Public Consultation on Proposed Amendments to Infectious Diseases Act
The Ministry of Health (MOH) invites you to submit feedback on the proposed amendments to the Infectious Diseases Act (IDA). The public consultation will be held from 27 June 2018 to 7 August 2018. You may provide your feedback via email to firstname.lastname@example.org. We will consolidate and publish a summary of the feedback provided as well as our responses, after the close of the consultation exercise.
RATIONALE FOR AMENDMENTS
2. The IDA was enacted in 1977 and was last revised in 2008. It is the principal legislation that provides for the detection, prevention and control of infectious diseases (IDs) entering into and/or circulating within Singapore.
3. As part of continual efforts to improve the measures to prevent and control the spread and importation of IDs, MOH is proposing amendments to the IDA in three key areas of:
a) Enhancing ID surveillance;
b) Preventing the introduction of IDs into Singapore; and
c) Strengthening ID control within Singapore.
4. These amendments are intended to better protect the community against existing and re-emerging IDs, as well as safeguard public health against new and emerging IDs.
SCOPE OF THE CONSULTATION EXERCISE
5. The areas where the IDA will be amended are described as follow:
A. Enhancing ID Surveillance
i) Clarification on the definition for “Medical Examination”
6. The definition of ‘medical examination’, as currently used in several sections of the IDA and necessitated by ID surveillance, will be added to Section 2.
7. ‘Medical examination’ relates to measures to ascertain a person’s state of health whether in person or remotely. The definition for ‘medical examination’ takes into account technological means which allows for the monitoring of the health status of persons exposed to IDs without requiring them to present themselves physically at a specified location.
8. Separately, the definition of ‘surveillance’ will be updated to clarify that surveillance, which is conducted over a period of time, can be either continuous or periodic.
ii) Submissions for public health surveillance programmes
9. Section 7 allows for MOH to require parties such as laboratories or doctors to submit information or samples currently in their possession for testing and investigations.
10. Amendments to Section 7 will be made to allow MOH to require such information or samples to be submitted on an ongoing basis, when parties come into possession of the information or sample. The frequency and time period for which information or samples are required will also be specified by the Director of Medical Services (henceforth ‘the Director’) through a notice.
11. The amendments are meant to streamline administration by negating the need for repeating requests for submissions that are needed on an ongoing basis (e.g. during a prolonged outbreak).
iii) ID notification
12. Section 6 subsection 1 to subsection 3 require parties to notify MOH of suspected or known cases of IDs.
13. Section 6 will be amended to specify the IDs for which notification is required of (i) medical practitioners, (ii) laboratories, and (iii) any prescribed persons. Notifiable IDs for each group of persons will be specified in the new Fifth Schedule. This is to minimise duplicate reporting, e.g. for laboratories to report an ID instead of medical practitioners in situations where an ID can only be properly diagnosed with a laboratory test.
14. The Infectious Diseases (Notification of Infectious Diseases) Regulations 2008 will also be mainstreamed into the main Act under the Fifth Schedule which will stipulate the timeline for reporting of specific IDs by specific persons.
B. Preventing the Introduction of IDs into Singapore
i) Discretion to turn away unvaccinated travellers
15. In line with the World Health Organisation’s International Health Regulations, Section 31 currently requires persons entering (or leaving) Singapore to be vaccinated against or receive other preventive treatment for specific infectious diseases (such as Yellow Fever), and provide documentation of such vaccination/preventive treatment. Failing which, subsection 2 allows Port Health Officers to require such persons to undergo the necessary vaccination/preventive treatment, isolation or surveillance for a specified period of time. If any person who is a non-citizen refuses to comply with the aforementioned requirements, subsection 3 currently allows Port Health Officers to return the person to his/her place of origin or embarkation. The intent of the provision is to prevent the introduction of specific infectious diseases (such as Yellow Fever) where vaccination or preventive treatment is available into Singapore, and to minimise the risk of local transmission.
16. Section 31 will be amended to reserve the rights to require an unvaccinated non-citizen to return to his/her place of origin or embarkation without first offering vaccination, isolation or surveillance. The amendment is meant to safeguard Singapore against high-risk persons who have not been vaccinated, and is not meant to turn away unwell patients who require medical care. The amended Section 31 will be exercised judiciously and will apply in scenarios where it is not practical for Singapore to offer vaccination/preventive treatment, isolation or surveillance. Unwell travellers arriving in Singapore will not be turned away, and will continue to receive medical attention as required, regardless of their vaccination status.
