness by drawing lessons from the COVID-19 pandemic.

I will introduce the key substantive amendments in the Bill in my speech. Thereafter, I will pass the time to Senior Parliamentary Secretary Ms Rahayu Mahzam to elaborate on the other amendments to the IDA.

The main change to the IDA is to provide for a hierarchy of responses to address outbreaks of differing severity. This was a key takeaway from COVID-19, when we had to step-up responses as the situation escalated and taper down measures when the threat subsided. We need the IDA to provide the Minister for Health the powers to effect relevant measures at different phases of the pandemic.

Currently, the IDA is somewhat binary. It is either peace or emergency. It only provides for the declaration of a Public Health Emergency (PHE) by the Minister for Health. This was not declared during COVID-19 because while the pandemic situation was dire, we felt it fell short of an emergency – partly also due to the way we had managed the situation. We would associate an emergency with more extreme situations, like widespread riots, or war; or in the context of a pandemic, a healthcare system that is totally overwhelmed.

The IDA will therefore enable the Minister for Health to declare either a Public Health Threat (PHT) or PHE, depending on the severity of the situation. It will also provide the powers for the Minister to respond appropriately, based on each situation.

Let me first explain PHT and what it entails. The Minister may declare a PHT if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health and it is necessary to take measures to prevent, protect against, delay or control such incidence or transmission.

The outbreak of COVID-19 in Singapore in 2020 would have been considered a PHT under the new provisions. Minister will also have the powers to make regulations to implement measures to respond to the PHT as we had. These include movement restrictions; prohibitions of gatherings or events beyond a specified group size; or the suspension of non-essential businesses; up to and including a circuit breaker. All these powers are currently found in Part 7 and will be ported over to the IDA, as powers under a PHT – a threat.

Then, what constitutes PHE? A PHE will trigger powers in the most dire of situations. Declaration of a PHE is already an existing provision in the IDA, but we are finetuning the criteria of a PHE and proposing to make adjustments to the powers of the Minister under this situation.

We have enhanced the existing criteria for the declaration of a PHE, by factoring in the state of our healthcare systems and resources, in addition to the epidemiology of the disease. The amended IDA will empower the Minister to declare a PHE if he or she is satisfied that the actual or likely incidence and transmission of an infectious disease in Singapore constitutes a serious threat to public health and he additionally finds that the disease poses a substantial risk of either: one, a significant number of fatalities or incidents of serious disability of persons in Singapore; or two, a severe shortage or impairment of healthcare services and supplies in Singapore. A PHE declaration, if done, will unlock two additional powers for the Minister for Health.

First, based on the current PHE powers in the IDA, the Minister will be able to declare the whole of or any area in Singapore to be a restricted zone and impose curfew-like measures in those zones. These are envisioned to be much more stringent than the measures, including a circuit breaker, provided under a PHT. For example, the Minister may impose an island-wide curfew during specific time periods of the day or limit the number of persons that may leave a home every day.

During COVID-19, some countries had imposed such curfew-like measures. For example, in parts of India, persons were restricted from leaving the home overnight; and some China provinces restricted the number of persons per household who could leave the home and then only to obtain necessities. Fortunately, we did not need to impose any of these highly-restrictive measures during COVID-19, partly because our hospitals, while strained and stressed, were never overwhelmed like in many other countries where a big number of patients had to be left unattended. But we cannot be complacent and assume that we will be as fortunate in the next pandemic. There is a need to be ready for a situation where more stringent measures are needed to avoid a public health catastrophe.

Second, the Minister for Health will be able to exercise relevant powers under the Requisition of Resources Act 1985 (RORA) for the requisition of necessary resources to secure the safety of human life and health.

The RORA can already be exercised by the Minister for Defence during a PHE. What we will be doing with the amendments to the IDA is to also allow the Minister for Health to exercise requisition powers in a PHE. This is consistent with the overall objective of RORA, one of which is to provide for requisition of resources as necessary for the securing of the safety of human life and health in the event of a PHE.

We can envision that in a situation when Disease X strikes, the Minister may need to acquire private hospital beds, medical equipment, ambulances and manpower to shore up resources to tend to our population who may otherwise not be able to receive care expediently. Parties affected by such requisitions will be appropriately compensated under the RORA.

PHT and PHE declarations can be in force for a duration of up to 90 days and the duration is extendable. Drawing from our experience with epidemic waves – including that of COVID-19 – 90 days will provide sufficient time for the effect of measures to kick in and for MOH to review and assess the impact on the public health situation. If needed, the duration can be extended. If the situation subsides early, the declaration may be revoked early.

The measures under a PHT and PHE can be intrusive and disruptive, so they need to be triggered only when necessary to protect lives. These decisions will only be taken, following careful consideration based on prevailing scientific evidence and risk assessments and at the highest level of Government.

There will also be safeguards in place. The Minister must first, by order, declare a PHT or PHE and publish a notice to bring the order to the public's attention. All orders to declare or extend a PHT or PHE and any regulations made during a PHT or PHE, must be published in the Gazette and presented to Parliament as soon as possible. Parliament has the authority to scrutinise the order or regulations and if unsatisfied with the decisions, vote to annul them.

