APAAACI 2023 International Conference - Dr Amy Khor

Opening Address by Dr Amy Khor at Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) 2023 International Conference on 23 October 2023

Professor Sachin Chaturvedi

APAAACI Steering Committee Members

Distinguished healthcare professionals from all over the world

Ladies and gentlemen

1 Good evening. It is my great pleasure to join you here today. I am delighted to see so many delegates in attendance. A warm welcome to everyone, and to our friends from abroad.

2 I am heartened to see that APAAACI places such importance on the environment and has even published a key white paper in 2020 on Climate Change, Air Pollution, and Biodiversity and its Impact on Allergic Diseases. I note that the paper highlights how increasing urbanisation, air pollution and climate change have come together to adversely affect respiratory health and contribute to the risk factors for the epidemic rise in allergic diseases in Asia-Pacific.

3 I applaud APAAACI’s dedication to the issue of sustainability over the years. More recently, APAAACI Allergy Week has focused on the impact of climate change on public health. In fact, there is a plenary session on “Environment and One Health” that is coming up on the third day of this conference. For those interested in this topic, do join in.

Human health and the planetary health are interrelated

4 Healthcare systems worldwide are finding themselves thrust at the forefront of the climate crisis. As climate conditions change, we will find ourselves facing more intense and frequent weather and climate events, which in turn affects human health. According to the World Health Organization (WHO), climate change is expected to cause approximately 250,000 additional deaths each year between 2030 and 2050 from just malnutrition, malaria, diarrhoea and heat stress alone.

Ministry of Sustainability and the Environment’s role in public health

5 Public health and the environment go hand in hand. The Ministry of Sustainability and the Environment started out being part of the Ministry of Health back in the 1960s. It was only after the United Nations Conference on the Human Environment in 1972, which highlighted the rights of the human family to a healthy environment, that Singapore formed the Ministry of Environment, just over 50 years ago, taking over functions previously held by the Ministry of Health.

6 One of the then new Ministry’s roles was to provide environmental public health services and to build up awareness, training, and education in those areas. Today, public health remains one of the key work areas under my ministry. We see this especially in three key public health issues: vector-borne diseases, air pollution and heat-related illnesses.

Spike in vector-borne diseases

7 Rising temperatures and erratic rainfall patterns not only increase pathogens’ survivability, but it also accelerates their transmission rates and changes the geographical range of disease-spreading vectors. In Singapore, we see that in the form of dengue.

8 Dengue is endemic here. Prolonged hot spells and intense thundery showers have extended the breeding and transmission season of Aedes mosquitoes, leading to more frequent and severe dengue outbreaks.

9 Last year, we recorded over 32,000 cases, the second-highest in a year, following a record of over 35,000 cases in 2020. This year, about 8,000 cases are reported to date, a decline of around 3.6 times compared to the same period last year, but nonetheless still a significant number. Beyond Singapore, the dengue mosquito is making itself at home in more regions than ever before. With urbanisation and climate change creating favourable conditions for breeding, WHO has reported a six-fold increase in cases since 2000, with almost 390 million dengue infections occurring each year.

10 To address this, the government has implemented several measures to curb the mosquito population. Since 2016, Singapore’s National Environment Agency (NEA) has introduced Project Wolbachia, releasing non-biting male Aedes aegypti mosquitoes carrying the Wolbachia bacteria. When these infected males mate with females, their eggs do not hatch, effectively reducing mosquito numbers and lowering the risk of dengue transmission in the suppression sites. High-risk neighbourhoods with a consistently high Aedes mosquito population and historical dengue risk level are selected in a targeted approach.

11 While Project Wolbachia has shown promising results in suppressing the Aedes aegypti mosquito population and reducing dengue cases in areas with releases, source reduction remains the key strategy for dengue control.

