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
3
Ethical considerations –
Measures
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
3
Ethical considerations –
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
3
Ethical considerations –
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