To sum up, what I have just described can be found under clause 22 of the Bill, which inserts into the IDA a new Part 3A on the control of infectious disease during a PHT and PHE. Further details on amendments to enhance operational efficiency during a PHT and PHE will be elaborated on by Senior Parliamentary Secretary Ms Rahayu Mahzam.

In effect, with these amendments, our public health response will comprise four postures.

First, "Baseline". This is a peacetime state where routine disease prevention and control measures, along with public health surveillance programmes, are in place. During peacetime, the primary objective is to detect outbreaks early to prevent and mitigate disease spread.

Second, "Outbreak Management", where there are signs of an emerging infectious disease overseas, upstream measures, such as pre-departure health requirements, temperature screening or stay orders on persons entering Singapore, may be implemented to prevent the disease from being introduced into Singapore. This will help prevent disease importation and transmission and buy us time to understand the new disease. In the event of a local outbreak, measures such as testing, treatment and contact tracing, may be implemented. This is what we did recently at Bukit Merah due to a local tuberculosis outbreak.

The IDA does not explicitly mention "Baseline" and "Outbreak Management" situation tiers. These measures are already well-established and routinely carried out and for these two tiers, they are already legally backed by various sections in the IDA; but these two are useful lexicons for us to remember.

Third tier is "Public Health Threat", which I have described to be for situations that may require more widespread or prolonged measures, up to and including those that were imposed during the circuit breaker.

Fourth, "Public Health Emergency", being the most dire of public health crises where even stricter measures, such as curfews or requisition of resources, may be implemented.

These four public health postures will inform the application of the IDA henceforth and will greatly facilitate nimbler management of different stages of an outbreak or pandemic. They will also become our common language.

As part of this Bill, the Government will be proposing the repeal of Part 11 of the COVID-19 (Temporary Measures) Act, in short, I will refer to it as Part 11. Part 11 was introduced in 2021 to provide assurance to the public that personal contact tracing data collected during digital contact tracing systems, including TraceTogether and SafeEntry were limited for the purposes of contact tracing for COVID-19 and for criminal investigations and proceedings in respect of serious offences.

TraceTogether and SafeEntry have not been active for about a year as we transitioned to treating COVID-19 as an endemic disease and SMMs were stepped down. Senior Minister Teo Chee Hean, as the Minister charged with the responsibility for digital Government and public sector data governance, in consultation with MOH, determined that these digital contact tracing systems would no longer be required after 5 January 2024.

TraceTogether and SafeEntry have since been removed from the app stores and the backend digital infrastructure supporting the TraceTogether and SafeEntry systems have been dismantled. The TraceTogether and SafeEntry websites have also been shut down. As of 1 February 2024, all COVID-19 related personal contact tracing data derived from TraceTogether and SafeEntry has been deleted; with the exception of TraceTogether data pertaining to a murder case in May 2020, which will be retained by the Police indefinitely. With the deactivation of TraceTogether and SafeEntry, and the deletion of personal contact tracing data, Part 11 is no longer required and we will therefore repeal it.

As for the future, with the rapid advancement of digital technology, precision medicine and artificial intelligence, it may not be wise to pre-judge what we may or can do in future pandemics. We may collect different kinds of data digitally. We may use them differently to fight the pandemic. The public may need new forms of assurances. Part 11 is bound to be obsolete when the next pandemic hits us.

In the event of a future pandemic crisis and should we implement a digital personal data collection tool to be part of our arsenal to fight the pandemic, we will need to address data protection concerns and provide assurance to the public. To do so, the Government will come back to Parliament to pass legislation, if necessary.

In the meantime, we will closely monitor the technologies available, their possible use cases and relevance for future pandemics. This will allow us to quickly determine, at the onset of the next outbreak, whether and what tools should be deployed as well as the relevant safeguards to be implemented to ensure that an individual's personal data are used with discernment.

Mdm Deputy Speaker, besides the amendments relating to pandemic management, there are also other refinements to the IDA. I will now pass the time to Senior Parliamentary Secretary Ms Rahayu Mahzam to elaborate on these amendments.

Mdm Deputy Speaker: Senior Parliamentary Secretary Rahayu. Sorry, could you take a seat first?

Question proposed.

Mdm Deputy Speaker: Senior Parliamentary Secretary Rahayu.

3.59 pm

The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam): Mdm Deputy Speaker, as mentioned by the Minister for Health, a key intent behind the amendments to the IDA is to introduce powers that provide for a gradation of measures that can be taken during a PHT and a PHE. Besides the Minister's powers to make regulations during a PHT or PHE, the following amendments are also being introduced to enhance operational and enforcement efficiency during a PHT or PHE.

One, the Minister may direct all persons or any class of persons in charge of premises, such as the owners of shopping malls, to implement contact tracing or surveillance measures.

Two, oral directions may be given by authorised Health Officers to require persons to comply with the relevant PHT or PHE regulations in force. For example, if there is a regulation that imposes limits on the size of gatherings and a Health Officer comes across a gathering that exceeds this limit, the Health Officer may give an oral direction to the group requiring them to disperse.

