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

2. Agenda   Pandemic response plan   Recent developments   Ethical considerations 1 2 3

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

4.   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 2 Recent developments

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

6.   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) Ethical considerations – Distribution of resources * Lung disorders, heart diseases, diabetes, kidney failure, neuromuscular disorders and immunosuppressed 3 Consider- ations Measures

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

8. Ethical considerations – Obligations towards HCWs 3  Try to establish a right balance  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 Consider- ations Measures

9. Thank you