FLU PANDEMIC PREPAREDNESS -- SINGAPORE INPUT

C O N F I D E N T I A L SECTION 01 OF 03 SINGAPORE 002524

SIPDIS

NOFORN

CIA FOR NATIONAL INTELLIGENCE COUNCIL NIO/EA

E.O. 12958: DECL: 08/08/2015
TAGS: PINR SOCI TBIO ECON KHIV EAGR ETRD SN
SUBJECT: FLU PANDEMIC PREPAREDNESS -- SINGAPORE INPUT

REF: A. STATE 151549


B. SINGAPORE 1311

Classified By: Management Counselor Karen Stanton,
reason 1.4 (d)


1. (U) SUMMARY. Post is satisfied that the Government of
Singapore (GOS) would rapidly respond to halt the spread of
an influenza pandemic within Singapore. The Singapore
Ministry of Health (MOH) has developed an "Influenza Pandemic
Readiness and Response Plan" that is available for public
viewing at www.moh.gov.sg. Post has an inter-agency Avian
Influenza Taskforce to monitor the spread of avian influenza
and coordinate planning for our preparedness and response.
END SUMMARY.


2. (C/NF) The following answers correspond to reftel A
questions in para 2:

-- Where does preparing for an avian flu pandemic rank among
government priorities?
The GOS considers prevention of an avian influenza (AI)
outbreak among its highest public health priorities. It has
developed a detailed readiness and response plan and has
published it on the MOH website (www.moh.gov.sg). It reacts
instantly and forcefully to any threat of AI as, for example,
when it stopped all imports of chickens and eggs from
Malaysia when AI was detected at farms there last year.
Since Singapore imports almost all of its food, such actions
have grave consequences. The Government also conducted an
"operational readiness" drill to test its ability to react to
a bird flu outbreak in which it actually destroyed 5,000
healthy chickens.

-- Who and what would most influence the country to give the
issue a higher priority?
As stated above, the GOS is already at an extremely high
state of readiness. The MOH plan defines a scale of
increasing alert levels and the triggers for each of those
levels. Increases in priority will take effect under
occurrences such as: evidence that the disease is spreading
via human-to-human respiratory infection; significant spread
of the disease in other Asian regions; or, suspected case(s)
of Avian Flu within Singapore or border regions in Malaysia
or Indonesia.

-- Does the government have a strategy for containing the
pandemic?
The MOH plan assumes that, with vigilant screening of the
local bird population, any outbreak of AI in human beings in
Singapore would be imported. The plan describes a strategy
to "establish an effective surveillance system to detect the
importation of a novel influenza virus, mitigate the
consequences when the first pandemic wave hits and then race
to achieve national immunity when a vaccine becomes
available."

-- If the country has a strategy, how capable is it of
implementing it?
Most capable. As demonstrated by its effective and efficient
response during the 2003 severe acute respiratory syndrome
(SARS) outbreak, the GOS is extremely effective at managing a
communicable disease outbreak. Lessons learned from SARS
have further improved preparedness and response capability.

-- What measures has it taken to date to prepare for the
pandemic (stockpiling antiviral medications, conducting
surveillance, developing human vaccines, etc.)?
The GOS is stocking 200,000 doses of the antiviral drug
Tamiflu, enough for five percent of its 4.2 million
population. Surveillance is on-going.

-- How capable is Singapore of detecting and responding to an
outbreak, especially in rural areas?
Singapore, only 25 miles across, is a highly developed,
urbanized, and well-organized country. Scientists at the
Genome Institute of Singapore recently developed a
commercially available H5N1 Diagnostic Kit which can detect
genes specific to H5N1 in under four hours.
-- How truthful will the government be in reporting the scope
of any outbreak?
SARS showed the Singapore authorities were very transparent
and frank when faced with a problem like this. They also
have retroactively seen that this approach set them apart in
a positive way from other affected countries, and so would be
likely to take a similar approach.

-- How willing and capable is the government of imposing
quarantines and social distancing measures?
The government is willing and capable. Quarantine and
control mechanisms are in place, and the GOS used those
mechanisms effectively during the SARS outbreak. A detailed
description of these plans may be found on the MOH website.

-- What are the critical gaps that need to be filled in order
to enhance the country's disease detection and outbreak
response capabilities?
None.

-- What is the country's greatest need from the US or
international organizations?
Singapore is very self-sufficient and likely would be in a
support, rather than supported role, vis-a-vis countries in
the region.

-- Would government leaders be receptive to messages from US
leaders at APEC or other settings or would they prefer a
multilateral approach or bilateral contacts with another
country?
The GOS would be receptive to messages through either
channel. We already have a bilateral mechanism in place, the
U.S.-Singapore Regional Emerging Diseases Intervention (REDI)
Center, which could become multilateral if we chose.

-- Who is the key "go-to" person or office for USG officials
to interface with?
The Ministry of Health is the lead agency. In the event of
an outbreak, a variety of crisis management groups would be
convened in various agencies, with the MOH group in the lead.
Again, details are on the MOH website. Embassy Singapore
has regular and cooperative contacts with these officials, as
does the CDC.

-- How well informed is the population about the avian flu
threat and about measures they should take to mitigate the
threat?
In addition to the information available on the web, local
media regularly report on AI and other disease prevention
campaigns. The public is generally well-educated and
receptive to these efforts, much as they were during the SARS
outbreak.


3. (C/NF) The following answers correspond to reftel A
questions in para 3:

-- Is the host country working with any international
organizations or other countries on the avian flu issue?
The GOS is already working closely with the WHO and CDC to
share information and develop preparations.

-- Are government leaders likely to ask for assistance from
the United States or other countries?
The close coordination already in evidence would continue at
an even greater level. Singapore may very likely be in the
position of providing assistance and expertise to the United
States and countries in the region.

-- Would its military enforce quarantines?
Quarantines would be enforced by civilian agencies. It is
unlikely that military support would be required.

-- What would it want from the United States in return for
its efforts?
Singapore expects to be a partner in professional exchanges
with United States experts. In the case of SARS, CDC and
other United States agencies studied Singapore's response as
a possible model for us and others. Singapore is likely to
request antiviral vaccines.

-- What mechanisms are available for providing additional
information to the population, particularly in rural areas
and how effective are these measures?
Singapore has a very effective and pervasive state
information dissemination system.

LAVIN