Three, a higher maximum penalty can be provided for repeat offenders who do not comply with PHT or PHE regulations. The effectiveness of disease containment efforts is contingent on the public's cooperation in taking public health measures seriously. Non-compliance does not only put oneself at risk of disease, but also others in the community and can set our national efforts back significantly.

Four, to focus our resources on the pandemic response, statutory appeals to the Minister will be temporarily suspended during a PHT and PHE. Members of the public will still be able to reach out to MOH to seek exceptional handling on a case-by-case basis, and MOH will attend to these quickly and administratively.

These amendments will allow the expeditious implementation of public health measures during a PHT or PHE.

Besides incorporating the relevant powers under Part 7 of the COVID-19 (Temporary Measures) Act and providing a gradation of responses under the IDA, MOH has also taken this opportunity to review and update the IDA in its entirety.

The COVID-19 pandemic has required us to adopt new ways to prevent, mitigate and manage infectious disease outbreaks. Advancements in scientific technology and ever-growing international connectivity have demonstrated the need for a new paradigm of infectious disease management measures to fit the modern times.

Let me start with the appointment of officers who need to carry out the public health actions. Public health actions under the IDA are mainly carried out by the Health Officers appointed by the Director-General of Health, the Director-General of Public Health, or the Director-General, Food Administration. As the powers exercisable under the IDA may potentially be intrusive, only public officers, officers of statutory bodies and employees of prescribed institutions, may currently be appointed as Health Officers.

However, manpower from the public service forms a relatively smaller portion of the local workforce. When faced with a pandemic, there is often the need to tap on the rest of the workforce to supplement the national response. With diverse partnerships or working arrangements, less intrusive functions can be performed by other parties in partnership with the public service.

Clause 4 of the Bill thus expands the pool of people who can be appointed as Health Officers to implement and enforce the IDA. The first new group of persons are employees of prescribed entities and institutions. These will include employees of private healthcare providers and MOH-linked entities such as MOH Holdings and the Agency for Integrated Care. The second new group are employees of prescribed service providers that the Government or statutory bodies have engaged. These could include call centres engaged to do contact tracing. The third group are auxiliary police officers. These three groups were in fact closest to the action during the COVID-19 pandemic, and will be the first sources of manpower MOH will tap on, especially during an escalating outbreak.

As public sector resources will be stretched further during a PHT or PHE, there may be a need to bring together additional manpower to supplement and support these Health Officers. Clause 22 introduces a new section 21I of the Bill, which will allow persons who are deemed suitable to be appointed as adjunct Health Officers during a PHT or PHE, to perform the functions of a Health Officer. These persons could include volunteers, such as former nurses, who have stepped forward to help with contact tracing and surveillance.

To ensure proper oversight over these Health Officers and adjunct Health Officers, they will need to be appointed and authorised with powers on an as-needed basis. They will also be informed of the scope of their powers and the validity period of their appointments and receive appropriate training before being tasked to carry out their functions under the IDA.

The IDA also provides for specific situations where the arrest of offenders may be carried out by authorised Health Officers without a warrant, such as the arrest of persons who breach isolation orders. MOH recognises that the power of arrest is a serious one which should only be exercised by persons who are trained to do so. Accordingly, clauses 14 and 36, and the new section 21H of the Bill, insert an additional safeguard where only Health Officers who are public officers, officers of statutory bodies and auxiliary police officers can be authorised to arrest persons without a warrant. In addition, these officers must also be separately authorised by the Minister to exercise such powers of arrest.

We also will be strengthening our levers to safeguard our population against the importation of disease. Global connectivity in modern times can facilitate the spread and migration of diseases. Outbreaks in one country can spread rapidly to the rest of the world. We saw that for COVID-19 and SARS. Given that Singapore is an international trade and travel hub, we remain vulnerable to the importation of emerging infectious diseases and must take the necessary precautions.

Many would be familiar with the concept of pre-departure testing and mask-wearing on international flights implemented during the COVID-19 pandemic. These measures were implemented through sectoral levers. As circumstances may differ in future outbreaks, clause 27 of the Bill introduces new provisions to empower the Minister to specify pre-departure or onboard health requirements which persons travelling to Singapore are required to comply with. Upon arrival, travellers may also be required to produce proof of their compliance with any pre-departure health requirement. Non-compliance with any of these requirements can give rise to an offence. Clause 27 of the Bill will provide us with the ability to impose such requirements uniformly and to take firm action against incoming travellers who do not comply with them.

Currently, section 31 of the IDA requires persons arriving in Singapore by air or sea to fulfil specified vaccination requirements and show proof of such vaccination. In line with the World Health Organization’s (WHO's) recommendations, this provision is currently applied in respect of yellow fever vaccinations for travellers from certain African and South American countries that are endemic for yellow fever. This is intended to protect Singapore against the risk of importation of the disease. To guard against new diseases and to capture all possible modalities of travel into Singapore, clause 28 of the Bill will expand section 31 to include travellers entering Singapore by land.