12 Mosquito surveillance must also continue to guide interventions. Over 70,000 Gravitraps have been deployed across housing estates in Singapore to monitor the mosquito population. Data from the network of traps enables NEA to prioritise its preventive inspections and raise awareness within communities about the risks of dengue.

Respiratory and cardiovascular diseases increase with air pollution

13 Beyond vector-borne diseases, city-states like Singapore must address air pollution given the scarcity of space and continued urbanisation. Air pollution has far-reaching health effects, causing respiratory problems like coughing and wheezing, reduced lung function, increased vulnerability to respiratory infections, and even cardiovascular issues like high blood pressure. Individuals with pre-existing conditions may even experience worsened symptoms and complications.

14 Singapore has taken numerous steps to reduce air pollution. The government employs a strategy of integrated urban and industrial planning, enforcement of emission standards and the adoption of cleaner energy. Industries are situated within designated industrial estates with adequate buffer from residences. Before industries are allowed to operate in Singapore, they are screened to ensure proper pollution management in compliance with NEA’s air emissions standards and regulations.

15 To address vehicular emissions, Singapore has stopped vehicle population growth and is actively transitioning to electric vehicles as part of the Green Plan 2030. By 2030, we envision around 60,000 charging points across the island and anticipate that electric buses will constitute half of our bus fleet. Our ambitious target is to phase out internal combustion vehicles and for all vehicles to run on cleaner energy by 2040.

16 Of course, you would have also noted the recent incidences of haze in Singapore. Singapore experiences haze from time to time, due to hotspots in the region and subject to prevailing winds. Warmer and drier than usual weather from the current El Niño phenomenon may also increase the risk of haze.

17 Like other forms of air pollution, haze could become hazardous to human health. We have taken active steps to address this periodic issue, through regional collaboration to combat transboundary haze, as well as educating our local population on the response measures.

18 A few weeks back, Singapore’s 24-hour Pollutant Standards Index (PSI) entered the Unhealthy range. NEA has issued daily haze advisories since 7 October 2023 to advise the public on how to plan their outdoor activities for the next 24 hours.

Heat-related illnesses

19 Another pressing concern for Singapore, like the rest of the world, is rising global temperatures. Globally, the year 2023 is on track to be the warmest year on record, with June, July, August and September all breaking monthly temperature records. In Singapore, temperatures hit a 40-year high of 37°C in May. That month, our hospitals reported an uptick in the number of patients with heat related illnesses.

20 Prolonged exposure to extreme heat carries significant health risks. For vulnerable populations and those with pre-existing medical conditions, it can lead to heat-related illnesses such as heat exhaustion and potentially life-threatening heat strokes.

21 This is why Singapore is taking action to equip our citizens with the necessary information to help them manage such risks. We do this through a recently introduced Heat Stress Advisory by our National Environment Agency. The advisory comprises a reading of the Wet Bulb Globe Temperature (WGBT), which factors in air temperature, humidity, wind, and solar radiation. To make it easy to understand, the advisory follows the traffic light system – green, amber and red, which informs users on how to adjust their activities, actions and attire accordingly.

22 As part of the Singapore Green Plan, we are also looking at ways to moderate the rise of urban heat through innovative approaches in our cityscape, including buildings with cooler paint coatings on facades and pavements, varying building heights to facilitate air flow, and a growing provision of greenery. These measures are a testament to our dedication to mitigating the impact of heat stress and ensuring a cooler, more sustainable urban environment.

Conclusion

23 The World Health Organisation’s call for a “One Health” approach is undeniably apt. It is time for us to adopt an integrated perspective that balances and optimises the health of people and the environment.

24 I would like to commend APAAACI once again for initiating this conversation, fostering momentum, and bridging discussions across the healthcare and climate change sectors. It is essential that these two realms synergise, leveraging each other’s strengths to achieve a ‘one-health’ outcome. We must recognise that investments in climate-resilient and mitigation measures are investments in better health.

25 Thank you, and I wish everyone a fruitful conference ahead.