The new Communicable Diseases Agency (CDA) has the potential to not only act as the main liaison with other countries in the event of future pandemics, but also as the central organising agency for the region, too.

This is what some medical experts envision for the agency, they told TODAY on Wednesday (March 22), a day after Health Minister Ong Ye Kung announced its formation in Parliament during a debate on the Covid-19 White Paper.

The CDA, said Mr Ong, will be set up under the Ministry of Health to oversee disease preparedness, prevention and control, surveillance, risk assessment and outbreak response.

It will consolidate relevant public health functions that now reside in the ministry, National Centre for Infectious Diseases (NCID) and the Health Promotion Board.

The National Public Health Laboratory, a department under the NCID that investigates outbreaks, will be transferred to the CDA, which will also maintain oversight of the clinical facilities in NCID.

Mr Ong added that similar setups are already adopted in other countries such as South Korea, the United Kingdom and the United States.

WHY CREATE THE CDA?

Would it not be sufficient to just have the NCID in Singapore to deal with future pandemics?

As Associate Professor Jeremy Lim, the director of global health at the National University of Singapore's Saw Swee Hock School of Public Health, pointed out, the NCID predominantly serves a clinical services function during a public health crisis.

Otherwise, it focuses on surveillance and policy work, he said.

Infectious disease expert Leong Hoe Nam from Rophi Clinic at Mount Elizabeth Novena Specialist Centre added that although the NCID was often sought for medical advice and its knowledge was used in managing outbreaks, its involvement was “primarily consultative in nature”.

TODAY has sought comment from the NCID.

In any case, Assoc Prof Lim said the pandemic has shown that the “policy response is very tightly coupled to the clinical response”, and as such, having both clinical and public health functions under one roof would make for “better policy translation”.

On the five points that the CDA will consolidate — disease preparedness, prevention and control, surveillance, risk assessment and outbreak response — Dr Paul Tambyah said they are currently overseen by various ministries and government agencies.

As such, the president of the Asia Pacific Society of Clinical Microbiology and Infection said that the CDA can serve as a “reference point for all other agencies” that do various parts of outbreak prevention and response.

Professor Dale Fisher, a senior consultant at National University Hospital's division of infectious diseases, anticipates that the CDA will ultimately create a more streamlined, efficient and coordinated system.

“(This will) improve our preparedness for outbreaks as well as alerts, early warnings, risk assessment and a prompt response,” he said.

That said, Assoc Prof Lim stressed that the creation of the CDA does not indicate that there was anything wrong with the way Singapore's healthcare systems were organised previously to deal with infectious disease outbreaks. They were appropriate for the time.

"Nobody ever thought there'll be outbreaks on the scale of a global pandemic," he said.

"Having learned from Covid that the next outbreak can be very large and move very fast, we do not have the luxury to spread the powers and responsibilities (to deal with the crisis) and hope that when the next pandemic comes, we can hold hands and integrate nicely."

HOPES FOR THE CDA

As Mr Ong did not provide additional information about the CDA, TODAY has reached out to his ministry for more details.

In the absence of such information, the experts have drawn on the experiences of analogous foreign organisations to weigh in on the possible form and function of the CDA.

Assoc Prof Lim said that the “Covid experience” has made it clear that cross-border interactions are important during a global health crisis.

“Like it or not, we should organise in a way that the world organises so that we have (similar) counterparts to make interactions easier,” he said.

Similar agencies to CDA would include the United States’ Centres for Disease Control and Prevention, the European Centre for Disease Prevention and Control, and the Africa Centres for Disease Control and Prevention.

If Singapore remains without a similar organisation in the event of a future pandemic, Assoc Prof Lim believes that it could be troublesome for cross-border communication since there will be multiple parties to deal with here.

Said Assoc Prof Lim: “The harder it is to interact, the less the interactions will occur.”

In a similar vein, Dr Tambyah said he hopes that the CDA can be the “nucleus for the Asean CDC or even the Asian CDC” where work can be carried out to target diseases of public health importance for the region.

Dr Tambyah also suggested that the CDA could be more effective in managing future pandemics than the NCID if it focuses on areas like surveillance, public health, education and training, rather than providing clinical care.

According to him, the current NCID leadership and staff are burdened with multiple responsibilities, whereas a specialised approach could help the CDA to be more focused.

“Of course all the medically or nursing qualified public health leaders would need to provide some clinical care in order to ensure that the policies are relevant, meaningful and practical… But this should not be their primary responsibility.”

Dr Tambyah is also of the view that the CDA should not take on a regulatory role, which he said is best left to the ministries.

Separating the two, he said, is invaluable in public health, as illustrated in the case of the surveillance for sexually transmitted infections.

“The Department of Sexually Transmitted Infections Control can honestly tell people that they are not involved in enforcement, so those working illegally in the commercial sex world can safely get treated and contact tracing done without the fear of prosecution,” he said.

“That kind of model could be expanded to other infectious diseases.”

Source:
courtesy of TODAY

by LOW YOUJIN

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