Besides strengthening our levers to prevent the importation of diseases into Singapore, Singapore should also be responsible in preventing the exportation of diseases if we are experiencing an outbreak. Therefore, clause 32 of the Bill removes the prerequisite under section 45B of the IDA for a PHE to be declared before the Minister can require persons to undergo medical examinations before leaving Singapore. Such medical examinations, also known as "exit-screening", are implemented in advance of a PHT or PHE as a key measure to prevent the cross-border spread of an infectious disease. Such measures are also in line with the WHO’s recommendations under the International Health Regulations.

Singapore is a densely populated country, and this can accelerate the spread of an infectious disease within the population. Therefore, additionally, we will be strengthening our levers to prevent disease transmission within our communities.

Currently, the IDA recognises three categories of persons in relation to an infectious disease: one, actual infected "cases" who have the disease; two, "carriers" who are harbouring, likely to or suspected of harbouring the disease; and three, "contacts" who have been exposed to the risk of infection from the disease. The COVID-19 pandemic showed that there may be situations where we will need to take public health measures pre-emptively for persons who do not fall within any of these three categories, but are still at a higher risk of exposure to infection and onward transmission of the disease due to their unique circumstances and the nature of that particular disease.

Hence, clause 2 of the Bill supplements these three categories by introducing the concept of an "at-risk individual". An "at-risk individual" includes an individual who is or appears to the Director-General of Health or a Health Officer to be a contact or carrier of an infectious disease. Examples of such individuals include those who live in high-risk living arrangements or work in high-risk occupations where prolonged close contact with others may be unavoidable. An "at-risk individual" would also include individuals entering Singapore from a country during a period when there is an outbreak or suspected outbreak in that country. Individuals who have undergone a medical examination in connection with an infectious disease but have not received a conclusive test result are also "at-risk individuals". The recognition of "at-risk individuals" and the application of the powers under the IDA to such individuals allow public health measures, such as testing or isolation, to be carried out at an early stage to stem the spread of an infectious disease.

During the COVID-19 pandemic, there were instances where persons who were served with isolation orders went about running errands or having meals, before heading home to be isolated. Such actions have heightened the risk of disease transmission. Clause 12 of the Bill introduces a new provision that makes it an offence if such persons, without reasonable cause, fail to proceed to the place of isolation as soon as possible, if the isolation order does not specify a time to do so.

Currently, section 21A of the IDA requires persons who know or have reason to suspect that they are a case, carrier or contact of a dangerous infectious disease to not expose others to the risk of infection in places outside of their homes. Household members inherently face higher transmission risk, and the current provision assumes that they are willing to accept such risks due to their close relationship or living arrangements with one another. However, the COVID-19 pandemic showed us that there can be varied living arrangements in Singapore where the assumption may not apply. These include co-tenants or employer-employee living arrangements. Additionally, there may also be cases where a person behaves irresponsibly inside their home to the detriment of other household members.

Hence, clause 20 of the Bill amends section 21A by additionally making it an offence to deliberately or recklessly put another person in one’s own place of residence at risk of infection by one’s own conduct. This would allow us to act against infected persons who refuse to isolate in their rooms or continue to use communal areas without taking reasonable precautions.

Various provisions in the IDA will also be refined to meet our operational needs in managing the outbreak of infectious diseases.

Clause 3 of the Bill introduces a new section 2A, which provides that, one, parents or guardians of minors and, two, guardians of persons with any intellectual disability or lacking in mental capacity, may be notified of any requirement, direction, notice or order that has been issued to the person under their care. Upon receipt of such notice, the parent or guardian will be personally required to ensure that the person under their care complies with the requirement, direction, notice or order, as the case may be.

Currently, section 17 of the IDA requires the declaration of an isolation area to be published in the Gazette before it can take effect. Clause 14 of the Bill amends section 17 to provide that the declaration of an isolation area takes effect once it is brought to the notice of all persons who need to be aware of the declaration. This amendment will allow for the effective and timely isolation of persons within a particular area to prevent the spread of disease. For public awareness, MOH will continue to publish the declaration of an isolation area in the Gazette.

The IDA will also be updated to account for the latest modalities and approaches to disease management. For example, the definition of "medical examination" in section 2 of the IDA will be expanded to include self-administered examinations such as antigen-rapid tests. Separately, for clarity, the service of orders and notices under the IDA using electronic means such as email and SMS will also be explicitly recognised.

The powers under the IDA that involve public health assessment will now reside with the Director-General of Health instead of the Minister for Health. These amendments are in recognition that such decisions would be better suited to the professional expertise of the Director-General. These powers include imposing requirements on healthcare professionals or institutions for the purposes of investigating or preventing the spread of an infectious disease; the declaration of isolation areas; and orders to disseminate health advisories.

Finally, in addition to the amendments relating to outbreak response, we have also updated other sections of the IDA. MOH will be removing the requirement which circumscribes the group of persons who can perform vaccinations. The provision of vaccination, including the persons who may perform vaccinations, will be regulated under relevant levers that govern healthcare service delivery and the conduct of practitioners, such as the Healthcare Services Act 2020 and the Medical Registration Act 1997.

