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     Proposed amendments to the Infectious Diseases Act

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(iv) Restrictions on gatherings in times of emergencies

A severe outbreak of a highly contagious disease, like an influenza pandemic, can spread quickly within the population and cause many deaths unless steps are taken to limit its spread.  Social distancing, or restrictions on meetings or gatherings, is therefore an important and effective strategy that can help to limit the spread of a highly contagious disease.

Existing legislation allows the prohibition of specific meetings, gatherings and public entertainment.  However, in a severe outbreak, a more extensive prohibition on gatherings may need to be quickly implemented across the island.  We propose to amend the IDA so

that the Minister may declare a public health emergency in the event of an outbreak or imminent outbreak of an infectious disease that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability in Singapore.  Further to this, the Minister may for the purpose of securing public health and safety declare that the whole or any part of Singapore to be a restricted zone, in which the entry and stay of persons, or the holding of meetings and gatherings, will be prohibited or restricted. Such restrictions will reduce opportunities for further transmission of the disease.

In view of the serious implications of such a measure, the declaration of restricted zones will only be carried out as a last resort, when public education has failed to achieve social distancing.  To ensure that restricted zones are declared only when necessary, and only for the shortest period necessary, the amended IDA will provide that the Minister for Health must first declare a public health emergency, and that an order for a restricted zone will expire after 14 days (unless further renewed by the Minister).  Furthermore, such orders will have to be presented to Parliament as soon as possible.

(v) Public health research

Public health research plays an important role in strengthening the country’s capacity to respond to an outbreak of an infectious disease.  We propose to amend the IDA to empower the DMS to undertake public health research to determine more effective infection control measures, as well as to develop new diagnostic tests or forms of treatment for infectious diseases. Under this proposed amendment, DMS may require any clinic, hospital or other institution to furnish him with such information or samples (e.g. blood) in his possession, as the DMS may consider necessary or appropriate for public health research purposes. To safeguard confidentiality, the data and samples obtained will be anonymised before they are provided to the DMS.  Public health research may only be conducted in the public interests.

(vi) Enhanced measures to contain HIV/AIDS

Despite efforts to educate the population on the prevention and control of HIV, individuals continue to engage in unsafe sexual practices, putting themselves and their
partners at risk of contracting HIV.  There is a need to step up efforts to reduce the spread of HIV, and one of the means by which MOH proposes to do so is by requiring a person who may have been exposed to the risk of contracting HIV to take the necessary steps to protect his sex partners from the risk of HIV infection.

It is presently an offence under the IDA for a person who knows that he is HIV-infected, to have sexual intercourse if he does not first inform his partner of his HIV status, and obtain his partner’s agreement to accept the risk of infection.   

MOH proposes to expand the IDA to address the situation where an individual who, although unaware that he is HIV-positive, has reason to believe that he has been exposed to the risk of contracting HIV or AIDS (e.g. by having unprotected casual sex with multiple partners).  The amendments will impose an obligation on an individual not to engage in any sexual activity, unless before doing so, (a) he had informed his partner of the risk of contracting HIV infection from him and that the partner has voluntarily agreed to accept the risk; or (b) he had tested negative for HIV and he had not, between the time of his test and sexual activity with the partner, engaged in any activity which might have exposed him to the risk of HIV infection; or (c) he takes reasonable precautions during the sexual activity (e.g. by wearing a condom) to ensure that he does not expose his partner to the risk of contracting HIV infection.

Public Consultation

The Ministry of Health will now like to seek the views and feedback of the public, specifically on the following issues:
• Public Health Surveillance
• Prevention, Control and Investigation of Outbreaks
• Public Health Emergencies
• Prevention of HIV/AIDS

A table on the current Act and proposed key amendments is shown below.

 

 

Current situation Proposed amendments
Public HealthSurveillance Information on the occurrence of infectious diseases is obtained from notifications submitted by doctors and laboratories and from routine and ad-hoc studies carried out by MOH.

 

DMS will be empowered to obtain left over samples generated in the course of routine medical care, and carry out the necessary tests to determine the prevalence of an infectious disease and other determinants of the risks of an outbreak taking place in the population.  
Closure of premises responsible for outbreaks DMS has the authority to close  and order disinfection of food establishments suspected to be responsible for the outbreak or transmission of an infectious disease. Powers of the DMS will be expanded to order closure and disinfection of any premises if conditions on the premises are likely to lead or have led to an outbreak or spread of any infectious disease. 
Obtaining information from patients For the purpose of preventing the spread of an infectious disease or for investigating into an outbreak or suspected outbreak, the Director may require medical practitioners to obtain relevant information from patients e.g. travel or contact history.   This will be extended to other categories of health care workers (e.g. TCM practitioners and pharmacists) as patients may seek treatment from them during an outbreak.
Restrictions on gatherings in times of public health emergency

 

The Director is empowered to order the closure of specific premises and prohibit specific gatherings.   Health Minister empowered to declare a public health emergency, and declare the whole any area in Singaporeto be a restricted zone in order to restrict gatherings during such a public health emergency. 
Enhanced measures to contain HIV/AIDS It is an offence for a person who knows he is infected with HIV to have sexual intercourse without first informing his partner of his HIV positive status and the partner has not voluntarily agreed to accept the risk of infection.

 

It is an offence for a person who is unaware of his HIV status, but who  has reason to believe that he has been exposed to the risk of contracting HIV, to engage in sexual activity unless he takes certain steps to protect his partner from infection before or during the sexual activity.

 

The public consultation document can be found on the MOH website. All feedback should reach the Ministry by 9 November 2007.

Reference:

Public Consultation on the Proposed Amendments to the Infectious Diseases Act

Source: www.moh.gov.sg Press Release 28 Sep 2007