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