Let me now discuss the proposed amendment concerning the human immunodeficiency virus (HIV). Section 23(1) of the IDA was introduced in 1992 as one of the public health measures to control and curb HIV transmission. It requires persons living with HIV to inform their sexual partners, prior to sexual activity, of the risk of contracting HIV from them and to obtain the partner’s consent to accept the risk of transmission. This allows the sexual partner to make an informed decision on whether to proceed with the sexual activity and take necessary precautions to minimise the risk of contracting HIV. In practice, doctors regularly inform patients about this legal obligation at the point of HIV diagnosis.

The intention of this disclosure requirement was to control the spread of HIV and deter the irresponsible behaviour of those that put others at risk of contracting HIV. The disclosure requirement remains relevant as a public health safeguard to protect the sexual partners of persons living with HIV.

Section 23(2) of the IDA similarly requires persons who do not know that they have HIV but have reason to believe that they may have HIV, to inform their sexual partners of the risk of infection. These safeguards remain and will continue to deter irresponsible behaviour, including from those who attempt to hide behind the ignorance of their HIV status.

While the safeguards are in place to deter irresponsible behaviour, it is important also for our HIV legislation to be aligned with medical advancements in HIV treatment, in order to encourage early detection and treatment of HIV. HIV remains incurable. However, with medical advancements in HIV treatment, persons living with HIV who adhere to their HIV treatment as prescribed by their doctors are now able to reduce the amount of HIV in their bodies to an undetectable level. This is referred to as having an undetectable viral load. A person who maintains a stable undetectable viral load over time, as a result of a consistent adherence to their treatment, cannot transmit HIV to their sexual partner. The sexual partner therefore is not at risk of contracting HIV from these individuals.

The amendment Bill introduces a provision which excludes persons living with HIV from the disclosure requirement under section 23(1), if the person has maintained an undetectable viral load for a certain period of time preceding the sexual activity in question. A person is presumed to have done so if certain conditions are met.

These conditions are that the person living with HIV adhere to treatment, have stable and consistent undetectable viral load test results from a licensed laboratory in Singapore, and have an undetectable viral load test result within a specified period prior to sexual activity. More details will be set out in subsidiary legislation. This amendment aligns with medical advancements and our public health objective to curb transmission by shifting greater responsibility to individuals to get tested and treated for HIV in order to achieve and maintain a stable undetectable viral load.

The objectives of the amendments are to encourage individuals who are at high risk of getting HIV to be tested regularly for HIV, and if possible, to get treated early, so that they can achieve undetectable viral load as early as possible. We urge persons living with HIV to adhere to HIV treatment and monitor their viral load closely with their doctors. In doing so, we aim to reduce the risk of HIV transmission.

Singapore is not the first or only country to amend the law on this. Other jurisdictions such as Sweden, Taiwan, United States have removed the disclosure requirement for persons living with HIV who have no risk of transmitting HIV. I would like to emphasise that in proposing the amendments, we are not relaxing the public health safeguards against HIV transmission, but encouraging infected persons to come forward to be tested and treated, thereby better protecting their sexual partners. Irresponsible behaviour that can lead to the transmission of HIV remains an offence in Singapore and appropriate enforcement action will be taken as required.

To conclude, I return to the primary aim behind the amendment Bill. We have sought to enhance the IDA to enable the swift prevention and control of infectious diseases, and the flexibility to calibrate our response according to the public health situation. We have ported over relevant provisions under the COVID-19 (Temporary Measures) Act, Part 7, which served us well and updated the existing IDA provisions.

As experts have cautioned, the likelihood of another pathogen with even deadlier potential than COVID-19 remains. The intent behind these amendments is to better equip MOH and Singapore to tackle future outbreaks and pandemics, safeguard the lives of our people and the functioning of our healthcare system.

I ask for the support of all Members for this Bill. Mdm Deputy Speaker, I beg to move.

Mdm Deputy Speaker: Mr Louis Ng.

4.17 pm

Mr Louis Ng Kok Kwang (Nee Soon): This Bill will enhance the Government’s powers to deal with future pandemics, introduce more nuanced public health measures and align HIV disclosure requirements with scientific developments. I have four points of clarification to raise.

My first point is on the responsibility of parents and guardians. The new section 2A places responsibility on parents and guardians to ensure that an individual with an intellectual disability or who otherwise lacks mental capacity to comply with requirements under the Infectious Disease Act. The parent or guardian may be served with a notice to ensure the compliance of the individual. The parent or guardian may be found liable for an offence if they fail to ensure that the individual complies with any requirement of the Act.

Under the Mental Capacity Act, there are certain principles to balance a person’s right to make their own decisions and the need to protect them. These principles include that before an act is done or a decision is made, it must be considered whether the purpose of the act or decision can be effectively achieved in a way that is less restrictive of the person’s rights and freedom of action. Another principle is that a person must be assumed to have capacity unless it is established that the person lacks capacity. A further principle is that a person is not to be treated as unable to make a decision merely because the person makes an unwise decision.