17. In the case of Yellow Fever, it should be noted that the turning away of unvaccinated travellers arriving from Yellow Fever endemic countries is already in practice in other jurisdictions. For example, South Africa, which is not endemic for Yellow Fever but susceptible to its introduction and spread due to the presence of the Aedes aegypti mosquito (one of the vectors for Yellow Fever), currently turns back travellers from Yellow Fever endemic countries if they are unable to produce a valid vaccination certificate at point of entry.
ii) Medical examination of persons arriving in or leaving Singapore
18. Cross-border medical examination and surveillance of travellers (e.g. through the use of temperature scanners at the borders) for the prevention of the import and export of IDs is commonly practiced in different jurisdictions. Regulation 3 of the Infectious Diseases (Measures to Prevent or Control the Spread of IDs) Regulations 2004, which currently empowers MOH to require the medical examination of travellers arriving in or departing from Singapore will be mainstreamed into the Act as new Sections 45A and 45B.
19. Section 45A is already in practice, and is meant to allow MOH to require travellers arriving from overseas areas with ongoing outbreaks to undergo medical examination. A current example is temperature screening of travellers arriving from countries with Middle East Respiratory Syndrome coronavirus (MERS-CoV). Such pre-emptive screening allows MOH to identify carriers or cases of IDs and take the appropriate measures (e.g. treatment or isolation of infected persons) to prevent the potential introduction and spread of IDs into Singapore.
20. In the event of a public health emergency1 involving an ID declared by the Minister for Health (henceforth ‘the Minister’), Section 45B will allow MOH to require persons departing Singapore to undergo medical examination. This provision serves to prevent the spread of IDs beyond our borders. An example was during the SARS outbreak in 2003, where travellers leaving Singapore had to undergo temperature screening with the aim of preventing export of cases to other countries.
C. Strengthening ID Control within Singapore
i) Risk-stratified management of ID cases or carriers
21. Section 21 currently provides for the blanket cessation of occupation, trade or business on cases or carriers of an ID, as necessary.
22. Section 21 will be amended to allow for the risk-stratified management of cases or carriers of an ID. This means that persons (e.g. those assessed to be of lower risk of ID transmission) may be permitted to continue with specific occupational activities not directly associated with disease transmission. For example, food handlers who are confirmed or suspected to have an ID of concern, will be restricted from handling and preparing food, but may be allowed to perform administrative tasks that do not require direct contact with food e.g. cashiering, store management.
23. Section 21A currently prohibits any persons who are cases, carriers or contacts of dangerous IDs from being in public or common places outside of their homes. To calibrate the restriction of movement of persons of lower risk of transmission (e.g. contacts), Section 21A will be amended to allow some liberty to visit specified places (e.g. to their workplace), subject to conditions (e.g. for a defined period or via a specified mode of transport to that place) to minimise the risk of ID exposure.
ii) Transfer of power to order persons to undergo vaccination
24. In a situation of an ID outbreak or imminent outbreak where it is necessary to secure public safety, Section 47 currently gives the Minister the power to order any person not protected against the ID to undergo vaccination.
25. The order for vaccination is exercised based on clinical and public health considerations, which is assessed by Director. To expedite ground responses to notify persons and put in place necessary measures, Section 47 will be amended to transfer the power from the Minister to the Director.
iii) Tightening of movement restrictions for high-risk individuals
26. The IDA allows the Director to restrict the movement of cases or contacts of an ID or require such persons to be isolated. Persons may however break isolation (e.g. ignore the order, absconding from place of isolation) and put the community at risk. In this regard, Section 56 currently authorises the arrest of non-compliant persons who fail to proceed to the specified place of isolation or attempt to leave that place.
27. The arrest of non-compliant persons, however, may not directly mitigate the public health risks. To enable Health Officers to immediately address the risk of disease transmission, Section 56 will be amended to allow Health Officers to take necessary measures, including the use of physical means, to enforce the isolation e.g. to bring the person back to place of isolation, in lieu of arrest. In similar regard, Section 56 will also be amended to allow MOH to stop persons breaking isolation or movement restriction orders from leaving Singapore, so as to maintain the isolation or movement restriction order, and prevent any possible spread of diseases during travel. Where there is pertinent need to leave the country, requests will be subject to MOH’s risk assessment and specific conditions imposed by the Director, as necessary.
iv) Dissemination of health advisories to persons travelling to and from, present within or likely to enter infected areas
28. A new provision in Section 21B will be added to enable MOH to enlist the assistance of Singapore-based (i) mobile operators, (ii) land (including rail), air and sea transport operators providing local and cross-border transport services to or from Singapore, (iii) port service and transport facility operators, (iv) persons in charge of premises2 , and (v) event organisers to disseminate health advisories on behalf of MOH to persons:
29. Such health advisories may be disseminated via various means (e.g. SMS, leaflets) and may include information on the ID, its symptoms, precautions to take, and instructions to seek medical care if any symptoms develop after visiting affected areas. The IDs and affected areas for which this provision will apply will be prescribed by the Minister.
a. Travelling to or returning from overseas areas affected by ID outbreaks; or
b. Present within or likely to enter any place within Singapore which is affected by or likely to be affected by an ID outbreak.