When a parent or guardian is served with a notice to ensure compliance of the individual, the measures taken to ensure compliance may involve some restriction of rights or freedom of action. Can the Minister clarify whether these principles under the Mental Capacity Act continue to apply when the parent or guardian is served with a notice to ensure the compliance of the individual with requirements under the Infectious Diseases Act? How should a parent or guardian of an individual lacking mental capacity balance their responsibilities under the Infectious Diseases Act and the principles they must abide under the Mental Capacity Act?

[Mr Speaker in the Chair]

My second point is on the Director-General’s power to require classes of persons to provide information or samples for any public health surveillance programmes, investigations or surveys. The Director-General already has powers to require any person to provide any information or sample. The amendment to section 7 will expand the scope of the powers from any person to any classes of persons.

While there is public health interest in doing so, there is also greater risk from any breach of data privacy. Can Minister share what safeguards are in place for the management and storage of the information collected? Will the data collected be anonymised? Are there any time limits for how long the data collected can be stored? Will there be an effort to heighten safeguards when the provision of information or sample is from classes of persons as opposed to from individuals?

My third point is on Director-General’s power to order detention and isolation. The Director-General already has the power to order detention and isolation of certain individuals under the existing section 15 of the Infectious Diseases Act. The new section 15 expands and specifies this power. It specifies that individuals may now be ordered to isolate for a period of time “necessary for the protection of the public.” This proviso about being necessary for the protection of the public is not included in relation to individuals ordered to isolate in a hospital. Can the Minister clarify the significance of this difference?

Additionally, there are certain renewable time limits prescribed for Director-General’s other powers. For example, under the new section 17, the Director-General may declare a premise to be an isolation area for up to a period of 90 days. This can be extended for a period up to 90 days at any one time. Can the Minister share if the Ministry considered including similar renewable time limits for the isolation and detention of individuals?

My final point is on updates to the HIV disclosure laws. Under the new section 23(1A), the disclosure requirement for a person with HIV infection does not apply if he or she has maintained an undetectable HIV viral load for at least the prescribed period preceding the sexual activity. I thank the Ministry for updating our HIV disclosure law to be aligned with the latest scientific understanding. Members of civil society have also shared with me that they are heartened by this development. Can the Minister confirm that the length of the prescribed period and the threshold for determining undetectable HIV viral load will be determined and periodically updated based on the latest state of scientific knowledge?

Notwithstanding these clarifications, I stand in support of the Bill.

Mr Speaker: Ms He Ting Ru.

4.22 pm

Ms He Ting Ru (Sengkang): Sir, I support the amendment to section 23 of the IDA, which contains provisions dealing with sexual activity by persons with HIV infection. For too long, the law has lagged behind medical developments and the proposed amendment to section 23 will recognise the recognised principle "U equals U", or undetectable equals untransmittable.

However, I am concerned that the proposed amendment to section 23 does not go far enough to assist in our journey towards the UN AIDS 90-90-90 targets for 90% of people living with HIV knowing their status, 90% of people living with HIV who know their status being on antiretroviral therapy and 90% of people living with HIV on antiretroviral therapy achieving viral suppression.

As Asst Prof Dr Rayner Tan from the National University of Singapore (NUS) Saw Swee Hock School of Public Health argued in a recent CNA commentary, stigma and a lack of access to prevention methods stand in the way of an HIV-free future. The 2023 Global Update by the Joint United Nations (UN) Programme on HIV and AIDS has also found that punitive laws are more likely to drive people away from seeking HIV support and services and may be counterproductive to public health efforts. In light of the consensus among public health experts on the ineffectiveness of criminal law in ending HIV, does the Government plan to eventually do away with section 23? If so, can the Government explain its decision to tweak section 23 instead of entirely repealing this law?

Sir, I also wish to seek the Government's clarification on the duty of disclosure under section 23 in light of the Singapore High Court's decision in GCP vs Public Prosecutor. In that case, the Judge held that even though the accused had only been informed by the Public Health Officer working at the National Public Health Unit that he was required to disclose his HIV-positive status to his sexual partners, the Public Health Officer's opinion of the law was not conclusive. Instead, the High Court held that the plain language of section 23 means that a person must communicate the risk of contracting HIV and not merely one's HIV status. This judgement has caused confusion among people who are subject to the disclosure obligation under section 23 as to what would satisfy this requirement to communicate the risk of contracting HIV. What steps have or will the Government take to clarify the ambiguity in section 23?

Finally, under section 23(2) of the IDA, persons who have reason to believe that they have been exposed to a significant risk of contracting HIV similarly have a legal duty to disclose the risk of contracting HIV to their sexual partners or take other precautionary steps before engaging in sexual activity. Can the Government provide an update on the number of complaints it has received and the number of investigations it has conducted under this law since it was introduced in 2008? Can the Government also confirm if, in light of medical advances, the reasonable precautions under section 23(2)(c) will include the correct use of pre-exposure prophylaxis, also known as PrEP? If so, would the Government consider amending this sub clause to remove the phrase during the sexual activity and or explicitly recognise the use of PrEP as reasonable precaution? If not, can the Government explain why not?