30. Section 21B is put in place for the purpose of providing critical health information to protect at-risk persons, so that they can take the necessary precautions to minimise the risk of infection, thereby also minimising the introduction and further spread of IDs into and within Singapore.
31. Such health advisories were observed to be helpful in effectively reaching out to the public. For example, during the 2013 outbreak of H7N9 avian influenza in various parts of China, MOH had worked with the Civil Aviation Authority of Singapore (CAAS), Immigration & Checkpoints Authority (ICA), Changi Airport Group (CAG) and the relevant airlines to distribute health advisory notices to travellers returning from the affected areas.
32. Other use examples include sending of SMS by mobile operators, where technically feasible, to their customers who were present in the vicinity of an ID outbreak, or the dissemination of leaflets by premise managers, event organisers or transport operators whose occupants or customers might have come into contact with an ID outbreak within that premise or transport service.
33. While operators have hitherto been supportive of requests for the issuance of health advisory, it is necessary to include this important aspect of ID prevention and control measure as an obligation under the IDA. In the event of large outbreaks of re-emerging or novel IDs or public health emergencies, MOH may potentially enlist the assistance of a wide range of operators, and it would not be effective for MOH to negotiate the issuance of health advisory with individual operators.
34. As the need arises, MOH will work with the aforementioned operators and the relevant persons in charge to ensure that the implementation of this provision is technically practicable and within their existing infrastructural capabilities.
v) Disclosure of information to prevent and control ID spread
By the Director to third parties
35. Section 57A currently allows the Director, contingent on the Minister’s approval, to disclose information MOH has obtained under the IDA regarding cases, carriers or contacts of IDs to third parties for the purpose of preventing ID spread. One of the conditions for this is that the Minister must give an approval for the disclosure to be made. As such decision on disclosure is contingent on assessment of clinical and risk factors e.g. disease severity, outbreak seriousness, with the purpose to facilitate expedient ID control measures, Section 57A will be amended to allow the Director to authorise the disclosure in lieu of the Minister.
Between parties providing healthcare services
36. Besides the Director disclosing information MOH has obtained to third parties (as in Section 57A), there is a need for healthcare service providers to share specific ID- related information on patients between themselves, so that necessary ID control measures can be effected. An example is in the transfer of a patient infected with a multi-drug resistant organism (MDRO), which can be a long-term infection. When a patient is transferred from one care setting to another, information on the patient’s infection should be disclosed to the receiving healthcare service providers, so that the necessary isolation or cohorting measures can be conducted to prevent the transmission of MDRO to other patients.
37. To allow this, a new provision in Section 57B will be added to allow the Director to authorise the disclosure of information concerning any person who is a case, carrier or contact of an ID between parties providing healthcare services. Such information will include the identifiers of the person and the ID of concern. To ensure the judicious management of information, the Director will determine the IDs and purpose for which such disclosure is necessary. The Director will also specify conditions regarding the disclosure and receipt of information that authorised parties shall adhere to.
vi) Facilitating public health research
38. Section 59A currently empowers the Director to undertake or facilitate national public health research on IDs, but this is contingent on an outbreak being imminent or the ID being of high health risk. As part of national public health research, the Director may require information and samples to be provided by any person, and send the obtained information and samples to third parties to aid in the research. Only anonymised information and samples may be transferred to third parties.
39. Public health research is an important tool in preventing disease outbreaks and to develop our preparedness plans and disease prevention and control policies, and should not be scoped to (i) only situations where outbreak is imminent, and (ii) be based on information collected under Section 59A. Section 59A will be amended to allow national public health research to be conducted (i) even in times when there is no crisis, and (ii) using information or samples obtained through other sections of the IDA (e.g. surveillance data), beyond Section 59A. In instances where research can only be carried out with individually-identifiable information or samples, the Director will be able to permit the use and the transfer such information or sample.
vii) Adjustments to requirements for surveillance and contact tracing at premises
40. Regulation 4 of the Infectious Diseases (Measures to Prevent or Control the Spread of IDs) Regulations 2004 currently empowers MOH to require the monitoring of body temperature at workplaces and dormitories, which is an important feature of ID prevention and control. The SARS outbreak in 2003, where MOH worked with schools to roll out temperature monitoring measures to identify potential cases, highlighted the need for levers to enable the expeditious introduction of medical monitoring measures. This Regulation will therefore be mainstreamed into the main Act under Sections 19A. The reference to the scheduled IDs (in the Regulations) will be expanded to all IDs in general.