Mr Speaker: Leader.

Debate resumed.

Mr Speaker: Senior Parliamentary Secretary Rahayu.

4.27 pm

The Senior Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam): Thank you. Members have sought clarifications on the proposed amendments. Allow me to respond.

Mr Louis Ng sought clarifications on how the guardian of an individual who lacks mental capacity should balance their responsibilities under the Infectious Diseases Act (IDA) and the principles under the Mental Capacity Act. I would like to clarify that the IDA does not limit the Mental Capacity Act. The principles under the Mental Capacity Act will therefore continue to apply.

Under the new section 2A, the IDA notice must first be served on the minor or individual. Where the minor or individual is not able to fully understand and follow through with the requirements in the IDA notice, the same IDA notice is then served on the parent or guardian, requiring them to facilitate the minor or individual’s compliance. This is a reasonable expectation, that the parent or guardian should play a part. Section 2A allows the Ministry of Health (MOH) to take action in cases of irresponsible parents or guardians, who without reasonable excuse, fail to do so.

Mr Ng asked about the safeguards for the management of information collected from classes of persons under section 7. The current section 7 already allows the Director-General of Health (DGH) to require any person to provide information for the purposes of public health surveillance, epidemiological investigations or surveys. The amendment is not an expansion of powers. Rather, it clarifies and makes explicit the manner in which DGH may exercise his power to require information from classes of persons. This facilitates operational efficiency. For example, a notice can be issued to the class of “persons who are in charge of a laboratory”, as opposed to multiple individual notices issued to each person in charge of a laboratory.

Data collected may not necessarily be anonymised. It may be necessary to match the samples collected to the data collected for the right patient. But where data can be used in anonymised form, such as to conduct trend analysis, MOH will do so.

MOH treats the management and protection of personal data very seriously, regardless of whether the information is collected from individuals or a class of persons. Sensitive personal data is managed and protected in compliance with whole-of-Government standards. Disclosure of information under the IDA requires DGH’s authorisation and is only for public health purposes, including measures to prevent and control an outbreak and national public health research. DGH may also impose additional conditions on the receiving party to better protect the information.

In relation to section 15 on the detection and isolation of persons, Mr Ng pointed out that while an individual may be ordered to be isolated in his own residence "for the protection of the public", this phrase is not used in relation to individuals being ordered to isolate in a hospital.

The difference in language is not new and already exists in the current Act. Isolation of persons in a hospital protects other patients and hospital staff, whereas isolation of individuals in their residence is more directly for the protection of the public within the community.

On whether MOH considered providing for a time limit for isolation orders under section 15, the duration of a section 15 isolation order is not open ended or arbitrary. During the COVID-19 pandemic and also in the context of other communicable diseases, the duration has always been based on public health considerations and grounded in medical science, typically until the individual is no longer infectious or potentially infectious.

I note that Mr Louis Ng as well as Ms He Ting Ru welcomed the provisions in relation to HIV. Mr Ng asked about the definition of undetectable viral load, length of the prescribed period and whether these would be periodically updated.

I would like to emphasise that the criteria for the maintenance of an undetectable viral load were rigorously determined based on latest scientific evidence and clinical knowledge after consultation with HIV and infectious diseases experts.

Ms He Ting Ru has also raised some other questions. In response, I would say that section 23 remains relevant to reduce sexual transmission of HIV, by requiring persons living with HIV with a detectable viral load and persons who do not know of their status, but have reasons to believe that they have HIV, to disclose their risk of acquiring HIV to their sexual partners prior to sexual activity. This allows sexual partners to make an informed decision before engaging in sexual activities and to encourage responsible sexual behaviour by taking mitigating measures such as ensuring condom use to protect themselves. The intention of the HIV laws is not to criminalise persons living with HIV, but to deter irresponsible behaviour.

She had also made reference to the high court judgment. The high court judgment will be superseded by the amendment.

In relation to the queries on the prosecution, from 2015 to 2023, seven people were convicted under section 23(1) for failing to inform their sexual partners of the risk of getting HIV infection from them. Of the seven, four had undetectable viral loads at the time of their offences. All four convictions had aggravating circumstances, including simultaneous offences under the Misuse of Drugs Act; committing a second offence while under investigation for a first offence; one victim was a minor; and one deceived and exploited a victim by lying and posing as a police officer. The law at that time was that a person living with HIV was required to inform their sexual partners of the risk of getting HIV infection from them. This law was informed by the state of medical science and there have since been developments in this, and that is why we are updating the laws to align with these developments.

Mr Speaker, to summarise, persons living with HIV do not need to disclose the risk of HIV transmission to their sexual partners if they have, first, maintained stable undetectable HIV viral load consistently below 200 copies per millilitre of blood, for at least six months, based on test results from a recognised laboratory. Second, their most recent undetectable viral load test result should be nine months or less before the sexual activity in question. Third, they had adhered to medical treatment for HIV infection up to the time of the sexual activity in question. Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner. We will set out the criteria in subsidiary legislation, to allow for timely and responsive adjustments should the state of medical science change in the future.