41. Beyond the powers to require the monitoring of body temperature at workplaces and dormitories, Section 19A will be expanded to require persons who control or manage any premises to carry out surveillance or contact tracing measures on its occupants or visitors in the event of an outbreak to prevent the spread of ID in such premises, as necessary. Such measures are to facilitate early identification of cases, carriers or contacts to control or prevent ID spread, as well as arrangement for medical investigation or treatment of cases. For this purpose, the definition of ‘contact tracing’ will be added to Section 2.
42. In implementing these measures, the Director will issue a notice defining the boundaries of premises to which they apply, the scope and duration of measures and specific parameters of a case or carrier for which notification to MOH will be required. Reasonable time will also be given for measures to be put in place.
viii) Prescribing timelines and formats of data collection for surveillance and outbreak investigation
43. On requiring any person to furnish information to the Director for the purposes of public health surveillance or ID outbreak investigation or control, Sections 7(2) and 55(1)(e) will be amended to allow the Director or Health Officer to specify the form or manner (including transmission mode) in which the information shall be furnished, and the timelines for the submission of such information. This is to facilitate timely and efficient submission and use of information in identifying, investigating, controlling and preventing outbreaks.
ix) Seizure of items for investigation and disposal upon conclusion of investigation
44. Section 55A currently allows Health Officers to require any person to produce any book, document or record for the inspection or making of copies for the purpose of investigating an offence under the IDA, as consistent with other legislations which involve investigation such as the Human Biomedical Research Act and Private Hospitals and Medical Clinics Act. This will be amended to also allow Health Officers to seize as evidence during the course of investigations, original books, documents or records, including other forms such documents or records may come in (e.g. electronic devices, laptops, mobile phones).
45. Section 55B will be added to allow the disposal of such physical evidence seized upon conclusion of investigations, if they are not otherwise wanted by owners, or required by the Courts. This new provision will also apply to substance or matter seized under Section 55, subsection (1)(c) for the investigation of outbreaks or suspected outbreaks.
D. Others – Administrative and Nomenclature Changes
i) Repeal of redundant powers
46. Section 30, which requires persons who have given an undertaking to rectify any unsatisfactory state of sanitation of a vessel leaving another country to report to a Port Health Officer upon arrival in Singapore, will be repealed. This requirement is contingent on self-reporting and given that there are other existing measures through the World Health Organization’s International Health Regulations National Focal Point system which enable NEA to be alerted of an incoming unsanitary or infected ship by the health authorities of foreign countries, Section 30 is no longer necessary.
ii) Protecting persons providing any information or thing required by the IDA
47. To protect persons disclosing information or providing anything as required under the IDA or as authorised by the Director, the newly added Section 67A will confer such persons immunity against disciplinary action by a professional body or liability under other written laws (e.g. the Personal Data Protection Act). That is, such persons having disclosed information or provided anything necessary to prevent an outbreak or spread of ID will not be considered guilty of any breach of confidence or an offence under other laws.
iii) Aligning HIV nomenclature
48. All references to ‘AIDS’ will be removed from the IDA, leaving just the terminology ‘HIV infection’ as it encompasses ‘AIDS’ which is a late stage subset of a HIV infection.
49. The public is invited to participate in the online public consultation exercise on the proposed amendments to the IDA over 6 weeks, from 27 Jun 2018 to 7 Aug 2018.
50. During the exercise, feedback can be submitted to MOH via email to email@example.com.
51. Your feedback on the proposed amendments to the IDA is important to us. We look forward to receiving your feedback.
DOCUMENTS TO DOWNLOAD
52. For further reference, please click on the following links to download the relevant documents related to this public consultation exercise:
1As described in Section 17A, the Minister may declare a public health emergency should there be an outbreak or imminent outbreak that poses a substantial risk of a significant number of human fatalities or incidents of serious disability in Singapore.
2Persons in charge of premises include any occupier, lessee or person who is responsible for the management of the premises, or any manager, assistant manager or supervisor of the premises or any person holding an analogous appointment.