Mr Speaker, the COVID-19 pandemic has greatly widened our perspectives on the management of infectious diseases. The proposed amendments will allow Singapore to respond more nimbly to future infectious diseases threats, by providing the flexibility to calibrate our measures in accordance with the public health situation.

COVID-19 will not be the last pandemic that we encounter. The world remains vigilant against the next infectious disease threat; likewise, we must stand ready.

I am confident that with these amendments, Singapore will be better equipped to tackle future outbreaks and pandemics and safeguard the health of our population. I thank Members for their support of this Bill.

Mr Speaker: Minister Ong Ye Kung.

Mr Ong Ye Kung: Thank you, Speaker. I just want to add a comment to the amendment to section 23. We are keeping section 23 because it is still relevant for those who are infected, or think that they are infected, that they continue to have an obligation to inform. At the same time, the Bill provides an exemption for those who have tested, sought treatment and then lower themselves to an undetectable and untransmissible level.

We think this combination best protects public health. Other countries might have come to a different combination, but MOH has studied together with the experts, and we find that this combination probably best protects public health.

As Senior Parliamentary Secretary Rahayu Mahzam has answered all questions, I have nothing further to add.

Mr Speaker: Are there any clarifications for the Minister and Senior Parliamentary Secretary? Dr Tan.

4.35 pm

Dr Tan Wu Meng: Mr Speaker, I declare that I am a medical doctor at a public healthcare institution.

I have a clarification to ask of Minister for Health Mr Ong Ye Kung. With the new Act and the new classifications of public health threat and public health emergency, a number of Clementi residents will be wondering what becomes of the older DORSCON classification – the Disease Outbreak Response System Condition Classification. A number of residents had shared that the different colours green, yellow, orange and red can mean different things to different people. So, can the Minister advise us what will become of DORSCON now that we have the clearer status of public health threat and public health emergency.

Mr Ong Ye Kung: That was a very good question from Clementi residents. DORSCON stands for Disease Outbreak Response System Condition, it has four colours. It was used by the Public Service for agencies to coordinate response and to plan resources. It is actually internal. But during COVID-19, somehow it became an external communication code and it triggered all kinds of reactions in supermarkets.

With this change, now that we have the new Act, we have four levels of alerts, which is: Baseline, Outbreak, Threat and Emergency. I think it is more intuitive and clearer. So, amongst the agencies, through our Homefront Crisis Executive Group (HCEG), we agreed that this new four tiers will replace DORSCON, both for internal planning as well as our external communications.

Mr Speaker: Yes, Ms He Ting Ru.

Ms He Ting Ru: Thank you, Speaker. I have two quick clarifications.

The first is, I thank Senior Parliamentary Secretary Rahayu Mahzam for saying that the amendment supersedes the ruling in GCP vs Public Prosecutor. I acknowledge that amendment supersedes the court sentencing framework. However, I am not clear about the use of the interpretation of meaning of risk of disclosing HIV. So, I would like to ask for further clarifications about that. What specifically in particular are the persons living with HIV are supposed to do in that context.

The second point that I wanted to seek further clarifications on is that I do not believe that there is any local study on the effectiveness of criminalisation of HIV non-disclosure on reducing HIV infection rates, albeit this time where we are talking about a reduced group of people that this applies to. I am just wondering what can MOH do to address the potential stigma that might arise from this continued criminalisation.

Ms Rahayu Mahzam: I thank Member for the question. In relation to her point, actually how this works is that when a complaint is made, the person investigated for the offence would then have to produce the necessary evidence or show undetectable viral load (UVL) that they have had.

So, when at that juncture, the strongest evidence for adherence of medical treatment would be the UVL test result from a recognised laboratory at the next regular medical follow-up visit for HIV after the sexual activity in question because it will show that they have maintained their UVL, as this would not have been possible without treatment.

There would be other circumstantial evidence for adherence to treatment that may include contemporaneous records at the next follow-up visit after the sexual activity in question, of documented treatment adherence, or documentation in past medical records of a consistent pattern of treatment adherence and consistent past UVL test results carried out by a recognised laboratory. These are the things that they would have to show in the event there is a complaint made and investigations follow.

In as far as how they would conduct themselves, the reality is that this is a law, a provision that says you are not supposed to do it. So, if they then do this and there is a complaint made, investigations will follow, and these are the provisions and the evidence that they can rely on.

On the second question on the criminalisation of non-disclosure, the amendments consider the established scientific evidence that transmission risk with an undetectable viral load is effectively zero. That is the premise upon which we are making this change.

In contrast, other sexual activities, although lower risk, pose some transmission risk. So, we will not want to change our position completely on this because what we are doing is based on data, based on evidence, and requiring disclosure of the risk of acquiring HIV prior to sexual activity so as to allow the sexual partners to make an informed decision before engaging in sexual activities, and be able to then take the mitigating measures, such as medications, to protect themselves.

Mr Speaker: Any other clarifications for the Minister and the Senior Parliamentary Secretary? None.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Mr Ong Ye Kung].

Bill considered in Committee; reported without amendment; read a Third time and passed.

Mr Speaker: Order. Leader.